A COMPARISON OF EARLY RESULTS OF NON-RESECTION TECHNIQUES FOR CORRECTING DEGENERATIVE MITRAL REGURGITATION

Highlights

Non-resection repair techniques – transposition of secondary chordae and chordal replacement – in mitral valve prolapse showed comparable short-term results, which indicated the effectiveness of the methods.

Aim. To compare the early outcomes of chordal transposition and chordal replacement techniques in patients with degenerative mitral regurgitation.

Methods. The prospective study included 58 adult patients (mean age 57 (49; 64) years, 21 female) with severe degenerative type II MR (ERO 43 (30; 50) mm²) who underwent primary MV repair. 94,7% of patients were in NYHA class II or III before surgery. The patients were randomized in two groups: 1) chordal transposition (CT) group included 30 patients, 2) chordal replacement (CR group) included 28 patients. Mitral prosthetic ring implantation was performed in all cases. Transthoracic echocardiography was performed one year after surgery.

Results. Successful MV repair was accomplished in all patients without conversion to valve replacement. Both groups had comparable structural and functional ultrasound heart characteristics in postoperative period. Patients in both groups did not have recurrent MR of more than 1 degree (41% with MR 1 degree). Systolic anterior motion of MV and iatrogenic mitral stenosis after valve repair were not detected. One patient in the CR group had an ischemic stroke in early postoperative period. No other secondary endpoints were reached in either group.

Conclusion. Compared non-resection techniques are effective comparable methods of MV reconstruction with good early outcomes.

1. von Oppell U.O., Mohr F.W. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann Thorac Surg. 2000;70(6):2166-8. doi: 10.1016/s0003-4975(00)02047-6.

2. Wu S., Chai A., Arimie S., Mehra A., Clavijo L., Matthews R.V., Shavelle D.M. Incidence and treatment of severe primary mitral regurgitation in contemporary clinical practice. Cardiovasc Revasc Med. 2018;19(8):960-963. doi: 10.1016/j.carrev.2018.07.021.

3. Meier S., Seeburger J., Borger M.A. Advances in Mitral Valve Surgery. Curr Treat Options Cardiovasc Med. 2018;20(9):75. doi: 10.1007/s11936-018-0666-3.

4. Desai M.Y., Grigioni F., Di Eusanio M., Saccocci M., Taramasso M., Maisano F., Suri R.M., Gillinov A.M. Outcomes in Degenerative Mitral Regurgitation: Current State-of-the Art and Future Directions. Prog Cardiovasc Dis. 2017;60(3):370-385. doi: 10.1016/j.pcad.2017.10.005.

5. van Wijngaarden A.L., Tomšič A., Mertens B.J.A., Fortuni F., Delgado V., Bax J.J., Klautz R.J.M., Marsan N.A., Palmen M. Mitral valve repair for isolated posterior mitral valve leaflet prolapse: The effect of respect and resect techniques on left ventricular function. J Thorac Cardiovasc Surg. 2022;164(5):1488-1497.e3. doi: 10.1016/j.jtcvs.2021.02.017.

6. Chemtob R.A., Wierup P., Mick S., Gillinov M. Choosing the -Best" surgical techniques for mitral valve repair: Lessons from the literature. J Card Surg. 2019;34(8):717-727. doi: 10.1111/jocs.14089.

7. Sá M.P., Cavalcanti L.R.P., Van den Eynde J., Amabile A., Escorel Neto A.C., Perazzo A.M., Weymann A., Ruhparwar A., et al. Respect versus resect approaches for mitral valve repair: A study-level meta-analysis. Trends Cardiovasc Med. 2023;33(4):225-239. doi: 10.1016/j.tcm.2022.01.005.

8. Anyanwu A.C., Itagaki S., Chikwe J., El-Eshmawi A., Adams D.H. A complexity scoring system for degenerative mitral valve repair. J Thorac Cardiovasc Surg. 2016;151(6):1661-70. doi: 10.1016/j.jtcvs.2016.01.033.

9. Caldonazo T., Sá M.P., Jacquemyn X., Van den Eynde J., Kirov H., Harik L., Fischer J., Vervoort D., Bonatti J., Sultan I., Doenst T. Respect Versus Resect Approaches for Mitral Valve Repair: A Meta-Analysis of Reconstructed Time-to-Event Data. Am J Cardiol. 2024;213:5-11. doi: 10.1016/j.amjcard.2023.12.010.

