Non-resection techniques for correcting type II mitral regurgitation by A. Carpentier

Introduction. Mitral valve (MV) repair is more preferable than valve replacement because of stable long-term outcomes and low mortality rate. Chordal replacement and transposition of secondary chordae are two methods of MV plasty with similar results. Comparison of the long-term outcomes of these non-resection methods precisely have not provided yet.

Aim: To compare the long-term outcomes of chordal replacement and transposition of secondary chordae techniques in type II mitral regurgitation of Carpentier’s functional classification.

Material and Methods. 58 adult patients with severe type II MR (ERO 43 (30; 50) mm2) due to degenerative valve disease, underwent primary MV repair from 2009 to 2019, were prospectively studied. The mean patient age was 57 (49; 64) years. 21 patients were female. Initially, 94.7% of patients referred to NYHA II III before surgery. Mean follow-up period was 7,2 (2,5) years. The patients were randomized in two groups: 1) chordal transposition (CT) – 30 patients, 2) chordal replacement with polytetrafluoroethylene artificial chordae (CR) – 28 patients. Mitral prosthetic ring implantation was performed in all cases.

Results. There were no any statistically significant differences in main hemodynamic parameters in both groups: left atrium diameter 46,5 (37; 53) mm – 42,5 (42; 45) mm, p = 0,49; left ventricle (LV) myocardial mass index 101(81; 133) g/m2– 81,5 (71,5; 94,5) g/m2, p = 0,15; LV end-diastolic diameter 52,5 (47; 56) mm – 51,5 (48; 52,5) mm, p = 0,64; LV end-systolic diameter 31 (29; 34) mm – 33 (30; 34,5) mm, p = 0,97; LV end-diastolic volume 124 (103; 148) ml – 118 (89,5; 128,5) ml, p = 0,8; LV end-systolic volume 54 (40; 59) ml – 48,5 (30; 54,5) ml, p = 0,37; LV ejection fraction (В) 59,5 (51; 64) % – 62 (58; 66) %, p = 0,16; LV end-diastolic volume index 60,3 (54,7; 73,8) ml/m2 – 57,7 (51,9; 66,1) ml/m2, p = 0,58; LV end-sistolic volume index 26,7(22,1; 27,9) ml/m2 – 23,6 (17,4; 27,9) ml/m2, p = 0,35, GLS LV -13,7 (-11,6; -16,3) % – -15,4 (-13,5; -16,5) %, p = 0,45. Statistically significant difference was detected in mean MV pressure gradient: 3 (2,5; 4) mm Hg in CT group versus 4,5 (3,5; 5) mm Hg in CR group, p = 0,009. LA thrombosis was not recorded in any case according to results of transesophageal echocardiography. Patients in both groups had not recurrent MR more than 1 degree (38,6% patients with MR 1 degree). The next secondary endpoints were achieved in both groups. Death as secondary endpoint: 2 patients in CT group (6,9%), 2 patients in CR group (7,1%), p = 0,91. One patient had a stroke in early postoperative period in CR group. Reoperation with MV replacement was required in 2 patients due to rupture of posterior mitral leaflet chordae in native segment (CT) and rupture of polytetrafluoroethylene artificial chordae (CR), observation period was 36 and 24 months after MV repair accordingly.

Conclusion. Both non-resection techniques are effective methods of MV repair in type II MR with comparable long-term outcomes.

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