Clinical Effects And Predictors Of Surgical Strategy For Pediatric Mitral Insufficiency

Objective:Surgical treatment of mitral insufficiency in children remains a major clinical challenge.Studies have shown that mitral valve angioplasty for mitral regurgitation in children is superior to mitral valve replacement in maintaining good left ventricular structure,no anticoagulant therapy,and hemodynamics after surgery.This study aims to evaluate the clinical effects of mitral valve repair and related factors that affected their prognosis by analyzing the clinical data of surgical repair of mitral regurgitation in childrenMethods:This study is a retrospective analysis clinical research,collection of Chinese academy of medical sciences,the teda international hospital pediatric cardiac surgery cardiovascular disease from January 1,2013 to December 31,2017,during the preoperative by echocardiogram of mitral regurgitation in related valve malformation merger or other cardiac abnormalities,and treated with surgical repair of baseline data of 84 cases underwent preoperative and intraoperative and postoperative clinical data as well as the midterm follow-up.Surgical repair mainly include mitral leaf keratoplasty,chordae tendineae nipple musculoplasty(including transfer of chordae tendineae,chordae tendineae repair technology such as shorten,artificial chordal replacement),mitral valve ring keratoplasty(shrinkage ring and folding shrinkage ring)and edge to edge technology.Comprehensive analysis of patients with perioperative clinical baseline characteristics and the surgical operation parameter.Results:This study included 84 patients(average age was 51.5 months,median age was 24.0 months,ranging from 5.0 to 180.0 months).The average follow-up time was 35.8 months,and the median follow-up time was 40.0 months,ranging from 21.2 to 47.1 months.In surgical repair,the mitral valve ring keratoplasty accounted for 66(78.6%),artificial chordal replacement accounted for 47(56.6%),artificial chordal shorten accounts for 1(1.2%),1 artificial chordal transfer accounts for 1(1.2%),mitral valve valvuloplasty accounts for 22(26.5%),edge to edge technology accounts for 4(4.8%).In this study,there were no deaths or mitral related secondary operations(mitral repair again and mitral valve replacement).Cox regression analysis showes that the age of children,preoperative MR grading are children with mitral valve surgery repair of independent risk factors of postoperative recurrence of mitral valve again.Conclusion:This study based on artificial chordal replacement,mitral valve ring keratoplasty and edge to edge technique such as individualized surgical valve repair strategies for the treatment of children with mitral insufficiency,obtained satisfactory results and follow-up survival rate.It is a simple,reliable and effective method to use the artificial key cable insertion and adjustable annular ring compression as the main repair strategy.It is easy to carry out in clinical practice owing to its convenient operation and good near-middle-term effect.However,the long-term effects of this treatment strategy are still to be assessed by large-scale clinical studies.Based on the current regression analysis of the follow-up results of the children,the older the child is at the time of surgery,the higher the risk of recurrence of mitral regurgitation.The higher the grade of preoperative mitral regurgitation,the higher the risk of recurrence of postoperative mitral regurgitation.