The ordeal of left atrioventricular valve replacement in children under 1 year of age.

OBJECTIVES: This study reviews the outcomes of children under 1 year of age who had left atrioventricular valve (LAVV) replacement (LAVVR) in one centre and explores the benefits of an innovative approach for LAVVR in very small patients.

METHODS: Thirteen consecutive patients operated for LAVV replacement between 1997 and 2016 were reviewed retrospectively. Indication for surgery was regurgitation in 7, stenosis in 5 and both stenosis and regurgitation in 1. Nine patients (69%) had previous LAVV repair. Median age at surgery was 126 days (39-327 days). In the primary surgery, 7 mechanical valves and 1 mitral homograft were implanted. Five inverted semilunar valve conduits were implanted consisting of a Contegra valve in 4 and a pulmonary homograft in 1.

RESULTS: Hospital mortality was 31% (4 of 13). Two patients required postoperative extracorporeal membrane oxygenation. Six patients developed complete atrioventricular block, with 2 survivors requiring a pacemaker. Late mortality was 31% (4 of 13). Two of the 4 patients who received an inverted Contegra conduit died. Median follow-up of the 5 survivors was 4 years (2-16 years). Four patients had 10 further replacements consisting of 6 redo conventional mechanical valves replacement, 3 supra-annular valve implantation, and 1 modified Ross II. The 5 inverted semilunar valve conduits implanted lasted for 1, 5, 6, 22 and 37 months.

CONCLUSIONS: LAVVR below 1 year of age is associated with a considerable operative and late mortality. LAVVR with an inverted conduit bearing semilunar valves may be an alternative strategy for patients with the smallest annuli.