Comparison of Anterior Mitral Leaflet Repair Techniques with and without the Use of Chordal Replacement in Patients with Degenerative Mitral Valve Insufficiency
DOI:
https://doi.org/10.1532/hsf.2317Abstract
Background: The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency.
Methods: This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair
techniques performed.
Results: No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral
valve insufficiency.
Conclusion: Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.
References
Braunberger E, Deloche A, Berrebi A, et al. 2001. Very long-term results (more than 20 years) of valve repair with Carpentier’s techniques in nonrheumatic mitral valve insufficiency. Circulation 104(12 suppl 1):I8-11.
Calafiore AM, Di Mauro M, Iacò AL, et al. 2006. Overreduction of the posterior annulus in surgical treatment of degenerative mitral regurgitation. Ann Thorac Surg 81:1310-6.
Castillo JG, Anyanwu AC, El-Eshmawi A, Adams DH. 2014. All anterior and bileaflet mitral valve prolapses are repairable in the modern era of reconstructive surgery. Eur J Cardiothoracic Surg 45:139-45; discussion 145.
David TE, Armstrong S, Ivanov J. 2013. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: a 25-year experience. J Thorac Cardiovasc Surg 145:1563-9.
David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. 2005. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse. J Thorac Cardiovasc Surg 130:1242-9.
David TE, Omran A, Armstrong S, Sun Z, Ivanov J. 1998. Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg 115:1279-85; discussion 1285-6.
DiBardino DJ, ElBardissi AW, McClure RS, Razo-Vasquez OA, Kelly NE, Cohn LH. 2010. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome. J Thorac Cardiovasc Surg;139:76-83; discussion 83-4.
Dumont E, Gillinov AM, Blackstone EH, et al. 2007. Reoperation after mitral valve repair for degenerative disease. Ann Thorac Surg 84:444-50; discussion 450.
Frater RW, Vetter HO, Zussa C, Dahm M. 1990. Chordal replacement in mitral valve repair. Circulation 82(5 suppl):IV125-30.
Gammie JS, Sheng S, Griffith BP, et al. 2009. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 87:1431-7; discussion 1437-9.
Gan HL, Zhang JQ, Wang SX, et al. 2008. [Repair of anterior leaflet mitral valve prolapse: the comparison between chordal replacement and chordal shortening]. Zhonghua Wai Ke Za Zhi 46:1727-9. Chinese.
Gillinov AM, Blackstone EH, Alaulaqi A, et al. 2008. Outcomes after repair of the anterior mitral leaflet for degenerative disease. Ann Thorac Surg 86:708-17.
Goldsmith IRA, Lip GYH, Patel RL. 2001. A prospective study of changes in the quality of life of patients following mitral valve repair and replacement. Eur J Cardiothoracic Surg 20:949-55.
Jokinen JJ, Hippeläinen MJ, Pitkänen OA, Hartikainen JEK. 2007. Mitral valve replacement versus repair: propensity-adjusted survival and quality-of-life analysis. Ann Thorac Surg 84:451-8.
Kuntze T, Borger MA, Falk V, et al. 2008. Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (‘loop technique’). Eur J Cardiothoracic Surg 33:566-72.
Mohty D, Orszulak TA, Schaff HV, Avierinos JF, Tajik JA, Enriquez-Sarano M. 2001. Very long-term survival and durability of mitral valve repair for mitral valve prolapse. Circulation 104(12 suppl 1):I1-7.
Morimoto H, Tsuchiya K, Nakajima M, Akashi O. 2008. Mitral valve repair for anterior leaflet prolapse: surgical techniques review and 16-year follow-up results. J Card Surg 23:426-30.
Okada Y, Nasu M, Koyama T, et al. 2012. Outcomes of mitral valve repair for bileaflet prolapse. J Thorac Cardiovasc Surg 143(4 suppl):S21-3.
Phillips MR, Daly RC, Schaff HV, Dearani JA, Mullany CJ, Orszulak TA. 2000. Repair of anterior leaflet mitral valve prolapse: chordal replacement versus chordal shortening. Ann Thorac Surg 69:25-9.
Sand ME, Naftel DC, Blackstone EH, Kirklin JW, Karp RB. 1987. A comparison of repair and replacement for mitral valve incompetence. J Thorac Cardiovasc Surg 94:208-19.
Smedira NG, Selman R, Cosgrove DM, et al. 1996. Repair of anterior leaflet prolapse: chordal transfer is superior to chordal shortening. J Thorac Cardiovasc Surg 112:287-91; discussion 291-2.
Zoghbi WA, Enriquez-Sarano M, Foster E, et al. 2003. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777-802.
