Long term results of mitral valve repair of posterior or bileaflet prolapse with two different concepts

Background

To evaluate the long term results of two simple techniques for correction of posterior or bileaflet prolapse with no incidence of postoperative systolic anterior motion of the anterior mitral leaflet (SAM).

Methods

From June 2010 to June 2016, 64 patients underwent mitral valve repair. Edge to edge,(35 patients)(group A) Vs. (‘U’) technique, (29 patients) (group U). A mean follow-up of 58 ± 13 months in (group A) and 42 ± 16 months in (group U).

Results

There were no early or late deaths. Both surgical techniques showed excellent immediate postoperative results regarding reduction of the mitral regurgitation grade-accepted mean pressure gradients (MPG) through the mitral valve (2.3 ± 0.6). Left ventricular function was maintained, and tricuspid regurgitation grade was reduced overall. During the follow-up period, Significant increase in the MPG was observed in (group A) with no significant change in the degree of mitral regurge. The majority of them with significant increase are due to the rheumatic pathology(9/12). They became symptomatic and came out of the study after a follow up period of 41 ± 13 months and their valves were replaced while those with non rheumatic pathology remained of reasonable gradient. Redo mitral valve replacement was done in only one patient in (group U) due to early endocarditis.

Conclusions

Despite the rationale is completely different in both techniques (double orifice, double leaflet(A) versus Uni-leaflet, Uni-orifice(U)), the long-term results are comparable in both. The U technique is mostly better in rheumatic patients but need more follow up on larger scales of this patient group.