Comparison of myocardial mechanics after mitral valve repair with leaflet preservation versus leaflet resection: A subanalysis of the randomized Canadian Mitral Research Alliance CardioLink-2 trial

Affiliations

¹ Division of Cardiology, University of California San Francisco, San Francisco, Calif; Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada.
² Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada. Electronic address: Subodh.Verma@unityhealth.to.
³ Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Public Health, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada.
⁶ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
⁷ Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montréal, Quebec, Canada.
⁸ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁹ Division of Cardiac Surgery, London Health Sciences Center, Western University, London, Ontario, Canada.
¹⁰ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada.
¹¹ Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹² Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
¹³ Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada. Electronic address: Kim.Connelly@unityhealth.to.

PMID: 40783073
DOI: 10.1016/j.jtcvs.2025.07.047

Comparison of myocardial mechanics after mitral valve repair with leaflet preservation versus leaflet resection: A subanalysis of the randomized Canadian Mitral Research Alliance CardioLink-2 trial

Rawan K Rumman et al. J Thorac Cardiovasc Surg. 2025.

. 2025 Aug 7:S0022-5223(25)00654-3.

doi: 10.1016/j.jtcvs.2025.07.047. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiology, University of California San Francisco, San Francisco, Calif; Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada.
² Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada. Electronic address: Subodh.Verma@unityhealth.to.
³ Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Public Health, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada.
⁶ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
⁷ Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montréal, Quebec, Canada.
⁸ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁹ Division of Cardiac Surgery, London Health Sciences Center, Western University, London, Ontario, Canada.
¹⁰ Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada.
¹¹ Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹² Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
¹³ Division of Cardiology, St. Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada. Electronic address: Kim.Connelly@unityhealth.to.

PMID: 40783073
DOI: 10.1016/j.jtcvs.2025.07.047

Abstract

Background: Previous studies comparing leaflet resection versus leaflet preservation for surgical repair of mitral regurgitation caused by prolapse have focused predominately on measurement of left ventricular ejection fraction without adjusting for loading conditions. This post hoc subanalysis evaluated subclinical differences in myocardial mechanics before mitral valve repair, immediately after, and 1 year after repair, as well as differences between leaflet resection and preservation strategies.

Methods: A total of 104 patients were randomized to the resection or preservation group for surgical treatment of posterior leaflet prolapse in the Canadian Mitral Research Alliance CardioLink-2 study. Speckle-tracking echocardiography was performed at baseline (prerepair), immediately postrepair, and 1-year postrepair. Global longitudinal strain (GLS) was compared at the 3 time points, as well as between leaflet preservation and resection groups using descriptive statistics. GLS was adjusted for left ventricular (LV) end-diastolic dimensions to adjust for loading conditions.

Results: The mean (standard deviation) age of the participants was 65 ± 10 years, and 83% were male. The mean GLS before mitral valve repair was -19.6% ± 5.4% and did not differ between the leaflet resection and leaflet preservation groups. The mean GLS decreased to -12.8% ± 4.7 immediately postrepair (P = .001 compared with prerepair). At 1-year after repair, the mean GLS improved to -16% ± 4% in both groups but remained below prerepair values; however, the GLS indexed to loading conditions was similar to preoperative values. Preoperative GLS was an independent predictor of postoperative reduced GLS independent of age, sex, body surface area, and repair strategy.

Conclusions: Mitral valve repair is associated with an immediate reduction in GLS, but when corrected for loading conditions, indexed GLS demonstrates complete preservation of LV function at 1 year. The leaflet preservation and resection techniques for surgical repair of mitral regurgitation have similar effects on myocardial mechanics 1-year postrepair. Preoperative GLS may be used to predict LV myocardial mechanics 1-year postoperatively (Trial registration number NCT02552771, https://clinicaltrials.gov/study/NCT02552771).

Keywords: mitral valve; mitral valve function; mitral valve prolapse; mitral valve repair.

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Conflict of interest statement

Conflict of Interest Statement S.V. holds a Tier 1 Canada Research Chair in Cardiovascular Surgery and reports receiving grants and/or research support and/or speaking honoraria from Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Canadian Medical and Surgical Knowledge Translation Research Group, Eli Lilly, HLS Therapeutics, Humber River Health, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, PhaseBio, S & L Solutions Event Management Inc, Sanofi, and Sun Pharmaceuticals; he is the President of the Canadian Medical and Surgical Knowledge Translation Research Group, a federally incorporated not-for-profit physician organization. B.E.d.V. is a consultant for Edwards Lifesciences. M.W.A.C. has received speakers' honoraria from Medtronic, Edwards Lifesciences, Terumo Aortic, Abbott Vascular, and Artivion and is also supported as the Ray and Margaret Elliott Chair in Surgical Innovation. H.T. reports personal fees from the Canadian Medical and Surgical Knowledge Translation Research Group. H.L.P. holds the Brazilian Ball Chair in Cardiology and reports receiving honoraria for speaking engagements from Lantheus Medical Imaging and Janssen. C.D.M. is supported by a Merit Award from the University of Toronto Department of Anesthesiology and Pain Medicine; holds the Cara Phelan Chair in Critical Care at St. Michael's Hospital-Unity Health Toronto; and has received has received Advisory Board honoraria/consulting fees from Amgen, Alexion, AstraZeneca, BioAge, Biotest, Boehringer Ingelheim, Cardior, CytoSorbents, ONA, PhaseBio, Sandoz, Trimedic Therapeutics, and Werfen as well as Data Safety Monitoring Board stipends from Beth Israel Deaconess Medical Center, Cerus, and Takeda. K.A.C. is listed as an inventor on a patent application by Boehringer Ingelheim on the use of dipeptidyl peptidase-4 inhibitors in heart failure and reports receiving research grants to his institution from AstraZeneca, Servier and Boehringer Ingelheim; support for travel to scientific meetings from Boehringer Ingelheim; and honoraria for speaking engagements and ad hoc participation in advisory boards from Servier, Merck, Eli Lilly, AstraZeneca, Boehringer Ingelheim, Ferring, Novo Nordisk, Novartis, and Janssen. K.A.C. holds the Keenan Chair in Research Leadership. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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Comparison of myocardial mechanics after mitral valve repair with leaflet preservation versus leaflet resection: A subanalysis of the randomized Canadian Mitral Research Alliance CardioLink-2 trial

Affiliations

Comparison of myocardial mechanics after mitral valve repair with leaflet preservation versus leaflet resection: A subanalysis of the randomized Canadian Mitral Research Alliance CardioLink-2 trial

Authors

Affiliations

Abstract

Conflict of interest statement

Associated data

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous