Triangular Resection for Repair of Mitral Regurgitation Due to Degenerative Disease

p egenerative mitral valve disease is now the most common cause of mitral regurgitation in an aging Western opulation because of a decline in postinflammatory rheuatic valve pathology.1 The diagnosis of mitral valve proapse caused by leaflet degeneration can easily be made by chocardiography. Recent guidelines and publications ave underlined the importance of the early echocardioraphic diagnosis and quantification of mitral regurgitaion leading to prompt surgical correction of moderate-toevere regurgitation before the onset of left ventricular LV) dilation and decreased LV function. This is also the ase in asymptomatic patients.2 Mitral repair offers the dvantage of improved perioperative and long-term surival, greater regression of LV dimension, and the mainteance of LV function. Mitral repair has durability at least quivalent to replacement and offers the freedom from ong-term anticoagulation. Despite the advantages of miral valve repair, it is currently only performed in roughly 0% of patients undergoing operation for mitral regurgiation in the United States according to the Society of horacic Surgeons’ voluntary database. The remaining ajority undergo mitral valve replacement. This practice ay be due to the assumption that reparative techniques re complicated. Some of the more intricate procedures reviously popularized have led to the perception that itral valve repair is an elitist operation and may not be ndertaken successfully by the community cardiac sureon. The purpose of this article is to familiarize all cardiac urgeons with a more user-friendly, reproducible, and duable valve repair. Mitral regurgitation secondary to degenerative valve disase is most commonly caused by segmental leaflet prolapse ue to ruptured or elongated chordae tendineae. Statistically, he middle of the posterior leaflet, or P2, is the most common ulprit and, fortuitously, also the easiest leaflet to repair. The echniques for the repair of this particular lesion will be decribed. A durable repair can be performed in approximately 8% of patients with a mortality of less than 1%.3