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Erschienen in: Pediatric Cardiology 8/2019

03.09.2019 | Original Article

Outcome for Conservative Surgery for the Correction of Severe Mitral Valve Regurgitation in Children: A Single-Center Experience

verfasst von: Gianluca Brancaccio, Marcello Chinali, Matteo Trezzi, Carolina D’Anna, Claudia Esposito, Gabriele Rinelli, Walter Vignaroli, Sonia B. Albanese, Fiore S. Iorio, Adriano Carotti

Erschienen in: Pediatric Cardiology | Ausgabe 8/2019

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Abstract

Evolving reconstructive techniques have progressively become the preferred approach for treatment of pediatric mitral valve regurgitation. We present our experience in a cohort of patients undergoing surgical correction for severe mitral regurgitation. Fifty-five patients (age 1 month–18 years; median 5 years) were included in the present analysis. Different surgical techniques were used (posterior leaflet augmentation in 25, isolated cleft closure in 12, Alfieri-type procedure in 10, annuloplasty in 5, with artificial chordae in 2, and quadrangular resection with chordal transposition in 1). Follow-up time ranged from 1 to 192 months (median 38[IQR 12–54] months). Operative and follow-up mortality was 0%. Reintervention in the whole population occurred in 31% of patients. However, when first surgery was performed under 2 years of age (no = 17), reintervention reached nearly 50%. The degree of residual mitral regurgitation at follow-up remained stable after surgery, while a significant increase in mean transmitral gradient was observed over time (paired t test = 0.03). In multivariable Cox-regression analysis, post-surgical transmitral gradient was the only independent predictor for reintervention (p = 0.017; HR 2.4; 95%CI 1.2–5.1), after correcting for differences in age at surgery, type of reintervention, mitral annulus dimension, and BSA at the first surgery. ROC curve demonstrated that a post-surgical transmitral mean gradient value > 5 mmHg, was predictive for reintervention (AUC = 0.89; Youden index = 0.44). Our study suggests that the use of conservative technique strategy achieves satisfactory functional results in infants and children with severe MR, although the rate of reoperation in younger patients remains substantial. Post-operative moderate mitral stenosis was the strongest predictor for reoperation.
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Metadaten
Titel
Outcome for Conservative Surgery for the Correction of Severe Mitral Valve Regurgitation in Children: A Single-Center Experience
verfasst von
Gianluca Brancaccio
Marcello Chinali
Matteo Trezzi
Carolina D’Anna
Claudia Esposito
Gabriele Rinelli
Walter Vignaroli
Sonia B. Albanese
Fiore S. Iorio
Adriano Carotti
Publikationsdatum
03.09.2019
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 8/2019
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-019-02201-4

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