Efficacy of 3-Step Standardized Mitral Valvuloplasty for Pediatric Patients With Volume-overloaded Mitral Regurgitation
10.3969/j.issn.1000-3614.2024.02.007
- VernacularTitle:三步标准化儿童二尖瓣成形手术在儿童容量负荷型二尖瓣反流中的应用
- Author:
Zheng DOU
1
,
2
;
Fengqun MAO
;
Kai MA
;
Kunjing PANG
;
Benqing ZHANG
;
Lu RUI
;
Qiyu HE
;
Yuze LIU
;
Shoujun LI
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 小儿外科中心, 北京 100037
2. 中国医学科学院 北京协和医学院国家心血管病中心 阜外医院 心血管疾病国家重点实验室, 北京 100037
- Keywords:
mitral regurgitation;
valvular repair;
volume-overloaded;
standardized strategy;
congenital heart disease
- From:
Chinese Circulation Journal
2024;39(2):148-155
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:This study aims to investigate optimal surgical management strategies for pediatric patients diagnosed with volume-overloaded mitral regurgitation. Methods:A comprehensive retrospective analysis was conducted on a cohort of 110 pediatric patients who underwent primary mitral valve repair for volume-overloaded mitral regurgitation at Fuwai Hospital between April 2020 and March 2022.The cohort,with an average age of(14.5±15.1)months and 38.2%males,was divided into standardized group for patients receiving 3-step standardized mitral valvuloplasty(n=69)and annuloplasty group for patients undergoing annuloplasty only(n=41).After propensity score matching,a total of 38 pairs of patients were included,comparing the primary endpoint(functional mitral failure and postoperative heart failure)between the two groups. Results:Over a median follow-up of 26.3(19.8,32.9)months,and with a median echocardiographic follow-up of 11.9(7.5,14.8)months,no death was recorded.Among the cases,one patient(0.8%)necessitated unplanned reoperation;and seven patients(6.4%)experienced a recurrence of moderate-severe mitral regurgitation as observed through echocardiography beyond 6 months post-surgery.Additionally,nine patients developed heart failure at one month post-discharge.Above events were similar between the two groups.Following propensity score matching,patients in the standardized group demonstrated significantly longer cardiopulmonary bypass and aortic cross-clamp times compared to the annuloplasty group(both P＜0.05),other outcomes were similar between the two groups.Subgroup analysis based on age indicated that infants(＜1 year old)in the standardized group exhibited a significantly lower incidence of major endpoint events compared to the annuloplasty group.Additionally,postoperative echocardiography in annuloplasty group indicated that Z score of left ventricular end diastolic diameter was still greater than 2 during the latest follow-up. Conclusions:Patients with volume-overloaded mitral regurgitation in the standardized group exhibited comparable perioperative recovery and postoperative outcomes as in the annuloplasty group.For pediatric patients suffering from volume-overloaded mitral regurgitation,particularly those under one year of age,the standardized surgical approach exhibited reduced rates of heart failure and major endpoint events,and this strategy is more suitable for this patient group.
