Long-term results of mitral valve repair using leaflet resection versus chordae replacement

The available data on long-term durability of mitral valve repair using chordae replacement versus leaflet resection for degenerative mitral regurgitation (MR) is contradictory. Although some studies report equal long-term durability, others demonstrate worse durability for chordae replacement.

All consecutive patients receiving mitral valve repair using chordae replacement versus leaflet resection for degenerative MR from January 2003 to December 2010 at a high-volume single center were analyzed. Long-term survival, cumulative incidence of reoperation, and recurrent MR as well as echocardiographic follow-up were investigated.

In total, 658 patients were included. Median follow-up was 13.6 years (interquartile range, 9.5-16.0 years). Chordae replacement and leaflet resection were performed in 72.5% (n = 477) and 24.2% (n = 159) of cases, respectively. At unadjusted analysis, cases of leaflet resection tended to have worse survival when compared with cases of chordae replacement (66.3% ± 4.1% vs 77.2% ± 2.3% at 15 years; P = .053). Patients with chordae replacement had a significantly higher risk for recurrent MR (33.4% ± 3.6% vs 12.1% ± 3.6% at 15 years; P < .001) and reoperation (19.1% ± 2.4% vs 7.1% ± 2.6% at 15 years; P = .013) than patients with leaflet resection. The risk remained significant even after excluding all patients with Barlow's disease and endocarditis. Risk factors for recurrent MR were chordae replacement (hazard ratio, 2.218; 95% CI, 1.237-3.979; P = .008), endocarditis (hazard ratio, 3.382; 95% CI, 1.676-6.825; P < .001), and MR >I at discharge (hazard ratio, 5.602; 95% CI, 3.009-10.441; P < .001).

Mitral valve repair using chordae replacement was associated with slightly higher survival rates and significantly higher cumulative incidence of MR recurrence and reoperation when compared with mitral valve repair using leaflet resection.