# The Fate of Mitral Valve Surgery in the Pediatric Age: A 25-Year Single-Center Experience

## TL;DR

This study examines the long-term outcomes of mitral valve surgery in children and finds that valve repair leads to better results than replacement.

## Contribution

The study provides a 25-year single-center analysis of pediatric mitral valve surgery outcomes, emphasizing repair over replacement.

## Key findings

- Valve repair had a 2.1% operative mortality and 71.2% freedom from reoperation after 4 years of follow-up.
- Mitral valve replacement had 100% reoperation rate, while repair had 40% reoperation rate in surviving patients.
- Operative mortality was higher in the mitral stenosis group (13.3%) compared to the regurgitation group.

## Abstract

Background: The aim of this study was to evaluate the natural history of patients after mitral valve intervention in the pediatric age. Methods: This is a retrospective study including all patients who underwent mitral valve surgery from 1998 to 2022. The patients’ surgical reports, postoperative records, and ambulatory visits were reviewed. The endpoints of the study were survival and freedom from mitral valve reoperation. Results: Of the 70 patients included in the cohort, 61 patients (86.7%) had congenital mitral valve disease, of whom 46 patients (75.4%) had a predominantly mitral regurgitation lesion, and 15 patients (24.6%) had a predominantly mitral stenosis. In the mitral regurgitation group, all of the patients underwent valve repair with an operative mortality of one patient (2.1%), and with median follow-up of 4 years (range, 0.5–13 years), there was 4.3% mortality (n = 2) and 71.2% freedom from reoperation. In the mitral stenosis group, 11 patients underwent mitral valve repair, and 4 patients underwent valve replacement. There was an operative mortality of two patients (13.3%). With a 2-year median follow-up (range: 0.1–23 years), there were no additional mortality cases in the mitral stenosis group. All three patients who survived primary mitral valve replacement (100%) and four patients who survived a primary repair (40.0%) underwent reoperation. Conclusions: This study demonstrates encouraging outcomes for mitral valve repair. The mortality of patients with congenital mitral valve disease may also be related to a difficult postoperative course, rather than the MV lesion itself.