Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era
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(2019) 14:205
RESEARCH ARTICLE
Open Access
Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era Daisuke Kaneyuki*, Hiroyuki Nakajima, Toshihisa Asakura, Akihiro Yoshitake, Chiho Tokunaga, Masato Tochii, Jun Hayashi, Akitoshi Takazawa, Hiroaki Izumida and Atsushi Iguchi
Abstract Background: Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions. Methods: Fifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011–2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively. Results: Additional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%. Conclusions: Seventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions. Keywords: Mitral valve repair, Bileaflet prolapse, Mitral regurgitation
Background Compared with promising long-term outcomes of mitral valve (MV) repair of isolated posterior leaflet lesions, anterior leaflet and bileaflet lesions have been recognized as a risk factor associated with repair failure [1–6]. Better outcomes of MV repair of anterior leaflet lesions have been reported after the emergence of several refined techniques, including neochordoplasty [2, 7, 8]. Despite the limited literature available, the long-term durability of MV repair of isolated commissural lesions * Correspondence: [email protected] Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama 350-1298, Japan
is comparable to that of posterior leaflet lesions [9, 10]. Even repair of bileaflet lesions can be feasible and result in good mid-term durability when
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