Frequency and surgical management of complex posterior leaflet prolapse of the mitral valve.
OBJECTIVE
Isolated posterior leaflet prolapse of the mitral valve may present with more complex anatomy than limited middle scallop prolapse (P2). The study aim was to describe the incidence and surgical management of extensive or commissural posterior leaflet prolapse, in addition to long-term outcomes following repair.


METHODS
Between October 2001 and May 2008, among 481 patients operated on for mitral valve prolapse, 201 consecutive patients underwent mitral valve repair for isolated posterior leaflet prolapse. Of the latter patients, only 81 (40%) had limited P2 prolapse, while the remaining 120 (60%) showed complex posterior leaflet prolapse, including either extensive (n = 105) or commissural (n = 15) prolapse. Extensive leaflet prolapse was treated with aggressive leaflet resection and sliding plasty, combined with a longitudinal annular plication using polytetrafluoroethylene running sutures. Commissural prolapse was repaired with an edge-to-edge technique or commissuroplasty. The clinical and echocardiographic follow up was complete for all patients, and extended up to 6.8 years (mean 2.4 +/- 1.9 years).


RESULTS
There was no hospital mortality. Repair was successful in 200 patients (99%), who showed no or trivial mitral regurgitation (MR) intraoperatively. The five-year freedom from recurrent MR (grade > 1+) was 91.5 +/- 4.2% in patients with isolated P2 prolapse, compared to 98.8 +/- 1.2% in patients with complex posterior leaflet prolapse (p = 0.07). The repair of complex posterior leaflet prolapse was also similar to that of isolated P2 prolapse with regard to five-year freedom from reoperation (98.9 +/- 5.9% versus 100%; p = 0.4), and survival (92.1 +/- 3.3% versus 88.9 +/- 8.0%; p = 0.9).


CONCLUSIONS
In the present series, posterior leaflet prolapse offered more complexity than usually reported, requiring surgical skills beyond simple quadrangular resection. However, the surgical approach, which typically involved extensive leaflet resection and sliding plasty, offered high repair rates and acceptable durability, considering the initial severity of the prolapse anatomy.
Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Dominique
D
Grisoli
Vincent
V
Chan
Anthony
A
Tran
Ladislaus
L
Ressler
Donna
D
Nicholson
Mark
M
Hynes
Marc
M
Ruel
Thierry G
TG
Mesana
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013504:Cardiovascular Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008945:Mitral Valve Prolapse / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D011138:Polytetrafluoroethylene; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013537:Sutures; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene