Optimizing long-term outcomes in pediatric mitral valve repair: A focus on posterior leaflet augmentation

Objective: To evaluate mid- and long-term outcomes of posterior leaflet augmentation with fresh autologous pericardium for congenital or acquired mitral regurgitation in pediatric populations, and to identify predictors of valve-related reintervention. Methods: A retrospective review was conducted on all patients who underwent mitral valve repair, including posterior leaflet augmentation, at Bambino Gesù Children's Hospital between 2011 and 2024. Patients with atrioventricular septal defects or single-ventricle physiology were excluded. Demographic, operative, and echocardiographic data were analyzed. Freedom from reintervention was estimated using Kaplan-Meier analysis and risk factors were identified by Cox proportional hazards modeling. Results: = .004). Conclusions: Posterior leaflet augmentation with fresh autologous pericardium provides a durable, growth-preserving, and physiologic repair for pediatric mitral valve disease predominantly presenting with severe regurgitation. A postoperative transmitral gradient >5 mm Hg identifies patients at higher risk for late mitral valve replacement, emphasizing the importance of accurate intraoperative tailoring and early echocardiographic follow-up.