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Pediatric Mitral Regurgitation: Standardized Repair-Oriented Strategy With Leaflet Plication
Lei Qi1, Kai Ma1, Benqing Zhang1
1Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
Seminars in Thoracic and Cardiovascular Surgery
|June 8, 2020
Summary
This study presents a standardized mitral repair strategy using leaflet plication for pediatric mitral regurgitation. The technique shows favorable short- to mid-term outcomes, though ischemic mitral regurgitation poses challenges.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Surgical Techniques
Background:
- Mitral regurgitation (MR) in pediatric patients requires effective surgical solutions.
- Standardized and reproducible mitral repair techniques are crucial for optimal outcomes in children.
Purpose of the Study:
- To introduce a standardized strategy and reproducible procedures for pediatric mitral repair.
- To evaluate the efficacy of leaflet plication as a principal technique for mitral regurgitation in children.
Main Methods:
- Retrospective review of 113 pediatric patients undergoing mitral repair from January 2016 to December 2019.
- Standardized 3-step repair strategy (subvalvular, leaflet, annular levels) with leaflet plication for chordae distances >4 mm.
- Key techniques included chordae detachment, papillary muscle splitting, leaflet plication, and posterior annuloplasty.
Main Results:
- 113 patients were enrolled with a median follow-up of 22.6 months.
- 13.3% experienced primary endpoints (1 death, 14 functional mitral failure).
- Leaflet plication was linked to better valve function; younger age and ischemic MR were predictors of failure. Ischemic MR had higher event rates.
Conclusions:
- The standardized mitral repair technique with leaflet plication demonstrates favorable short- to mid-term outcomes in pediatric patients.
- Leaflet plication is associated with improved mitral valve function.
- Repair of ischemic mitral regurgitation in children remains a significant challenge.
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