Mitral-valve repair without annuloplasty rings: results after repair of anterior leaflet versus posterior-leaflet defects using polytetrafluoroethylene sutures for chordal replacement

Objective: Defects of the anterior mitral leaflet (AML), including ruptured chordae, are often regarded as difficult or even impossible to repair. Cho rdal replacement may also be an option in extensive disease of the posterio r mitral leaflet (PML). It has not yet been clearly defined whether the rep air of either mitral leaflet using chordal-replacement techniques is as saf e as the standard repair of the mitral valve (MV) including quadrangular re section and ring reduction alone. Methods: Between October 1995 and June 19 99, 160 patients underwent MV repair for mitral regurgitation (MR) in our i nstitution. Chordal replacement with polytetrafluoroethylene (PTFE) sutures for elongated or ruptured chordae was performed in 72 (45%) patients. Thes e patients were divided into two groups according to the location of the MV lesions: 48 patients with prolapse of the anterior or both leaflets (AML g roup) received an average of 2.2 +/- 1.1 PTFE sutures for repair; in 24 pat ients with isolated PML defects (PML group), we used an average of 1.5 +/- 0.8 PTFE sutures. No prosthetic annuloplasty rings were used. Dilatation of the posterior mitral ring was corrected by PTFE suture annuloplasty. The r emaining 88 patients underwent a standard mitral repair without chordal rep lacement. There were no statistically significant CNS) differences between the two groups (AML/PML) regarding age (59/62 years, P = 0.49), left ventri cular (LV) ejection fraction (64/66%, P = 0.6) and preoperative NYHA class (2.9/2.9, P = 0.36). Postoperatively, all patients were followed by serial transthoracic echocardiography at 1 week and after 3, 6, 12 and 24 months b y the same investigator. Results: In-hospital mortality was 4.2% (2/48) in the AML group and 0% (0/24) in the PML group (P = 0.55). Three of the AML p atients (6.3%) and one PML patient (4.2%) underwent reoperation for recurre nt MR (P = 1.0). The 1- and 2-year freedom from MV reoperation was 95.1 +/- 3.4 and 92.6 +/- 4.2% in the AML group versus 95.0 +/- 4.9 and 95.0 +/- 4. 9% (P = 0.67). The 1- and 2-year freedom from residual or recurrent NIR gra de 2 or higher was 97.6 +/- 2.4 and 94.9 +/- 3.58 (AML) versus 95.8 +/- 4.0 and 95.8 +/- 4.0% (PML) (P = 0.97). Conclusions: We were unable to find st atistically significant differences concerning mortality, freedom from recu rrent MR and MV reoperation between the AML and PML groups. Extensive prola pse or chordal pathology of the anterior and PML can be corrected by chorda l replacement. Using these techniques, stable repair can be achieved in mor e than 90% of patients at mid-term follow-up. Long-term observations are ne cessary to confirm the durability of this type of MV repair. (C) 2000 Elsev ier Science B.V. All rights reserved.