Minimally invasive mitral valve repair for anterior leaflet prolapse

Objective: Mitral valve repair for anterior mitral leaflet prolapse is technically challenging. We report here our experience with minimally invasive anterior mitral leaflet repair. Methods: Our institutional database for minimally invasive mitral valve surgery was screened for patients with mitral regurgitation caused by isolated prolapse of the anterior mitral leaflet. Patient characteristics, intraoperative data, and short- and long-term outcomes are analyzed and reported. Results: A total of 180 patients presented with mitral regurgitation caused by isolated anterior mitral leaflet prolapse. All patients underwent minimally invasive surgery at our institution between 1999 and 2010. Mitral valve repair was performed in 170 cases (94.4%), and these patients form the focus of this study. The mean age of the patients was 59.7 +/- 14.8, and their mean log EuroSCORE was 4.9 +/- 5.1. Mean aortic crossclamp time (cardiopulmonary bypass time) was 82 +/- 25 minutes (130 +/- 40 minutes). Mitral valve repair techniques were neochordal replacement with the loop technique in 68.2% of patients, chordal transfer in 14.7%, anterior mitral leaflet resection in 7.1%, and edge-to-edge repair in 5.9%. Thirty-day mortality was 1.8%. Kaplan-Meier estimates showed 86.7% +/- 3.2% survival and 95.7% +/- 1.6% freedom from mitral valve reoperation at 5 years. Conclusions: This large series demonstrates good results for anterior mitral leaflet repair with the minimally invasive approach.