Supraannular mitral valve replacement reduced the 'a' wave to left ventricular end-diastolic pressure gradient (17 vs 4 mm Hg, p=0.003), though 10-year survival remained poor at 53%.
Observational (n=17)
Does supraannular mitral valve replacement improve survival and hemodynamics in infants and children with symptomatic mitral valve disease and a small annulus?
Supraannular mitral valve replacement in infants relieves mitral valve disease, but long-term outlook remains poor due to persistent elevated LA pressures and associated lesions.
Absolute Event Rate: 4% vs 17%
p-value: p=0.003
OBJECTIVES: We report the clinical course and unique hemodynamic findings after placement of a supraannular mitral valve prosthesis. BACKGROUND: Children with symptomatic mitral valve disease whose annulus is too small for the smallest prosthesis are difficult to manage. One option is valve replacement with a prosthesis positioned entirely within the left atrium (LA). METHODS: We reviewed 17 patients (median age 10 months) with symptomatic mitral valve disease who underwent placement of a supraannular valve prosthesis between 1980 and 1994. RESULTS: The actuarial survival rates were 88% at 1 month and 71%, 62% and 53% at 1, 2 and 10 years, respectively. Preoperative hemodynamic data (mean +/- SD)) compared with those after placement of the supraannular mitral prosthesis were as follows: "a" wave to left ventricular end-diastolic pressure gradient 17 +/- 5 versus 4 +/- 4 mm Hg (p = 0.003), mean LA pressure 25 +/- 6 versus 20 +/- 6 mm Hg (p = 0.07), "a" wave 30 +/- 6 versus 19 +/- 5 mm Hg (p = 0.006), "v" wave 28 +/- 5 versus 30 +/- 9 mm Hg (p = 0.31), mean pulmonary artery pressure 54 +/- 19 versus 42 +/- 15 mm Hg (p = 0.07) and left ventricular end-diastolic pressure 14 +/- 5 versus 16 +/- 4 mm Hg (p = 0.12). CONCLUSIONS: Supraannular mitral valve replacement provides relief of mitral stenosis or mitral regurgitation. However, LA to left ventricular early diastolic gradients with large atrial "v" waves contribute to elevated mean LA pressures in the absence of prosthetic valve obstruction or regurgitation. As a result of this unexpected finding, associated left heart obstructive lesions and pulmonary and left ventricular end-diastolic hypertension, the outlook remains poor.
Adatia et al. (Tue,) conducted a observational in Symptomatic mitral valve disease (n=17). Supraannular mitral valve replacement vs. Preoperative baseline was evaluated on "a" wave to left ventricular end-diastolic pressure gradient (mm Hg) (p=0.003). Supraannular mitral valve replacement reduced the 'a' wave to left ventricular end-diastolic pressure gradient (17 vs 4 mm Hg, p=0.003), though 10-year survival remained poor at 53%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: