Objective: Repair of mitral regurgitation (MR) due to bileaflet prolapse poses many technical challenges. The late outcomes after repair are also not well characterized in this population. Published series have often included patients with mixed causes of prolapse and/or lack long-term echocardiographic follow-up. Myxomatous disease represents an important cause of bileaflet prolapse and MR and, thus, served as the focus of the present study.
Methods: A total of 142 patients, mean age 60.4 ± 13.2 years, underwent mitral valve (MV) repair of bileaflet prolapse due to myxomatous disease from 2001 to 2010. Concomitant coronary artery bypass grafting was performed in 16 patients (11%). All patients were followed up by a dedicated MV clinic with a follow-up interval that extended up to 8.6 years.
Results: No hospital deaths occurred. Ring annuloplasty was used for all patients. Additional MV repair techniques included chordal transfer in 73, a hybrid-flip-over technique in 23, polytetrafluoroethylene neochords in 26, edge-to-edge repair in 11, and commissuroplasty in 9. Prolapse involving more than 1 posterior leaflet scallop was observed in 103 patients (73%), and prolapse of more than 1 anterior leaflet scallop was observed in 76 (54%). During follow-up, 4 patients had MR grade 2+ or greater, and 2 patients required subsequent MV reoperation. The 5-year survival, freedom from recurrent MR (≥ 2+), and freedom from MV reoperation was 95.2% ± 2.8%, 92.6% ± 3.9%, and 94.0% ± 4.9%, respectively.
Conclusions: MV repair of bileaflet prolapse due to myxomatous disease is safe and durable. Successful repair often requires a combination of surgical repair techniques.
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