Comparison of early postoperative results between conventional and transapical mitral valve repair

Abstract

Introduction: Conventional mitral valve repair (CMVR) is well-established, safe and effective treatment for degenerative mitral regurgitation (MR). Transapical off-pump implantation of artificial chordae (TA) has been introduced into practice and gained interest among surgeons. However, there are no publications comparing the results between TA and CMVR. Aim: To compare early postoperative outcomes of CMVR with TA in patients with degenerative MR. Material and methods: This was a retrospective cohort study. A total of 169 patients who underwent mitral valve repair between 2011 and 2018 were included in this analysis. Patients were divided into two groups: the TA group, n = 78 and CMVR group, n = 91. The groups were compared for early postoperative outcomes. Results: Patients in the TA group were younger, 54.2 ±11.1 vs. 59.5 ±12.8 years (p = 0.005). Patients in the CMVR group had more complicated postoperative course with higher incidence of blood transfusion (42.9% vs. 7.8%, p = 0.001), atrial fibrillation (25.3% vs. 11.7%, p = 0.031), renal insufficiency (15.4% vs. 2.6%, p = 0.007) and stroke (2.1% vs. 0%). In the early postoperative period, one patient died in the TA group, and there were no deaths in the CMVR group (p = 0.277). Residual moderate to severe mitral regurgitation was present in nine (11.5%) TA patients, while none of the patients in the CMVR group had moderate or a higher degree of residual regurgitation (p = 0.001). Conclusions: Off-pump transapical MV repair is a feasible and safe procedure with low postoperative morbidity rates. Higher rates of mitral regurgitation reoccurrence would require a careful and thorough selection of the patients suitable for the TA approach.

Actual perspective on off‐pump transapical artificial chord implantation

“…42 More than a paper has tried to directly compare the Neochord system and surgical mitral valve repair. The study by Zorinas et al 43 on a cohort of 169 patients treated for MR (78 Neochord procedures vs. 91 conventional mitral surgical repairs) shows a more complicated perioperative course for patients who underwent surgery which, however, is associated with significantly better results in terms of postoperative residual MR (0% for surgical repair vs. 11% in the Neochord group).…”