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J Thorac Cardiovasc Surg 2004;127:440-447
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Neochordal repair of the posterior mitral leaflet

^a Department of Cardiothoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif, USA
^b Department of Anesthesiology, Keck School of Medicine of the University of Southern California, Los Angeles, Calif, USA

Read at the Twenty-ninth Annual Meeting of The Western Thoracic Surgical Association, Carlsbad, Calif, June 18-21, 2003.

Received for publication June 18, 2003; revisions received September 9, 2003; accepted for publication October 7, 2003.

^* Address for reprints: John J. Nigro, MD, Children's Hospital Los Angeles, Department of Cardiothoracic Surgery, 4650 Sunset Blvd, MS 66, Los Angeles, CA 90027, USA
jnigro{at}chla.usc.edu

BACKGROUND: Myxomatous mitral valve insufficiency is traditionally repaired by posterior leaflet quadrangular resection and reconstruction. A simplified repair technique without leaflet resection is described, and our initial experience is reviewed.

METHODS: Thirty-nine consecutive patients with significant mitral regurgitation underwent repair since January 2000 by placement of expanded polytetrafluoroethylene sutures between the leading (coapting) edge of the posterior leaflet and the corresponding papillary muscle. An annuloplasty ring was placed, and no leaflet tissue was resected. Patient medical records were obtained and retrospectively reviewed.

RESULTS: Twenty-five men and 14 women (median age, 61 years; range, 40-88 years) had their mitral valve repaired by a variety of surgical approaches, including robotic (18 patients), right thoracotomy (6 patients), and sternal (15 patients). Three patients have required valve replacement: 1 at the initial operation, 1 because of dehiscence of the annuloplasty ring, and 1 after subsequent rupture of a previously normal native chorda. At follow-up (median, 12 months), 92% (33/36) of the remaining patients had an intact mitral repair with no to mild regurgitation, 8.3% (3/36) of patients had moderate regurgitation, and 92% of all patients (36/39) were in New York Heart Association class I. There were no deaths.

CONCLUSIONS: Myxomatous mitral regurgitation due to posterior leaflet insufficiency can be repaired without leaflet resection by placement of neochordae. This repair technique is effective and is readily accomplished by traditional and minimally invasive surgical approaches.

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