Leaflet resection versus chordal replacement for degenerative mitral regurgitation: Long-term outcomes according to the technique used

Abstract

Background: Mitral valve repair (MVR) is the technique of choice for the treatment of degenerative mitral regurgitation (MR). Leaflet resection has demonstrated excellent mid-term and long-term outcomes, but there are still disagreements in the literature at the moment of choosing between resection or conservative techniques. Objective: The primary outcome was to compare the durability of MVR and freedom from reoperation of the quadrangular and triangular leaflet resection techniques versus chordal replacement in degenerative MR. The secondary outcome was to analyze the results of the surgical techniques, the incidence of early postoperative complications and a composite outcome of mortality, reoperation or progression to significant MR in this population. Methods: We conducted a retrospective cohort study in patients with degenerative MR undergoing MVR (leaflet resection or chordal replacement) between January 2005 and December 2017. A total of 154 patients were included: 78 in the leaflet resection group and 76 in the chordal replacement group. Ten patients underwent both procedures and were excluded from the analysis. Results: Mean age was 66.4±13.9 years (p=0.3) A minimally invasive approach was used in 29.8% of cases. Mortality at 30 days was 1.2% in the leaflet resection group vs. 1.3% in the chordal replacement group (p=0.31), and it was 2.4% vs. 1.3%, respectively, in the long-term follow up (p=0.62). Cardiopulmonary bypass time was longer in the chordal replacement group (160.3±51.3 minutes vs. 130.4±42.4 minutes, p <0.001), as well as the number of anterior leaflet (17.1% vs. 3.8%, p=0.007) and both leaflet repairs (17.1% vs. 3.8%, p <0.001). At the long-term follow-up, freedom from reoperation was 97.4%, freedom from significant MR was over 90% and survival at 7 years was 97.4% in the entire cohort. Atrial fibrillation was the most common complication (5.8%). Conclusions: Both techniques had excellent and similar results in terms of mortality, freedom from reoperation and freedom from significant MR.