Mitral valve repair with leaflet augmentation for recurrent mitral regurgitation in children: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MAO Fengqun , MA Kai , PANG Kunjing , LIN Ye , ZHANG Benqing , RUI Lu , WANG Guanxi , YANG Yang , YUAN Jianhui , HE Qiyu , DOU Zheng ,  LI Shoujun

Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;

Corresponding author：

LI Shoujun, Email: drlishoujunfw@163.com

Keywords：

Mitral regurgitation; mitral valvuloplasty; reoperation; leaflet augmentation

DOI：

10.7507/1007-4848.202304079

Video：

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Objective To summarize the reoperation experience for mitral regurgitation with leaflet augmentation in children. Methods From 2018 to 2022, the patients who underwent reoperation for mitral regurgitation with leaflet augmentation after atrioventricular septal defect repair or mitral valve repair in Fuwai Hospital were retrospectively collected. The characteristics of mitral valve disease, key points of surgery and short and mid-term follow-up results were analyzed. Results Finally 24 patients were enrolled, including 6 males and 12 females with an average age of 49.1±29.1 months. The time interval from the primary valve surgery to the reoperation was 24.9±17.0 months. The cardiopulmonary bypass time was 150.1±49.5 min and the aortic clamp time was 94.0±24.2 min. There was no early death. The average follow-up period was 20.3±9.1 months. During the follow-up period, the mortality rate was 4.2%, the rate of reoperation was 4.3%, and the rate of moderate or severe mitral regurgitation was 13.0%. The left ventricular ejection fraction was 62.6%±6.7%. In addition, the mean left ventricular end-diastolic dimension was 35.8±7.8 mm, which was significant smaller than that before the operation (t=4.858, P<0.000 1). Conclusion The application of leaflet augmentation is a safe and effective treatment option with good results in the short and mid-term, which thus provides a good technical option for pediatric patients with recurrent mitral regurgitation.

1.	Fong LS, Betts K, Bell D, et al. Complete atrioventricular septal defect repair in Australia: Results over 25 years. J Thorac Cardiovasc Surg, 2020, 159(3): 1014-1025.
2.	Ho DY, Katcoff H, Griffis HM, et al. Left valvar morphology is associated with late regurgitation in atrioventricular canal defect. Ann Thorac Surg, 2020, 110(3): 969-978.
3.	Mayr B, Vitanova K, Burri M, et al. Mitral valve repair in children below age 10 years: Trouble or success? Ann Thorac Surg, 2020, 110(6): 2082-2087.
4.	Ibezim C, Sarvestani AL, Knight JH, et al. Outcomes of mechanical mitral valve replacement in children. Ann Thorac Surg, 2019, 107(1): 143-150.
5.	Qi L, Ma K, Zhang B, et al. Pediatric mitral regurgitation: Standardized repair-oriented strategy with leaflet plication. Semin Thorac Cardiovasc Surg, 2020, 32(4): 1002-1012.
6.	Deja MA, Malinowski M, Widenka K, et al. Repair or replacement for secondary mitral regurgitation: results from Polish national registry. Ann Thorac Surg, 2022, 113(1): 146-156.
7.	Sughimoto K, d'Udekem Y, Konstantinov IE, et al. Mid-term outcome with pericardial patch augmentation for redo left atrioventricular valve repair in atrioventricular septal defect. Eur J Cardiothorac Surg, 2016, 49(1): 157-166.
8.	王官玺, 马凯, 祁磊, 等. 标准化二尖瓣修复策略在完全房室间隔缺损术后左侧房室瓣反流治疗中的应用. 中国胸心血管外科临床杂志, 2021, 28(8): 959-962.
9.	Kanani M, Elliott M, Cook A, et al. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: The morphologic perspective. J Thorac Cardiovasc Surg, 2006, 132(3): 640-646.
10.	祁磊, 马凯, 张本青, 等. 瓣叶折叠在小儿二尖瓣成形中的应用. 中国胸心血管外科临床杂志, 2021, 28(4): 421-426.
11.	Kalfa D, Vergnat M, Ly M, et al. A standardized repair-oriented strategy for mitral insufficiency in infants and children: Midterm functional outcomes and predictors of adverse events. J Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.
12.	Ikeda N, Yamaguchi H, Takagaki M, et al. Extended posterior leaflet augmentation for ischemic mitral regurgitation - augmented posterior leaflet snuggling up to anterior Leaflet. Circ J, 2019, 83(3): 567-575.
13.	Deorsola L, Bellone A. The Golden Proportion in the scallop geometry of normal mitral valves. When nature plays with jigsaw puzzles. Echocardiography, 2019, 36(6): 1028-1034.
14.	Vida VL, Zanotto L, Carrozzini M, et al. Repair techniques for mitral valve insufficiency in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2018, 21: 41-45.
15.	Carpentier A, Branchini B, Cour JC, et al. Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J Thorac Cardiovasc Surg, 1976, 72: 854-66.
16.	Liu LX, Zhang JF, Xu WX, et al. Mitral valve repair using an autologous pericardial strip in infants and young children. J Card Surg, 2017, 32(1): 45-48.
17.	Yakub MA, Sivalingam S, Dillon J, et al. Mitral valve repair for congenital mitral valve disease: Impact of the use of a biodegradable annuloplasty ring. Ann Thorac Surg, 2015, 99(3): 884-890.

