Loop neochord versus leaflet resection techniques for minimally invasive mitral valve repair: long-term results. (10th August 2020)

• Record Type: Journal Article
• Authors: Pfannmueller, Bettina; Misfeld, Martin; Verevkin, Alexander; Garbade, Jens; Holzhey, David M; Davierwala, Piroze; Seeburger, Joerg; Noack, Thilo; Borger, Michael A
• Is Part Of: European journal of cardio-thoracic surgery. Volume 59:Number 1(2021)
• Page Start: 180
• Page End: 186
• Publication Date: 2020-08-10
• Subjects: Minimally invasive mitral valve surgery -- Mitral valve repair -- Long-term results; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa255
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Non-leaflet resection techniques including loop chordal replacement are being used with increasing frequency, but the long-term results of these techniques are still unknown. The aim of this study was to compare the long-term results of loop neochord replacement with leaflet resection techniques in patients undergoing minimally invasive mitral valve (MV) repair for MV prolapse. METHODS: Between 1999 and 2014, 2134 consecutive MV prolapse patients underwent minimally invasive MV repair with isolated loop ( n = 1751; 82.1%) or resection techniques ( n = 383, 17.9%) at our institution. Follow-up data were available for 86% of patients with a mean follow-up time of 6.1 ± 4.3 years. RESULTS: The 30-day mortality was 0.8% for all patients (loop: 0.7%, resection: 1.6%; P = 0.09). Leaflet resection was associated with more moderate or more mitral regurgitation on predischarge echocardiography ( P = 0.003). The 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively ( P = 0.003). Significant predictors for late mortality were MV repair technique ( P = 0.004), left ventricular ejection fraction ( P < 0.001), age ( P < 0.001) and myocardial infarction ( P < 0.001). Freedom from MV reoperation at 1, 5 and 10 years was 98 ± 1%, 97 ± 1%, 97 ± 1% and 97 ± 1%, 97 ± 1%, 96 ± 1% for patients operated on with the loop technique and leaflet resection ( P = 0.4). CONCLUSIONS: In our patient cohort, MV repair with loop chordal replacement is associated with less early recurrent mitral regurgitation and very good long-term results when compared to classical leaflet resection techniques for MV prolapse and is therefore an excellent option for such patients.