Midterm Outcomes After Surgical Management for Mitral Valve Regurgitation in Infancy

Abstract

Background Mitral valve repair is preferred for pediatric mitral valve disease. However, it is technically difficult because of complex lesions, poor surgical exposure, and tissue fragility, especially in infants. We investigated the midterm outcomes of mitral valve surgery for mitral regurgitation in infancy. Methods We retrospectively reviewed 18 patients (aged <12 months old) undergoing mitral valve surgery for mitral regurgitation at our institution between October 2005 and March 2019. The patients had 10 acquired and 8 congenital valve lesions as follows: torn chordae ( n = 6), leaflet prolapse ( n = 4), posterior leaflet hypoplasia ( n = 3), anterior leaflet cleft ( n = 2), infective endocarditis ( n = 1), papillary muscle rupture ( n = 1), and hammock valve ( n = 1). Results All patients initially underwent mitral valve repair. There was no operative mortality, and 1 case of late death. The median follow-up period was 7 years and 9 months. Reoperation was performed in 3 patients, re-repair (twice) in 1 patient with a hammock valve, and mitral valve replacement in 2 patients. Fifteen patients had at most mild mitral regurgitation at the last follow-up. A transmitral mean pressure gradient of over 5 mm Hg was observed in 3 cases, including the patient with a hammock valve. Postoperative mitral annular diameter increased within the normal range in all patients. Survival and reoperation-free rates at 5 and 10 years were 94.4% and 83.0%, respectively. Conclusions Mitral valve repair for mitral regurgitation in infancy is safe and feasible with satisfactory midterm outcomes, even under serious preoperative conditions.

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

“…Others report rates of freedom from reoperation of 69% to 94% after 10 and 20 years, respectively. 12‐16 In our experience, mitral valve repair proved feasible and successful in all patients, with an acceptable early and late mortality and reoperation rate.…”

“…2 Maeda et al also underlined the obligation of an annuloplasty. 16 We performed commissural annuloplasty as reinforcement and prevention of annular dilation for all patients with sufficient mitral valve diameter, whereby the mitral annular diameter was adjusted to over 80% of normal (Figure 1). Some patients experienced postoperative MS, but this improved at the last follow-up.…”