Abstract
ObjectivePosterior mitral valve leaflet prolapse repair can be performed by leaflet resection or chordal replacement techniques. The impact of these techniques on left ventricular function remains a topic of debate, considering the presumed better preservation of mitral-ventricular continuity when leaflet resection is avoided. We explored the effect of different posterior mitral valve leaflet repair techniques on postoperative left ventricular function. MethodsIn total, 125 patients were included and divided into 2 groups: leaflet resection (n = 82) and isolated chordal replacement (n = 43). Standard and advanced echocardiographic assessments were performed preoperatively, directly postoperatively, and at late follow-up. In addition, left ventricular global longitudinal strain was measured and corrected for left ventricular end-diastolic volume to adjust for the significant changes in left ventricular volumes. ResultsAt baseline, no significant intergroup difference in left ventricular function was observed measured with the corrected left ventricular global longitudinal strain (resect: 1.76% ± 0.58%/10 mL vs respect: 1.70% ± 0.57%/10 mL, P = .560). Postoperatively, corrected left ventricular global longitudinal strain worsened in both groups but improved significantly during late follow-up, returning to preoperative values (resect: 1.39% ± 0.49% to 1.71% ± 0.56%/10 mL, P < .001 and respect: 1.30% ± 0.45% to 1.70% ± 0.54%/10 mL, P < .001). Mixed model analysis showed no significant effect on the corrected left ventricular global longitudinal strain when comparing the 2 different surgical repair techniques over time (P = .943). ConclusionsOur study showed that both leaflet resection and chordal replacement repair techniques are effective at preserving postoperative left ventricular function in patients with posterior mitral valve leaflet prolapse and significant regurgitation.
Highlights
At baseline, no significant intergroup difference in left ventricular function was observed measured with the corrected left ventricular global longitudinal strain
Mixed model analysis showed no significant effect on the corrected left ventricular global longitudinal strain when comparing the 2 different surgical repair techniques over time (P 1⁄4 .943)
Our study showed that both leaflet resection and chordal replacement repair techniques are effective at preserving postoperative left ventricular function in patients with posterior mitral valve leaflet prolapse and significant regurgitation. (J Thorac Cardiovasc Surg 2021;-:1-10)
Summary
125 patients were included and divided into 2 groups: leaflet resection (n 1⁄4 82) and isolated chordal replacement (n 1⁄4 43). Patients who underwent MV repair for isolated prolapse of the posterior leaflet with moderate-to-severe or severe mitral regurgitation (MR) at the Leiden University Medical Center (Leiden, The Netherlands) between January 2000 and December 2018 were included. The following exclusion criteria were used (Figure E1): unavailable echocardiogram preoperatively, postoperatively, or late follow-up; GLS measures not feasible; concomitant coronary artery bypass grafting and aortic valve replacement. Preoperative demographic and clinical characteristics of patients were collected from the hospital information system (HIX 6.1; ChipSoft BV, Amsterdam, The Netherlands) and the patient electronic record used by the cardiology department (EPD-Vision; Leiden University Medical Center, Leiden, The Netherlands). The study complies with the Declaration of Helsinki, and this retrospective study was approved by the Institutional Review Board and Medical Ethical Committee, which waived the need of written patient informed consent
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