Outcomes following repair of bileaflet prolapse due to myxomatous disease of the mitral valve

ObjectivesMyxomatous disease represents the most common cause of MR due to bileaflet prolapse. Mitral valve repair of mitral regurgitation (MR) due to bileaflet prolapse poses many technical challenges. In addition, late outcomes following repair are not well characterized in this population. Published series have included mixed patient cohorts and/or lacked long-term echocardiographic follow-up. And thus constitutes the focus of the current study.MethodsOne-hundred thirty six patients (mean age 57.3±17.5years) underwent mitral valve repair of bileaflet prolapse due to myxomatous disease from 2002–2010. Concomitant CABG was performed in 16 (12%) patients. All patients were followed by a dedicated mitral valve clinic with a follow-up interval that extended up to 6.6years.ResultsThere were no hospital deaths. Ring annuloplasty was used for all patients. Additional mitral valve repair techniques included chordal transfer (N=67), polytetrafluoroethylene neochords (N=22), edge-to-edge repair, including lateral edge-to-edge repair towards either commissure (N=30), or use of the hybrid-flip over technique (N=23). Prolapse involving more than one scallop of the posterior leaflet was observed in 32 (24%) patients whereas prolapse of more than one scallop of the anterior leaflet was observed in 56 (41%) patients. At follow-up, 3 patients had MR⩾2+, and no patients required subsequent mitral valve re-intervention. Five-year survival and freedom from recurrent (⩾2+) MR were 81.9±2.7% and 95.8±2.7%, respectively.ConclusionsMitral valve repair of bileaflet prolapse due to myxomatous disease is safe and durable. Successful repair often requires a combination of surgical repair techniques