Abstract
The aim – to study the long-term results of mitral valve prosthetics with mechanical prostheses in children and adolescents.
Material and methods. The long-term results of 248 mitral valve replacement operations performed in childhood and adolescence were analyzed. Among the patients, 114 (46.0%) were male, 134 (54.0%) were female. The age at the time of surgery ranged from 3 months to 18 years (median – 4 years), the period after surgery – from 1 to 33 years (median – 9 years, 25 and 75 quartiles of 6 and 14 years), the age at the time of examination – from 1 year 8 months to 40 years (median – 13.3 years). Mitral valve disc mechanical prostheses were implanted in 66 (26.6%) cases, bicuspid ones – in 182 (73.4%). Simultaneous correction of concomitant CHD was performed in 49 (19.8%) patients.
Results. In the long-term postoperative period, the satisfactory function of the mitral prosthesis was revealed in 117 (47.2%) patients, in 131 (52.8%) patients, signs of mitral prosthesis dysfunction were noted. Among patients with signs of prosthetic dysfunction, 70 (28.2%) had pannus, 47 (18.9%) had a discrepancy in the size of the prosthesis to the body surface area, 7 (2.8%) had prosthetic thrombosis, 5 (2%) developed prosthetic endocarditis, 2 (0.8%) had paraprosthetic fistula. In all patients with “overgrowth”, the size of the implanted prosthesis was 23 or less. Thromboembolic complications were noted in 19 (7.7%) patients, hemorrhagic complications in 8 (3.2%) patients. Prosthetic infectious endocarditis in 7 (2.8%) patients. Mitral valve replacement surgery was performed in 128 (51.6%) patients. The mortality rate during mitral valve replacement surgery was 3.9%. The cumulative 20-year survival rate was 90%.
Conclusion. Valve replacement is a common procedure after mitral valve replacement with a mechanical prosthesis, especially in children with implanted small prostheses. With repeated valve replacement surgery, larger prostheses can be implanted, which indicates the continued growth of the fibrous ring. Regular conducting of a complex of clinical and instrumental examinations, strict monitoring of International Normalized Ratio indicators allows to avoid the development of life-threatening complications, to ensure a good long-term result of surgical treatment and a high quality of life for children and adolescents in the long term.
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About the authors
- Sergey F. Nikonov, Dr. Med. Sci., Professor, Head of Department;
- Susanna A. Avakova, Cand. Med. Sci., Head of Department; ORCID
- Olga I. Medvedeva, Dr. Med. Sci., Leading Researcher; ORCID
- Mariya N. Nevedrova, Cand. Med. Sci., Researcher; ORCID
- Timur Yu. Danilov, Dr. Med. Sci., Head of Department; ORCID
- Dmitry V. Kovalev, Dr. Med. Sci., Head of Department; ORCID
- Viktor B. Samsonov, Dr. Med. Sci., Leading Researcher;ORCID
- Anton V. Minaev, Dr. Med. Sci., Senior Researcher; ORCID
- Svetlana I. Babenko, Dr. Med. Sci., Leading Researcher, Cardiologist; ORCID
- Irina V. Arnautova, Dr. Med. Sci., Chief Researcher; ORCID
- Marina L. Ermolenko, Dr. Med. Sci., Head of Department; ORCID
- Vera I. Dontsova, Cand. Med. Sci., Ultrasound Diagnostician; ORCID
