Safety and durability of mitral valve repair for anterior leaflet perforation

Objective: We sought to evaluate mitral valve repair for anterior leaflet perforation. Methods: Between October 1987 and October 2006, 26 patients with mitral valve anterior leaflet perforation underwent mitral valve repair (median age, 54 years; 18 [69%] were male). Results: The indication for operation was severe mitral regurgitation only in 14 patients, both aortic regurgitation and mitral regurgitation in 11, and ventricular septal defect repair in 1. Twenty-four (92%) patients had endocarditis and 13 (50%) had at least mild aortic regurgitation preoperatively. Left atriotomy was performed in 17 (65%) and aortotomy in 8 (31%). Six (23%) patients had visible vegetations at the time of repair. For anterior leaflet repair, a patch was used in 11 (42%) patients and primary suture closure in 15 (58%). Eighteen patients underwent concomitant cardiac surgical procedures. Postoperative follow-up (mean, 6 years) was available for 25 (96%) patients. There was 1 early death from multiorgan failure and 2 late deaths. Patient survival was 95% at 1 year and 90% at 5 years. Left ventricular end-diastolic dimension improved significantly after mitral valve repair at dismissal (n = 16; -9.4 mm; P < .01) and during follow-up (n = 11; -10.8 mm; P < .01). Only 1 (4%) patient had mitral valve reoperation after 7 years owing to recurrent endocarditis 6 months after repair. Conclusions: Mitral valve anterior leaflet perforation may be safely repaired with good midterm survival and durability.