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| Dividing Secondary Chords Improves Mitral Leaflet Mobility and Reduces Mitral Regurgitation in Patients with Ischemic MR |
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Back to 86th Annual Meeting Back to Program Outline Objective: Division of secondary chords (chordal-cutting) has been proposed as a method to decrease mitral valve (MV) leaflet tethering and decrease mitral regurgitation (MR) in patients with ischemic MR. However, very little clinical data exists to date for this procedure. Methods: We compared transesophageal and transthoracic echocardiographic data in patients who underwent chordal-cutting MV repair (n = 15) to those undergoing conventional MV repair (control, n = 26) for ischemic MR. Variables assessed included tent height (distance from the apex of the anterior MV leaflet (AMVL) to the mitral annulus), tent area (area between mitral annulus and AMVL apex), and distance between the AMVL apex and the posterior left ventricular (LV) wall, in addition to standard clinical outcomes. Results: Chordal-cutting patients were older than the control group (69 + 8 vs 63 + 10 years respectively, p = 0.05) and had a higher prevalence of diabetes (53% vs 22%, p = 0.04), peripheral vascular disease (40% vs 7%, p = 0.01) and urgent surgical timing (67% vs 37%, p = 0.05). Chordal-cutting patients were also more likely to have an LV ejection fraction (LVEF) of less than 40% (100% vs 41%, p < 0.001). Aortic crossclamp times were significantly longer in the chordal-cutting group (116 + 35 vs 83 + 23 min, p < 0.001), as were cardiopulmonary bypass times (141 + 37 vs 105 + 37 min, p = 0.004). Perioperative mortality occurred in one chordal-cutting patient (7%) and zero control patients (0%) (p = 0.17). Other complication rates were similar for the two groups. The reduction in tent height pre- to post-repair was similar in the two groups of patients (19% mean reduction in the chordal-cutting group vs 18% in the control group, p = 0.7). However, chordal-cutting patients had greater reductions in tent area (48% vs 37%, p = 0.07) and in the distance between the AMVL apex and posterior LV wall (30% vs 12%, p = 0.003). A greater proportion of control patients had moderate or more MR in the early postoperative period (19% vs 0%, p = 0.05). Four patients in the control group (15%) and zero patients in the chordal-cutting group (0%) underwent mitral valve replacement surgery for recurrent severe MR post-repair (p = 0.1). Chordal-cutting did not adversely affect postoperative LV function (3% mean reduction in LVEF vs 1% in the control group, p = 0.9) on early postoperative echo. Conclusions: Chordal-cutting improves MV leaflet mobility and reduces early MR recurrence in patients with ischemic MR, without any obvious deleterious effects on LV function. Back to 86th Annual Meeting Back to Program Outline |
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