Abstract
Objectives: In patients with significant primary mitral regurgitation (PMR), the success of mitral valve repair (MVr) depends upon precise preop planning, including accurate assessment of chordal length. Both 2-dimentional (2D) & 3-dimentional (3D) transthoracic (TTE) & transesophageal (TEE) echocardiography visualize anterior and posterior chords. We sought to assess concordance of echo-based MV chordal measurements against direct intraop (robotic vs. midline) measurements. Methods: After informed consent, we prospectively enrolled 56 consecutive patients (59±11 years, 86% men) who underwent MVr (52% robotic, 48% sternotomy) between 12/14-6/15 by a single experienced surgeon. The lengths of anterior & posterior MV chords were measured in 2-, 3-, & 4-chamber views on preop 2D/3D TTE & 2D/3D TEE (Philips & General Electric) & were compared to intraop length of the most perpendicular normal anterior & posterior chords. All measurements were performed in a blinded manner & noninvasive measurements were compared against intraop measurements using intraclass correlation coefficient (ICC). Results: Intraoperatively, the mean lengths of anterior & posterior chords were 2.02±0.4 & 1.81±0.4 cm, respectively. For the anterior chords, the mean lengths on 2D & 3D TTE were 1.96±0.3 & 1.96±0.3 cm, respectively, while they were 1.99±0.3 & 1.93±0.3 cm on 2D & 3D TEE, respectively. Similarly, for posterior chords, the mean length on 2D & 3D TTE was 1.90±0.3 & 1.89±0.3 cm, while they were 1.91±0.3 & 1.90±0.3 cm on 2D & 3D TEE, respectively. Data on ICC’s (for the concordance of the whole group & separated on different surgical approaches) are shown in Figure. Conclusion: There is high concordance in measurement of anterior MV chords by 2D/3D TTE/TEE with surgical techniques. However, concordance for posterior chord measurement is less accurate, especially when a robotic approach is used. In such patients, precise preop planning using imaging (including tomography) may be crucial.
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