Pediatric Mitral Valve Surgery: Current Practice from the European Congenital Heart Surgeons Association Congenital Database Analysis

J Thorac Cardiovasc Surg. 2026 Jul 3:S0022-5223(26)01131-1. doi: 10.1016/j.jtcvs.2026.06.013. Online ahead of print.

ABSTRACT

OBJECTIVE: Managing pediatric mitral valve (MV) conditions remains demanding. This study characterizes contemporary practice patterns and outcomes in pediatric MV surgery across the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD).

METHODS: We conducted a retrospective, multi-institutional analysis using ECHSA-CD. The cohort included 6,736 patients <18 years who underwent MV surgery (01/01/2003-12/31/2024). Exclusion criteria were atrioventricular septal defects, functionally univentricular physiology, and non-systemic mitral valves.

RESULTS: MV-Dysplasia was the primary etiology (5,916/6,736=87.8%), and regurgitation was the predominant hemodynamic mechanism (4,284/5,548=77.2%). MV repair was the most common surgical strategy (5,513/6,736=81.8%), and, while MV repair predominated across all age groups, the frequency of mitral valve replacement (MVR) increased with advancing age. Overall, in-hospital mortality rate was 245/6,736=3.6%, with a significant reduction observed in the most recent decade (130/2,814=4.6% versus 115/3,922=2.9%; p<0.001). In-hospital mortality was significantly elevated among neonates (OR:14.8; 95%CI:9.86-22.2; p<0.001), patients with MV stenosis (OR:2.50; 95%CI=1.77-3.54; p<0.001), and those receiving MVR (OR:2.35; 95%CI:1.78-3.10; p<0.001), and intraoperative conversion from MV repair-to-MVR (OR:3.62; 95%CI:1.71-7.65; p<0.001). Receiver operating characteristic analysis identified critical weight thresholds for mortality at 5.8kg for the overall cohort (AUC=0.73; 95%CI:0.70-0.77; p<0.001) and 12.6kg in MVR (AUC=0.74; 95%CI:0.67-0.80; p<0.001).

CONCLUSIONS: Pediatric MV 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.

PMID:42398639 | DOI:10.1016/j.jtcvs.2026.06.013