Reparación valvular mitral con cuerdas artificiales. ¿Qué aporta respecto a la técnica clásica?

Abstract

BackgroundThe use of neochordal repair has recently increased, not only as a combined procedure with quadrangular resection, but also as an isolated technique. Our aim was to evaluate its impact on the feasibility and outcomes of mitral valve repair. Material and methodsA global group of 203patients underwent valve repair for degenerative mitral regurgitation between 1997-2011. Their mean age was 62±12years and 36% were females. Complex repair was considered in case of multi-scalloped, bileaflet or commissural prolapse. Two technical subgroups were compared: resection without neochordal repair (Group-A: 140patients) and neochordal repair without resection (Group-B: 46patients). Seventeen patients with artificial chordae combined with resection were excluded. Complexity of valvular lesions, early and long-term mortality and repair durability were studied. ResultsIn-hospital mortality was 3.4% (7patients); 4.3% in Group-A (6patients) and 2.2% in Group-B (one patient). Five and 10-year survival was 89±2% and 77±4%. At follow-up (58±42months), 22patients from Group-A (15.7%) and 2 from Group-B (4.3%) died. The recurrence of grade 3-4/4 mitral regurgitation in Group-B versus Group-A was 1 (2.2%) versus 20 (14.3%); P<.05. Sixty five patients (32.0%) underwent complex repairs, especially from Group-B: 27 (58.7%) vs 27 (19.3%), P<.0001. This group had a higher incidence of multi-scalloped prolapse (mean number of segments): 1.80±0.80 vs 1.20±0.44, P<.0001; anterior leaflet prolapse: 14 (30.4%) vs 14 (10.0%), P<.01, and multiple chordal rupture: 24 (52.2%) vs 29 (20.7%), P<.0001. ConclusionsNeochordal repair showed excellent mid-term results with significant increase of repair feasibility. Its use as an isolated procedure has been really effective in patients with more extensive and complex lesions