Can Augmentation of the Posterior Mitral Leaflet Prolong Repair Durability?

Objectives: The aim of this study was to evaluate the long-term results of mitral valve repair with augmentation of the posterior leaflet with regard to late recurrence of valve incompetence in functional mitral regurgitation.

Methods: From December 2011 to March 2020, a total of 174 patients (mean age: 65 ± 11.8) years) with severe mitral insufficiency of Carpentier Classification I and IIIa/b and an average tenting height of 11.9 mm, underwent a mitral valve repair with augmentation of the posterior leaflet besides a true size remodeling annuloplasty.

One hundred and twelve patients had dilative cardiomyopathy (64.4%), 48 patients (27.6%) had ischemic cardiomyopathy and 12 patients (6.9%) had a rheumatic mitral valve. For one patient, it was status post endocarditis and another had a congenitally restricted posterior leaflet. Concomitant bypass surgery was necessary for 16.1% and the tricuspid valve was repaired in 39.1%. Mean follow-up was 40 ± 28.2 months.

Result: There was no perioperative mortality. In-hospital mortality was 1.1% (two patients); late mortality was 10.9% (19 patients). Freedom from moderate or severe recurrent mitral regurgitation was 91.9% at 8 years and freedom from reoperation due to mitral valve insufficiency was 97%.

Conclusion: Augmenting the posterior leaflet of the mitral valve in addition to a remodeling annuloplasty is a safe and reproducible mitral reconstruction technique which renders good early and long-term mitral valve competence.

Publication History

Article published online:
19 February 2021