Bahaaldin Alsoufi, MD, Cedric Manlhiot, BSc, Brian W

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Presentation transcript:

Results after mitral valve replacement with mechanical prostheses in young children Bahaaldin Alsoufi, MD, Cedric Manlhiot, BSc, Brian W. McCrindle, MD, MPH, Zohair Al-Halees, MD, Ahmed Sallehuddin, MD, Saud Al- Oufi, MD, Elias Saad, MD, Bahaa Fadel, MD, Charles C. Canver, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 5, Pages 1189-1196.e2 (May 2010) DOI: 10.1016/j.jtcvs.2009.10.038 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Model for survival to reoperation has only late phase, because risk of reoperation steadily increases as years since surgery progress. Solid lines represent parametric point estimates, dashed lines enclose 70% confidence intervals, and circles with error bars represent nonparametric estimates. B, Hazard function for mitral valve reoperation. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Model for raw survival is composed of 2 phases of risk, early phase with high level of risk in immediate postoperative period and a constant phase indicating low attrition rate with time. Solid lines represent parametric point estimates, dashed lines enclose 70% confidence intervals, and circles with error bars represent nonparametric estimates. B, Hazard function for death. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Competing-risks analysis depiction of events after initial mitral valve replacement in 79 children younger than 8 years. After initial mitral valve replacement, patients could transition to either death or a subsequent replacement. At any point, sum of percentages of children in each state is 100%. At 10 years after initial surgery, approximately 40% of patients have died, 20% have undergone mitral reoperation, and 40% are alive and free from reoperation. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Stratified analysis of risk of death by ratio of implanted valve size (VS) to patient weight (W). Unfavorable effect on mortality of higher ratio is shown. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Stratified analysis of risk of reoperation by age at initial surgery. Unfavorable effect on mitral reoperation of age is shown. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Overall freedom from all-cause time-related mortality after mitral valve replacement in children younger than 8 years. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Graph showing relationship between ratio of prosthesis size to weight and age. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Age distribution of patients at initial mitral valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

A, Stratified analysis of risk of death by ratio of implanted valve size (VS) to weight (W) in children younger than 2 years. Unfavorable effect on mortality of ratio is shown. B, Stratified analysis of risk of death by ratio of valve size to weight in children between 2 and 8 years old. Unfavorable effect on mortality of ratio is shown. Graphs clearly show that although risk of death is higher in younger patients than in older ones, ratio of valve size to weight is risk factor for mortality in both groups. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1189-1196.e2DOI: (10.1016/j.jtcvs.2009.10.038) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions