Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes.

PURPOSE: Residual mitral regurgitation (MR) is a risk factor of reoperation. Here we report the midterm results of mitral valve repair for degenerative disease with mitral valve prolapse and identify important factors for durable repair.

METHODS: From April 1999 to September 2007, 116 patients with leaflet prolapse (59 men; mean age 63 years) underwent mitral valve repair; they consisted of 19 anterior, 67 posterior, 23 bileaflet, and 7 isolated commissures. The mean clinical and echocardiographic follow-ups were at 4.1 +/- 2.3 and 3.3 +/- 2.4 years, respectively.

RESULTS: Altogether, 12 patients showed recurrent moderate or severe MR during the follow-up period; and 10 of the 12 patients (83.8%) had recurrent moderate or severe MR within 1.5 years. Causes of early MR recurrence were dehiscence of sutured segments and ineffectiveness of the artificial chords. The rates of freedom from reoperation at 3 and 7 years were 95.3% +/- 2.0% and 91.0% +/- 4.7%, respectively. The rates of freedom from recurrent moderate or severe MR at 3 and 7 years were 90.5% +/- 2.9% and 83.8% +/- 5.9%, respectively.

CONCLUSIONS: The prevention of dehiscence of the sutured segment and reestablishment of coaptation using artificial chords are imperative to maintain the durability of mitral valve repair for patients with degenerative disease.