Outcomes of Leaflet Resection versus Chordal Replacement for Degenerative Mitral Regurgitation

Abstract

Debate persists regarding the outcomes of leaflet resection (RESECT) versus chordal replacement (CHORD) for degenerative mitral regurgitation. Our aim was to compare early and late outcomes of the leaflet resection versus chordal replacement techniques for degenerative mitral regurgitation. 1066 consecutive patients receiving mitral repair for degenerative regurgitation using RESECT versus CHORD techniques were evaluated from a prospectively maintained database. Propensity score matching was used to compare outcomes in RESECT versus CHORD repairs. CHORD patients had later operative dates, more flail leaflet, and more anterior leaflet disease. With switch to predominant CHORD technique in 2010, the percent repair for all degenerative valves improved significantly from 83% to 91% (P=0.002). 467 patients were matched for baseline characteristics. CHORD patients had larger rings (34mm v 32mm, P<0.001) and more use of an Alfieri stitch (66% v 22%, P< 0.001) in matched patients. 10-year survival was similar for matched patients (RESECT vs CHORD: 86±3% v 84±4%, P=0.5). RESECT patients had a lower 10-year cumulative incidence of mitral reoperation (RESECT vs CHORD: 1±1% v 8±3%, P=0.002), and severe mitral regurgitation (RESECT vs CHORD: 1±1% v 9±5%, P=0.05) compared to matched CHORD patients. Late ejection fraction and mitral gradient were not different between two groups in matched patients, respectively (P=0.9 and P=0.2, respectively). The use of CHORD technique for degenerative mitral regurgitation increased the repair rates, but CHORD technique had slightly lower repair durability at 10-years compared to RESECT technique. These results could be related to more complex pathology in CHORD group.