Clinical Outcomes of Mitral Valve Replacement With the 16-mm ATS Advanced Performance Valve in Neonates and Infants

Background Although mitral valve repair is the preferred treatment for mitral regurgitation in neonates and infants, mitral valve replacement (MVR) is sometimes necessary. Methods From 1999 through 2013, 18 patients younger than 1 year underwent MVR with the smallest (16 mm) commercially available mechanical valve. At surgery, mean age was 4.0 ± 1.8 months (range, 4 days to 7 months), and mean body weight was 5.3 ± 1.6 kg (range, 3.2 to 8.3 kg). Prosthetic valves were implanted in the supra-annular position in 17 of the 18 patients. Results All patients were followed up, and the mean follow-up period was 4.5 ± 3.8 years (range, 0.2 to 14 years). The rates of overall survival and freedom from redo MVR at 10 years were 88.9% and 57.8%, respectively. The causes of redo MVR were pulmonary hypertension in patients with left ventricular outflow obstruction (n = 2), hemolysis (n = 1), and a stuck valve (n = 1). The estimated effective orifice area index (effective orifice area/body surface area) was significantly inversely correlated with peak transmitral pressure gradient (r = −0.784, p < 0.01). The rate of freedom from permanent pacemaker implantation at 10 years was 71.2%. Three of the 5 pacemaker implantation procedures were for postoperative sick sinus syndrome. Although intracranial hemorrhage developed in 3 infants, all neurologic sequelae resolved. Conclusions The implanted valves were durable, and no premature increase in transmitral pressure gradient was observed. Complications included injury of the sinus node artery and hemorrhage related to anticoagulation therapy.