JTCVS open · 2025
Posterior leaflet reconstruction in mitral valve repair: Does resect versus respect strategy matter?
СтатьяНазвание и аннотация: Перевод в очереди
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Ogami Takuya, Chetkof Ethan, Bonatti Johannes O, Pantelis Christopher, Waterford Stephen D, Ferdinand Francis D, Hasan Irsa S, Serna-Gallegos Derek, Kaczorowski David J, Chu Danny, Thoma Floyd W, Sultan Ibrahim
Аннотация
OBJECTIVE: Previous randomized controlled trials demonstrated comparable outcomes between posterior leaflet resections and neochord implantation in mitral valve (MV) repair. However, these studies were limited up to 1-year follow-up, and more recent evidence suggested that leaflet resections may offer superior long-term outcomes.
METHODS: All patients who underwent MV repair with either resection or neochord implantation for posterior leaflet pathology between October 2011 and July 2024 were included. Propensity-score matching was used.
RESULTS: A total of 457 patients underwent posterior leaflet reconstruction, with 334 (73.1%) requiring leaflet resection (resection group) and 123 (26.9%) receiving neochordae (neochord group). The median [interquartile range] follow-up for survival and reintervention was 5.93 [2.00, 9.09] and 5.48 [1.84, 9.02] years, respectively. Overall, the mean age was 63.9 years, and the mean ejection fraction was 58.9%. Robotic-assisted surgery was performed in 28.9% (n = 132). The 30-day mortality was 2.4% (n = 11). Propensity-score matching provided 119 patients in each group. Kaplan-Meier curves demonstrated similar survival at 5 years between these groups (93.1 ± 2.8% in the resection group and 89.6 ± 3.1% in the neochord group, P = .5). However, the neochord group had a greater cumulative incidence of reoperative MV surgery (8.0% vs 0.9% at 5 years in the resection group, P = .01).
CONCLUSIONS: Neochordae were implanted in 27.3% of patients undergoing MV repair. Neochord implantation was associated with a greater risk of MV reintervention in the long term. Careful patient selection and technical considerations are important when choosing the repair method.
METHODS: All patients who underwent MV repair with either resection or neochord implantation for posterior leaflet pathology between October 2011 and July 2024 were included. Propensity-score matching was used.
RESULTS: A total of 457 patients underwent posterior leaflet reconstruction, with 334 (73.1%) requiring leaflet resection (resection group) and 123 (26.9%) receiving neochordae (neochord group). The median [interquartile range] follow-up for survival and reintervention was 5.93 [2.00, 9.09] and 5.48 [1.84, 9.02] years, respectively. Overall, the mean age was 63.9 years, and the mean ejection fraction was 58.9%. Robotic-assisted surgery was performed in 28.9% (n = 132). The 30-day mortality was 2.4% (n = 11). Propensity-score matching provided 119 patients in each group. Kaplan-Meier curves demonstrated similar survival at 5 years between these groups (93.1 ± 2.8% in the resection group and 89.6 ± 3.1% in the neochord group, P = .5). However, the neochord group had a greater cumulative incidence of reoperative MV surgery (8.0% vs 0.9% at 5 years in the resection group, P = .01).
CONCLUSIONS: Neochordae were implanted in 27.3% of patients undergoing MV repair. Neochord implantation was associated with a greater risk of MV reintervention in the long term. Careful patient selection and technical considerations are important when choosing the repair method.