Introduction
Mitral regurgitation (MR) can cause severe heart failure and left ventricular dysfunction if left untreated. The Society for Thoracic Surgeons database reported that over 20,000 patients underwent mitral valve (MV) surgery from 2014-2016, with over half receiving a repair. Mitral valve repair (MVr) for degenerative valve disease has been proven to improve survival in patients undergoing MV surgery. Traditionally, repair was done by resecting diseased segments of the MV leaflets. Recently, there has been interest in repairing valves using artificial neochords. There is a clinical equipoise between neochordal repair and leaflet resection for MVr and thus, the choice of repair is based on surgeon preference.
This study aims to evaluate if the use of artificial neochords for MVr can lead to better long-term outcomes than resection of the mitral valve leaflet.
Methods
This study is a retrospective chart review of all patients (n=401) who underwent MVr surgery at Abbott Northwestern Hospital between January 2011 and December 2019. Patients were stratified by method of MVr: Resection+Annuloplasty Ring, Neochord+Annuloplasty Ring, or Annuloplasty Ring. Primary end-points include freedom from mitral re-intervention surgery over time, changes in postoperative MV gradient, and freedom from postoperative severe MR.
Results
There were no clinically significant differences in preoperative comorbidities and risk-factors between groups. One-year post-operation, patients who underwent neochordal repair of the MV had a greater rate of MV re-intervention surgeries compared to all groups (Figure 1, p<0.001). There were no differences in postoperative recurrence of severe MR between the neochord and leaflet resection groups (2% incidence for both) and no differences in post-operative MV mean gradient (3.0 mmHg for both). However, there was a larger MV area observed among patients who underwent neochordal repair compared to leaflet resection (3.8 cm2 vs 2.4 cm2; p < 0.05), suggesting that native MV leaflet tissue is better preserved in neochordal repair.
Conclusions
At our center, neochordal repair of the MV had an increased rate of mitral re-intervention, but better preserved native MV leaflet area. Clinically meaningful outcomes of neochordal repair vs leaflet resection remain unclear given our study's limitations.
