Resecting and nonresecting techniques for posterior mitral leaflet prolapse

Posterior leaflet (PL) prolapse is commonly treated with quadrangular resection, but nonresecting techniques were proposed as an alternative. We evaluated our experience to identify specific indications to nonresecting techniques.

From March 2006 to February 2009, 60 patients were treated for PL prolapse, 21 using resecting (group R), and 39 nonresecting (group NR) techniques. Patients in group R had fibroelastic deficiency with isolated P2 prolapse and P1 or P3 (or both) thin or short (n = 15); need of excessive P2 resection (more than 1/3 of the posterior annulus) (n = 10); dominant or codominant circumflex artery (n = 10). Some of them were young and were operated on without preoperative coronary angiography (n = 4).

One patient (1.7%) in group R died during the first 30 days after surgery. Three-year survival was 89.6 ± 4.5, similar in both groups. A postoperative echocardiogram was obtained 20 ± 6 months after surgery in every survivor. Mitral regurgitation decreased significantly soon after surgery without any significant modification at follow-up in both groups.

nonresecting techniques provide good midterm results, similar to resecting ones. To resect or not resect part of the PL has, in our personal practice, its own indications and contraindications. Extensive use of artificial chords and reduction of PL height, when indicated, is able to provide other tools to safely expand mitral repair for PL prolapse.