Midterm outcomes of mitral valve replacement in children: a retrospective study

Objective This study aimed to evaluate the midterm outcomes of mitral valve replacement (MVR) in children aged 1–18 years with irreparable mitral valve disease. Methods We conducted a retrospective analysis of patients who underwent MVR at our institution between January 2010 and December 2025. We excluded patients who underwent valve repair or were outside the age range. We collected and analyzed preoperative, intraoperative, postoperative, and follow-up data for the enrolled pediatric patients. Results A total of 89 patients were enrolled in this study, including 41 males and 48 females, with a median age of 9.0 years (IQR 4.0–14.0). Median weight and body surface area were 24.8 kg (IQR 13.5, 38.6) and 0.9 m 2 (IQR 0.6–1.3), respectively. The preoperative diagnoses included mitral stenosis in 31 patients (34.8%), mitral regurgitation in 78 patients (87.6%), and combined mitral stenosis and regurgitation in 20 patients (22.5%). A subset of patients had associated anomalies, including complete atrioventricular septal defect, partial anomalous pulmonary venous connection, and congenital mitral valve malformations. All 89 patients successfully underwent the procedure. The operative time was 310.3 ± 96.4 min, cardiopulmonary bypass time was 177.2 ± 72.5 min, and aortic cross-clamp time was 102.5 ± 44.3 min. Postoperative mechanical ventilation duration was 21.0 h (IQR 10.0–36.9), ICU stay was 3.0 days (IQR 2.0–6.3), and hospital length of stay was 26.0 days (IQR 18.8–37.5). A total of 34 patients (38.2%) underwent implantation with a 25# valve, 24 patients (27.0%) with a 27# valve, and 11 patients (12.4%) with a 23# valve. At a median follow-up of 24.5 months (IQR 7.0, 69.0), crude overall survival was 98.9% (88/89). Conclusion MVR represents a feasible and safe treatment strategy for children with irreparable mitral valve lesions, demonstrating excellent midterm survival and low complication rates in this cohort.