Congenital Mitral Regurgitation Repair Based on Carpentier's Classification: Long-Term Outcomes

Abstract

Background There are few reports of the outcomes of standardized surgical management addressing the etiologic and morphologic aspects of mitral valve malformation according to Carpentier's classification. This study aimed to evaluate the long-term outcomes of mitral valve repair in children according to Carpentier's classification. Methods Patients who underwent mitral valve repair at our institution between 2000 and 2021 were retrospectively reviewed. Preoperative data, surgical techniques, and outcomes were analyzed according to Carpentier's classification. The proportion of patients free of mitral valve replacement and reoperation was estimated using Kaplan-Meier analysis. Results Twenty-three patients (median operative age, four months) were followed up for 10 (range, 2-21) years. Preoperative mitral regurgitation was severe in 12 patients and moderate in 11 patients. Eight, five, seven, and three patients had Carpentier's type 1, 2, 3, and 4 lesions, respectively. Ventricular septal defect (N = 9) and double outlet of the great arteries from the right ventricle (N = 3) were the most commonly associated cardiac malformations. There were no cases of operative mortality or deaths during the follow-up. The overall five-year rate of freedom from mitral valve replacement was 91%, whereas the five-year rates of freedom from reoperation were 74%, 80%, 71%, and 67% in type 1, 2, 3, and 4 lesions, respectively. Postoperative mitral regurgitation at the last follow-up was moderate in three patients and less than mild in 20 patients. Conclusions Current surgical management of congenital mitral regurgitation is generally considered adequate; however, more complicated cases required a combination of various surgical techniques.

Invited Commentary: One Home Run Is Much Better Than Two Doubles

“…On the other hand, in a subgroup analysis of patients with two-ventricle Fontan, they found that the larger rudimentary ventricular end-diastolic volume/dominant ventricular enddiastolic volume ratio was associated with significantly higher dominant ventricular end-diastolic pressure and a significant decrease of maximum oxygen consumption (VO 2 max). 1 The findings of the study by Miwa and colleagues are in line with a number of recent studies that demonstrated again no advantage of having a larger rudimentary ventricle on Fontan outcomes. 2,3 These findings challenge the intuitive notion that having a larger rudimentary ventricle might be advantageous for adding additional squeezing power to the dominant ventricle; thus, a greater contribution to stroke volume.…”

“…On the other hand, in a subgroup analysis of patients with two-ventricle Fontan, they found that the larger rudimentary ventricular end-diastolic volume/dominant ventricular end-diastolic volume ratio was associated with significantly higher dominant ventricular end-diastolic pressure and a significant decrease of maximum oxygen consumption (VO 2 max). 1…”