Mitral valve repair for isolated prolapse of the anterior leaflet: an 11-year follow-up

Objective: Mitral valve insufficiency (MVI) because of involvement of the a nterior mitral leaflet may pose additional risks for late outcome after mit ral valve repair, because of more complex techniques. We retrospectively re viewed our experience in patients operated on for isolated anterior mitral leaflet prolapse approached by various techniques. Methods: Between 1986 an d 1997, 616 patients underwent mitral valve repair at our Institution. Isol ated pathology of the anterior mitral leaflet was the cause of MVI in 84 pa tients (13.6%). Age ranged from 23 to 74 years (mean 50 +/- 14), Etiology o f MVI was predominantly degenerative (57 patients, 67.8%), and the mechanis m of the regurgitation was mainly due to a chordal rupture (58 patients, 69 %). Annular dilatation was present in 75 patients (89.5%). A variety of sur gical techniques were applied including chordal shortening (five patients, 5.9%), chordal transposition (three patients, 3.5%), artificial chordae (11 patients, 13%). Since 1992, however, the majority of procedures was perfor med using the 'edge to edge' technique (52 patients, 51.9%). Annular dilata tion was treated mainly by means of a prosthetic ring (46 patients, 61.3%) whereas 18 patients (24%) underwent posterior annuloplasty using gluteralde hyde-treated native pericardium. Results: Follow-up ranged from 3 to 122 mo nths (mean 46 +/- 24 months). There were three hospital deaths (3.5%) and f ive late deaths (5.9%) for a Kaplan-Meier estimated survival of 87.6% at 8 years. Three patients underwent early reoperation within 30 days (3.5%), an d six patients underwent late reoperation (7.1%), for a cumulative freedom from reoperation of 85.4% at 8 years. Seventy-four percent of the survivors (50 patients) are still in New York Heart Association Class I, and 92% of survivors (62 patients) have no or trivial (1+) residual mitral regurgitati on at echocardiographic follow-up. Conclusion: In spite of the greater comp lexity, conservative surgery to correct anterior mitral valve prolapse pert ains high success rate at long term. Recent technical modifications ('edge- to-edge' technique) may allow more expeditious and reproducible procedures with expected favorable influence of mitral valve repair applicability. (C) 1999 Elsevier Science B.V. All rights reserved.