Background: Uncorrected severe mitral regurgitation due to posterior prolapse/flail leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to avoid permanent myocardial injury. However, which technique among neochoardae implantation and leaflet resection provides the best results in this scenario remains unknown. Methods: We selected 332 patients with left ventricular dilatation and severe degenerative mitral regurgitation due to posterior leaflet prolapse who underwent neochoardae implantation (85 patients) or posterior leaflet resection (247 patients) at our Institution between 2008 and 2020. A propensity score matching analysis was carried on to decrease the differences at baseline. Results: Matching yielded 85 neochordae implantations and 85 posterior leaflet resections. At 10-years, freedom from cardiac death and freedom from mitral valve reoperation, was 92.6 ± 6.1% vs 97.8 ± 2.1% and 97.7 ± 2.2% vs 95±3% in the neochordae group and in the posterior leaflet resection group respectively.The mitral regurgitation ≥2+ recurrence rate was 23.9±10% in the neochordae group and 20.8 ± 5.8% in the posterior leaflet resection group (p = 0.834) at 10-years. At last follow-up, neochordae group showed a higher reduction of left-ventricular end-diastolic diameter (44mm vs 48 mm; p = 0.001) and a better ejection fraction (60% vs 55%; p < 0.001) compared to posterior leaflet resection group. Conclusions: In this subgroup of patients, both neochordae implantation and leaflet resection provide excellent durability of the repair in the long-term. Neochordae implantation might have a better effect on dilated left ventricle.

Neochordae implantation versus leaflet resection in mitral valve posterior leaflet prolapse and dilated left ventricle: a propensity score matching comparison with long-term follow-up / Del Forno, Benedetto; Tavana, Kevin; Ruffo, Claudio; Carino, Davide; Lapenna, Elisabetta; Ascione, Guido; Bisogno, Arturo; Belluschi, Igor; Scarale, Maria Giovanna; Nonis, Alessandro; Monaco, Fabrizio; Alfieri, Ottavio; Castiglioni, Alessandro; Maisano, Francesco; De Bonis, Michele. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1010-7940. - 64:4(2023). [10.1093/ejcts/ezad274]

Neochordae implantation versus leaflet resection in mitral valve posterior leaflet prolapse and dilated left ventricle: a propensity score matching comparison with long-term follow-up

Tavana, Kevin
Secondo
;
Ruffo, Claudio;Ascione, Guido;Bisogno, Arturo;Belluschi, Igor;Scarale, Maria Giovanna;Alfieri, Ottavio;Castiglioni, Alessandro;Maisano, Francesco
Penultimo
;
De Bonis, Michele
Ultimo
2023-01-01

Abstract

Background: Uncorrected severe mitral regurgitation due to posterior prolapse/flail leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to avoid permanent myocardial injury. However, which technique among neochoardae implantation and leaflet resection provides the best results in this scenario remains unknown. Methods: We selected 332 patients with left ventricular dilatation and severe degenerative mitral regurgitation due to posterior leaflet prolapse who underwent neochoardae implantation (85 patients) or posterior leaflet resection (247 patients) at our Institution between 2008 and 2020. A propensity score matching analysis was carried on to decrease the differences at baseline. Results: Matching yielded 85 neochordae implantations and 85 posterior leaflet resections. At 10-years, freedom from cardiac death and freedom from mitral valve reoperation, was 92.6 ± 6.1% vs 97.8 ± 2.1% and 97.7 ± 2.2% vs 95±3% in the neochordae group and in the posterior leaflet resection group respectively.The mitral regurgitation ≥2+ recurrence rate was 23.9±10% in the neochordae group and 20.8 ± 5.8% in the posterior leaflet resection group (p = 0.834) at 10-years. At last follow-up, neochordae group showed a higher reduction of left-ventricular end-diastolic diameter (44mm vs 48 mm; p = 0.001) and a better ejection fraction (60% vs 55%; p < 0.001) compared to posterior leaflet resection group. Conclusions: In this subgroup of patients, both neochordae implantation and leaflet resection provide excellent durability of the repair in the long-term. Neochordae implantation might have a better effect on dilated left ventricle.
2023
dilated left ventricle
mitral valve repair
neochoardae implantation
posterior leaflet resection
reverse remodelling
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/151398
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