Pediatric mitral valve surgery: Current practice from the European Congenital Heart Surgeons Association congenital...

Managing pediatric mitral valve conditions is demanding. This study characterizes the contemporary practice patterns and outcomes in pediatric mitral valve surgery across the European Congenital Heart Surgeons Association Congenital Database.

We conducted a retrospective, multi-institutional analysis using the European Congenital Heart Surgeons Association Congenital Database. The cohort included 6736 patients aged less than 18 years who underwent mitral valve surgery (January 1, 2003, to December 31, 2024). Exclusion criteria were atrioventricular septal defects, functionally univentricular physiology, and nonsystemic mitral valves.

Mitral valve dysplasia was the primary cause (5916/6736 = 87.8%), and regurgitation was the predominant hemodynamic mechanism (4284/5548 = 77.2%). Mitral valve repair was the most common surgical strategy (5513/6736 = 81.8%), and although mitral valve repair predominated across all age groups, the frequency of mitral valve replacement increased with advancing age. Overall, in-hospital mortality rate was 245 of 6736 = 3.6%, with a significant reduction observed in the most recent decade (130/2814 = 4.6% vs 115/3922 = 2.9%; P < .001). In-hospital mortality was significantly elevated among neonates (odds ratio, 14.8; 95% CI, 9.86-22.2; P < .001), patients with mitral valve stenosis (odds ratio, 2.50; 95% CI, 1.77-3.54; P < .001), and those receiving mitral valve replacement (odds ratio, 2.35; 95 CI, 1.78-3.10; P < .001) and intraoperative conversion from mitral valve repair to mitral valve replacement (odds ratio, 3.62; 95% CI, 1.71-7.65; P < .001). Receiver operating characteristic analysis identified critical weight thresholds for mortality at 5.8 kg for the overall cohort (area under the curve, 0.73; 95% CI, 0.70-0.77; P < .001) and 12.6 kg in mitral valve replacement (area under the curve, 0.74; 95% CI, 0.67-0.80; P < .001).

Pediatric mitral valve surgery outcomes have significantly improved over time. However, the procedure remains a high-risk intervention specifically for infants, where low body weight is one of the primary drivers of adverse outcomes.