BACKGROUND: We studied the results of a dynamic mitral repair technique which preserves normal mitral valve function by avoiding leaflet resection and rigid/semi-rigid annuloplasty rings. METHODS: In previous reports we demonstrated that intraoperative simulation of mitral valve locking and isovolumic systole by rapid left ventricular inflation with pressurized saline accurately simulates mitral annular and leaflet shape and position, and LV outflow tract dimensions. Length of PTFE neochordae and size of fully flexible adjustable annuloplasty ring can be adjusted in 3D for accurate apposition of zones of leaflet coaptation, pre-marked with dots. We followed 1068 consecutive patients after repairs performed between 2001 and 2018. RESULTS: There were 674 (63.1%) males. Mean age was 62.25±13.0. Leaflet repaired was anterior 118 patients (11.05%), posterior 564 (52.81%), both 55 (5.15%), neither 123(11.5%). Barlow's disease was present in 208 (19.48%). Repair was isolated, 82.5% (881/1068). Reparability was 100%. Perioperative mortality overall was 1.59% (17/1068), isolated repair: 1.14% (10/881), isolated posterior leaflet: 0.85% (4/472). Leaflet SAM occurred in 1.7 % (18/1068), significant in 0.4% (4/1068). Survival at 10 yrs by Kaplan-Meier analysis was 74.65%, freedom from reoperation, 96.01%, freedom from severe mitral regurgitation (MR) 94.0%. The only predictor of reoperation (Cox Analysis) was: male, p=0.001. CONCLUSIONS: Use of intraoperative simulation of mitral dynamics led to 100% reparability for degenerative valves with minimal SAM, despite no leaflet resection. Long term durability has been good and similar for all leaflets.
BACKGROUND: We studied the results of a dynamic mitral repair technique which preserves normal mitral valve function by avoiding leaflet resection and rigid/semi-rigid annuloplasty rings. METHODS: In previous reports we demonstrated that intraoperative simulation of mitral valve locking and isovolumic systole by rapid left ventricular inflation with pressurizedsaline accurately simulates mitral annular and leaflet shape and position, and LV outflow tract dimensions. Length of PTFE neochordae and size of fully flexible adjustable annuloplasty ring can be adjusted in 3D for accurate apposition of zones of leaflet coaptation, pre-marked with dots. We followed 1068 consecutive patients after repairs performed between 2001 and 2018. RESULTS: There were 674 (63.1%) males. Mean age was 62.25±13.0. Leaflet repaired was anterior 118 patients (11.05%), posterior 564 (52.81%), both 55 (5.15%), neither 123(11.5%). Barlow's disease was present in 208 (19.48%). Repair was isolated, 82.5% (881/1068). Reparability was 100%. Perioperative mortality overall was 1.59% (17/1068), isolated repair: 1.14% (10/881), isolated posterior leaflet: 0.85% (4/472). Leaflet SAM occurred in 1.7 % (18/1068), significant in 0.4% (4/1068). Survival at 10 yrs by Kaplan-Meier analysis was 74.65%, freedom from reoperation, 96.01%, freedom from severe mitral regurgitation (MR) 94.0%. The only predictor of reoperation (Cox Analysis) was: male, p=0.001. CONCLUSIONS: Use of intraoperative simulation of mitral dynamics led to 100% reparability for degenerative valves with minimal SAM, despite no leaflet resection. Long term durability has been good and similar for all leaflets.