Left ventricular performance early after repair for posterior mitral leaflet prolapse: Chordal replacement versus leaflet resection

Abstract

Objective: To review hemodynamic performance early after valve repair with chordal replacement versus leaflet resection for posterior mitral leaflet prolapse.

Methods: Between April 2006 and September 2014, 72 consecutive patients underwent valve repair with chordal replacement (30 patients) or leaflet resection (42 patients) for isolated posterior mitral leaflet prolapse. Left ventricular ejection fraction, end-systolic elastance, effective arterial elastance, and ventricular efficiency were noninvasively measured by echocardiography and analyzed preoperatively and ∼ 1 month postoperatively. Mitral valve repair was accomplished in all patients, and no regurgitation (including trivial) was observed postoperatively.

Results: Chordal replacement resulted in significantly less reduction in left ventricular ejection fraction, and significantly greater increase in end-systolic elastance than leaflet resection (left ventricular ejection fraction, 4.8% vs 16.7% relative decrease [P = .005] and end-systolic elastance, 19.0% vs -1.3% relative increase [P = .012]). Despite comparable preoperative ventricular efficiency between the groups, the postoperative ventricular efficiency in the chordal replacement group was superior to that in the leaflet resection group (ventriculoarterial coupling, 32.0% vs 89.3% relative increase [P = .007] and ratio of stroke work to pressure-volume area, 4.3% vs 13.4% relative decrease [P = .008]). In multivariate analysis, operative technique was a significant determinant of left ventricular ejection fraction and ratio of stroke work to pressure-volume area (P = .030 and P = .030, respectively).

Conclusions: Chordal replacement might provide patients undergoing valve repair for posterior mitral leaflet prolapse with better postoperative ventricular performance than leaflet resection. Longer follow-up is required to compare long-term outcomes.

Keywords: chordal replacement; leaflet resection; left ventricular performance; mitral valve repair.