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BACKGROUND: The results of mitral valve repair (MVr) for anterior leaflet prolapse (ALP) have been less gratifying than those reported for posterior leaflet prolapse (PLP). We compared the long-term durability of two different surgical techniques: the “edge-to-edge” repair, used for the treatment of ALP, and the quadrangular resection adopted for correction of PLP.
METHODS: From 1991, 133 patients with ALP and 605 with PLP due to degenerative mitral valve disease underwent MVr. The edge-to-edge repair was used for correction of ALP and the quadrangular resection, with or without sliding plasty, for correction of PLP. All patients received a concomitant annuloplasty.
RESULTS: No hospital deaths occurred in the ALP group whereas 2 pts (0,3%) died in the PLP one (P=0,7). Mean follow-up was 4,5±3,12 years (range 1month-13,2 years). At 10 years overall survival was 91±4,06% for ALP and 93,5±1,81% for PLP (p=0,18), and freedom from cardiac death 95,8±2,83% and 97,4±0,95% (p=0,27), respectively. Freedom from reoperation at 10-year was 96,5±1,18% in the ALP and 96±2,3% in PLP group (p=0,37). Ten-year freedom from cardiac morbidity/mortality (cardiac deaths, stroke, reoperation) was 81,8±8,08% and 85,1±4,35% (ALP vs PLP, p=0,43).
CONCLUSIONS: The long-term results of the “edge-to-edge” repair in the setting of ALP are similar to those obtained with quadrangular resection for the treatment of PLP. The edge-to-edge technique, associated to annuloplasty, has been able to neutralize the prolapse of the anterior mitral leaflet as an incremental risk factor for suboptimal results in MVr.