Leaflet Resection versus Chordal Replacement for Degenerative Mitral Regurgitation: Long-term Outcomes According to the Technique Used

Background: Mitral valve repair (MVR) is the technique of choice for the treatment of degenerative mitral regurgitation (MR). Leafletresection has demonstrated excellent mid-term and long-term outcomes, but there are still disagreements in the literature at themoment of choosing between resection or conservative techniques.Objective: The primary outcome was to compare the durability of MVR and freedom from reoperation of the quadrangular andtriangular leaflet resection techniques versus chordal replacement in degenerative MR. The secondary outcome was to analyze theresults of the surgical techniques, the incidence of early postoperative complications and a composite outcome of mortality, reoperationor progression to significant MR in this population.Methods: We conducted a retrospective cohort study in patients with degenerative MR undergoing MVR (leaflet resection or chordalreplacement) between January 2005 and December 2017. A total of 154 patients were included: 78 in the leaflet resection group and76 in the chordal replacement group. Ten patients underwent both procedures and were excluded from the analysis.Results: Mean age was 66.4±13.9 years (p=0.3) A minimally invasive approach was used in 29.8% of cases. Mortality at 30 days was1.2% in the leaflet resection group vs. 1.3% in the chordal replacement group (p=0.31), and it was 2.4% vs. 1.3%, respectively, in thelong-term follow up (p=0.62). Cardiopulmonary bypass time was longer in the chordal replacement group (160.3±51.3 minutes vs.130.4±42.4 minutes, p<0.001), as well as the number of anterior leaflet (17.1% vs. 3.8%, p=0.007) and both leaflet repairs (17.1%vs. 3.8%, p<0.001). At the long-term follow-up, freedom from reoperation was 97.4%, freedom from significant MR was over 90% andsurvival at 7 years was 97.4% in the entire cohort. Atrial fibrillation was the most common complication (5.8%).Conclusions: Both techniques had excellent and similar results in terms of mortality, freedom from reoperation and freedom fromsignificant MR.