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Outcomes of Mitral Valve Repair for Posterior Leaflet Prolapse, Anterior Leaflet Prolapse, and Bileaflet Prolapse

Kemin Liu1, Qing Ye1, Yichen Zhao1

  • 1Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 100069 Beijing, China.

Reviews in Cardiovascular Medicine
|July 30, 2024
PubMed
Abstract

Insights

Mitral valve repair outcomes for posterior leaflet prolapse (PLP), anterior leaflet prolapse (ALP), and bileaflet prolapse (BLP) show similar long-term survival and reoperation rates. However, anterior leaflet prolapse repair has higher rates of recurrent mitral regurgitation.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Mitral Valve Disease

Background:

  • Degenerative mitral regurgitation (DMR) is a common condition requiring surgical intervention.
  • Mitral valve repair (MVr) is the preferred treatment for DMR, aiming to restore valve function and improve patient outcomes.
  • Different types of mitral valve prolapse, including posterior leaflet prolapse (PLP), anterior leaflet prolapse (ALP), and bileaflet prolapse (BLP), may have varying surgical repair outcomes.

Purpose of the Study:

  • To compare the clinical outcomes of mitral valve repair in patients with degenerative mitral regurgitation due to PLP, ALP, and BLP.
  • To evaluate differences in short-term and long-term results, including survival, reoperation rates, and recurrent mitral regurgitation.

Main Methods:

  • A retrospective study analyzed 1069 patients who underwent mitral valve repair for DMR between 2010 and 2019.
  • Patients were categorized based on the type of leaflet prolapse: ALP (25.5%), BLP (13.8%), and PLP (60.6%).
  • Outcomes including in-hospital mortality, long-term survival, reoperation rates, and recurrent mitral regurgitation were compared across the three groups, with an average follow-up of 5.1 years.

Main Results:

  • Patients with ALP were younger and had a higher prevalence of atrial fibrillation. Those with PLP had more hypertension. ALP and BLP groups showed larger left ventricular dimensions.
  • Cardiopulmonary bypass and aortic cross-clamp times were longer for ALP and BLP repairs.
  • In-hospital mortality was low (10 patients). Ten-year survival and freedom from reoperation rates were similar across all prolapse types. However, ALP repair demonstrated higher cumulative incidences of recurrent mitral regurgitation compared to PLP.

Conclusions:

  • Mitral valve repair for PLP, ALP, and BLP achieves comparable long-term survival and freedom from reoperation.
  • Anterior leaflet prolapse repair is associated with a higher incidence of recurrent mitral regurgitation compared to posterior leaflet prolapse repair.
  • These findings highlight the importance of considering specific leaflet prolapse morphology when assessing mitral valve repair outcomes.
Keywords:
anterior leaflet prolapsedegenerative mitral valve regurgitationposterior leaflet prolapse

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