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A systematic review and meta-analysis of chordal replacement versus leaflet resection for isolated posterior mitral

Christos G Mihos1, Evin Yucel2, Orlando Santana3

  • 1Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA - cmihos@mgh.harvard.edu.

The Journal of Cardiovascular Surgery
|January 27, 2017
PubMed
Abstract

Insights

Chordal replacement (Chord MVr) for posterior mitral valve prolapse reduces reoperation rates and improves valve function compared to leaflet resection. This approach preserves the native valve apparatus, offering better long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Mitral Valve Repair

Background:

  • Mitral valve prolapse requires surgical intervention.
  • Chordal replacement (Chord MVr) preserves native mitral valve apparatus.
  • Leaflet resection is an alternative surgical approach.

Purpose of the Study:

  • To compare chordal replacement versus leaflet resection for isolated posterior mitral valve prolapse.
  • To evaluate operative, clinical, and echocardiographic outcomes.
  • To define the benefits of Chord MVr compared to leaflet resection.

Main Methods:

  • Systematic review and meta-analysis of eight studies.
  • Inclusion of 1922 patients (835 Chord MVr, 1087 Resection).
  • Calculation of risk ratios (RR) using Mantel-Haenszel method.

Main Results:

  • Chord MVr showed a lower reoperation rate (1.1% vs 4.3%) at 2.9-year follow-up.
  • Similar survival and recurrence of moderate mitral regurgitation were observed.
  • Chord MVr resulted in a lower transmitral gradient and larger orifice area.

Conclusions:

  • Chord MVr is associated with reduced reoperation rates for posterior mitral valve prolapse.
  • Favorable valve hemodynamics were observed with Chord MVr.
  • Chord MVr offers a viable alternative to leaflet resection, preserving native valve function.

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