Early and late results of mitral valve repair with anterior leaflet patch augmentation

• Published in: Interactive cardiovascular and thoracic surgery 2022-07, Vol.35 (2)
• Main Authors: Kehara, Hiromu, Minakata, Kenji, McCarthy, James, Sunagawa, Gengo, Mangukia, Chirantan, Brann, Stacey, Zhao, Huaqing, Boova, Robert, Toyoda, Yoshiya
• Format: Article
• Language: English
• Subjects: Adult Cardiac
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivac144

Abstract OBJECTIVES The aim of this study was to determine the long-term results of mitral valve (MV) repair with anterior leaflet patch augmentation. METHODS Between 2012 and 2015, 45 patients underwent MV repair using the anterior leaflet patch augmentation technique at our institution. The mean age of the patients was 65.9 ± 13.0 years (16 males). We reviewed the MV pathology and the surgical techniques used and assessed the early and late results. RESULTS In terms of MV pathology, 43 patients (95.6%) had pure mitral regurgitation (MR) and 2 patients (4.4%) had mixed mitral stenosis and MR. Rheumatic changes were seen in 18 patients (40.0%). Postoperative echocardiography showed that 95.6% of patients had none to mild MR. During a median follow-up period of 5.5 years (range 0.1–8.3 years), there were 8 late deaths. Nine patients (20%) required reoperation. The mean interval between the initial operation and redo operation was 3.7 ± 3.1 years (range: 0.4–7.8 years). The causes of reoperation included patch dehiscence (n = 4), progression of mitral stenosis (n = 2), band dehiscence (n = 1), patch enlargement (n = 1) and unknown (n = 1). Eight patients underwent MV replacement and 1 underwent repeat MV repair. The freedom from reoperation at 3 and 5 years was 85.7 ± 6.7% and 81.2 ± 7.7%, respectively. CONCLUSIONS Anterior leaflet patch augmentation can provide excellent early results in the majority of the patients even in the presence of rheumatic pathology; however, we observed late reoperation in 20% of patients. Thus, this technique should be used with caution and careful follow-up with serial echocardiography is essential. Mitral valve (MV) repair is a common procedure and the rule rather than exception in patients suffering from mitral regurgitation (MR) due to degenerative disease [1], with a repair rate of >90% by experienced centres [2, 3].