VALVE REPAIR FOR MITRAL REGURGITATION CAUSED BY ISOLATED PROLAPSE OF THE POSTERIOR LEAFLET

Background. Although prolapse of the posterior leaflet is the most com mon abnormality of the mitral valve causing dysfunction, the long-term results of mitral valve repair for this condition are seldom reported . Methods. From October 1988 to June 1994, 208 patients (mean age, 59. 4 years) with mitral regurgitation caused by isolated prolapse of the posterior leaflet underwent mitral valve repair alone or combined with myocardial revascularization (n = 30). The surgical techniques were q uadrangular resection (n = 199) followed by annulus plication (n = 101 ) or sliding leaflet plasty (n = 98), use of artificial chordae (n = 5 ), or papillary muscle shortening (n = 4). All patients had an annulop lasty with a Carpentier ring. Mean follow-up was 3.4 +/- 0.1 years and total follow-up, 656 patient-years. Results. There were six operative deaths (2.9%). Postoperative Doppler echocardiography found two cases of systolic anterior motion (1%), and echocardiographic studies at fo llow-up showed satisfactory mitral valve function in 97% of 112 patien ts. At 6 years, the actuarial survival rate was 87% +/- 7%, and freedo m from thromboembolic complications, bleeding complications, and reope ration was 93% +/- 7%, 95% +/- 3%, and 95% +/- 4%, respectively. Concl usions. Mitral valve repair for regurgitation caused by prolapse of th e posterior leaflet provides excellent survival at 6 years and should be considered the method of choice for its surgical treatment. (C) 199 7 by The Society of Thoracic Surgeons.