Long-term outcomes of infant mitral valve surgery

This study aims to evaluate patient outcomes related to mitral valve disease (stenosis, regurgitation, or mixed) who benefited from mitral repair or replacement under one year of age.

Monocentric retrospective study including all children with mitral valve repair or replacement under 1 year of age over a period of 22 years (2001-2023).

early mortality (at 30 days), late mortality, and need for re-intervention.

A total of 56 patients were identified, with a median age of 147 days and median weight of 5.1 kg. Of these, 39 underwent mitral valve repair and 17 underwent replacement. The median follow-up duration was 2.9 years (interquartile range 0.3-8.1). Patients who underwent replacement had longer ICU stays, hospital stays, and assisted ventilation times (p = 0.005, p = 0.01, p = 0.019), with higher early mortality (12% vs. 0%). Survival was significantly higher in the repair group (p = 0.039). Re-intervention was required in 23 patients (41.1%): 16 had replacement, 6 had re-repair, and 2 needed pacemaker implantation. Seven patients (12.5%) needed more than one re-intervention. Re-intervention-free survival rates after repair were 81%, 65%, and 46% at 1, 5, and 10 years, respectively. After replacement, rates were 74% at 1 year and 55% at 5 and 10 years. Conclusion Mitral valve surgery in infants is particularly high risk and is associated with high rate of re-intervention. While mitral repair demonstrates superior outcomes in mortality, it often delays but does not always prevent the need for valve replacement.