Post-repair coaptation length and durability of mitral valve repair for posterior mitral valve prolapse

Abstract

Chordal placement with no or minimal leaflet resection has been suggested as the preferred technique for mitral valve repair for posterior leaflet prolapse, because it creates a longer coaptation zone. However, whether or not a long coaptation zone improves the durability of mitral valve repairs remains unclear. We reviewed 119 patients with chronic degenerative mitral regurgitation including posterior middle scallop prolapse who underwent mitral valve repair between June 2004 and July 2008. We divided them into two groups according to post-repair coaptation length ≥8 mm (group A) or <8 mm (group B). We assessed whether coaptation length is associated with recurrent mitral regurgitation at 1 year after surgery and increase in the regurgitant jet area over 1 year. The group A had a lower incidence of recurrent mitral regurgitation (4.7 vs 9.2%, p = 0.30), smaller increase in mitral regurgitant jet area over 1 year (0.29 vs 0.40 cm(2), p = 0.43), and higher 5-year freedom from recurrent mitral regurgitation (85.6 vs 76.1%, p = 0.76), although the differences were not statistically significant. The multivariate analysis showed that large coaptation length tends to be associated with decreased recurrent mitral regurgitation at 1 year (odds ratio 0.02, 95% confidence interval 0.00-3.67, p = 0.14). This study did not confirm the association between coaptation length and durability of mitral valve repair for posterior middle scallop prolapse. However, there was a trend towards decreased recurrent mitral regurgitation with larger coaptation length.