Leaflet suspension to the contralateral annulus to address restriction or tethering-induced mitral and tricuspid regurgitation in children: results of a case-control study

Abstract

Acceptable coaptation cannot always be obtained using standard repair techniques. We assessed the safety and mid-term results using a novel technique to address leaflet retraction or tethering in children with type III mitral or tricuspid regurgitation as an addition to standard valve repair techniques. Forty children were included, 36 for the mitral valve and 4 for the tricuspid valve, with a mean age of 11.3± 3.9 years. A polypropylene suture was placed on the free edge of the retracted or tethered leaflet segment and anchored to the atrial side of the opposite annulus. This avoided valve replacement in all patients. An additional 40 children were matched for age, etiology, leaflet retraction or tethering, and surgery in which the suspension stitch was not used and constituted the control group. The mean aortic crossclamp and cardiopulmonary bypass time was 36± 9 and 57± 9 minutes, respectively. No early or late deaths occurred. At discharge, no patient had more than mild regurgitation with a gradient of 4.4± 2.4 mm Hg in the mitral position and 2± 1.75 mm Hg in the tricuspid position. The results were not significantly different than those of the control group. During a follow-up of 37.7± 18.4 months, 3 patients required reoperation for mitral valve replacement in the suspension stitch group and 2 within the control group. At echocardiography of the remaining patients, the repair remained stable, with no suspension suture breakage. This suspension technique improved coaptation and resulted in avoidance or delay of valve replacement in patients with type III regurgitation, with an acceptable transvalvular gradient in most patients that did not significantly increase with growth.