Foldoplasty: a new and simplified technique for mitral valve repair that produces excellent medium-term outcomes.

BACKGROUND

Quadrangular resection with sliding valvuloplasty is the most common technique used to repair the posterior leaflet of the prolapsed mitral valve. Folding valvuloplasty is a simplified repair that does not involve resection and reduces the effective height of the posterior leaflet. We describe medium-term outcomes of patients who underwent folding valvuloplasty at our institution.

METHODS

From 2002 to 2010, 161 patients underwent folding valvuloplasty at our institution. The primary endpoints in our study of these patients' medium-term outcomes included survival, freedom from reoperation, and echocardiographic evidence of recurrent mitral regurgitation (MR).

RESULTS

The patients' median age was 61 ± 14 years, 68 of the patients (42%) were male, and 146 of the patients (90%) had more than moderate to severe MR. Cardiopulmonary bypass and cross-clamp times were 117 ± 40 minutes and 83 ± 29 minutes, respectively. In addition to folding valvuloplasty, mitral rings with a median size of 38 mm (interquartile range, 34 mm to 38 mm) were used in 155 (96%) of the patients. One patient died during surgery. Medium-term follow-up data were available for all of the patients at a mean of 3.0 ± 1.9 years after folding valvuloplasty. The patients' mean New York Heart Association class decreased significantly, from 2.0 ± 0.9 to 1.1 ± 0.4 (p < 0.0001), from the time of valvuloplasty to their mean medium-term follow-up evaluation. Two patients required reoperative mitral valve repair in the follow-up period. Postoperative echocardiograms were obtained for 142 (88%) patients at a mean of 1.6 ± 1.2 years after valvuloplasty. The patients' mean grade of MR decreased significantly from the time of valvuloplasty to the time of mean medium-term follow up, from 3.8 ± 0.5 (severe) to 0.8 ± 0.8 (trace-mild) (p < 0.0001), with only five patients (3%) having moderate MR at follow-up.

CONCLUSIONS

Folding valvuloplasty is durable and provides excellent structural and symptomatic results in patients with mitral prolapse. Given the ease and reproducibility of this technique, it should be offered as a suitable alternative to quadrangular resection for repair of the posterior leaflet in mitral prolapse.