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Anterior vs Posterior MV Repair — EECC MCQ

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ModerateValvular Heart DiseaseAnterior vs Posterior MV RepairEECC

A 70-year-old man with severe symptomatic MR due to a flail A2 segment of the anterior mitral leaflet is assessed. The Heart Team discusses the surgical approach. Why is anterior leaflet pathology more challenging to repair than posterior?

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Correct answer: D — Anterior leaflet repair is technically more demanding with lower durability compared with posterior leaflet repair; P2 pathology has >95% repair rates at expert centres, while anterior leaflet repair rates are lower (~70-85%) even at expert centres

The posterior mitral leaflet (particularly the P2 scallop) is the most common site of degenerative MR pathology and is amenable to standardised repair techniques (quadrangular/triangular resection, artificial chordae) with excellent durability (>95% repair rate, <5% reoperation at 20 years at expert centres). Anterior leaflet pathology is more challenging because: (1) the anterior leaflet constitutes a larger proportion of the coaptation surface; (2) resection is limited (risk of restrictive leaflet motion); (3) repair relies more heavily on artificial chordae (Gore-Tex neochordae), which have evolving but somewhat less established long-term durability data; (4) commissural and bileaflet prolapse adds complexity. The 2025 ESC VHD Guidelines recommend referral to expert centres for anterior leaflet repair.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease