Current Status of Mitral Valve Repair

Abstract
Background: Techniques of MV repair have undergone many modifications and improvements in the last three decades, which have made it a more predictable and reproducible method either in rheumatic or degenerative mitral valve repair.
Aim of Study: 1- Comparing the results of repairing degenerative mitral valve versus the rheumatic pathology. 2- Assessment the results of resectional technique (excising part of valve leaflet) and the respect one (preserving the valve leaflet without excision any part of it) for posterior leaflet prolapse during the degenerative mitral valve repair.
Patients and Methods: This prospective study was con-ducted in the Department of Cardiac Surgery, National Heart Institute (NHI) from July 2014 to December 2017 including postoperative follow-up at 6 months. One hundred cases with severe mitral valve regurgitation underwent mitral valve repair divided into two groups: Group “D” where 50 cases had degenerative mitral valve pathology with a predominant mitral regurgitation and Group “R” where 50 cases had rheumatic valve disease with a predominant mitral regurgitation and high likelihood of repair. Techniques used for repair of prolapsed degenerative PML divided into resection technique and respect one.
Results: As regards comparison between Group “D” versus Group “R” there was significant increase in MV area, MPAP and mean diastolic gradient of MV in group “D” than group “R” at 6 months of post-operative follow-up. Five cases in Group “R” had a mean diastolic mitral gradient more than 10mmHg that needed mitral valve replacement, four cases of them were post leaflets' shaving and decalcification. Degree of residual mitral regurgitation in Group “D” included 41 (82%) cases with no or trivial regurgitation while 9 (18%) cases were mild, whereas in group “R” 37 (74%) cases had no or trivial regurgitation, 9 (18%) had mild mitral regurgita-tion, 2 (4%) was mild to moderate and 2 (4%) cases had moderate mitral regurgitation that needed further follow-up with echocardiography every 6 months. Comparison between resection technique versus respect one revealed a significance difference between both groups as regards MVA and size of the ring annuloplasty but no significance difference was found between both groups as regards degree of residual MV regurgitation or mean diastolic MV gradient after 6 months of follow-up.
Conclusions: The early postoperative results for posterior mitral leaflet repair with respect technique using Uniscalloping of posterior leaflet or artificial chordae-ePTFE-is very accept-able and recommended. Using of artificial chordae to AML is very effective and safe to solve the problem of leaflet prolapse. Rheumatic valve repair appears to be possible in selected cases with rheumatic mitral valve dysfunction. Leaflet procedures in rheumatic valve repair may be associated with reduced durability of rheumatic MV repair.