A New Paradigm for the Repair of Posterior Leaflet Prolapse: Respect Rather Than Resect

p a ( t a d s a c t n f p osterior leaflet prolapse is the most frequent dysfunction of the degenerative mitral valve and has been the first esion accessible to repair.1 In 1994, we started to cautiously se a method to respect the posterior leaflet by its preservaion for this dysfunction. The goal of this approach is to orrect the prolapse by using expanded polytetrafluoroethylne (e-PTFE)1 suture neochordae without leaflet resection to esuspend the free edge of the posterior leaflet. Today, this echnique represents our method of choice in repairing poserior leaflet prolapse and can be applied to the vast majority f these patients. Currently, our institution applies this ethod in 85% of the patients with this dysfunction. Several advantages may orient toward this technique in especting the tissue of the posterior leaflet. 1. The goal of mitral valve repair relies on the restoration of good surface of coaptation to ensure a satisfactory function f the mitral valve.2 Leaflet tissue is the primary component efining the surface of coaptation, and it may be preferable to reserve as much of the leaflet tissue, as opposed to resecting significant portion of it. 2. Three scallops of different heights compose the posteior leaflet. The highest leaflet (P2)3 sustains the most imporant stress during systole. Instead of resecting this area, repecting the tissue of the posterior leaflet maintains anatomic nd dynamic relationships, allowing for a better distribution f forces and stresses on the valve components. 3. Artificial chordae has been used to repair mitral valves