Outcomes After Rheumatic Mitral Valve Repair in Children

Daniel McGurty, Boglarka Remenyi, Michael Cheung, Daniel Engelman, Diana Zannino, Catherine Milne, Marea Fittock, Andrew Steer, Christian Brizard

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: It has been shown that mitral valve repair is superior to mechanical replacement in children with rheumatic heart disease; however there are limited data on the factors affecting the long-term durability of repaired mitral valves. This study describes outcomes after rheumatic mitral valve repair, with adaptation of a risk score to clarify some novel predictors of repair instability. 

    Methods: A total of 79 children (median age, 11.4 years) with rheumatic heart disease underwent their first mitral valve surgery between 1997 and 2015. Patients with concomitant aortic and tricuspid repair were included. Mean follow-up time was 7.72 years. Mitral valve deterioration (defined as cardiac death, reoperation, or recurrent moderate to severe valvular disease) was used as a key end point. Preoperative echocardiographs were analyzed and graded with respect to valvular mobility, subvalvular apparatus alteration, and function. 

    Results: All patients underwent successful mitral valve repair. Seven patients died during follow-up. Kaplan-Meier analysis demonstrated survival at 15 years to be 83%. A total of 38 patients were deemed to have deterioration in mitral valve function, with a rate of freedom from deterioration at 15 years of 28%. The presence of an immobile anterior mitral leaflet preoperatively and the technique of posterior patch extension were shown to be significant determinants of mitral valve deterioration. 

    Conclusions: The outcomes after mitral repair for rheumatic heart disease in the young were in keeping with those reported in previous studies. Although the survival was high, long-term valve stability was poor. These findings suggest that the preoperative finding of a restricted anterior mitral leaflet is a negative predictor of repair durability.

    Original languageEnglish
    Pages (from-to)792-797
    Number of pages6
    JournalAnnals of Thoracic Surgery
    Volume108
    Issue number3
    DOIs
    Publication statusPublished - Sep 2019

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    Mitral Valve
    Rheumatic Heart Disease
    Survival
    Kaplan-Meier Estimate
    Reoperation
    Outcome Assessment (Health Care)

    Cite this

    McGurty, D., Remenyi, B., Cheung, M., Engelman, D., Zannino, D., Milne, C., ... Brizard, C. (2019). Outcomes After Rheumatic Mitral Valve Repair in Children. Annals of Thoracic Surgery, 108(3), 792-797. https://doi.org/10.1016/j.athoracsur.2019.03.085
    McGurty, Daniel ; Remenyi, Boglarka ; Cheung, Michael ; Engelman, Daniel ; Zannino, Diana ; Milne, Catherine ; Fittock, Marea ; Steer, Andrew ; Brizard, Christian. / Outcomes After Rheumatic Mitral Valve Repair in Children. In: Annals of Thoracic Surgery. 2019 ; Vol. 108, No. 3. pp. 792-797.
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    title = "Outcomes After Rheumatic Mitral Valve Repair in Children",
    abstract = "Background: It has been shown that mitral valve repair is superior to mechanical replacement in children with rheumatic heart disease; however there are limited data on the factors affecting the long-term durability of repaired mitral valves. This study describes outcomes after rheumatic mitral valve repair, with adaptation of a risk score to clarify some novel predictors of repair instability. Methods: A total of 79 children (median age, 11.4 years) with rheumatic heart disease underwent their first mitral valve surgery between 1997 and 2015. Patients with concomitant aortic and tricuspid repair were included. Mean follow-up time was 7.72 years. Mitral valve deterioration (defined as cardiac death, reoperation, or recurrent moderate to severe valvular disease) was used as a key end point. Preoperative echocardiographs were analyzed and graded with respect to valvular mobility, subvalvular apparatus alteration, and function. Results: All patients underwent successful mitral valve repair. Seven patients died during follow-up. Kaplan-Meier analysis demonstrated survival at 15 years to be 83{\%}. A total of 38 patients were deemed to have deterioration in mitral valve function, with a rate of freedom from deterioration at 15 years of 28{\%}. The presence of an immobile anterior mitral leaflet preoperatively and the technique of posterior patch extension were shown to be significant determinants of mitral valve deterioration. Conclusions: The outcomes after mitral repair for rheumatic heart disease in the young were in keeping with those reported in previous studies. Although the survival was high, long-term valve stability was poor. These findings suggest that the preoperative finding of a restricted anterior mitral leaflet is a negative predictor of repair durability.",
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    McGurty, D, Remenyi, B, Cheung, M, Engelman, D, Zannino, D, Milne, C, Fittock, M, Steer, A & Brizard, C 2019, 'Outcomes After Rheumatic Mitral Valve Repair in Children', Annals of Thoracic Surgery, vol. 108, no. 3, pp. 792-797. https://doi.org/10.1016/j.athoracsur.2019.03.085

