Overreduction of the posterior annulus in surgical treatment of degenerative mitral regurgitation

The concept of overreduction of the posterior annulus was applied in surgical treatment of degenerative mitral valve disease.From April 1993 to November 2004, 141 patients underwent overreduction of the posterior annulus of the mitral valve in mitral valve repair for degenerative disease. Mean scallop involvement per patient was 2.3 and increased to 3.0 in the last period. Correction of the prolapse of the posterior leaflet included resection with focal sliding (n = 100), or application of artificial chordae (n = 28), with (n = 11) or without (n = 17) plication of one or more scallops. The anterior leaflet prolapse was corrected with edge-to-edge technique (n = 20) or chordal replacement (n = 28). An overreducting ring, 40 (n = 81) or 50 (n = 60) mm long (autologous pericardium in 64 cases and Sovering Miniband [Sorin, Saluggia, Italy] in 77) was used in all the patients.Three patients died in the early period (2.1\%) and 3 (2.1\%) were reoperated on from 3 to 24 months due to endocarditis (2 cases) and failure of repair (1 case). Ten-year freedom from death any cause was 91.6\%, from reoperation 96.4\%, from death any cause and reoperation 87.7\%, from death any cause, reoperation, and New York Heart Association class III-IV 79.8\%. Sixty-four patients out of 68 who survived more than 2 years (94.1\%) at a mean follow up of 4.2 +/- 2.5 years had no or 1+ residual mitral regurgitation.Although the complexity of mitral valve repair for degenerative disease increased, results of surgery remained stable. Apposition of a posterior overreductive ring was useful to cover any mistake performed during the correction.