What is the clinical evidence from this study?

Study design: Cohort. Population: Mitral regurgitation (n=309). Intervention: Preoperative echocardiography. Primary outcome: Composite of postoperative functional MV failure, heart transplantation, or death (HR 3.69, 95% CI 1.46-9.33, p=0.006).

February 28, 2026

Preoperative echocardiographic predictors of mitral valve repair failure in children

Key Result

Preoperative underdeveloped chordae tendineae (HR 3.69; 95% CI 1.46-9.33; P=0.006) and elevated mitral valve annulus area index independently predicted mitral valve repair failure in children.

Key Points

The study aims to identify preoperative echocardiographic predictors of mitral valve repair failure in pediatric patients with mitral regurgitation.
Retrospective review of pediatric patients with mitral regurgitation grade ≥ 2.
Echocardiographic assessment using two- and three-dimensional techniques.
Follow-up duration averaged 6.93 months.
11.97% of patients experienced mitral valve repair failure during follow-up.
Underdeveloped chordae tendineae were associated with a hazard ratio (HR) of 3.69 (95% CI 1.46 to 9.33; P=0.006).
Elevated mitral valve annulus area index (MVAI) was linked to an HR of 1.23 (95% CI 1.07 to 1.40; P=0.003).

Study Design

Type

Cohort (n=309)

Structured PICO

Do preoperative echocardiographic parameters predict mitral valve repair failure in pediatric patients with mitral regurgitation grade ≥ 2?

Population

309 pediatric patients with mitral regurgitation (MR) grade ≥ 2 who received mitral valve repair, median age 15.50 months, 53.1% male.

Intervention

Preoperative two- and three-dimensional echocardiography assessment prior to mitral valve repair

Outcome

Mitral valve repair failure (composite of postoperative functional mitral valve failure, heart transplantation, or death)composite

Preoperative echocardiographic identification of underdeveloped chordae tendineae and an enlarged mitral annulus (MVAI > 8.73 cm2/m2) strongly predicts mitral valve repair failure in pediatric patients, supporting early intervention before substantial remodeling.

Main Result

Effect estimate: HR 3.69 (95% CI 1.46-9.33)

p-value: p=0.006

Abstract

UNLABELLED: The objective of this study is to identify preoperative echocardiographic predictors of mitral valve (MV) repair failure in pediatric patients. Pediatric patients with mitral regurgitation (MR) grade ≥ 2 who received MV repair between January 2019 and July 2024 were retrospectively reviewed. MV repair failure was defined as a composite of postoperative functional MV failure, heart transplantation, or death. MV morphology and related parameters were assessed using two- and three-dimensional echocardiography. A total of 309 pediatric patients were included, with a median age of 15.50 (6.00, 52.30) months; 164 (53.1%) were male. During a follow-up of 6.93 (1.37, 14.67) months, 11.97% cases experienced MV repair failure. The underdeveloped chordae tendineae (hazard ratio (HR) = 3.69, 95% confidence interval (CI) = 1.46 to 9.33; P = 0.006) and elevated mitral valve annulus area index (MVAI) (HR = 1.23, 95% CI = 1.07 to 1.40; P = 0.003) were identified as two independent preoperative echocardiographic predictors. The significantly dilated mitral annulus, measured with MVAI exceeding 8.73 cm CONCLUSION: For pediatric patients with MR grade ≥ 2, echocardiography identified underdeveloped chordae tendineae and significantly dilated mitral annulus may serve as crucial preoperative predictors for risk stratification of MV repair failure. WHAT IS KNOWN: • In pediatric populations with mitral regurgitation, MV repair is generally preferred, yet it remains one of the most technically demanding and less predictable congenital cardiac surgeries. WHAT IS NEW: • Preoperative underdeveloped chordae tendineae and enlarged annulus (MVAI > 8.73 cm2/m2) are strong predictors of MV repair failure in pediatric patients, particularly those with isolated MR. These findings support performing repair early, before substantial annular remodeling occurs.

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