Background : To assess the techniques used to repair anterior mitral leaflet (AML) and commissures (Com).
Methods : From January 2000 to December 2002, 396 mitral valve (MV) procedures were performed. 332 (84%) were MV repairs, of which 127 (38%) concerned AML (83) and/or Com (posterior 67, anterior 25). Among those 127 patients, 80 were males and mean age was 58 years. 26 (20.5%) patients were asymptomatic, 10 (7.9%) were not elective, 18 (14.2%) were reoperation. Mean predicted operative mortality (log-EuroSCORE) was 8%. Etiologies were fibroelastic deficiency (56), endocarditis (20), rheumatic (19), Barlow (13), ischemic (10), congenital (6), Marfan (3). The techniques used consisted of :
| Neo-chordae | 70 |
| Commissuroplasty | 23 |
| Repositioning of posterior papillary muscule | 18 |
| Commissurotomy | 15 |
| Commissural resection and sliding plasty | 14 |
| Pericardial patching | 12 |
| Closure of perforation or cleft | 8 |
| Triangular resection | 3 |
| Chordal transfer | 2 |
| Alfieri stitch | 1 |
MV repair was completed with posterior leaflet (PL) repair (79) and ring annuloplasty (112). Intraoperative TEE was performed systematically. Associated procedures were CABG (22), AF ablation (22), tricuspid valve repair (18), aortic valve and/or root surgery (16), congenital repair (4), left ventricle aneurysmectomy (2).
Results : Postoperative TTE/TEE showed no mitral regurgitation (MR) in 113 (89%) patients and MR grade II in 6 (4.7%). Recurrence of MR grade III appeared in 8 (6,3%) patients who underwent early re-repair (2) or replacement (6). Hospital mortality was 6.3% (8 patients). At a mean follow-up of 20.4 months, 7 (5.5%) patients have needed re-repair (1) or replacement (6). Only 5 (3,9%) of the reoperations were directly related to AML or Com repair.
Conclusions : Anterior Mitral Leaflet and Commissures can be efficiently repaired in various etiologies with acceptable morbidity and mortality.