Mitral valve reconstruction in a pediatric population: late clinical results and predictors of long-term outcome.

OBJECTIVE: Pediatric mitral valve anomalies present complex management challenges to the surgeon, who may have to choose between valve replacement or repair. We review our 18 years of experience to establish the long-term outcomes of pediatric mitral repair.

METHODS: Forty-five children (22 boys) with mitral valve anomalies were studied. Mitral reconstruction was performed in all cases at the first instance. The median age at operation was 2.16 years with 18 (40%) younger than 1 year. Patients were divided into two groups: group 1, isolated (mitral anomaly with or without atrial septal defect or patent ductus arteriosus), contained 30 patients (66.6%), and group 2, complex (mitral anomaly with concurrent intracardiac disease), contained 15 patients (33.3%).

RESULTS: In-hospital (30-day) mortality in group 1 was 3.3% (1/30); overall in-hospital mortality was 11.1%. Group 2 had a significantly higher in-hospital death rate of 26.6% (4/15; P < .05). There was 1 late death, that of a child who required reoperation. The median follow-up was 5.08 years (range 1-211 months). The 15-year survival in group 1 was 93%, versus 73% in group 2. Seven patients required 9 revision surgical procedures. Two mitral valve replacements were required at reoperation. The 15-year freedom from reoperation was 81.7%. There were no thromboembolic events. The event-free rate at 15 years was 73.5%.

CONCLUSION: This series compares favorably with others, with 74% to 85% survival and 66% to 85.7% freedom from reoperation reported with valve replacement. Patients with significant associated congenital cardiac abnormalities are at a higher risk of early death after mitral reconstructive surgery.