“Respect When You Can, Resect When You Should”: A Realistic Approach to Posterior Leaflet Mitral Valve Repair

“Respect When You Can, Resect When You Should”: A Realistic Approach to Posterior Leaflet Mitral Valve Repair

https://www.ctsnet.org/jans/%E2%80%9Crespect-when-you-can-resect-when-you-should%E2%80%9D-realistic-approach-posterior-leaflet-mitral-valve?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+12%2F7%2F2018

J Thorac Cardiovasc Surg　2018;156:1856-66

“respect when you can, resect when you should” concept
 Resection was performed only if an excess tissue in height or width was present. The excess tissue in height was treated if P2, after a complete unfolding, was twice as high than P1 or P3. In such cases, a transverse resection of P2 was performed to bring it to approximately the same height as P1 and P3 (P2 being slightly higher than P1 and P3 in a normal valve).
This usually removes the rough area that was thickened. During this
operative step, great care was taken to individualize the secondary, and
even marginal, chordae that were at the adequate length (when compared
with the reference point) to resuspend the new free edge of P2. As far as
the excess in width is concerned, it was treated and carried out each time
there was an obvious and natural transverse folding of the leaflet. The
most objective way to evaluate such an excess of tissue in width was to
lay P2 on the posterior ventricular wall and to see if there was any natural
folding. When this happened, a small triangular resection was performed,
the base of the triangle being at the level of the free edge and the apex at the
annulus. A small resection was often effective in eliminating the excess
transverse tissue without putting the posterior leaflet (PL) under tension

2005 - 2015
701 consecutive  severe mitral regurgitation
441 degenerative:  376 posterior leaflet prolapse (24.7% isolated P2 and 75.3% P2 associated with other segments)

aged 65.8 ± 13 years, and 70.5% were male.
Median follow-up was 61.1 months.

There were 3 hospital deaths (0.8%). Reoperation was necessary in 7 patients (1.9%).

After 1, 5, and 10 years,
overall survival was 97.8%, 93.6%, and 86.7%
recurrent/residual >2+ mitral regurgitation was  0.7%, 1.9%, and 5.9%
New York Heart Association III/IV at 0.8%, 1.9%, and 5.3%.