    Outcomes After Rheumatic Mitral Valve Repair in Children. / McGurty, Daniel; Remenyi, Boglarka; Cheung, Michael; Engelman, Daniel; Zannino, Diana; Milne, Catherine; Fittock, Marea; Steer, Andrew; Brizard, Christian.

    In: Annals of Thoracic Surgery, Vol. 108, No. 3, 09.2019, p. 792-797.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - McGurty, Daniel

    AU - Remenyi, Boglarka

    AU - Cheung, Michael

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    AU - Milne, Catherine

    AU - Fittock, Marea

    AU - Steer, Andrew

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    N2 - Background: It has been shown that mitral valve repair is superior to mechanical replacement in children with rheumatic heart disease; however there are limited data on the factors affecting the long-term durability of repaired mitral valves. This study describes outcomes after rheumatic mitral valve repair, with adaptation of a risk score to clarify some novel predictors of repair instability. Methods: A total of 79 children (median age, 11.4 years) with rheumatic heart disease underwent their first mitral valve surgery between 1997 and 2015. Patients with concomitant aortic and tricuspid repair were included. Mean follow-up time was 7.72 years. Mitral valve deterioration (defined as cardiac death, reoperation, or recurrent moderate to severe valvular disease) was used as a key end point. Preoperative echocardiographs were analyzed and graded with respect to valvular mobility, subvalvular apparatus alteration, and function. Results: All patients underwent successful mitral valve repair. Seven patients died during follow-up. Kaplan-Meier analysis demonstrated survival at 15 years to be 83%. A total of 38 patients were deemed to have deterioration in mitral valve function, with a rate of freedom from deterioration at 15 years of 28%. The presence of an immobile anterior mitral leaflet preoperatively and the technique of posterior patch extension were shown to be significant determinants of mitral valve deterioration. Conclusions: The outcomes after mitral repair for rheumatic heart disease in the young were in keeping with those reported in previous studies. Although the survival was high, long-term valve stability was poor. These findings suggest that the preoperative finding of a restricted anterior mitral leaflet is a negative predictor of repair durability.

    AB - Background: It has been shown that mitral valve repair is superior to mechanical replacement in children with rheumatic heart disease; however there are limited data on the factors affecting the long-term durability of repaired mitral valves. This study describes outcomes after rheumatic mitral valve repair, with adaptation of a risk score to clarify some novel predictors of repair instability. Methods: A total of 79 children (median age, 11.4 years) with rheumatic heart disease underwent their first mitral valve surgery between 1997 and 2015. Patients with concomitant aortic and tricuspid repair were included. Mean follow-up time was 7.72 years. Mitral valve deterioration (defined as cardiac death, reoperation, or recurrent moderate to severe valvular disease) was used as a key end point. Preoperative echocardiographs were analyzed and graded with respect to valvular mobility, subvalvular apparatus alteration, and function. Results: All patients underwent successful mitral valve repair. Seven patients died during follow-up. Kaplan-Meier analysis demonstrated survival at 15 years to be 83%. A total of 38 patients were deemed to have deterioration in mitral valve function, with a rate of freedom from deterioration at 15 years of 28%. The presence of an immobile anterior mitral leaflet preoperatively and the technique of posterior patch extension were shown to be significant determinants of mitral valve deterioration. Conclusions: The outcomes after mitral repair for rheumatic heart disease in the young were in keeping with those reported in previous studies. Although the survival was high, long-term valve stability was poor. These findings suggest that the preoperative finding of a restricted anterior mitral leaflet is a negative predictor of repair durability.

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    McGurty D, Remenyi B, Cheung M, Engelman D, Zannino D, Milne C et al. Outcomes After Rheumatic Mitral Valve Repair in Children. Annals of Thoracic Surgery. 2019 Sep;108(3):792-797. https://doi.org/10.1016/j.athoracsur.2019.03.085