Chordal Reconstruction versus Leaflet Resection for Repair of Degenerative Posterior Mitral Leaflet Prolapse

Chua, Yeow Leng; Pang, Philip Y.K.; Yap, Yen Ping; Salam, Zakir Hussain Abdul; Chen, Yang Tian

doi:10.5761/atcs.oa.15-00322

Cited by 8 publications

(5 citation statements)

References 23 publications

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“…In addition, isolated chordal reconstruction with leaflet preservation permits the use of larger annuloplasty rings and thus is associated with lower transmitral gradients, as has also been confirmed by Chua and colleagues. 8 In conclusion, I fully support the conclusions of Mazine and colleagues 6 that ''high-quality RCTs of chordal replacement versus leaflet resection are needed.'' At least to me, however, the main conclusion to be derived is that both techniques have so far shown excellent long-term results, probably not significantly different.…”

supporting

confidence: 64%

Isolated posterior mitral leaflet prolapse: Resect, respect, or resect with respect?

Antunes

2018

The Journal of Thoracic and Cardiovascular Surgery

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supporting

confidence: 64%

Isolated posterior mitral leaflet prolapse: Resect, respect, or resect with respect?

Antunes

2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Patients who underwent MV repair via non‐resection techniques reportedly had preserved PML mobility, 12,13 larger annuloplasty rings, 12,14–17 and lower incidence of SAM 18 and postoperative AF 19,20 than those for whom resection techniques were used. However, regarding postoperative MV hemodynamics, only a few clinical studies have compared the two techniques.…”

Section: Resultsmentioning

confidence: 96%

“…However, regarding postoperative MV hemodynamics, only a few clinical studies have compared the two techniques. Unmatched observational studies found lower MV gradients with non‐resection techniques than with resection techniques, 14,17 whereas a randomized control trial failed to show superior MV hemodynamics in non‐resection techniques 21 . It should be noted that these studies compared the results of resection alone versus those of chordal replacement alone, excluding cases in which both techniques were performed.…”

Section: Resultsmentioning

confidence: 99%

Clinical impact of the repair technique for posterior mitral leaflet prolapse: Resect or respect?

Sakaguchi

Hiraoka²,

Totsugawa³

et al. 2021

J Card Surg

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Background and Aim Leaflet resection and chordal reconstruction are established repair techniques for posterior mitral valve (MV) prolapse. This study aimed to compare the clinical results of the resect and respect approaches, with a particular focus on MV hemodynamics. Methods Overall, 291 patients who underwent elective MV repair for isolated posterior leaflet prolapse between 2012 and 2020 were enrolled. Patients who underwent leaflet resection alone were classified as the “resection” group (n = 166), while patients who underwent neochordal replacement with/without limited leaflet resection were classified as the “respect” group (n = 125). Early postoperative MV hemodynamics and midterm repair durability were compared between the groups. Results The annuloplasty ring size was significantly larger in the respect group than in the resection group (31.0 ± 2.1 vs. 30.4 ± 2.0 mm, p = .028). The respect group showed significantly lower mean MV gradient (2.6 ± 1.1 vs. 3.0 ± 1.4 mmHg, p = .03) and larger effective orifice area (EOA) (1.86 ± 0.48 vs. 1.66 ± 0.47 cm2, p < .001) than the resection group. Multivariable analysis identified the respect approach, younger age, female sex, larger ring size, and partial band as independent determinants of larger EOA. The rate of freedom from moderate or greater recurrent mitral regurgitation 5 years postoperatively was 90.9% in both groups. Conclusions The respect approach allowed for a lower MV gradient and a larger EOA than the resection approach, which is possibly due to the capability of implanting a larger annuloplasty ring.

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“…leaflet resection is employed. [12][13][14][15] Numerous studies have shown that the presence of functional MS with physiological stress after repair is associated with functional limitations, along with increased rates of atrial fibrillation 6 16 17 and heart failure even in the absence of recurrent MR. 6 7 Predictors of FMS following MV repair have been explored in retrospective studies and case series. [4][5][6][7][8][9][10] The size and type of annuloplasty prosthesis and technique of repair were previously reported as predictors of FMS.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

“…Functional mitral stenosis (FMS), defined as a reduction of the MV effective orifice area and elevation of transmitral pressure gradients, has emerged as a clinically relevant endpoint for patients undergoing MV repair 4–11. The aetiology of MS post repair has been attributed in part to the anatomic alterations that occur after MV repair, particularly when leaflet resection is employed 12–15. Numerous studies have shown that the presence of functional MS with physiological stress after repair is associated with functional limitations, along with increased rates of atrial fibrillation6 16 17 and heart failure even in the absence of recurrent MR 6 7…”

Section: Introductionmentioning

confidence: 99%

Predictors of mitral valve haemodynamics after mitral valve repair for degenerative mitral regurgitation

Rumman

Verma

Chan

et al. 2023

Heart

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ObjectiveIntraoperative predictors of functional mitral valve (MV) stenosis after surgical repair of mitral regurgitation (MR) caused by prolapse remain poorly characterised. This study evaluated the effect of annuloplasty size on postoperative MV haemodynamics during exercise and evaluated predictors of MV hemodynamics.Methods104 patients were randomly assigned to leaflet resection or preservation for surgical repair of MR in the Canadian Mitral Research Alliance CardioLink-2 study. In this post hoc analysis, we compared MV haemodynamics between the two surgical groups and examined the relationship between annuloplasty size and MV haemodynamics 1 year after repair in the combined groups. Echocardiograms were performed at baseline and intraoperatively. Exercise transthoracic echocardiography was performed 1 year postoperatively. Multivariable linear regression analysis was used to identify predictors of exercise MV gradients at follow-up.ResultsMean age of participants was 65±10 years, and 83% were male. Median annuloplasty size was 34 (IQR 32–36). Dividing by the median, 48 (46%) had annuloplasty size of <34 mm and 56 (54%) had ≥34 mm. Mean and peak exercise gradients at 1 year were 11±5 mm Hg and 22±9 mm Hg in <34, and 6±3 mm Hg and 14±5 mm Hg in ≥34 (p<0.001). Rate of residual MR was similar in both groups. In multivariable analyses, annuloplasty size of ≥34 mm was associated with lower mean and peak exercise gradients at 12 months, after adjustment for repair type, age, sex, heart rate and body surface area (β −4.1, 95% CI −6 to –3, p<0.001, and β −7 95% CI −10 to –4, p<0.001, respectively). Intraoperative mean and peak MV gradients by transesophageal echocardiography independently predicted mean and peak resting and exercise gradients at follow-up (p<0.001). Similar results were obtained in both leaflet resection and preservation.ConclusionAnnuloplasty size of ≥34 mm is associated with a 4 and 7 mm Hg reduction in mean and peak exercise MV gradients, respectively, 1 year post MV repair regardless of the repair strategy used. Intraoperative TEE MV gradients predict exercise MV gradients 1 year post repair.Trial registration numberNCT02552771.

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Chordal Reconstruction versus Leaflet Resection for Repair of Degenerative Posterior Mitral Leaflet Prolapse

Cited by 8 publications

References 23 publications

Isolated posterior mitral leaflet prolapse: Resect, respect, or resect with respect?

Isolated posterior mitral leaflet prolapse: Resect, respect, or resect with respect?

Clinical impact of the repair technique for posterior mitral leaflet prolapse: Resect or respect?

Predictors of mitral valve haemodynamics after mitral valve repair for degenerative mitral regurgitation

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