The Fate of Mitral Valve Surgery in the Pediatric Age: A 25-Year Single-Center Experience

Abstract

Background: The aim of this study was to evaluate the natural history of patients after mitral valve intervention in the pediatric age. Methods: This is a retrospective study including all patients who underwent mitral valve surgery from 1998 to 2022. The patients' surgical reports, postoperative records, and ambulatory visits were reviewed. The endpoints of the study were survival and freedom from mitral valve reoperation. Results: Of the 70 patients included in the cohort, 61 patients (86.7%) had congenital mitral valve disease, of whom 46 patients (75.4%) had a predominantly mitral regurgitation lesion, and 15 patients (24.6%) had a predominantly mitral stenosis. In the mitral regurgitation group, all of the patients underwent valve repair with an operative mortality of one patient (2.1%), and with median follow-up of 4 years (range, 0.5-13 years), there was 4.3% mortality (n = 2) and 71.2% freedom from reoperation. In the mitral stenosis group, 11 patients underwent mitral valve repair, and 4 patients underwent valve replacement. There was an operative mortality of two patients (13.3%). With a 2-year median follow-up (range: 0.1-23 years), there were no additional mortality cases in the mitral stenosis group. All three patients who survived primary mitral valve replacement (100%) and four patients who survived a primary repair (40.0%) underwent reoperation. Conclusions: This study demonstrates encouraging outcomes for mitral valve repair. The mortality of patients with congenital mitral valve disease may also be related to a difficult postoperative course, rather than the MV lesion itself.

Keywords: acquired mitral valve disease; congenital mitral valve disease; mitral valve repair; mitral valve surgery.

Figure 1

The clinical course for patients with congenital mitral valve disease. (A) presents patients with mitral regurgitation as their primary lesion. All of the patients in this group underwent mitral valve repair as the first surgical mitral valve intervention. (B) covers patients with mitral stenosis as their primary lesion. Four patients in this group underwent a mitral valve replacement, and eleven underwent a mitral valve repair. (MV—mitral valve; MVR—mitral valve replacement; y—years).

Figure 2

Kaplan–Meier curves for survival and freedom from mitral valve reoperation. (a) 13-year Kaplan–Meier curves for survival. There were no statistically significant group differences in the short- or long-term mortality. There was no long-term mortality. (b) 6-year Kaplan–Meier curves for mitral valve reintervention. No significant group differences were found, however, there were higher rates for mitral valve reintervention for the mitral stenosis group.