10. Noack T., Borger M. Chordal replacement: future surgical gold standard or first-line option as bridge to definitive therapy in primary mitral regurgitation? Ann Cardiothorac Surg. 2021;10(1):167-169. doi: 10.21037/acs-2020-mv-22.

11. Makogonchuk I.S., Evtushenko V.V., Evtushenko A.V. Clinical and fundamental aspects of prosthetics and translocation of mitral valve chords. Siberian Journal of Clinical and Experimental Medicine. 2018;33(1):27-32. doi:10.29001/2073-8552-2018-33-1-27-32. (In Russian)

12. Di Mauro M., Bonalumi G., Giambuzzi I., Messi P., Cargoni M., Paparella D., Lorusso R., Calafiore A.M. Mitral valve repair with artificial chords: Tips and tricks. J Card Surg. 2022;37(12):4081-4087. doi: 10.1111/jocs.17076.

13. Elde S., Woo Y.J.. Neochords: How long, how many, too many? JTCVS Tech. 2023;22:59-64. doi: 10.1016/j.xjtc.2023.10.018.

14. Marin-Cuartas M., Imbrie-Moore A.M., Zhu Y., Park M.H., Wilkerson R., Leipzig M., Borger M.A., Woo Y.J. Biomechanical engineering analysis of commonly utilized mitral neochordae. JTCVS Open. 2021;8:263-275. doi: 10.1016/j.xjon.2021.07.040.

15. Smyshlyaev K.A., Evtushenko A.V., Evtushenko V.V., Pavlyukova E.N. Analysis of the longxterm results of combined myectomy in patients with hypertrophic obstructive cardiomyopathy. Siberian Journal of Clinical and Experimental Medicine. 2016;31(2):82-87. doi:10.29001/2073-8552-2016-31-2-82-87. (In Russian)

16. Chan V., Mazer C.D., Ali F.M., Quan A., Ruel M., de Varennes B.E., Gregory A.J., Bouchard D., et al. Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet Resection Versus Leaflet Preservation on Functional Mitral Stenosis: The CAMRA CardioLink-2 Study. Circulation. 2020;142(14):1342-1350. doi: 10.1161/CIRCULATIONAHA.120.046853.

17. Pfannmueller B., Misfeld M., Verevkin A., Garbade J., Holzhey D.M., Davierwala P., Seeburger J., Noack T., Borger M.A. Loop neochord versus leaflet resection techniques for minimally invasive mitral valve repair: long-term results. Eur J Cardiothorac Surg. 2021;59(1):180-186. doi: 10.1093/ejcts/ezaa255.

18. Brescia A.A., Watt T.M.F., Rosenbloom L.M., Murray S.L., Wu X., Romano M.A., Bolling S.F.; Michigan Mitral Research Group. Anterior versus posterior leaflet mitral valve repair: A propensity-matched analysis. J Thorac Cardiovasc Surg. 2021;162(4):1087-1096.e3. doi: 10.1016/j.jtcvs.2019.11.148.

19. David T.E., David C.M., Lafreniere-Roula M., Manlhiot C. Long-term outcomes of chordal replacement with expanded polytetrafluoroethylene sutures to repair mitral leaflet prolapse. J Thorac Cardiovasc Surg. 2020;160(2):385-394.e1. doi: 10.1016/j.jtcvs.2019.08.006.

20. El Gabry M., Mourad F., Loosen L., Ruhparwar A., Demircioglu E., Wendt D., Jakob H., Shehada S.E. A new simplified technique for artificial chordae implantation in mitral valve repair with its early results. J Thorac Dis. 2020;12(3):724-732. doi: 10.21037/jtd.2019.12.105.

21. Jeong S., Kim S.M., Hong W., Ko M., McPherson D.D., Kim H. Biomechanical Evaluation of Mitral Valve Repair: Virtual Chordal Transposition to Restore Anterior Leaflet Prolapse. Rev Cardiovasc Med. 2023;24(12):367. doi: 10.31083/j.rcm2412367.