Chordal rupture. II: comparison between repair and replacement

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Valvular Heart Disease

Background:

• Chordal rupture is a serious complication requiring surgical intervention.
• Mitral valve surgery options include repair and replacement.
• Outcomes of these procedures for chordal rupture need clear comparison.

Purpose of the Study:

• To compare the early and late outcomes of mitral valve repair versus replacement in patients with chordal rupture.
• To evaluate survival rates and complication incidence between the two surgical techniques.

Main Methods:

• Retrospective analysis of 183 patients undergoing mitral valve surgery for chordal rupture between 1970-1981.
• Categorization of patients into mitral valve repair (82) and mitral valve replacement (101) groups.
• Follow-up for mortality, cerebrovascular events, and need for reoperation, with actuarial survival curve analysis.

Main Results:

• Early mortality was 4.9%, with slightly higher rates in the replacement group.
• Late mortality was significantly higher after mitral valve replacement (23 deaths) compared to repair (4 deaths).
• Actuarial six-year survival was 68% for replacement versus 88% for repair (p<0.01), with cerebrovascular events being a major cause of death after replacement.

Conclusions:

• Mitral valve repair is associated with significantly better long-term survival than mitral valve replacement for chordal rupture.
• Repair is favored due to lower mortality and reduced incidence of cerebrovascular events.
• Repair is a safe and effective option, with rare failure rates, especially for isolated posterior cusp repair.