Repair of chronic ischemic mitral regurgitation with posterior leaflet extension

We read with great interest the review article ‘Chronic ischaemic mitral regurgitation – current treatment results and new mechanism-based surgical approaches’ by Bouma and colleagues in a past issue of this journal [1]. Management of severe ischaemic mitral regurgitation remains challenging with disappointing long-term surgical results. Furthermore, despite the increasing popularity of valve repair, its long-term durability in chronic ischaemic mitral regurgitation continues to be uncertain. In this article, the authors worked in an excellent manner to review the different mechanisms of ischaemic mitral regurgitation, and to describe the variety of surgical approaches used to deal with this entity. To address leaflet tethering commonly observed in these patients, our group had recently reported the midterm results of posterior leaflet extension with a bovine pericardium, coupled with remodelling annuloplasty [2]. After extending the posterior leaflet height by about 1 cm from the medial half of P2 to the end of P3 in 44 consecutive patients with type IIIb ischaemic mitral regurgitation, the observed actuarial freedom from recurrent mitral regurgitation was 90% at 2 years. This also correlated with 90% of patients remaining in the New York Heart Association class I at 2 years. We believe that this is a relatively easy technique, safely reproduced, which can lead to good midterm results. Longer follow-up is necessary to assess the competency of the mitral valve and confirm the effectiveness of this approach.