Midterm Outcome of Mitral Valve Repair with Artificial Chordae; Comparison between Anterior and Posterior leaflet Prolapse; Single Center Experience

Sameh Sayed, Dejan Radakovic, Costanaze Bening , Khaled Hamouda, Ina Schade, Veronika Gebhardt, Rainer Leyh, Ivan Aleksic

Cardiothoracic Surgery Department, University of Würzburg , Würzburg , Germany

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–B

Abstract

Objektives :

Still, few studies report long-term outcomes of anterior mitral leaflet repair using artificial chordae. The aim of this study is to compare our short and mid-term outcomes after anterior and posterior mitral valve repair using chordal replacement and complete leaflet preservation (respect rather than resect approach).

Methods:

Between 2010 and 2014, 174 patients underwent mitral repair with chordal replacement by expanded polytetrafluroethylene sutures and leaflet preservation.  55 patients (group 1) had prolapse of the anterior leaflet compared to 119 patients (group 2) with posterior leaflet prolapse. Mean age was 64.7±12.4 and 61.5 ±11.8 years in group 1 and 2, Patient characteristics and co-morbidities were comparable. The mean number of artificial chordae used/ patient was significantly higher for anterior leafet repair (3.3±2.4) vs posterior leaflet repair (2.5±1.2)(p=0.017). Follow up period ranged from 1 to 6 years (mean 33.0±17.3).

Results:

In-hospital mortality  was 0.0% and 2.5 % for group 1 and 2 respectively. Early complications was similar in both groups. There was one late death in group 1 and  6 late mortalities in group 2( five of them due to non-cardiac related causes). Kaplan-Meier survival analysis at 3 years was 92% for group 1 and 95% for group 2 (p= 0.40). Four patients in group 1 underwent reoperation for severe mitral regurgitation in the follow up period versus 12 patients in group 2 (p= 0.760). Freedom from reoperation was 96% and 94% after 3 years in goup 1 and 2, respectively.

Conclusions:

Anterior leaflet prolapse can be repaired with chordal replacement and complete leaflet preservation with good early and midterm results similar to posterior leaflet prolapse. The respect rather than resect approach for anterior leaflet prolapse is an effective and durable technique for repair.