Mitral Valve Repair with Pericardial Leaflet Augmentation

Objectives: Mitral valve repair with leaflet augmentation, utilizing a pericardial patch, for mitral valve insufficiency in ischemic and dilatative cardiomyopathy is postulated to reduce the recurrence of mitral valve insufficiency. The aim of this study was to evaluate the midterm results of augmented mitral valve repair regarding late valve failure.

Method and Results: From January 2011 to May 2015, 68 patients underwent a mitral valve repair with leaflet augmentation for restricted leaflet motion or annular dilatation. The technique used was posterior mitral leaflet extension utilizing the patient's pericardial patch. Annuloplasty-ring implantation was performed in all cases without downsizing.

The follow up was complete for 68 patients. Mean age was 66.6 years ranging from 25 to 86 years. 34 patients were female, 34 male. 46 patients (67.6%) had moderate (30.8%), to severely reduced (36.8%) ejection fraction; 22 patients had good (20%) or slightly reduced (11.7%) ejection fraction. Isolated mitral valve repair was performed in 25 patients (36.7%). Associated cardiac operation were MVR and TVR in 29 (42.6%), MVR and CABG in 8 (11.7%), MVR, TVR and CABG in 4 (5.9%), MVR and AVR in 2 (2.9%) cases. Three patients were redo operations; in two patients the approach was minimally invasive. Follow up was 4 months to 4.5 years.

There were no perioperative deaths. One patient died in hospital (1.4%) on postoperative day 60. Nine patients died late (13.2%); two patients related to the cardiac disease, three patients due to renal failure, and one patient due to multi-organ failure. In three patients cause of death could not be named.

58 patients were included in the follow up. Of these 49 patients were in NYHA Class I (84.5%), 9 patients were in NYHA Class II (15.5%), there were no patients in NYHA Class III or IV.

33 patients (57%) had no mitral insufficiency at follow up, 22 patients (38%) had mild insufficiency (I°), 3 patients (5%) had moderate insufficiency (II°). There was no patient with severe, more than Grade II°, mitral insufficiency.

There was no cardiac reoperation necessary for the reoccurrence of a mitral valve insufficiency (Freedom from reoperation 100%).

Conclusion: Mitral valve repair for leaflet restriction and annular dilatation with pericardial patch augmentation and annuloplasty ring without downsizing shows very good midterm results regarding the reoccurrence of mitral valve insufficiency.