Transcatheter mitral valve replacement (TMVR) may provide significant value as an alternative to surgery when treating pediatric patients, according to new research published in Circulation: Cardiovascular Interventions.
“Congenital mitral valve disease presenting in childhood continues to represent a significant management challenge,” wrote lead author Nicola Maschietto, MD, PhD, a cardiologist at Boston Children’s Hospital, and colleagues. “Despite improvements in surgical mitral valve repair techniques, mitral valve replacement (MVR) is frequently unavoidable. “Options for surgical MVR in children include mechanical, bioprosthetic valves (BPVs), and autografts; unfortunately, none of these solutions are ideal. In growing children, the fixed diameter of the mechanical and BPV valves is a disadvantage, since they require replacement as the child grows, thereby increasing morbidity and mortality related to multiple reoperations in a lifetime.”
Maschietto’s team reviewed data from eight consecutive pediatric patients at a high risk of needing surgery who underwent TMVR with the Sapien S3 valve from October 2018 to July 2020. All patients received care at the same facility. The median patient age was 9 years old, and each one had already undergone multiple mitral valve surgeries or MVR.
Overall, the authors found, TMVR was successful in all eight patients. TMVR was consistently associated with reducing left atrium and pulmonary hypertension, and no serious complications were reported.
“TMVR is an attractive alternative to surgical MVR in high surgical risk patients,” the authors wrote. “In this small series of patients, TMVR has proven acutely effective and safe, with very encouraging early results.”
Maschietto and colleagues also explored the potential long-term impact of TMVR becoming a regular treatment for mitral valve disease in children.
“If this approach is validated on a larger scale, surgical MVR with BPV could see a resurgence,” the authors wrote. “TMVR can extend the life of a dysfunctional BPV. It could theoretically be performed multiple times in a particular patient, especially if the sewing ring of the BPV is fractured to allow for extra room for the subsequent valves, avoiding the Russian doll effect.”
The team also emphasized that additional research is still needed so that specialists can better understand the potential of the Sapien S3 valve in this specific patient population.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.