Midterm Results of Mitral Valve Repair With Pericardial Leaflet Augmentation: A Single-Center Experience

In certain pathologies, mitral valve repair is complicated by a paucity of tissue caused by fibrosis or destruction. Utilization of autologous pericardium for leaflet augmentation may be the only option to repair these valves. We present the midterm results of mitral valve leaflet augmentation with glutaraldehyde-fixed autologous pericardium. One hundred thirty consecutive patients undergoing mitral valve repair with glutaraldehyde-fixed pericardial augmentation of leaflets were followed up clinically and by echocardiography at 6-month intervals. Mean age was 24.8 years (range 2-64). The etiology was rheumatic in 75.3%, indeterminate in 8.4%, and other in 16.1%. Out of the rheumatics, 57.1%, 24.4%, and 18.3% had combined mitral stenosis and mitral regurgitation, isolated mitral regurgitation, and mitral stenosis, respectively. About 21.5% had a recent history of rheumatic activity. Eight were operated emergently for intractable heart failure. Majority of the patients required repair of multiple components of the mitral valve apparatus. Leaflet peeling was done in 52.3%. Pericardial patch augmentation of anterior mitral leaflet, posterior mitral leaflet, or both were carried out in 61.5%, 34.6%, and 3.8% patients respectively. Sixty percent got chordal procedures, while 92.3% got annuloplasty. There were no deaths during the mean follow-up period of 28 months. Ninety-three percent of our patients were in New York Heart Association class I and II on follow-up. There were 11 repair failures. Seven patients underwent a reoperation, while 4 patients are being managed conservatively (reoperation rate 5.38%). Augmentation of mitral valve leaflets with autologous pericardium allows many significantly fibrosed and destroyed valves to be reliably repaired with good midterm durability and hemodynamics.