226. Long-Term Results of The Loop Neochord Versus Leaflet Resection Technique for Minimal Invasive Mitral Valve Repair
*Michael A. Borger, Bettina Pfannmueller, Piroze Davierwala, Alexander Verevkin, Jens Garbade, David Holzhey, Joerg Seeburger, Martin Misfeld
Leipzig Heart Center, Leipzig, Germany
Invited Discussant: *Neal D. Kon
Objective: The optimal treatment of mitral valve prolapse (MVP) remains controversial. We compared long-term results for minimal invasive mitral valve (MV) repair using the Loop neochord technique versus leaflet resection in patients with mitral regurgitation due to MVP.
Methods: Between 1994 and 2015, 2642 consecutive MVP patients underwent minimally invasive MV repair at our center. MVP was treated with Loop neochord reconstruction in 2019 patients (76.4%) and leaflet resection in 479 (18.1%) patients. Patients who underwent combined Loop and resection techniques (n = 144, 5.5%) were excluded. Concomitant procedures consisted of tricuspid valve repair in 8% of patients, closure of an atrial septal defect/patent foramen ovale in 13%, and atrial fibrillation ablation in 21%. Patient follow up by mail and/or telephone questionnaire was performed in 100% of patients at mean duration of 6.1±3.5 (max 17.6) years postoperatively.
Results: Of the patients undergoing Loop neochord repair, 65.8% were applied to the posterior leaflet, 10.7% to the anterior leaflet, and 23.5% to both leaflets. Leaflet resection was performed of the posterior leaflet in 91.6% of patients, the anterior leaflet in 3.6%, and both leaflets in 4.8%. Mean aortic cross clamp time was 83±31 minutes, cardiopulmonary bypass time was 133±45 min and total duration of surgery was 183±47 minutes in the Loop cohort compared to 69±27 minutes, 122±96 and 164±43 minutes in the leaflet resection technique group (all p<0.0001). Ten-year survival was 84±1% for the entire cohort. Ten-year survival was 85±2% vs 81±2% in the Loops vs resection group (p<0.002), freedom from cardiac mortality was 89±2% vs 85±2% (p<0.003) and freedom from reoperation was 96±1% vs 95±1% (p=0.046) for Loop vs resection patients, respectively. Cox proportional hazards analysis revealed that the Loop neochord technique was an independent predictor of freedom from cardiac death (HR 0.57, 95% CI 0.41-0.78, p=0.0005).
Conclusions: The Loop neochord technique is superior to leaflet resection in MVP patients undergoing minimal invasive MV repair.