1. Fong LS, Betts K, Bell D, et al. Complete atrioventricular septal defect repair in Australia: Results over 25 years. J Thorac Cardiovasc Surg, 2020, 159(3): 1014-1025.
2. Ho DY, Katcoff H, Griffis HM, et al. Left valvar morphology is associated with late regurgitation in atrioventricular canal defect. Ann Thorac Surg, 2020, 110(3): 969-978.
3. Mayr B, Vitanova K, Burri M, et al. Mitral valve repair in children below age 10 years: Trouble or success? Ann Thorac Surg, 2020, 110(6): 2082-2087.
4. Ibezim C, Sarvestani AL, Knight JH, et al. Outcomes of mechanical mitral valve replacement in children. Ann Thorac Surg, 2019, 107(1): 143-150.
5. Qi L, Ma K, Zhang B, et al. Pediatric mitral regurgitation: Standardized repair-oriented strategy with leaflet plication. Semin Thorac Cardiovasc Surg, 2020, 32(4): 1002-1012.
6. Deja MA, Malinowski M, Widenka K, et al. Repair or replacement for secondary mitral regurgitation: results from Polish national registry. Ann Thorac Surg, 2022, 113(1): 146-156.
7. Sughimoto K, d'Udekem Y, Konstantinov IE, et al. Mid-term outcome with pericardial patch augmentation for redo left atrioventricular valve repair in atrioventricular septal defect. Eur J Cardiothorac Surg, 2016, 49(1): 157-166.
8. 王官玺, 马凯, 祁磊, 等. 标准化二尖瓣修复策略在完全房室间隔缺损术后左侧房室瓣反流治疗中的应用. 中国胸心血管外科临床杂志, 2021, 28(8): 959-962.
9. Kanani M, Elliott M, Cook A, et al. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: The morphologic perspective. J Thorac Cardiovasc Surg, 2006, 132(3): 640-646.
10. 祁磊, 马凯, 张本青, 等. 瓣叶折叠在小儿二尖瓣成形中的应用. 中国胸心血管外科临床杂志, 2021, 28(4): 421-426.
11. Kalfa D, Vergnat M, Ly M, et al. A standardized repair-oriented strategy for mitral insufficiency in infants and children: Midterm functional outcomes and predictors of adverse events. J Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.
12. Ikeda N, Yamaguchi H, Takagaki M, et al. Extended posterior leaflet augmentation for ischemic mitral regurgitation - augmented posterior leaflet snuggling up to anterior Leaflet. Circ J, 2019, 83(3): 567-575.
13. Deorsola L, Bellone A. The Golden Proportion in the scallop geometry of normal mitral valves. When nature plays with jigsaw puzzles. Echocardiography, 2019, 36(6): 1028-1034.
14. Vida VL, Zanotto L, Carrozzini M, et al. Repair techniques for mitral valve insufficiency in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2018, 21: 41-45.
15. Carpentier A, Branchini B, Cour JC, et al. Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J Thorac Cardiovasc Surg, 1976, 72: 854-66.
16. Liu LX, Zhang JF, Xu WX, et al. Mitral valve repair using an autologous pericardial strip in infants and young children. J Card Surg, 2017, 32(1): 45-48.
17. Yakub MA, Sivalingam S, Dillon J, et al. Mitral valve repair for congenital mitral valve disease: Impact of the use of a biodegradable annuloplasty ring. Ann Thorac Surg, 2015, 99(3): 884-890.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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