192 * CONTEMPORARY LONG-TERM OUTCOMES OF AN AGGRESSIVE APPROACH TO MITRAL VALVE REPAIR IN CHILDREN: IS IT EFFECTIVE AND DURABLE FOR BOTH CONGENITAL AND ACQUIRED MITRAL VALVE LESIONS?

Abstract

Objectives: We analysed the long-term outcomes of mitral valve (MV) repair in children and compared the repairs for both congenital and acquired lesions. Methods: A review of 634 children (≤18 years) who underwent MV repair between 1992 and 2011 (excluding patients with complete atrioventricular septal defects, single ventricle and atrioventricular discordance). Mean age was 9.6 years (6 weeks to 18 years). Associated cardiac anomalies present in 473 patients (74.6%). Congenital mitral lesions were found in 270 (42.6%) patients compared to the acquired aetiology in 364 (57.4%) patients (mainly rheumatic; 329 patients, 90.4%). Mitral regurgitation (MR) was predominant in 606 (95.6%) patients and 544 (85.8%) of these showed ≥3+ MR. Modified techniques of MV reconstructions were used. Results: Early mortality was 2.2% (14 patients). Mean follow-up was 55.1 months (1–239.6 months; 84.7% complete). Late mortality was 3.6% (23 patients) and survival at 10 and 15 years was 91.2% and 85.8%, respectively. There was no significant difference in 10-year survival between repair of the congenital (97.9%) and acquired lesions (87.2%) (P = 0.177). Freedom from re-operation after MV repair for the entire population was 79.4% at 10 years [no significant difference (P = 0.171) between the congenital (80.3%) and acquired lesions (78.5%)]. Fifty-six patients (8.8%) had reoperation. Mixed MV lesions, commissural fusions and residual MR (≥2+) were the predictors of valve failure and reoperation. All survivors remain in NYHA class 1 and none had thromboembolism or pacemaker insertion. Conclusion: MV repair can be successfully applied to both congenital and acquired MV disease in children. Modifications of standard repair techniques and avoidance of residual MR have improved survival and durability.