Mitral Valve Surgery in Neonates, Infants and Children: Surgical Approach, Outcomes, & Predictors.

The surgical treatment of mitral disease in pediatrics is challenging. Managing diversity in patient anatomy, growth, and the need for long term anticoagulation require tradeoffs between imperfect solutions. We sought to assess our approach to pediatric mitral valve surgery and identify predictors associated with mortality and recurrent mitral disease. The medical records, echocardiograms, and operative reports of all patients who underwent surgical intervention on the mitral valve from January 2000 through April 2016 were reviewed. 143 total patients underwent mitral valve surgery, 64 of which were neonates or infants (ages 10-355 days) and 79 of which were children (ages 1-17.8 years). Neonates and infants had a higher preoperative NYHA heart failure classification in comparison to children (p < 0.001) with a less severe degree of mitral valve insufficiency (p=0.007). Post-operative outcomes for primary repair patients (n=133) demonstrated significant differences in recurrence of mitral valve disease, with 38% of neonates/infants and 21% of children affected (p=0.028). Five-year rates of mortality or transplant were 22% [8%, 33%] in neonates and infants compared to 4% [0%, 10%] in children, p = 0.013. Mitral valve surgery in neonates and infants is particularly high risk and is associated with higher rate of recurrence and reintervention early. However, if successful early, mitral valve repair in neonates and infants can result in a durable freedom from reintervention that parallels freedom from reintervention in older children undergoing repair. Further understanding of mechanisms of failure and better matching of anatomic substrate to strategy is needed.