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

Ann Thorac Surg. 2011 Nov;92(5):1634-7; discussion 1637-8. doi: 10.1016/j.athoracsur.2011.05.123. Epub 2011 Oct 31.

Abstract

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.

MeSH terms

  • Female
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Annuloplasty / methods*
  • Mitral Valve Prolapse / surgery*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome