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


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.


Mitral valve insufficiency Pediatrics Surgery Stenosis Echocardiography 



Posterior leaflet augmentation


Other surgical techniques


Mitral valve


Mitral regurgitation


Expanded polytetrafluoroethylene


Body surface area


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.


  1. 1.
    Carpentier A, Branchini B, Cour JC, Asfaou E, Villani M, Deloche A, Relland J, DAllaines C, Blondeau P, Piwnica A, Parenzan L, Brom G (1976) Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J Thorac Cardiovasc Surg 72(6):854–866PubMedGoogle Scholar
  2. 2.
    Chauvaud S, Fuzellier JF, Houel R, Berrebi A, Mihaileanu S, Carpentier A (1998) Reconstructive surgery in congenital mitral valve insufficiency (Carpentier’s techniques): long-term results. J Thorac Cardiovasc Surg 115(1):84–93CrossRefGoogle Scholar
  3. 3.
    Caldarone CA, Raghuveer G, Hills CB, Atkins DL, Burns TL, Behrendt DM, Moller JH (2001) Long-term survival after mitral valve replacement in children < 5 years: a multi-institutional study. Circulation 104(12 Suppl 1):I143-7PubMedGoogle Scholar
  4. 4.
    Baird CW, Myers PO, Marx G, Del Nido PJ (2012) Mitral valve operations at a high volume pediatric heart center: evolving techniques and improved survival with mitral valve repair versus replacement. Ann Pediatr Cardiol 5(1):13–20CrossRefGoogle Scholar
  5. 5.
    Oppido G, Davies B, McMullan DM, Cochrane AD, Cheung MMH, d’Udekem Y, Brizard CP (2008) Surgical treatment of congenital mitral valve disease: midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg 135(6):1313–1321CrossRefGoogle Scholar
  6. 6.
    Kalfa D, Vergnat M, Ly M, Stos B, Lambert V, Baruteau A, Belli E (2014) A standardized repair-oriented strategy for mitral insufficiency in infants and children: midterm functional outcomes and predictors of adverse events. J Thorac Cardiovasc Surg 148(4):1459–1466CrossRefGoogle Scholar
  7. 7.
    Chauvaud S, Jebara V, Chachques JC, el Asmar B, Mihaileanu S, Perier P et al (1991) Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair. J Thorac Cardiovasc Surg 102:171–178PubMedGoogle Scholar
  8. 8.
    Dion RA, Gutermann H, Van Kerrebroeck C, Verhaert D (2012) Augmentation of the posterior leaflet of the mitral valve. Multimed Man Cardiothorac Surg 2012:mms015. CrossRefPubMedGoogle Scholar
  9. 9.
    Trezzi M, Cetrano E, Albano A, Carotti A (2015) Extending the limits for mitral valve replacement in low-weight infants using a stented bovine jugular vein graft. J Thorac Cardiovasc Surg 150(3):729–730CrossRefGoogle Scholar
  10. 10.
    Uva MS, Galletti L, Gayet FL, Piot D, Serraf A, Bruniaux J et al (1995) Surgery for congenital mitral valve disease in the first year of life. J Thorac Cardiovasc Surg 109(1):164–176CrossRefGoogle Scholar
  11. 11.
    Stellin G, Padalino MA, Vida VL, Bozzucco G, Orrù E, Biffanti R et al (2010) Surgical repair of congenital mitral valve malformations in infancy and childhood: a single-center 36-year experience. J Thorac Cardiovasc Surg 140(6):1238–1244CrossRefGoogle Scholar
  12. 12.
    Wood AE, Healy DG, Nolke L, Duff D, Oslizlok P, Walsh K (2005) Mitral valve reconstruction in a pediatric population: late clinical results and predictors of long-term outcome. J Thorac Cardiovasc Surg 130(1):66–73CrossRefGoogle Scholar
  13. 13.
    Aharon AS, Laks H, Drinkwater DC, Chugh R, Gates RN, Grant PW et al (1994) Early and late results of mitral valve repair in children. J Thorac Cardiovasc Surg 107(5):1262–1270PubMedGoogle Scholar
  14. 14.
    Krishnan US, Gersony WM, Berman-Rosenzweig E, Apfel HD (1997) Late left ventricular function after surgery for children with chronic symptomatic mitral regurgitation. Circulation 96:4280–4285CrossRefGoogle Scholar
  15. 15.
    Murakami T, Nakazawa M, Nakanishi T, Momma K (1999) Prediction of postoperative left ventricular pump function in congenital mitral regurgitation. Pediatr Cardiol 20:418–421CrossRefGoogle Scholar
  16. 16.
    Minami K, Kado H, Sai S, Tatewaki H, Shiokawa Y, Nakashima A, Fukae K, Hirose H (2005) Midterm results of mitral valve repair with artificial chordae in children. J Thorac Cardiovasc Surg 129(2):336–342CrossRefGoogle Scholar
  17. 17.
    Boon R, Hazekamp M, Hoohenkerk G, Rijlaarsdam M, Schoof P, Koolbergen D, Heredia L, Dion R (2007) Artificial chordae for pediatric mitral and tricuspid valve repair. Eur J Cardiothorac Surg 32(1):143–148. Epub 2007 May 2CrossRefGoogle Scholar
  18. 18.
    Alghamdi AA, Yanagawa B, Singh S, Horton A, Al-Radi OO, Caldarone CA (2011) Balancing stenosis and regurgitation during valve surgery in pediatric patients. Ann Thorac Surg 92:680–684CrossRefGoogle Scholar

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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