Posterior annulus elevation using pledget stitch: An adjuvant technique to improve the mitral valve coaptation in pediatric mitral valve repair

Abstract

Link of Video Abstract: https://www.youtube.com/watch?v=8PNO8KPQFTY Purpose: Achieving an optimal result in mitral valve repair can be challenging in children due to the delicate nature of the mitral valve tissue, a wide range of pathologies, and a high incidence of co-existing cardiac anomalies. This study aimed to evaluate a novel adjuvant technique, posterior annulus elevation using pledget stitch, to improve mitral valve coaptation in pediatric mitral valve repair. Patients and methods: A retrospective cohort study was conducted at the National Cardiovascular Center Harapan Kita. Patients with severe mitral regurgitation who underwent mitral valve repair with posterior annulus elevation using pledget stitch between January 2021 and October 2021 were included. Transesophageal echocardiography (TEE) at day-0 and transthoracic echocardiography (TTE) at day-5 and 3 months after surgery was performed to assess coaptation length and residual regurgitation. Results: Twelve patients were included in this study with a mean age of 13.13 ± 2.98 years. The mean coaptation length was 6.94 ± 1.44 mm immediately after surgery. At day 5, 11 patients exhibited no or only trivial regurgitation (91.67%), with a mean coaptation length of 7.18 ± 1.72 mm. During a three-month follow-up period, 10 patients had no or only trivial regurgitation (83.33%) with the rest only developing mild regurgitation (16.67%), with a mean coaptation length of 7.60 ± 1.41 mm. No mortality or adverse events related to the procedure were observed during the follow-up. Conclusion: Posterior annulus elevation using pledget stitch as a novel adjuvant technique during mitral valve repair showed promising results in improving leaflet coaptation in pediatric patients. This technique may provide an additional option for mitral valve repair when the conventional technique yields unsatisfactory results.