Transapical beating heart mitral valve repair versus conventional surgery: a propensity-matched study

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Minimally Invasive Cardiac Surgery

Background:

• Degenerative mitral regurgitation often requires surgical repair.
• Transapical Neochordae (NC) implantation enables beating heart mitral valve repair.
• Conventional surgical (CS) mitral valve repair is a standard treatment.

Purpose of the Study:

• To compare the outcomes of transapical Neochordae implantation (NC) versus conventional surgical (CS) mitral valve repair.
• To evaluate mortality, reoperation rates, mitral regurgitation severity, and functional class.
• To specifically analyze outcomes in patients with isolated P2 prolapse (type A anatomy).

Main Methods:

• Retrospective, single-centre study of patients undergoing isolated mitral valve repair (January 2010 - December 2018).
• Propensity score matching analysis to compare 88 pairs of NC and CS patients.
• Primary endpoint: overall all-cause mortality. Secondary endpoints: freedom from reoperation, freedom from moderate/severe mitral regurgitation (MR), and New York Heart Association (NYHA) functional class.

Main Results:

• No significant difference in 5-year survival between NC and CS groups.
• NC group had significantly worse freedom from moderate (57.6% vs 84.6%) and severe MR (78.1% vs 89.7%) at 5 years.
• NC group had lower freedom from reoperation (78.9% vs 92%).
• In type A anatomy patients, MR and reoperation rates were similar between groups.
• Over 90% of patients in both groups achieved NYHA class I/II at follow-up.

Conclusions:

• Transapical beating-heart mitral chordae implantation is a viable alternative to CS.
• NC is particularly effective for patients with isolated P2 prolapse.
• Careful patient selection is crucial due to potentially higher rates of residual MR and reoperation in non-P2 prolapse cases.