Long-term results of mitral valve repair for severe mitral regurgitation in infants: fate of artificial chordae

Abstract

Background: The experience with mitral valve repair for severe mitral regurgitation in infants was retrospectively reviewed.

Methods: From 1978 to 2009, 15 infant patients (4 boys, 7.2±3.2 months old) underwent mitral valve repair for severe mitral regurgitation. The etiology of mitral regurgitation according to Carpentier classification was type I in 1 patient, type II in 10 patients, and type III in 4 patients. Artificial chordal replacement was performed in 11 patients. The follow-up course was completed in all patients, with a median follow-up period of 10.2 years (range, 2.2 to 33.4 years).

Results: There were no operative or in-hospital mortalities. The actuarial survival and freedom from reoperation rates at 10 years were 89% and 65%, respectively. Five patients required redo mitral valve surgery, including 4 patients needing mitral valve replacement. Three of 4 patients with type III mitral regurgitation, caused by congenital subvalvar structural abnormality, required redo mitral valve surgery. In 11 patients who underwent artificial chordal reconstruction, 2 (18%) required mitral valve replacement during the early postoperative period, whereas the remaining patients showed no recurrent mitral regurgitation during the entire study period. The latest echocardiography findings at 7.3 years after the operation showed that the left ventricular diastolic diameter, mitral valve diameter, and ejection fraction were 99.2%±5.0% of normal, 101.7%±13.3% of normal, and 0.741±0.058, respectively.

Conclusions: Long-term durability of mitral valve repair for severe mitral regurgitation in infants was satisfactory. Artificial chordal reconstruction is an effective procedure without an elevated risk of late reoperation.