Mitral valve repair for anterior leaflet prolapse: surgical techniques review and 16-year follow-up results.

OBJECTIVE: Mitral valve repair is now the surgical treatment of choice for mitral regurgitation. However, the repair of anterior leaflet prolapse due to chordal rupture or elongation remains a technically challenging procedure. Here, we review our experience and present the long-term results of mitral valve repair for mitral regurgitation due to anterior leaflet prolapse.

METHODS: Between January 1988 and August 2006, 210 patients with mitral regurgitation underwent mitral valve reconstruction. We performed mitral valve repair in 49 patients with mitral regurgitation due to anterior leaflet prolapse. The preoperative degree of mitral regurgitation was moderate to severe in all patients. There were 36 patients (73.5%) with degenerative, eight (16.3%) with infective endocarditis, and five (10.2%) with rheumatic. Reconstructive techniques included chordal replacement in 13 patients, chordal shortening in 14, chordal transposition in five, chordal shortening and reinforcement with artificial chordae in four, leaflet folding plasty in six, and resection-suture in four.

RESULTS: Follow-up was complete with an average of 89 +/- 59 months (range 1-201 months). In the early postoperative period, transthoracic echocardiography was performed in all patients. The grade of regurgitation was trivial (Grade I) in 17 patients (34.7%) and mild (Grade II) in seven patients (14.3%). Survival rate at 10 and 15 years was 95.2% and 88.9%, respectively. Freedom from reoperation at 10 and 15 years was 95.8% and 89.0%, respectively.

CONCLUSIONS: The long-term results of mitral valve repair for anterior leaflet prolapse are satisfactory, with low mortality and morbidity. In particular, chordal replacement using temporary Alfieri stitch is a simple and effective procedure.