Mitral Valve Repair in Infants with Ventricular Septal Defect Combined with Mitral Regurgitation

Objectives: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the midterm follow-up period, to evaluate the clinical utility of intervention on the mitral valve in this cohort of patients.

Methods: A total of 60 patients with VSD and MR underwent surgical treatment between June 2005 and March 2014. After performing propensity score matching analysis, 46 patients were selected and divided in two groups: those with VSD closure and MVR (VSD + MVR, 23 patients) and those with VSD closure without mitral valve intervention (VSD only, 23 patients). The follow-up period ranged from 12 to 48 months (median, 32 months; interquartile range (IQR), 28–40 months).

Results: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups (ventilation time, p = 0.49; inotropic support, p = 0.50). Mean cardiopulmonary bypass (CPB) time and aortic cross-clamping time were significantly longer in the “VSD + MVR” group (CPB, p = 0.023; aortic cross-clamp, p < 0.001). There was no significant difference in regurgitation area (p = 0.30) and MR grade (p = 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, p = 0.28). In the “VSD + MVR” group, 12-, 36-, and 42-month freedom from MR ≥ 2+ values were 100%, 59 ± 10.4% (95% confidence interval (CI) 36.1–76.2%), and 44 ± 15% (95%CI 15.8–69.7%) respectively, while in the “VSD only” group these values were 100%, 54.5 ± 10.6% (95%CI 32–72.3%), and 54.5 ± 10.6% (95%CI 30–72.3%), respectively. The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period.

Conclusion: In infants with VSD combined with MR there are no benefits for simultaneous MVR prior to VSD closure only. The presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.