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Cattapan, C, Guariento, A, Jacobs, J, Bleiweis, M, Lotto, A 
ORCID: 0000-0002-8922-6107, Tobota, Z, Bacha, E, Sarris, G and Vida, V
(2026)
Pediatric mitral valve surgery: Current practice from the European Congenital Heart Surgeons Association congenital database analysis.
The Journal of Thoracic and Cardiovascular Surgery.
ISSN 0022-5223
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Abstract
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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | congenital heart disease; mitral valve; 32 Biomedical and Clinical Sciences; 3201 Cardiovascular Medicine and Haematology; 3202 Clinical Sciences; Transplantation; Patient Safety; Rare Diseases; Clinical Research; Cardiovascular; Heart Disease; Pediatric Research Initiative; Congenital Heart Disease; Congenital Structural Anomalies; 6.4 Surgery; Cardiovascular; 3 Good Health and Well Being; 1102 Cardiorespiratory Medicine and Haematology; 1103 Clinical Sciences; Respiratory System; 3201 Cardiovascular medicine and haematology; 3202 Clinical sciences |
| Subjects: | R Medicine > RD Surgery T Technology > T Technology (General) > T58.5 Information Technology |
| Divisions: | Public and Allied Health |
| Publisher: | Elsevier |
| Date of acceptance: | 3 June 2026 |
| Date of first compliant Open Access: | 13 August 2026 |
| Date Deposited: | 13 Aug 2026 10:09 |
| Last Modified: | 13 Aug 2026 10:23 |
| DOI or ID number: | 10.1016/j.jtcvs.2026.06.013 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/29146 |
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