Benefits in Simplicity of Folding Plasty for Mitral Valve Repair

Objectives: Although leaflet resection suture (RS) is the standard mitral valve (MV) repair in patients with degenerative MV regurgitation, folding plasty is an alternative method of MV repair. In this study, feasibility, reproducibility and postoperative mitral valve (MV) regurgitation were compared between leaflet resection suture (RS) and folding plasty (FP). Methods: Seventy-nine patients with degenerative MV disease of posterior (PL) and commissure lesion (CL) were reviewed. Two techniques were compared in; (1) feasibility of MV repair, (2) how to control residual MV regurgitation found by saline test, and (3) postoperative MV regurgitation area (MRA). Results: In PL, all patients in both groups underwent MV repair, and in CL, 8/9 (92%) in RS and 15/16 (94%) in FP underwent MV repair (p=0.667). In PL, 2/19 (11%) in RS required additional procedure (artificial chordae (2)), and 0/35 (0%) required additional procedure in FP (p=0.051). In CL, 6/8 (75%) in RS required additional procedure (artificial chordae (2), edge-to-edge (4)), and 0/15 (0%) required additional suture in FP (p<0.001). Redo-suture was not performed in RS, however, adjustment of the coaptation was dealt with redo-suture (posterior:57%, commissure: 56%) in FP. There were no differences in postoperative MRA. Ischemic time was shorter in FP than RS group (RS:103±24 min vs. 87±24 min, p=0.015). Conclusions: Leaflet resection is a standard operative procedure, however, folding plasty is an effective alternative which has advantages in reproducibility, easiness in redo-suture when coaptation re-adjustment is required, and these advantages were significantly shown in CL.