Two-Year Outcomes after Augmentation of Anterior Mitral Leaflet for Functional Mitral Valve Regurgitation

Background: Durable surgical repair in severe functional mitral regurgitation (fMR) remains still challenging. The aim of this prospective study was to analyze the 2-year outcome data after mitral valve reconstruction using augmentation of anterior mitral leaflet (AAML) with autologous pericardial patch.

Methods: Between 2020 and 2022, 30 adult patients with severe fMR (Carpentier Type IIIb) underwent AAML at our institution. Two years postoperatively, a follow-up examination was performed by transthoracic echocardiography as well as questionnaires.

Results: Twenty-three (76.7%) out of 26 still alive patients who survived 1 year reached 2 years follow-up. Four patients (13.3%) died within 12 months due to valve-unrelated complications. Freedom from recurrence of moderate or severe mitral regurgitation at 2 years was 100%. Three patients (10%), who haven’t reached the 24 months yet, had a trace or mild mitral regurgitation at 12 months. In one asymptomatic patient, a mild mitral valve stenosis (MS I°) was diagnosed at 2 years. No valve intervention or reoperation was required. No neurological or major adverse cardiac events (MACE) were observed. At 2 years mean left ventricular end-diastolic diameter (LVEDD) among surviving patients was 53.7 ± 6.1 mm (mean change from postoperative and 1 year: −2.0 mm and −0.3 mm, respectively, p = 0.529). Mean LV-EF was 44.8 ± 8.0% (mean change from postoperative and 1 year: +6.2% and +0.8%, respectively, p = 0.002). Mean anterior mitral leaflet (AML) length was 28.7 ± 1.9 mm (mean change from postoperative and 1 year: +3.1 mm and +1.0 mm, respectively, p < 0.001). Mean coaptation length was 8.8 ± 1.4 mm (mean change from postoperative and 1 year, −0.2 mm and −0.2 mm, respectively, p = 0.709).

Conclusion: In patients with severe functional mitral valve regurgitation, reconstruction by augmentation of anterior leaflet revealed durable results at 2 years follow-up, without recurrence of moderate or severe regurgitation. The reverse remodeling of the left ventricle develops mostly during first year and remains stable at 2 years.

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Artikel online veröffentlicht:
11. Februar 2025