Anterior leaflet augmentation with autologous pericardium for mitral repair in rheumatic valve insufficiency

The mechanism of insufficiency in rheumatic valve disease includes annulus dilatation and restricted leaflet motion. In order to improve the treatment of restriction, the anterior mitral leaflet (AML) can be augmented with a piece of glutaraldehyde-treated autologous pericardium.

Between January 1995 and December 1999, among 274 patients referred for rheumatic mitral disease, 143 (52%) underwent a valve repair. Of these patients, 81% had pure regurgitation and 19% had significant associated stenosis. Ring annuloplasty was used in all cases. Techniques used to treat the restrictive component of the regurgitation were compared in two consecutive cohorts of patients, either with (n = 62) or without (n = 81) AML augmentation. Mean patient age was 42 +/- 3 years, and all preoperative variables were comparable except for the incidence of redo patients, who all underwent AML extension.

In-hospital mortality was 0.7% (n = 1 with AML extension), and there was one early reoperation for pericardial patch dehiscence. After a mean follow up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2.5%) than without (12.9%) AML augmentation (p <0.05). Echocardiography showed a lower incidence in recurrence of mitral insufficiency when AML augmentation was performed (grade 2, 9% versus grade 3, 3%) as compared to no AML augmentation (grade 2, 35% versus grade 3, 14%) (p <0.05). The mitral orifice area was larger (AML augmentation 2.2 +/- 0.3 cm versus no AML augmentation 1.8 +/- 0.4 cm2).

Ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair, and decreased the risk of reoperation.