Premium
Clinical impact of the repair technique for posterior mitral leaflet prolapse: Resect or respect?
Author(s) -
Sakaguchi Taichi,
Hiraoka Arudo,
Totsugawa Toshinori,
Hayashida Akihiro,
Ryomoto Masaaki,
Sekiya Naosumi,
Chikazawa Genta,
Yoshitaka Hidenori
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15312
Subject(s) - medicine , leaflet (botany) , mitral valve repair , mitral valve prolapse , surgery , mitral valve , paleontology , biology
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 cm 2 , 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.