Abstract：
To retrospectively analyze the clinical efficacy of an innovative mitral valvuloplasty strategy in the treatment of mitral regurgitation in children. From January 2018 to December 2022, 140 patients undergoing surgical treatment for mitral regurgitation in our hospital were enrolled. Ninety patients underwent three-step standardized pediatric mitral valvuloplasty (group A) and 50 patients underwent simple annuloplasty (group B). The incidence of primary and secondary study endpoint was compared between the two groups, and the independent risk factors for the primary study endpoint were determined. Our primary study endpoint was a composite endpoint of postoperative functional mitral failure, postoperative heart failure, transplantation, and/or mortality. Secondary end points were defined as perioperative complications. During the follow-up period, there was no all-cause death. Primary endpoint events occurred in 22 patients, including 12 patients in group A and 10 patients in group B. There was no significant difference in the incidence of primary and secondary endpoint events between the two groups. Multivariate Cox proportional hazards regression analysis showed that younger age and residual mitral regurgitation at discharge were independent risk factors for the primary endpoint events, while type of MV repair was not an independent risk factor. Subgroup analysis based on age showed that primary endpoint events occurred in 4 patients in group A and 7 patients in group B in patients < 1 year old. The incidence of primary endpoint events in group A was lower than that in group B (6.06% vs. 20.59%, P = 0.041). In patients ≥ 1 year old, the primary endpoint event occurred in 8 cases in group A and 3 cases in group B. There was no significant difference in the incidence of primary endpoint events between groups A and B (33.33% vs. 18.75%, P = 0.312). The degree of mitral regurgitation at discharge was significantly improved compared with that before operation in both groups (P < 0.001), and the degree of mitral regurgitation at the last follow-up was not significantly worse than that at discharge (P = 0.090). The mid-term results of mitral valvuloplasty for mitral regurgitation in children are encouraging. The perioperative recovery and postoperative outcomes of three-step standardized mitral valvuloplasty in children are not inferior to those of annuloplasty alone. Three-step standardized pediatric mitral valvuloplasty has better postoperative outcomes than simple mitral annuloplasty, especially for patients younger than 1 year old. Children with residual mitral regurgitation at discharge should be followed up regularly to be alert to the occurrence of poor prognosis.
摘要：
回顾性分析创新二尖瓣成形术治疗儿童二尖瓣反流的临床疗效。选取2018年1月至2022年12月在我院接受手术治疗的140例二尖瓣反流患者。90例患者接受了三步标准化小儿二尖瓣成形术（A组），50例患者接受了简单的瓣环成形术（B组）。比较两组的主要和次要研究终点的发生率，并确定主要研究终点的独立危险因素.我们的主要研究终点是术后功能性二尖瓣衰竭的复合终点，术后心力衰竭,移植,和/或死亡率。次要终点定义为围手术期并发症。在后续期间,没有全因死亡。主要终点事件发生在22例患者中，其中A组12例,B组10例。两组主要终点事件和次要终点事件发生率无显著差异。多因素Cox比例风险回归分析显示年龄小和出院时残余二尖瓣返流是主要终点事件的独立危险因素。而MV修复类型不是独立的危险因素。基于年龄的亚组分析显示，在<1岁的患者中，A组4例患者和B组7例患者发生主要终点事件。A组主要终点事件发生率低于B组(6.06%vs.20.59%,P=0.041)。在≥1岁的患者中，A组8例发生主要终点事件，B组3例发生主要终点事件，A组和B组主要终点事件发生率无显著差异(33.33%vs.18.75%,P=0.312）。两组患者出院时二尖瓣反流程度较术前明显改善(P<0.001),末次随访时的二尖瓣反流程度与出院时相比无明显恶化(P=0.090)。二尖瓣成形术治疗儿童二尖瓣反流的中期结果令人鼓舞。儿童三步标准化二尖瓣成形术的围手术期恢复和术后结局不逊于单用瓣环成形术。三步标准化小儿二尖瓣成形术比单纯二尖瓣成形术具有更好的术后效果，尤其是小于1岁的患者。出院时残留二尖瓣返流的患儿应定期随访，警惕不良预后的发生。
