Transverse posterior mitral leaflet folding for mitral valve prolapse: surgical technique and outcomes

Objective. To evaluate the long-term results of transverse posterior mitral leaflet folding for mitral valve prolapse. Material and methods. Forty-nine patients underwent mitral valve repair between September 2013 and August 2022. All patients had posterior mitral leaflet prolapse in one segment. The sample included 26 men and 23 women, mean age — 57±12 years. All ones had LV enlargement (end-diastolic volume (EDV) 182±50 ml) and satisfactory left ventricular contractility (ejection fraction (EF) 67±7%). After assessing the mitral valve we invaginated the prolapsed segment of posterior leaflet into the left ventricle with subsequent interrupted polypropylene sutures. After that, ring annuloplasty was performed. Results. One patient died in 23 days after surgery due to stroke. In 5 cases, we intraoperatively observed severe residual mitral regurgitation that required additional manipulations: sliding repair (n=1) and triangular resection of P2 segment due to SAM syndrome (n=1), additional Alfieri sutures (n=2), mitral valve replacement with mechanical prosthesis (n=1) because the cause of recurrent failure could not be eliminated after repeated aortic cross-clamping. Other patients were discharged with no or minimal mitral regurgitation. Mean follow-up period was 66±25 months, mortality — 4.4% (n=2). One patient died after 48 months due to stroke, 1 patient — from arrhythmia complicated by chronic heart failure. Other patients had no active complaints. LV EF was 64±4%, LV EDV — 123±23 ml. There was only 1 (2.2%) case of severe mitral regurgitation. Other patients had no or minimal mitral regurgitation. Peak and mean pressure gradients were physiological (5±1 and 3±1 mm Hg, respectively). Conclusion. Transverse plication of prolapsed posterior mitral leaflet demonstrates stable immediate and long-term results. This reconstruction is easy and not irreversible. In case of intraoperative recurrence of regurgitation, this technique makes it possible to return to original state of the valve and perform other reconstructions.