Infant mitral valve surgery: Comparison between valvuloplasty and replacement

• Published in: Archives of cardiovascular diseases Vol. 117; no. 8-9; p. S221
• Main Authors: Bernheim, S., Pontailler, M., Haydar, A., Bonnet, D., Raisky, O.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01-08-2024
• ISSN: 1875-2136
• DOI: 10.1016/j.acvd.2024.07.005

Mitral valve replacement in infants is associated with high mortality and a significant rate of re-intervention. There is limited research examining the long-term consequences of valvuloplasty in this particular age group.
Evaluate patient outcomes with mitral disease (stenosis, regurgitation or both) who had mitral valvuloplasty or replacement in the first year of life.
Descriptive monocentric retrospective study including all children with mitral valve repair or replacement under 1year of age over a period of 22years (2001–2023). The outcomes assessed were: early mortality (at 30days), late mortality, need for re-intervention.
Fifty-six patients were identified. Median age at surgery was 147days and median weight was 5.1kg. Thirty-nine patients underwent mitral valve repair and 17 mitral valve replacement. Mean duration of ICU stay was 7days. Overall median hospital stay was 11days. Mortality rate was 17.9% (7.1% before discharge). Overall survival was 96% at 30days, 86% at 1year 82% at 3years. Overall survival was significantly higher in patient with mitral valve repair compared to mitral valve replacement (P=0.039). The only mortality risk factor identified was replacement of the mitral valve compare to repair, HR: 9 (1.3–94.8; P=0.038). Twenty-three patients (41.1%) needed re-intervention. The re-intervention free survival rate after repair was 81% at 1year; 65% at 5years and 46% at 10years. The re-intervention free survival rate after replacement was 74% at 1year; 55% at 5 and 10years. A log-rank test showed no difference in re-intervention free survival between mitral valve repair or replacement.
Mitral valve surgery in infants carries particularly high risks and is associated with a high rate of re-interventions. While mitral valvuloplasty demonstrates superior outcomes in term of mortality, it frequently serves as a temporary measure, postponing the need for valve replacement.