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We sought to define patient characteristics, outcomes, and associated factors after mitral valve replacement in children. We included 104 children undergoing at least one mitral valve replacement between 1980 and 2003 and reviewed clinica l records. Competing-risks methodology was used to determine time-related prev alence and associated risk factors after initial mitral valve replacement for de ath and repeat replacement. The underlying mitral valve disease was congenital i n 83%, rheumatic in 13%, Marfan syndrome in 3%, and isolated endocarditis in 1%, with 64%having primarily regurgitation, 16%having stenosis, 20%having bo th, and 32%having undergone previous valvotomy, valvuloplasty, or repair. There were 137 valve replacements, with 26 patients having more than one. Valve prost hesis type was St Jude Medical in 37%, Bjrk-Shiley in 25%, Carbomedics in 20 %, Ionescu-Shiley in 10%, and other types in 8%. Both early and late complic ations were common. Median age at the initial replacement was 5.9 years(range, b irth to 19 years). Competing-risks analysis predicted 19%to have died at 15 ye ars after initial replacement, with risk factors including noncongenital valve m orphology, lower weight, and longer duration of cardiopulmonary bypass. A repeat replacement was predicted for 71%, with risk factors including the presence of multiple left-heart obstructive lesions and Ionescu-Shiley valve prosthesis. Mitral valve replacement might be necessary in children with extremely dysplasti c valves and severe hemodynamic impairment or after failed repair. However, with the appropriate selection of the prosthetic valve and reduction of cardiopulmon ary bypass time, surgeons might decrease mortality and increase prosthesis longe vity.
We sought to define patient characteristics, outcomes, and associated factors after mitral valve replacement in children. We included 104 children undergoing at least one mitral valve replacement between 1980 and 2003 and reviewed clinica l records. Competing -ologies methodology was used to determine time- related prev alence and associated risk factors after initial mitral valve replacement for de ath and repeat replacement. The underlying mitral valve disease was congenital in 83%, rheumatic in 13%, Marfan syndrome in 3%, and isolated endocarditis in 1%, with 64 % had primarily regurgitation, 16% having stenosis, 20% having bo th, and 32% having undergone previous valvotomy, valvuloplasty, or repair. There were 137 valve replacements, with 26 patients having more than one. Medical in 37%, Bjrk-Shiley in 25%, Carbomedics in 20%, Ionescu-Shiley in 10%, and other types in 8%. Both early and late complic ations were common. Median age at the initial replac epeak was 5.9 years (range, b irth to 19 years). Competing-risks analysis predicted 19% to have died at 15 ye ars after initial replacement, with risk factors including noncongenital valve m orphology, lower weight, and longer duration of cardiopulmonary bypass . A repeat replacement was predicted for 71%, with risk factors including the presence of multiple left-heart obstructive lesions and Ionescu-Shiley valve prosthesis. Mitral valve replacement might be necessary in children with extremely dysplasti c valves and severe hemodynamic impairment or after failed repair. However, with the appropriate selection of the prosthetic valve and reduction of cardiopulmon ary bypass time, surgeons might decrease mortality and increase prosthesis longe vity.