Midterm Outcomes of Pediatric Mitral Valvuloplasty for Moderate to Severe Mitral Valve Regurgitation and Associated Risk Factors for Postoperative Deterioration.

Abstract

Background: Mitral valvuloplasty is considered the best treatment for pediatric mitral valve regurgitation. The objective of this analysis was to identify risk factors for postoperative mitral valve regurgitation progression and evaluate valvuloplasty effectiveness.

Methods: This retrospective, single-center study investigated the clinical efficacy of mitral valvuloplasty and identified factors that affect prognosis. Pediatric patients with moderate or severe mitral valve regurgitation who had undergone mitral valvuloplasty between September 2016 and August 2023 were included. Kaplan-Meier survival analysis was used to assess freedom from both mitral valve deterioration and cardiovascular death. Univariate and multivariate Cox regression analyses were performed to identify potential risk factors.

Results: The study comprised 137 pediatric patients (mean age, 37.5 months [range, 2.4-167.6 months]) who had moderate (64/137 [46.7%]) or severe (73.137 [53.3%]) mitral valve regurgitation. At midterm follow-up (median, 55.3 months), mitral valve regurgitation had statistically significantly decreased compared with preoperative levels (P < .001, Wilcoxon signed-rank test); freedom from cardiovascular death was 97.5%, and freedom from worsening mitral valve regurgitation was 89.4%. Cox regression analysis identified body weight (P = .02), left ventricular end-diastolic diameter (P = .005), and left ventricular ejection fraction (P = .01) at 1 month and cardiopulmonary bypass time (P = .007) as independent risk factors for deterioration. Patients weighing 10 kg or more (P = .04) or with a ventricular septal defect 8 mm or larger (P = .04) had worse outcomes.

Conclusion: Mitral valvuloplasty resulted in low mortality and positive long-term results in pediatric patients with mitral valve regurgitation. Early aggressive therapy is recommended to avoid late postoperative mitral valve deterioration.