Pediatric Mitral Regurgitation: Standardized Repair-Oriented Strategy with Leaflet Plication.

To introduce a standardized strategy and reproducible procedures of mitral repair for mitral regurgitation in the pediatric population with leaflet plication as a principal technique. Consecutive patients who had undergone mitral repair by our standardized repair-oriented strategy in our institution from Jan-2016 to Dec-2019 were included retrospectively. The standardized repair strategy included 3-step inspections and repair from the subvalvular to leaflet, and then to the annular level. The main surgical techniques included chordae detachment, papillary muscle splitting, leaflet plication and posterior annuloplasty. The indication for leaflet plication was that the distance between two adjacent chordae tendineae was greater than 4mm. A total of 113 patients were enrolled. During 22.6-months (range, 2 – 50 months) follow-up period, primary endpoint was documented in 15 (13.3%) patients, including 1 (0.9%) death, 0 transplantation and 14 (12.4%) functional mitral failure. Freedom form primary endpoints at 6 months, 1 year and 3 years was 94.7%, 94.7% and 82.3%, respectively. Significant independent predictors of functional MV failure were younger age (HR, 0.28; 95% CI, 0.04 – 0.72; P=0.037) and ischemic MR (HR, 24.34; 95% CI, 4.52 - 47.33; P