Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation.
OBJECTIVE
A nonresectional technique has been developed for repair of mitral leaflet prolapse causing mitral regurgitation. Polytetrafluoroethylene chordae are used for correction of edge misalignment of the prolapsed mitral leaflet. New chordal length is adjusted during progressive left ventricular inflation to systolic pressure. Annular sizing is determined dynamically after leaflet edge alignment is accomplished to produce an optimal zone of predefined leaflet apposition. The aim of this study was to document the 8- to 10-year durability of this nonresectional approach.


METHODS
From 1983 through 2008, 1121 consecutive patients had mitral valve repair on one service. Of these, 662 had repair of mitral leaflet prolapse. From 1983 until 1998, standard quadratic leaflet resection/plication was used in 72 (11.1%) patients, similar but smaller resection in 93 (14.1%) patients, and then smaller resection and polytetrafluoroethylene chordae in 24 (3.7%) patients. All received Puig-Massana fully flexible rings (Shiley, Inc, Irvine, Calif). After 1998, no leaflet resections or valve replacements have been performed regardless of leaflet size in 566 consecutive patients. Of the 662 patients, the mean age was 62.6±14.1 years, and 424 (64.1%) patients were male. Coronary artery disease was present in 147 (22.2%) patients and 33 (5.0%) had prior coronary artery bypass. Leaflets corrected were as follows: anterior, 152 (23.0%) patients; posterior, 427 (64.5%); and both, 83 (12.5%) Common pathologic characteristics of prolapsing valves were as follows: myxomatous, 332 (50.2%) patients, degenerative, 83 (12.5%), ischemic, 31 (4.7%), and rheumatic, 29 (4.4%).


RESULTS
Perioperative mortality was 2.9% (19/662) overall and 0.49% (2/414) for isolated repair. Freedom from reoperation at 10 years (Kaplan-Meier) was 90.1% and freedom from significant mitral regurgitation (echocardiography) was 93.9%.


CONCLUSIONS
This study confirms that mitral regurgitation from mitral leaflet prolapse can be repaired in all cases by a nonresectional technique provided that accurate dynamic evaluation of chordal length and annular sizing is achieved. The intermediate-term results are durable.
Lawrie
Gerald M
GM
Heart Valve Institute, Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA. gmlawrie@att.net
Earle
Elizabeth A
EA
Earle
Nan
N
D000368:Aged; D016009:Chi-Square Distribution; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011138:Polytetrafluoroethylene; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene