Mitral valve repair for myxomatous mitral regurgitation; Respect or Resect

Abstract

Background: The superiority of mitral repair using resection of the posterior leaflet versus neo-artificial chordea is still debatable. The objective of this study was to compare leaflet resection versus chordal replacement for mitral valve repair in patients with isolated myxomatous degeneration of the posterior mitral valve leaflet. 
 Methods: This study was conducted on 199 patients with severe symptomatic mitral regurgitation due to myxomatous mitral valve degeneration. Patients were grouped into two groups: Group (1): Respect technique which included 76 patients who had limited resection of the anterior leaflet, chordal transfer, and replacement of anterior leaflet chordae by polytetrafluoroethylene sutures, and placement of annuloplasty ring. Group (2): Resect technique included 123 patients where the operation was done by resecting the prolapsed mid scallop of the posterior leaflet and placement of flexible annuloplasty ring.
 Results: There was no difference between both groups regarding gender. Patients in the Respect group were younger (37 (25th- 75th percentiles: 29- 44) vs. 54 (48- 60) years, P<0.001). The minimally invasive approach was more commonly used in patients who had resection techniques (20 (26.32%) vs. 106 (86.18%); P<0.001). Ischemic (99 (95- 106) vs. 79 (75- 82); P<0.001) and cardiopulmonary bypass times (134.5 (130- 138.5) vs. 99 (97- 104) min; P<0.001) were higher in the Respect group. Blood loss was more in the Resect group (370 (305- 390) vs. 550 (490- 600) ml; P<0.001). There were no differences in the postoperative complications between groups. ICU stay was longer in patients in the Resect group (5 (5- 6) vs. 7 (6- 8) days; P<0.001). Mitral valve gradient after 12 months was significantly higher in the Resect group (3 (3- 3.5) vs. 4 (3- 5) mmHg; P<0.001). Mitral valve reoperation was required more in patients in the Respect group (5 (6.58%) vs. 1 (0.81%); P= 0.03).
 Conclusions: Both Respect and resect techniques for mitral valve repair had comparable outcomes and durability. The repair technique should be tailored according to the mitral valve pathology.