Objective : Repair of the degenerative prolapsing anterior mitral leaflet (AML) is more demanding than that of the posterior leaflet. We reviewed our experience in the past 8 years, in order to look at the safety, efficacy and stability of various repair artifices.
Methods : Between January ‘89 and December ‘97,102 pts with mitral regurgitation (MR) due to prolapse of the anterior or both mitral leaflets underwent mitral valve repair. Age averaged 64y (26-86). Sixty-six were in NYHA>III, 94 HAD A MR>II. 12 pts had acute endocarditis and 16 pts Barlow Disease. The surgical techniques consisted of chordal shortening (36 pts), chordal transposition (16), papillary muscle shortening or plication (10), flip over (20) and artificial chordae implantation (20).
Results : At the post weaning TEE, 2 pts had MR>Il. There was no early mortality; 1 pt required early mitral valve replacement (MVR) for a late appearing SAM, and 1 pt benefited from a successful
re-repair on day 8 for partial posterior valve desinsertion. Follow-up averages 30 m (3-92); there were 4 late deaths (2 valve related cerebrovascular accidents); 2 pts needed an iterative repair: one after 3 m for prosthetic ring thrombosis and one after 10 m for rupture of shortened chordae (corrected by flip-over). Five pts had MVR 4 to 32 m later: one for mitral stenosis due to posterior leaflet calcification, and 4 for recurrent MR due to the rupture of shortened chordae (3 pts) or plicated papillary muscle (1 pt). One pt suffered bacterial endocarditis which was treated medically. Of the 92 remaining pts with valve repair, 81 are asymptomatic, 5 are in NYHA II and 4 in III. TEE restudy (76 pts) at an average postoperative interval of 30 m revealed no MR in 68, and >II in 3.
Conclusions : AML prolapse repair is safe, durable, and therefore can be attempted in mildly symptomatic patients. However chordal shortening should be substituted by implantation of artificial chordae or by flip-over technique.