Posterior Annulus Elevation Technique in Reducing Residual Regurgitation During Mitral Valve Repair in Children: A Randomized Controlled Trial

Budi Rahmat, Bambang Budi Siswanto, Dicky Fakhri, Indriwanto Sakidjan, Tri Wahyu Murni, Ina Susianti Timan, Aria Kekalih, Yovi Kurniawati, Dwi Gunawan Fardhani, Putu Wisnu Arya Wardana

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The current technique used in severe mitral regurgitation in children can occasionally lead to residual regurgitation. To address this issue, the posterior annulus elevation technique was developed to enhance coaptation and reduce residual lesions. This study aims to evaluate the effectiveness of this technique in reducing residual regurgitation during mitral valve repair in children. Methods: A total of 64 patients aged <18 years old undergoing mitral valve repair were randomized into two groups: the intervention (with posterior annulus elevation) group and the control group, which underwent conventional repair techniques. Various parameters, including coaptation area, residual mitral regurgitation, clinical outcomes, metabolic, and hemolytic markers, were measured on days 0, 5, 2 weeks, and 3 months after surgery. Results: The intervention group (n = 32) showed a significant reduction in residual mitral regurgitation compared with the control group (n = 32) on each evaluation. At three months after surgery, we found that the posterior annulus elevation technique could be a protective factor that reduces the chance of residual regurgitation compared with the control group (RR = 0.31; confidence interval: 0.18-0.54; P ≤.001). Coaptation length and index were also found to be significantly higher in the intervention group (P ≤.001). Clinical outcomes, metabolic markers, and hemolysis marker did not show any significant differences between the two groups. Conclusions: The posterior annulus elevation technique demonstrated effectiveness in reducing residual mitral regurgitation and improving coaptation area in pediatric mitral valve repair. This technique showed better short-term surgical outcomes in children with mitral regurgitation compared with the conventional technique.

Original languageEnglish
JournalWorld Journal for Pediatric and Congenital Heart Surgery
DOIs
Publication statusAccepted/In press - 2023

Keywords

  • annuloplasty
  • mitral regurgitation
  • mitral valve repair

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