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Ann Thorac Surg 2006;81:849-856
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Feasibility and Intermediate Term Outcome of Repair of Prolapsing Anterior Mitral Leaflets With Artificial Chordal Replacement in 152 Patients

The Methodist DeBakey Heart Center, Houston, Texas

Accepted for publication August 29, 2005.

^_* Address correspondence to Dr Lawrie, 6560 Fannin, 1842, Houston, TX 77030 (Email: gmlawrie{at}att.net).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Mitral valve repair of the anterior leaflet has been more difficult than at other sites.

METHODS: Between February 1983 and June 2004, 607 mitral valve repairs were performed on one service. Of these, 410 patients had leaflet repair procedures: 152 were anterior leaflet repairs; isolated in 94, and combined with posterior repair in 58 patients. The results in these patients were compared with the results of posterior leaflet repair in 258 patients. All patients received flexible ring annuloplasty.

RESULTS: Age and sex of the anterior leaflet and posterior leaflet patients were similar: mean age 62.5 ± 14.3, 62.9 ± 14.9 years; males, 50.6%, p = not significant (NS). Preoperative ejection fraction was for anterior repairs 52.6 ± 12.8%; posterior repair, 58.2 ± 11.8%, p = NS. Coronary artery bypass was more frequently performed with anterior leaflet repair in 18 patients (19.1%) versus 45 (6.6%) for posterior leaflet repair (p = NS). The median number of chordae was similar in the anterior leaflet and posterior leaflet patients 4 (2–8), 4 (2–6), p = NS. Perioperative mortality was similar: anterior leaflet patients, 3.3% (2/94); posterior leaflet patients, 1.1% (2/258), p = NS. Hospital stay was for anterior leaflet patients and posterior leaflet patients: 12.86 ± 13.3 vs 11.0 ± 12.3, p = NS. Kaplan-Meier estimates of freedom from reoperation at 3 years were: for anterior leaflet patients, 91.9%: for posterior leaflet patients, 90.7%, p = 0.77. No structural polytetrafluoroethylene (PTFE) chordal failures were observed. Late echocardiographic data were obtained in 136 patients on 222 occasions at a mean of 3.2 ± 3.34 years. Severe mitral regurgitation was present in 10 patients (7.3%).

CONCLUSIONS: Repair of the anterior leaflet is facilitated by the use of PTFE replacement. Anterior leaflet repair can be performed reproducibly with the same results as posterior leaflet repair.

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