Annulus upsizing for mitral valve re-replacement in children

Patrick O. Myers, Pedro J. Del Nido, Doff B. McElhinney, Zain Khalpey, James E. Lock, Christopher W. Baird

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Mitral valve replacement remains the last resort for treatment of congenital mitral valve disease. Enlarging the mitral annulus at the time of mitral valve replacement may allow implantation of a larger prosthesis in children. Methods: All mitral valve replacement procedures from 1990 to 2012 were included, and mitral annulus enlargement techniques were analyzed. A control group of patients undergoing replacement of a previously implanted mechanical mitral valve prosthesis was compared with the cohort of patients who underwent annular enlarging procedures. Primary end points were increases in annulus size and Z score, and freedom from paced rhythm. Results: Among 205 mitral valve replacement procedures, 16 (8%) included techniques to upsize the mitral annulus in 15 patients, all but 1 of whom had undergone prior mitral valve replacement. These patients were compared with a control cohort of 53 patients undergoing mitral valve re-replacement without annulus enlargement. The annulus was upsized by 18% ± 11% (compared with 16% ± 20% in controls, P =.5) using open balloon dilation in 4 patients, radial annular incisions in 5 patients, and patch augmentation of the aorto-mitral continuity in 7 patients. The mean valvar diameter Z score increased from -0.2 ± 1.3 to +1.1 ± 1.4 (P <.001), compared with an increase from -0.3 ± 1.2 to 0.9 ± 1.1 in controls (P <.001). During a mean follow-up of 6.5 ± 6.4 years, 4 of 12 patients required permanent pacing in the upsizing group (predominantly with patch augmentation), versus 5 of 53 patients in the control group. Conclusions: In children undergoing mitral valve replacement, various techniques can be used to upsize the mitral annulus and allow implantation of a larger prosthesis. There is a nontrivial risk of heart block with annulus upsizing, which deserves further study.

Original languageEnglish (US)
Pages (from-to)347-351
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number2
StatePublished - Aug 2013
Externally publishedYes


  • MVR
  • mitral valve re-replacement
  • mitral valve replacement
  • reMVR

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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