Mitral Valve Replacement Still Problematic in Young Children
WESTPORT, CT (Reuters Health) – With the advent of mechanical prostheses, valve failure is no longer a problem after mitral valve replacement in children, but the procedure still often results in complications and impairs health-related quality of life, according to two reports from the same team of UK researchers.
In the first study, Dr. Martin Elliott and colleagues, from the Great Ormond Street Hospital for Children NHS Trust, London, evaluated outcomes of 54 children, median age 3.3 years, who underwent mitral valve replacement between January 1987 and December 1997.
In the December issue of Heart, they report that the 30-day mortality rate was 20.3%. Significant bleeding complications occurred in six patients during follow-up of up to 11 years. At 5 years the event-free survival rate was 52%.
On the other hand, at 5 years, 92% of the children were free from nonstructural valve dysfunction and had not required reoperation. Most reoperations were due to somatic growth. In addition, the researchers report, no valve failed and the incidence of thromboembolism and endocarditis was low.
The factors that contributed to an increased risk of death or reoperation were low weight, young age and small valve size, according to Dr. Elliott and colleagues. They recommend that due to the high rate of complications, mitral valve replacement in children should be reserved “for patients in whom valve repair is not technically feasible.”
In the second paper, the team reports on a retrospective study of the health-related quality of life of 19 patients, median age 14.4 years, who had undergone their most recent mitral valve replacement a median of 7.6 years previously.
The results appeared to be age specific. Younger children indicated a lower quality of life, with a moderate impairment in health status, while most adolescents and young adults rated their quality of life as near normal.
Among the 10 younger patients, those between 9 and 15 years of age, the group found that five rated their quality of life “within a range of children with chronic physical disabilities, and in the remaining five it was worse.” Regular blood tests were cited by three of these children as a reason for impaired quality of life.
