Key result
Age <1 year at paediatric mitral valve surgery was a significant risk factor for death or transplant (P=0.044) and increased the risk of reoperation (aHR 3.38, P=0.009).
Why the study?
Predictors of death and reintervention after paediatric mitral valve surgery remain to be clarified.
Does age at operation predict death or transplant in pediatric patients undergoing primary mitral valve surgery?
Cohort (n=142)
No
Does age at operation predict death or transplant in pediatric patients undergoing primary mitral valve surgery?
p-value: p=0.044
In pediatric patients undergoing mitral valve surgery, age <1 year is a significant risk factor for death, transplant, and reoperation.
Infants warrant intensified surveillance after mitral valve surgery; this Level 3 cohort finding leaves open optimal timing and interventions.
OBJECTIVES: The aim of this study was to elucidate predictors of death and reintervention after mitral valve (MV) surgery in children. METHODS: A single-centre retrospective study was performed enrolling 142 patients younger than 18 years who underwent primary index surgical mitral repair or replacement at Bambino Gesù Children's Hospital in Rome from July 1982 to April 2020. Patients with complete, transitional or partial atrioventricular septal defect and patients with single ventricle physiology were excluded. Patients were stratified according to the age group: group 1 (<1 year old), group 2 (1-5 years old) and group 3 (>5 years old). The composite primary outcome was freedom from death or transplant. The secondary outcome was freedom from redo MV surgery. RESULTS: Transplant-free survival was 89% at 5 years and 88% at 10 years. Stratified by age, group 1 had poorer outcome in comparison with other groups (log-rank test P = 0.105). Both univariate and multivariate analyses showed that age <1 year was a significant risk factor for death or transplant (P = 0.044). Age <1 year was associated with increased risk of reoperation (aHR = 3.38, P = 0.009), while the presence of genetic syndrome (aHR = 0.22) and preoperative EF% (aHR = 0.97) were protective factors for reoperation. CONCLUSIONS: The overall survival and freedom from reoperation in children undergoing MV surgery still need improvements. Younger age was a significant risk factor for death and reintervention both after repair and replacement of the MV. In particular, infants and neonates have a three-fold risk for death compared to children.
No takes yet. Share an insight, caveat, or question.
Brancaccio et al. (2022) conducted a cohort in paediatric mitral valve disease (n=142). Age <1 year at operation vs. Age ≥1 year at operation was evaluated on freedom from death or transplant (p=0.044). Age <1 year at paediatric mitral valve surgery was a significant risk factor for death or transplant (P=0.044) and increased the risk of reoperation (aHR 3.38, P=0.009).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: