Background: Mitral valve (MV) repair in children is challenging due to the complex morphology.
The purpose of the study was to show if MV repair is effective in the long term.
Methods: We reviewed all MV repairs in patients up to the age of 10 years operated between
1975 and 2017. End points of the study were survival after MV repair and freedom from
MV replacement. Morphologic and operative risk factors were evaluated for the end
points.
Results: In 50 consecutive patients, a total of 61 MV repairs were performed. Median age at
the time of MV repair was 1.5 years (14 days–4.9 years). A congenital malformation
of the MV was present in 40 patients (80%), and 20 patients had acquired MV disease.
Additional cardiac malformations were present in 38 patients (76%). Indication for
MV repair was either mitral regurgitation (MR) in 84% (n = 51), group MR, or mitral stenosis (MS) in 16% (n = 10), group MS. A redo MV repair was necessary in 11 patients (22%) at a median
time of 1.4 months (interquartile range [IQR], 0.24–20.7) after initial repair. Survival
after MV repair was 87 ± 6 and 77 ± 8% at 5 and 15 years, respectively. Patients with
MR showed a better survival than patients with MS at 15 years after MV repair (p = 0.01). MV replacement was necessary in 18% (n = 11/61) after initial repair at a median time of 0.57 years (IQR, 0.05–6.92). Freedom
from MV replacement was 82 ± 5 and 69 ± 8 at 5 and 15 years, respectively. There was
no significant difference in freedom from MV replacement at 15 years between patients
with MR and patients with MS (p = 0.09). Short chordae and operative leaflet/cleft suture were identified as independent
risk factors for MV replacement (p = 0.03).
Conclusion: MV repair in children proves to be an effective therapy with a good long-term survival
and durability of the repaired valve. Patients with MS have a worse outcome than patients
with MR. Patients with short chordae and the necessity of a leaflet/cleft suture have
a higher risk of MV replacement in the long term.
