Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Mitral Valve Disease

Background:

• The Carpentier technique for mitral regurgitation, while effective, has limitations including extensive posterior mitral leaflet resection and annular distortion.
• These limitations can negatively impact overall valve function and patient outcomes.

Purpose of the Study:

• To present an alternative mitral valve repair technique involving limited posterior mitral leaflet resection.
• To evaluate the 9-year clinical and echocardiographic outcomes of this modified technique.

Main Methods:

• A cohort of 54 patients with mitral prolapse undergoing repair using a limited posterior mitral leaflet resection technique between April 2005 and March 2014.
• The technique involves elliptical resection from the posterior smooth zone of the leaflet, preserving leaflet coaptation and annular integrity.
• Procedures were augmented with annuloplasty and neochordal insertion as needed.

Main Results:

• 98% follow-up completeness at 9 years.
• Excellent functional outcomes with 92% of patients in New York Heart Association class I and stable repair (regurgitation ≤1) in 92%.
• Good posterior mitral leaflet mobility was preserved in nearly two-thirds of patients, with low morbidity and mortality.

Conclusions:

• Limited parannular elliptical posterior leaflet resection is a safe and effective alternative for mitral valve prolapse repair.
• This technique avoids annular and leaflet distortion, restores proper coaptation, and maintains satisfactory leaflet motion, leading to excellent midterm results.