The surgical management of mitral regurgitation in children remains challenging. Leaflet augmentation using a patch has emerged as a promising technique for pediatric patients. This study aimed to evaluate the long-term results of mitral valve repair with leaflet augmentation in children.

We reviewed all consecutive patients under the age of 18 who underwent surgery for mitral valve regurgitation between January 2001 and December 2024. Patients with an atrioventricular septal defect were excluded.

Of 248 consecutive patients, primary repair was achieved in 241 (97.2%).

Leaflet augmentation using an autologous pericardial patch was performed in 44 (18.3%) patients. The median age at the time of surgery was 5.2 years (range, 44 days to 18 years), and 14 patients (31.8%) were younger than 1 year old. Coexistent mitral stenosis was present in 12 patients (27.3%). The median follow-up period was 9 years (range, 1 week to 19.3 years). The prevailing etiology was congenital mitral valve dysplasia (n = 24, 54.5%). Anterior or posterior leaflet augmentation was performed in 70.5% (n = 31) and 29.5% (n = 13) of the patients, respectively. The hospital mortality rate was 4.5% (n = 2), and no late deaths were reported. Fifteen patients (34.1%) underwent a total of 22 reoperations. Ultimately, 10 patients (22.7%) required mechanical valve replacement due to fibrosis/calcification of the patch, which led to functional deterioration. Reoperation and valve replacement rates did not differ significantly between the anterior and posterior leaflet augmentation groups (OR 1.24; p = 0.76 and OR 0.97; p = 0.97, respectively). Freedom from death and/or reoperation at 5, 10, and 15 years was 81.5%, 78.7% and 71.2%, respectively ( Fig. 1 ). Independent predictors of reoperation included age under 1 year at the time of surgery and residual moderate or greater mitral regurgitation postoperatively (both p < 0.05).

Leaflet augmentation with an autologous pericardial patch yields satisfactory early outcomes in pediatric mitral valve repair. However, this technique is associated with high rates of reintervention and valve replacement, primarily due to patch degeneration. Considering its limited long-term durability, patch augmentation should be a last-resort strategy. Future research should prioritize developing more durable materials for valvular reconstruction.