Durability of Mitral Valve Repair Performed Before the Age of 5 Years.

BACKGROUND: Intricate repairs performed for adult mitral valve disease may not be feasible in young children because of their small annulus, future growth and also fragile tissue.

METHODS AND RESULTS: Mitral valve repair was performed in 51 patients (1980-2011) aged younger than 5 years. The median follow-up was 3.0 (maximum, 24.2) years. Commissural annuloplasty technique was performed solely in 19 of 37 patients with coexisting cardiac disease. In 2 patients, Alfieri's edge-to-edge technique was used. Repairs for the remaining 30 patients used one of the following procedures: commissural closure (8), closure of the accessory cleft or hole (7), sliding leaflet technique (6), artificial chordal placement (6) and chordal shortening technique (3). There were 3 deaths. The postoperative degree of mitral regurgitation was mild or less in 41 patients (80.4%); 9 patients required reoperation for mitral regurgitation or stenosis. Freedom from reoperation for patients with isolated mitral regurgitation and those with other congenital heart disease at 10 years was 91.7±68.0% and 68.4±9.4%, respectively. Actuarial survival was 97.0±3.0% and 85.1±9.7%, respectively.

CONCLUSIONS: Excellent survival rates were achieved after mitral valve repair in patients younger than 5 years. The incidence of both reoperation and significant regurgitation was acceptable.