Abstract

BackgroundGood mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions.MethodsFifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011–2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively.ResultsAdditional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%.ConclusionsSeventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.

Highlights

  • Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; patients may develop failure during follow-up

  • The patients with mitral regurgitation (MR) due to bileaflet lesions had a mean age of 67 ± 12 years and 19 (34%) were women

  • This study provides information on mid-term clinical and echocardiographic outcomes with detailed mechanisms of recurrent MR focusing on bileaflet mitral valve (MV) repair due to degenerative disease

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Summary

Introduction

Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions. Compared with promising long-term outcomes of mitral valve (MV) repair of isolated posterior leaflet lesions, anterior leaflet and bileaflet lesions have been recognized as a risk factor associated with repair failure [1,2,3,4,5,6]. Better outcomes of MV repair of anterior leaflet lesions have been reported after the emergence of several refined techniques, including neochordoplasty [2, 7, 8]. Despite the limited literature available, the long-term durability of MV repair of isolated commissural lesions.

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