title: Contemporary long-term outcomes of an aggressive approach to mitral valve repair in children: is it effective and durable for both congenital and acquired mitral valve lesions?
abstract: OBJECTIVE
  We analysed the long-term outcomes of mitral valve (MV) repair in children and compared the repairs for both congenital and acquired lesions.
  
  
  METHODS
  A review of 634 children (≤18 years) who underwent MV repair from 1992 to 2011 was conducted [excluding patients with complete atrioventricular septal defect (AVSD), single ventricle and atrioventricular (AV) discordance]. Associated cardiac anomalies were present in 473 patients (75%). Congenital mitral lesions were found in 270 (43%) patients compared with an acquired aetiology in 364 (57%) [mainly rheumatic: 329 patients (90%)]. Mitral regurgitation (MR) was predominant in 606 (96%) patients, and 544 (86%) of these showed ≥3+ MR. Modified techniques of MV reconstructions were used.
  
  
  RESULTS
  The early mortality rate was 2% (14 patients). The mean follow-up was 55 months (1-240 months; 85% complete). The late mortality rate was 4% (23 patients) and survival rates at 10 and 15 years were 91 and 86%, respectively. There was no significant difference in 10-year survival between repairing the congenital (98%) and acquired lesions (87%) (P = 0.17). The rate of freedom from reoperation after MV repair for the entire population was 79% at 10 years, with no significant difference between congenital (80%) and acquired lesions (79%) (P = 0.20). Fifty-six patients (9%) required reoperation. Mixed MV lesions, commissural fusions and residual MR (≥2+) were the predictors of valve failure and reoperation. All survivors remain in New York Heart Association class I and none had thromboembolism or pacemaker insertion.
  
  
  CONCLUSIONS
  MV repair can be successfully applied to both congenital and acquired MV disease in children. Aggressive repair techniques and avoidance of residual MR have improved durability and survival.
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Mohd Azhari
authors.initials: MA
authors.lastname: Yakub
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia paneer@ijn.com.my.
authors.forename: Paneer Selvam
authors.initials: PS
authors.lastname: Krishna Moorthy
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Sivalingam
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Jeswant
authors.initials: J
authors.lastname: Dillon
authors.affiliation: Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia.
authors.forename: Pau Kiew
authors.initials: PK
authors.lastname: Kong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acquired lesions; Congenital; Durability; Mitral valve repair; Predictors