A Multiparameter Algorithm to Guide Repair of Degenerative Mitral Regurgitation

Abstract Purpose Degenerative mitral regurgitation repair using a measured algorithm could increase the precision and reproducibility of repair outcomes. Methods Direct and echocardiographic measurements guide the repair to achieve a coaptation length of 5-10 mm and minimize the risk of systolic anterior motion. Leaflet reconstruction restored the normal 2:1 ratio of anterior to posterior leaflet length without residual prolapse or restriction. The choice of ring size was based on anterior leaflet length, the distance from the leaflet coaptation point to the septum, and the anterior-posterior ring dimension. Freedom from reoperation and mitral regurgitation recurrence were based on multi-state models. Results 1,051 patients had mitral surgery and 1,026 (97.6%) were repaired. A2 length was 27.2 ± 4.5 mm; and the reconstructed posterior leaflet was 13.9 ± 2.3 mm. Median ring size was 34 mm and strongly correlated to A2 length (R=0.76, p Conclusions A simple, reproducible, measured algorithm for degenerative mitral valve repair provides excellent early and late results and is a useful adjunct to established surgical techniques.