Isolated Congenital Mitral Regurgitation Repair in Children: Long-term Outcomes of Artificial Rings

Abstract

Because isolated congenital mitral regurgitation (ICMR) is rare, the role of artificial rings in annuloplasty for ICMR is still debated. In this study we compared long-term results of annuloplasty with and without rings for ICMR. We performed a retrospective review of all patients ≤ 18 years old undergoing repair for ICMR from 1993 to 2019 at our hospital. Techniques of annuloplasty depended on individual lesions of the mitral valve (MV). One hundred twelve cases were divided into 3 groups: group A (43 cases) with ≥26-mm ring, group B (35 cases) with <26-mm ring, and group C (34 cases) with a band. Study endpoints were overall survival and MV reoperation. Patients in group A were older than the others (median age 11 compared with 5 and 4 years, respectively). The MV lesions were complicated, but annular dilatation existed in 91% of cases. Three patients died, and there were 25 reoperations during a median follow-up period of 11 years. Groups B and C had higher rates of reoperation than group A (hazard ratios, 5.35 [95% confidence interval, 1.71-17.75] and 3.61 [95% confidence interval, 1.03-12.60], respectively). Most reoperations in group B (13/14 cases) were due to stenosis, whereas 6 of 7 reoperations in group C were due to recurrent regurgitation. MV reconstruction for ICMR in children had good long-term survival. Annuloplasty with ≥26-mm ring had the lowest risk of reoperation. In cases of young children bands are more favored than <26-mm rings, but they carry a risk of recurrent regurgitation.