Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children

Abstract

Background: This study evaluates early and long-term outcome and freedom from reoperation after mitral valve (MV) reconstruction in children using various standard and modified reconstruction techniques.

Methods: Between June 1987 and December 2006, 111 children (mean age, 7.5 +/- 5.9 years) with congenital and acquired MV diseases underwent MV reconstruction. Six children were aged younger than 3 months old, 28 were 3 months to 2 years, and 77 were 2 to 18 years old. Congenital MV lesions were found in 84.6%, isolated MV disease was found in 54.1%, and MV insufficiency was the predominant pathophysiology in 80%. Various standard repair techniques and our own modifications were used according to the lesions.

Results: Early mortality was 4.5%, and late mortality was 7.3%. Actuarial survival at 10 years was 77.4%. Actuarial reoperation-free survival at 10 and 15 years was 79.2%. At 19 years, freedom from MV replacement was 81.8% +/- 7.5%, and freedom from repeat reconstruction 91% +/- 1.5%. Mean follow-up was 5.4 years. Age younger than 3 months, urgency of operation, concomitant procedures, and coexisting anomalies were strong predictors of poor overall freedom from reoperation and decreased early and late survival. The highly satisfactory results were achieved by careful structural and functional assessment of the valve, avoidance of prosthetic material, and use of a spectrum of repair techniques tailored to the individual case that address all components of the valve lesion.

Conclusions: Mitral valve reconstruction in children using various surgical techniques provides satisfactory early and long-term survival and clinical outcome with low reoperation rates.