Early outcome of folding mitral valve repair technique without resection for mitral valve prolapse in 60 patients

Objectives: Leaflet resection represents the reference standard for mitral valve regurgitation. However, the resection technique is irreversible and requires leaflet cutting and reapproximation. Folding mitral valve repair is a nonresectional technique with inversion of the prolapsed segment into the left ventricle. The present study evaluated the effectiveness of this technique. Methods: The prolapsed segment was inverted into the left ventricle vertically. A pilot suture was placed at the free edge of the leaflet. After confirming no mitral valve regurgitation with a pressure test, additional sutures were placed toward the annulus. If the test still showed mitral valve regurgitation, the suture was removed and repositioned. Ring annuloplasty was performed in all patients, except those with active infectious endocarditis. The repaired mitral valve was evaluated using echocardiography. Results: A total of 60 patients (37 men; mean age, 62.4 years) underwent folding mitral valve repair from January 2007 to September 2011. Of these patients, 38 (63%) had moderate and 18 (30%) had severe mitral valve regurgitation preoperatively. Folding mitral valve repair was applied to the anterior leaflet and posterior leaflet. The mean cardiopulmonary bypass time and crossclamp time were 148 and 90 minutes, respectively. No patient had systolic anterior motion. Postoperative echocardiography revealed no mitral valve regurgitation to trivial mitral valve regurgitation in 48 and mild mitral valve regurgitation in 12 patients. No patient required reoperation for recurrent mitral valve regurgitation. Conclusions: Folding mitral valve repair is an easily fine-tuned technique with a pilot suture, which can be easily removed and repositioned, if unsatisfactory. This reversibility is a significant advantage of this technique. Longterm follow-up is necessary to assess the durability of this technique. (J Thorac Cardiovasc Surg 2013;145:104-9)