Risk Factors of Unfavorable Outcome in Children with Mitral Valve Repair

Abstract

espanolAnalizar los factores de riesgo de evolucion desfavorable (ED) en ninos con insuficiencia mitral (IM) sometidos a plastica mitral (PM). Metodos: Se analizaron pacientes con IM sometidos a PM entre el 2004 al 2014. Se definio ED como reoperacion o IM significativa (moderada a severa (3+) o severa (4+)) durante el seguimiento. Las variables se expresaron como mediana. Se realizo analisis multivariado de regresion logistica de los factores predictores de ED. Resultados. Sesenta y cinco pacientes con IM3+ y IM4+ se sometieron a PM. La etiologia fue: displasia 44,6%, endocarditis infecciosa 13,8%, fiebre reumatica 18,4%, anomalia coronaria 7,7%, otros 13,8%. La mediana del seguimiento fue 26,5 meses. 44,6% presentaron disfuncion ventricular y el 46,1% hipertension pulmonar. 52 pacientes se encuentran en seguimiento. Quince presentaron ED: 9 fueron reoperados (7 reemplazos valvulares y 2 re-plastica). El analisis univariado demostro asociacion significativa entre ED y: fiebre reumatica (p0.005), anillo mitral preoperatorio ≥+5DS (p0.002), diametro sistolico del ventriculo izquierdo (DSVI) ≥+4DS (p0.022), hipertension pulmonar (p0. 024) y la IM residual postoperatoria inmediata ≥ moderada (p0.021). El analisis multivariado demostro como variables independientes de ED: diametro del anillo mitral (p0.012), fiebre reumatica (p0.026) y la IM residual temprana (p0.042). No se produjo mortalidad. Conclusiones. La plastica mitral en ninos con IM severa demostro resultados favorables a mediano plazo. La fiebre reumatica, el diametro del anillo mitral ≥+5DS y la IM residual ≥2 + fueron factores predictores de ED. Ni la edad, ni la disfuncion ventricular mostraron diferencias estadisticamente significativas durante el seguimiento. EnglishThe aim of this study was to analyze risk factors of unfavorable outcome (UO) in patients with mitral regurgitation(MR) undergoing mitral valve repair (MVR).Methods: Patients with MR who had undergone MVR from 2004 to 2014 were retrospectively analyzed. Unfavorable outcomewas defined as reoperation or significant MR [moderate to severe (3+) or severe MR (4+)] during follow-up. Variables wereexpressed as median. Univariate and multivariate logistic regression analyses were performed to identify predictive factorsof UO.Results: Sixty five patients with MR3+ and MR4+ underwent MVR. Etiology was dysplasia in 44.6% of cases, infective endocarditisin 13.8%, rheumatic fever in 18.4%, abnormal coronary origin in 7.7% and other disorders in 13.8%. Median follow-uptime was 26.5 months (52 patients are still being followed-up).Ventricular dysfunction was documented in 44.6% of casesand 46.1% had pulmonary hypertension. Fifteen patients presented UO and 9 were reoperated (7 valve replacements and 2re-repairs). Univariate analysis demonstrated a significant association between UO and the following conditions: rheumaticfever (p=0.005), preoperative mitral annulus ≥+5 SD (p=0.002), left ventricular end-systolic diameter ≥+4 SD (p=0.022),pulmonary hypertension (p=0.024) and immediate postoperative residual MR ≥ moderate (p=0.021). Multivariate analysisdemonstrated mitral annulus diameter (p=0.012), rheumatic fever (p=0.026) and early residual MR (p=0.042) as independentvariables of UO. No deaths occurred in this series.Conclusions: Mitral valve repair in children with severe MR demonstrated mid-term favourable results. Rheumatic fever,mitral annulus diameter ≥+5 SD and immediate postoperative residual MR ≥2+ were predictive factors of UO. Neither ageat surgery nor ventricular dysfunction showed statistically significant differences during follow-up.