Ten-year results of folding plasty in mitral valve repair.
BACKGROUND
Folding plasty (FP) for posterior mitral leaflet repair (PLR) is a technique that reduces the height of the repaired leaflet, closes the gap created by leaflet resection by rotation of residual leaflet, and reduces the need for localized annular plication. This report reviews late outcomes with FP repair.


METHODS
From January 1994 to August 2006, 1,402 mitral valve repairs were performed for degenerative disease: 1,012 had PLR and 531 had FP technique.


RESULTS
Overall hospital mortality was 2.4% (33 of 1,402 patients) and 1.3% (14 of 1,103 patients) for isolated mitral repair. For those patients with PLR, mortality for all procedures was 1.5% (15 of 1,012 patients) and 1.2% (11 of 891 patients) for isolated PLR repairs. Mortality was 0.9% (5 of 531 patients) for FP. In the last 5 years FP was used in 64.4% of PLR, compared with 35.6% of PLR in the prior era (p < 0.001). The 10-year actuarial freedom from mitral reoperation was 89%; 10-year freedom from reoperation or recurrent severe mitral insufficiency was 86% with FP and 87% without (p = 0.76). The 5-year freedom from reoperation or recurrent severe insufficiency was 89% when an annuloplasty device was used and 62% when not used (p < 0.001).


CONCLUSIONS
Repair of posterior leaflet prolapse with FP is straightforward and durable. In our experience, FP is currently used for two thirds of PLR. These data also confirm that valve repair for degenerative disease should include an annuloplasty device for optimal late results.
Schwartz
Charles F
CF
Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York 10016, USA.
Grossi
Eugene A
EA
Ribakove
Greg H
GH
Ursomanno
Patricia
P
Mirabella
Meg
M
Crooke
Gregory A
GA
Galloway
Aubrey C
AC
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D002423:Cause of Death; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000401:mortality / Q000601:surgery*; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation / Q000401:mortality; D012307:Risk Factors; D055502:Secondary Prevention; D013536:Suture Techniques