Chordal replacement versus quadrangular resection in degenerative posterior mitral leaflet repair

Area of Science:

• Cardiac Surgery
• Mitral Valve Repair
• Structural Heart Disease

Background:

• Quadrangular resection (QR) is a standard technique for posterior mitral leaflet (PML) prolapse.
• Chordal replacement (CR) is an alternative technique with less understood outcomes.
• Isolated degenerative PML (idPML) repair outcomes comparing CR and QR are not well-established.

Purpose of the Study:

• To compare mid- to long-term outcomes of chordal replacement (CR) versus quadrangular resection (QR) for isolated degenerative posterior mitral leaflet (idPML) repair.
• To evaluate the efficacy and safety of CR as an alternative to QR in mitral valve repair.

Main Methods:

• A retrospective review of 112 patients undergoing CR or QR for idPML repair from April 2010 to December 2015.
• Propensity score matching was used to compare outcomes between the CR and QR groups.
• Mid- to long-term clinical outcomes, including mitral regurgitation recurrence and event-free survival, were analyzed.

Main Results:

• Chordal replacement (CR) was more frequently performed via a minimally invasive approach (59.4% vs. 9.4%, P<0.001).
• Both techniques achieved successful mitral regurgitation (MR) reduction at discharge (P=0.337 between groups).
• CR group had shorter postoperative stays (9.9 vs. 14.0 days, P<0.004) and higher event-free survival (85.7% vs. 30.8% at 56 months, P=0.017).
• However, QR showed better freedom from recurrent MR (≥2.5+) during follow-up (96.3% vs. 50.2% at 60 months, P=0.061).
• Cox regression suggested CR as a risk factor for recurrent MR (HR 2.149, P=0.058).

Conclusions:

• Chordal replacement (CR) is associated with minimally invasive surgery, reduced complications, and shorter hospital stays for posterior mitral leaflet prolapse.
• Despite initial success, CR may be linked to a higher incidence of recurrent mitral regurgitation over time.
• Further research is needed to optimize chordal replacement techniques and ensure long-term mitral valve competence.