Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Outcomes of Mitral Valve Repair: Quadrangular Resection versus Chordal Replacement

  • Park, Kwon-Jae (Department of Thoracic and Cardiovascular Surgery, Dong-A University Medical Center, Dong-A University College of Medicine) ;
  • Woo, Jong Soo (Department of Thoracic and Cardiovascular Surgery, Dong-A University Medical Center, Dong-A University College of Medicine) ;
  • Yi, Jung Hoon (Department of Thoracic and Cardiovascular Surgery, Dong-A University Medical Center, Dong-A University College of Medicine) ;
  • Park, Jong Yoon (Department of Thoracic and Cardiovascular Surgery, Dong-A University Medical Center, Dong-A University College of Medicine)
  • Received : 2012.07.11
  • Accepted : 2012.10.17
  • Published : 2013.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Mitral valve repair for posterior mitral leaflet (PML) prolapse has been considered to be a standard treatment because of its high success rate and high level of patient satisfaction. The aim of this study was to evaluate the clinical results of two different techniques of PML prolapse, quadrangular resection (QR) and chordal replacement (CR). Materials and Methods: The subjects consisted of 56 patients who had undergone mitral valve repair for PML prolapse between November 1997 and December 2010. The patients were divided into two groups according to surgical technique. Among them, 31 patients underwent QR (group QR) and 25 patients had CR (group CR). We reviewed the medical records of the patients retrospectively to compare the clinical outcomes of both groups. Results: After mitral valve repair, the degree of mitral regurgitation (MR) in both groups decreased to the to a mild degree or less and the amount of remnant MR was slightly higher in the CR group but it was not statistically different. Three patients received mitral valve-related reoperation (2 in the QR group and 1 in the CR group). Freedom from mitral valve-related reoperation at 7 years was 93% for the QR group and 96% for the CR group and was not significantly different between the two groups. Conclusion: Both QR and CR showed excellent long-term results and were considered equally effective methods for PML prolapse.

Keywords

References

  1. Deloche A, Jebara VA, Relland JY, et al. Valve repair with Carpentier techniques: the second decade. J Thorac Cardiovasc Surg 1990;99:990-1001.
  2. Jebara VA, Mihaileanu S, Acar C, et al. Left ventricular outflow tract obstruction after mitral valve repair: results of the sliding leaflet technique. Circulation 1993;88(5 Pt 2): II30-4.
  3. Da Col U, Di Bella I, Bardelli G, Koukoulis G, Ramoni E, Ragni T. Triangular resection and folding of posterior leaflet for mitral valve repair. J Card Surg 2006;21:274-6. https://doi.org/10.1111/j.1540-8191.2006.00231.x
  4. David TE, Omran A, Armstrong S, Sun Z, Ivanov J. Longterm results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg 1998; 115:1279-85. https://doi.org/10.1016/S0022-5223(98)70210-7
  5. Salvador L, Mirone S, Bianchini R, et al. A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg 2008;135:1280-7. https://doi.org/10.1016/j.jtcvs.2007.12.026
  6. Perier P, Hohenberger W, Lakew F, et al. Toward a new paradigm for the reconstruction of posterior leaflet prolapse: midterm results of the "respect rather than resect" approach. Ann Thorac Surg 2008;86:718-25. https://doi.org/10.1016/j.athoracsur.2008.05.015
  7. Ling LH, Enriquez-Sarano M, Seward JB, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 1996;335:1417-23. https://doi.org/10.1056/NEJM199611073351902
  8. Wisenbaugh T, Skudicky D, Sareli P. Prediction of outcome after valve replacement for rheumatic mitral regurgitation in the era of chordal preservation. Circulation 1994;89:191-7. https://doi.org/10.1161/01.CIR.89.1.191
  9. Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg 2008;135:885-93, 893.e1-2. https://doi.org/10.1016/j.jtcvs.2007.11.039
  10. Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg 2007;31:267-75. https://doi.org/10.1016/j.ejcts.2006.11.014
  11. Baek MJ, Na CY, Oh SS, et al. Mitral valve reconstruction in patients with moderate to severe left ventricular dysfunction. Korean J Thorac Cardiovasc Surg 2003;36:812-9.
  12. Johnston DR, Gillinov AM, Blackstone EH, et al. Surgical repair of posterior mitral valve prolapse: implications for guidelines and percutaneous repair. Ann Thorac Surg 2010; 89:1385-94. https://doi.org/10.1016/j.athoracsur.2009.12.070
  13. Perier P, Stumpf J, Gotz C, et al. Valve repair for mitral regurgitation caused by isolated prolapse of the posterior leaflet. Ann Thorac Surg 1997;64:445-50. https://doi.org/10.1016/S0003-4975(97)00537-7
  14. Aoyagi S, Tanaka K, Kawara T, Oryoji A, Kosuga K, Oishi K. Long-term results of mitral valve repair for non-rheumatic mitral regurgitation. Cardiovasc Surg 1995;3:387-92. https://doi.org/10.1016/0967-2109(95)94156-Q
  15. Seeburger J, Kuntze T, Mohr FW. Gore-tex chordoplasty in degenerative mitral valve repair. Semin Thorac Cardiovasc Surg 2007;19:111-5. https://doi.org/10.1053/j.semtcvs.2007.05.003
  16. Lee JW, Lim HJ, Jung SH, et al. Midterm results of mitral valve repair by the new chordae formation technique. Korean J Thorac Cardiovasc Surg 2001;34:329-37.
  17. Chiappini B, Sanchez A, Noirhomme P, et al. Replacement of chordae tendineae with polytetrafluoroethylene (PTFE) sutures in mitral valve repair: early and long-term results. J Heart Valve Dis 2006;15:657-63.
  18. Nardi P, Pellegrino A, Scafuri A, et al. Survival and durability of mitral valve repair surgery for degenerative mitral valve disease. J Card Surg 2011;26:360-6. https://doi.org/10.1111/j.1540-8191.2011.01275.x
  19. Seeburger J, Falk V, Borger MA, et al. Chordae replacement versus resection for repair of isolated posterior mitral leaflet prolapse: a egalite. Ann Thorac Surg 2009;87:1715-20. https://doi.org/10.1016/j.athoracsur.2009.03.003
  20. Rankin JS, Orozco RE, Rodgers TL, Alfery DD, Glower DD. "Adjustable" artificial chordal replacement for repair of mitral valve prolapse. Ann Thorac Surg 2006;81:1526-8. https://doi.org/10.1016/j.athoracsur.2005.01.042
  21. Filsoufi F, Carpentier A. Principles of reconstructive surgery in degenerative mitral valve disease. Semin Thorac Cardiovasc Surg 2007;19:103-10. https://doi.org/10.1053/j.semtcvs.2007.04.003
  22. Falk V, Seeburger J, Czesla M, et al. How does the use of polytetrafluoroethylene neochordae for posterior mitral valve prolapse (loop technique) compare with leaflet resection?: a prospective randomized trial. J Thorac Cardiovasc Surg 2008;136:1205. https://doi.org/10.1016/j.jtcvs.2008.07.048

Cited by

  1. Personalized Computational Modeling of Mitral Valve Prolapse: Virtual Leaflet Resection vol.10, pp.6, 2013, https://doi.org/10.1371/journal.pone.0130906