Surgical management of mitral regurgitation after repair of endocardial cushion defects - Early and midterm results

Background-Mitral regurgitation (MR) represents the principal indication fo r reoperation in patients after repair of atrioventricular septal defects ( AVSD), Reports of mitral valvuloplasty (MVP) in such patients are few; the alternative, mitral valve replacement (MVR), necessitates commitment to fut ure valve replacement and long-term anticoagulation. We sought to determine the outcome of those patients who underwent either MVP or MVR between Janu ary 1, 1988, and December 31, 1998, for significant MR after repair of AVSD . Furthermore, we sought to identify (a) morphological predictors necessita ting MVR, and (b) predictors of future reoperation within the MVP group. Methods and Results-Retrospective review of clinical, operative, and echoca rdiographic data were performed. There were 46 patients identified (37 MVP and 9 MVR). The median age at initial AVSD repair was 0.6 years, and the ag e at subsequent mitral valve operation was 2.8 years. The early postoperati ve mortality rate was 2.2%, and survival at 1 and 10 years was 89.9% and 86 .6%, respectively. A high rate of complete heart block was noted within the MVR group (37.5%). Freedom from later mitral valve reoperation fur both gr oups was similar. No significant morphological predictors necessitating MVR were found. Predictors of reoperation within the MVP group included the pr esence of moderate or worse MR in the early postoperative period. In both g roups New York Heart Association class, degree of MR, growth, and ventricul ar volumes improved. Conclusions-Mitral valve surgery significantly improves clinical status, wi th a sustained improvement in ventricular chamber size. MR can be successfu lly managed in patients after repair of AVSD independent of morphological t ype. Overall survival is acceptable, and further reoperation within the MVP group is influenced by early outcome of repair.