Augmentation of the Anterior Mitral Leaflet With an Untreated Autologous Pericardial Patch in Functional Mitral Regurgitation

Abstract

Background: Patch augmentation of the anterior mitral leaflet (AAML) is being used to treat functional mitral regurgitation (fMR) with the choice of patch material, however, still being a matter of debate. Therefore, the aim of this study was to determine the early- and 1-year results of AAML for fMR.

Methods: Between 2020 and 2022, 30 patients underwent AAML for Carpentier Type IIIb fMR using an untreated autologous pericardial patch in our institution. The mean age of the patients was 61.3 ± 19.3 years, and 16 patients (53.3%) were male. Early- and 1-year results of mitral valve repair were assessed via clinical follow-up including echocardiographic examination.

Results: Twenty patients (66.7%) were operated on through a right mini-thoracotomy and 10 patients (33.3%) via a median sternotomy, with 19 patients (63.3%) receiving a concomitant procedure. Three patients (10%) required postoperative mechanical circulatory support (MCS), with one of those patients (3.3%) deceasing due to multiple organ failure. Postoperative echocardiography showed that all patients (100%) had either no or mild MR. Freedom from moderate to severe MR was 100% (n = 29) at discharge as well as after a 1.1 ± 0.17-year follow-up (n = 26; with an additional three patients (10%) that deceased during the first postoperative year due to non–valve-related causes). No patient required mitral valve-related reoperation or intervention.

Conclusions: AAML using an untreated autologous pericardial patch is a safe and reproducible surgical technique for fMR, with promising early results up to a 1-year follow-up. Further follow-up is warranted to determine long-term results especially with regard to the durability of mitral valve repair.