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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
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What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long-Term Durability?
Takashi Kakuta1,2, Satsuki Fukushima1, Kimito Minami3
1Department of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita Japan.
Journal of the American Heart Association
|May 26, 2023
Summary
Mitral valve repair for posterior leaflet prolapse showed recurrence of mitral regurgitation (MR) with chordal replacement and functional mitral stenosis with full rings. Leaflet resection with a partial band appears optimal for isolated posterior mitral valve prolapse.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Assessing long-term outcomes of mitral valve repair for isolated posterior mitral leaflet prolapse.
- Identifying risk factors for mitral regurgitation (MR) recurrence and functional mitral stenosis post-repair.
Purpose of the Study:
- To evaluate risk factors for MR recurrence and functional mitral stenosis after mitral valve repair.
- To determine optimal surgical strategies for isolated posterior mitral leaflet prolapse.
Main Methods:
- Retrospective analysis of 511 patients undergoing primary mitral valve repair for isolated posterior leaflet prolapse (2001-2021).
- Surgical techniques included partial band annuloplasty (86.3%) and leaflet resection (83.0%).
- Multivariable Fine-Gray regression model used to identify risk factors for MR recurrence (≥grade 2) and functional mitral stenosis (mean transmitral pressure gradient ≥5 mmHg).
Main Results:
- 10-year cumulative incidence of MR ≥grade 2 was 30.1%; functional mitral stenosis was 29.3%.
- Risk factors for MR recurrence included chordal replacement without resection and larger prosthesis size.
- Factors for functional mitral stenosis included use of a full ring, smaller prosthesis size, and larger body surface area.
Conclusions:
- Chordal replacement without resection and larger prosthesis size are associated with MR recurrence.
- Full ring annuloplasty, smaller prosthesis size, and larger body surface area are linked to functional mitral stenosis.
- Leaflet resection combined with a large partial band may represent an optimal surgical approach for isolated posterior mitral valve prolapse.
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