Key result
Mitral valve replacement linked to ~135% higher in-hospital pediatric mortality vs. repair.
Why the study?
Managing pediatric mitral valve conditions is demanding, motivating an evaluation of contemporary practice patterns and outcomes across the European Congenital Heart Surgeons Association Congenital Database.
Cohort (n=6,736)
Yes
Odds Ratio: 2.35 (95% CI 1.78–3.1)
Absolute Event Rate: 6.8% vs 2.9%
p-value: p=<0.001
Pediatric mitral valve surgery outcomes have improved over time, but the procedure remains a high-risk intervention for infants, with body weight <5.8 kg and the need for valve replacement being primary drivers of in-hospital mortality.
Contemporary European data benchmark 3.6% mortality after pediatric MV surgery; leaves open optimal strategies for infants and replacement candidates.
OBJECTIVE: Managing pediatric mitral valve conditions is demanding. This study characterizes the contemporary practice patterns and outcomes in pediatric mitral valve surgery across the European Congenital Heart Surgeons Association Congenital Database. METHODS: We conducted a retrospective, multi-institutional analysis using the European Congenital Heart Surgeons Association Congenital Database. The cohort included 6736 patients aged less than 18 years who underwent mitral valve surgery (January 1, 2003, to December 31, 2024). Exclusion criteria were atrioventricular septal defects, functionally univentricular physiology, and nonsystemic mitral valves. RESULTS: Mitral valve dysplasia was the primary cause (5916/6736 = 87.8%), and regurgitation was the predominant hemodynamic mechanism (4284/5548 = 77.2%). Mitral valve repair was the most common surgical strategy (5513/6736 = 81.8%), and although mitral valve repair predominated across all age groups, the frequency of mitral valve replacement increased with advancing age. Overall, in-hospital mortality rate was 245 of 6736 = 3.6%, with a significant reduction observed in the most recent decade (130/2814 = 4.6% vs 115/3922 = 2.9%; P < .001). In-hospital mortality was significantly elevated among neonates (odds ratio, 14.8; 95% CI, 9.86-22.2; P < .001), patients with mitral valve stenosis (odds ratio, 2.50; 95% CI, 1.77-3.54; P < .001), and those receiving mitral valve replacement (odds ratio, 2.35; 95 CI, 1.78-3.10; P < .001) and intraoperative conversion from mitral valve repair to mitral valve replacement (odds ratio, 3.62; 95% CI, 1.71-7.65; P < .001). Receiver operating characteristic analysis identified critical weight thresholds for mortality at 5.8 kg for the overall cohort (area under the curve, 0.73; 95% CI, 0.70-0.77; P < .001) and 12.6 kg in mitral valve replacement (area under the curve, 0.74; 95% CI, 0.67-0.80; P < .001). CONCLUSIONS: Pediatric mitral valve 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.
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Cattapan et al. (2026) conducted a cohort in Pediatric mitral valve disease (n=6,736). Mitral valve replacement vs. Mitral valve repair was evaluated on In-hospital mortality (OR 2.35, 95% CI 1.78-3.10, p=<0.001). Mitral valve replacement in pediatric patients was associated with a significantly higher risk of in-hospital mortality compared to mitral valve repair (OR 2.35).
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