title: A standardized repair-oriented strategy for mitral insufficiency in infants and children: midterm functional outcomes and predictors of adverse events.
abstract: OBJECTIVE
  Surgical management of mitral regurgitation (MR) in children remains a challenge because of the heterogeneity of the anatomy, growth potential, and necessity to avoid valve replacement. Our objective was to assess the functional outcomes and prognostic factors of a standardized strategy of mitral valve (MV) repair for children with MR.
  
  
  METHODS
  Consecutive patients aged <18 years who had undergone surgery for severe MR from 2001 to 2012 were studied retrospectively. The standardized repair strategy mainly included leaflet debridement, annuloplasty, and leaflet augmentation. Multivariable risk analyses for recurrent MR (grade>II), transmitral mean echocardiographic gradient>5 mm Hg, MV reoperation, replacement, and mortality were performed.
  
  
  RESULTS
  A total of 106 patients were included (median age, 5.1 years; range, 11 days to 18 years). The mean follow-up period was 3.9±3.2 years (range, 2 months to 11 years). The proportion of congenital and left heart obstruction-related (left ventricular outflow tract obstruction) etiology was 49% (n=52) and 11% (n=12), respectively. MV repair was performed primarily in 97% of the patients. The mortality, reoperation, replacement, and MR rate at the last follow-up visit was 4.5% (n=5), 23% (n=24), 5.5% (n=6), and 17% (n=18), respectively. Actuarial survival was 93%±2% at 10 years. Freedom from MV replacement was 95%±2% and 86%±7% at 5 and 15 years, respectively. Native valve preservation was obtained in 85% of the infants and 94% beyond infancy. Independent predictors of recurrent MR, MV reoperation, and replacement included left ventricular outflow tract obstruction etiology (hazard ratio, 45; P=.004), associated preoperative mitral stenosis (hazard ratio, 21; P=.03), and young age (hazard ratio, 1.2; P=.04).
  
  
  CONCLUSIONS
  A standardized and reproducible MV repair strategy can achieve satisfactory functional results in infants and children with severe MR, allowing native valve preservation. The left ventricular outflow tract obstruction-related etiology was the main independent predictor of recurrent MR, MV reoperation, and MV replacement.
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, University Paris Sud, Centre de Référence Nationale des Malformations Cardiaques Congénitales Complexes, "M3C," Le Plessis-Robinson, France.
authors.forename: David
authors.initials: D
authors.lastname: Kalfa
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, University Paris Sud, Centre de Référence Nationale des Malformations Cardiaques Congénitales Complexes, "M3C," Le Plessis-Robinson, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, University Paris Sud, Centre de Référence Nationale des Malformations Cardiaques Congénitales Complexes, "M3C," Le Plessis-Robinson, France.
authors.forename: Mohamedou
authors.initials: M
authors.lastname: Ly
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, University Paris Sud, Centre de Référence Nationale des Malformations Cardiaques Congénitales Complexes, "M3C," Le Plessis-Robinson, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Stos
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, University Paris Sud, Centre de Référence Nationale des Malformations Cardiaques Congénitales Complexes, "M3C," Le Plessis-Robinson, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, University Paris Sud, Centre de Référence Nationale des Malformations Cardiaques Congénitales Complexes, "M3C," Le Plessis-Robinson, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Baruteau
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, University Paris Sud, Centre de Référence Nationale des Malformations Cardiaques Congénitales Complexes, "M3C," Le Plessis-Robinson, France. Electronic address: e.belli@ccml.fr.
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008944:Mitral Valve Insufficiency / Q000151:congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome