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Pediatric Cardiology

, Volume 40, Issue 8, pp 1663–1669 | Cite as

Outcome for Conservative Surgery for the Correction of Severe Mitral Valve Regurgitation in Children: A Single-Center Experience

  • Gianluca BrancaccioEmail author
  • Marcello Chinali
  • Matteo Trezzi
  • Carolina D’Anna
  • Claudia Esposito
  • Gabriele Rinelli
  • Walter Vignaroli
  • Sonia B. Albanese
  • Fiore S. Iorio
  • Adriano Carotti
Original Article
  • 127 Downloads

Abstract

Evolving reconstructive techniques have progressively become the preferred approach for treatment of pediatric mitral valve regurgitation. We present our experience in a cohort of patients undergoing surgical correction for severe mitral regurgitation. Fifty-five patients (age 1 month–18 years; median 5 years) were included in the present analysis. Different surgical techniques were used (posterior leaflet augmentation in 25, isolated cleft closure in 12, Alfieri-type procedure in 10, annuloplasty in 5, with artificial chordae in 2, and quadrangular resection with chordal transposition in 1). Follow-up time ranged from 1 to 192 months (median 38[IQR 12–54] months). Operative and follow-up mortality was 0%. Reintervention in the whole population occurred in 31% of patients. However, when first surgery was performed under 2 years of age (no = 17), reintervention reached nearly 50%. The degree of residual mitral regurgitation at follow-up remained stable after surgery, while a significant increase in mean transmitral gradient was observed over time (paired t test = 0.03). In multivariable Cox-regression analysis, post-surgical transmitral gradient was the only independent predictor for reintervention (p = 0.017; HR 2.4; 95%CI 1.2–5.1), after correcting for differences in age at surgery, type of reintervention, mitral annulus dimension, and BSA at the first surgery. ROC curve demonstrated that a post-surgical transmitral mean gradient value > 5 mmHg, was predictive for reintervention (AUC = 0.89; Youden index = 0.44). Our study suggests that the use of conservative technique strategy achieves satisfactory functional results in infants and children with severe MR, although the rate of reoperation in younger patients remains substantial. Post-operative moderate mitral stenosis was the strongest predictor for reoperation.

Keywords

Mitral valve insufficiency Pediatrics Surgery Stenosis Echocardiography 

Abbreviations

PLA

Posterior leaflet augmentation

OST

Other surgical techniques

MV

Mitral valve

MR

Mitral regurgitation

ePTFE

Expanded polytetrafluoroethylene

BSA

Body surface area

Notes

Compliance with Ethical Standards

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Gianluca Brancaccio
    • 2
    Email author
  • Marcello Chinali
    • 1
  • Matteo Trezzi
    • 2
  • Carolina D’Anna
    • 1
  • Claudia Esposito
    • 1
  • Gabriele Rinelli
    • 1
  • Walter Vignaroli
    • 2
  • Sonia B. Albanese
    • 2
  • Fiore S. Iorio
    • 2
  • Adriano Carotti
    • 2
  1. 1.Cardiology, Department of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children’s Hospital and Research InstituteRomeItaly
  2. 2.Cardiac Surgery, Department of Pediatric Cardiology and Cardiac SurgeryBambino Gesù Children’s Hospital and Research InstituteRomeItaly

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