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F1. POSTERIOR MITRAL LEAFLET EXTENSION:
A NEW ADJUNCTIVE REPAIR OPTION FOR ISCHEMIC MITRAL REGURGITATION ?
Frank Langer, Filiberto Rodriguez, Allen Cheng, Saskia Ortiz, Mary K. Zasio, David Liang, George T. Daughters, Neil B. Ingels, D. Craig Miller; Stanford, Palo Alto, CA

Objective:
Residual or recurrent mitral regurgitation occurs frequently after mitral valve repair for ischemic mitral regurgitation (IMR). Undersized ring annuloplasty primarily addresses annular dilatation in IMR, but probably is not adequate in all cases. Therefore, we studied an additional adjunct technique addressing the underlying restricted systolic leaflet motion (Carpentier type IIIb) causal problem.

Methods:
Six sheep had radiopaque markers placed on the LV and mitral apparatus. An elliptical-shaped autologous pericardial patch was sutured into the central scallop of the posterior mitral valve leaflet (PMVL) with the long-axis of the ellipse being parallel to the annulus, and was furled in with a reefing stitch. Reversible coronary ischemia was induced with a snare around the proximal circumflex artery. Under open chest conditions, 3-D marker coordinates were obtained with biplane videofluoroscopy at baseline, during acute ischemia, and before and after release of the reefing stitch (leaflet extension=LEX). IMR was graded simultaneously using TEE (0-4+).

Results:
With LEX, IMR decreased (control: 0.9±0.3*, ischemia: 2.4±0.3 LEX: 1.5±0.3*). This was due to the larger effective PMVL length (control: 1.39±0.09*, ischemia: 1.48±0.11, LEX: 1.76±0.12*) and effective PMVL central scallop area (control: 1.66±0.20*, ischemia: 1.91±0.22, LEX: 2.36±0.23* cm2) after LEX. (mean±1SEM; RM ANOVA, Dunnet’s post-hoc test versus ischemia, *p<0.05)

Conclusions:
Leaflet extension of the PMVL reduced acute IMR. This technique may be a useful adjunct in combination with ring annuloplasty in selected patients with IMR due to restricted systolic leaflet motion and apical tenting.

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