Mitral valve replacement (MVR) in the very young is an imposing clinical challenge.
Early and late mortality risk is substantial, severe adverse events are common, and
redo mitral valve replacement is inevitable. Therapeutic options are limited. In the
older infant with an annulus of 17mm or larger, mechanical MVR is associated with
low risk of mortality and predictable durability. For the very young with annular
hypoplasia, bovine jugular vein conduit MVR appears to offer equivalent or better
early outcomes with the possibility of subsequent valve expansion, potentially prolonging
the interval to redo MVR. Experience with cylinder MVR and other forms of surgeon-manufactured
MVR is quite limited, and there is currently no information on late outcomes or durability.
Keywords
Abbreviations:
AVSD (Atrioventricular septal defect), BJVC (Bovine jugular vein conduit (Contegra®, Melody®)), BJVC-MVR (Bovine jugular vein conduit mitral valve replacement), C-MVR (Cylinder mitral valve replacement), ePTFE (Expandedpolytetrafluoroethylene (Gore-Tex®)), LVOT (Left ventricular outflow tract), LVOTO (Left ventricular outflow tract obstruction), MVR (Mitral valve replacement), M-MVR (Mechanical mitral valve replacement), OPTN (Organ Procurement and Transplantation Network), PCCC (Pediatric Cardiac Care Consortium)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery AnnualAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Near catastrophic accelerated structural degeneration of the Perimount magna pericardial bioprosthesis in children.Ann Thorac Surg. 2016; 102: 308-311
- Homograft replacement of mitral valve in children.Ann Thorac Surg. 1998; 66: 849-852
- Mitral valve replacement with the Ross II technique: initial experience.Ann Thor Surg. 2006; 81: 502-508
- Jugular vein conduit (Melody valve) for surgical mitral valve replacement.Ann Thor Surg. 2012; 94: e97-e98
- Long-term survival after mitral v alve replacement in children <5 years: a multi-institutional study.Circulation. 2001; 104: I143-I147
- Outcomes of mechanical mitral valve replacement in children.Ann Thorac Surg. 2019; 107: 143-150
- Predictors of prosthesis survival, growth, and functional status following mechanical mitral valve replacement in children aged <5 years; a multi-institutional study.Circulation. 2003; 108: II174-II179
- Mitral valve replacement with the 15-mm mechanical valve: a 20-year Multicenter Experience.Ann Thorac Surg. 2020; 110: 956-961
- Patient-specific approach to mitral valve replacement in infants weighing 10 kilograms or less.World J Pediatr Cardiovasc Surg. 2019; 10: 304-312
- Surgical atrioventricular valve replacement with melody valve in infants and children.Circ Cardiovasc Interv. 2018; 11e007145
- Assessment of the Melody valve in the mitral position in young children by echocardiography.J Thorac Cardiovasc Surg. 2017; 153: 153-160
- Melody valve in mitral position: complete fracture causing acute mitral stenosis in a child.Cath Cardiovasc Inter. 2019; 93: e101-e104
- Melody valve fracture causing mitral stenosis: novel solution for transapical valve-in-valve.Ann Thor Surg. 2021; 12: e165-e168
- Stented bovine jugular vein graft (Melody valve) for surgical mitral valve replacement in infants and children.J Thor Cardiovasc Surg. 2014; 148: 1443-1449
- Revisiting prosthesis choice in mitral valve replacement in children: durable alternatives to traditional bioprostheses.J Thor Cardiovasc Surg. 2021; 161: 213-225
- The anti-fragility of the melody valve.JTCVS Tech. 2020; 4: 251-252
- Left ventricular pseudoaneurysm after replacement of a Melody valve in the left atrioventricular valve position.JTCVS Tech. 2020; 4: 248-250
- Cylinder mitral and tricuspid valve replacement in neonates and small children.Eur J Cardiothor Surg. 2020; 58: 964-968
- The ordeal of left atrioventricular valve replacement in children under I year of age.Interac Cardiovasc Thoracx Surg. 2017; 25: 317-322
- Mitral valve replacement in infants and children 5 years of age or younger: evolution in practice and outcome over three decades with a focus on supra-annular prosthesis implantation.J Thorac Cardiovasc Surg. 2008; 136954961
- Complications of supra-annular mitral valve placement in infants.Heart. 2005; 91: e48
- Chimney technique for mitral valve replacement in children.Ann Thor Surg. 2013; 96: 1885-1887
- Modified technique for melody valve implantation in the mitral position.J Cardiovasc Thor Surg. 2018; 156: 1190-1191
- Melody valve to replace the mitral valve in small children: Lessons learned.Ann Ped Card. 2021; 14: 35-41
James M. Hammel, personal communication. (Abstract submitted to ACC).
- Mitral valve replacement in pediatrics using an exteracellular matrix cylinder valve: a case series.Pediatr Cardiol. 2020; 41: 1458-1465
Article info
Publication history
Published online: February 02, 2023
Footnotes
Conflict of Interest: No disclosures
Extramural Funding: None
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
