OBJECTIVE: Division of secondary chords (chordal cutting) has been proposed as a method for decreasing mitral valve leaflet tethering and mitral regurgitation in patients with ischemic mitral regurgitation. However, very little clinical data exist to date for this procedure. METHODS: We compared echocardiographic and clinical data in patients who underwent chordal-cutting mitral valve repair (n = 43) and those undergoing conventional mitral valve repair (control, n = 49) for ischemic mitral regurgitation. RESULTS: Patients who underwent chordal cutting had a higher prevalence of recent myocardial infarction, left main disease, diabetes, and peripheral vascular disease (all P < .05). Left ventricular ejection fraction was lower in the chordal-cutting group (33 +/- 2% vs 44 +/- 2%) (mean +/- SE) and preoperative tent height was greater (11.7 +/- 0.5 vs 9.7 +/- 0.6 mm; both P < .01). In-hospital mortality was 10% in control patients and 9% in the chordal-cutting group (P = .9). Other complication rates were similar for the two groups. The reduction in tent height before-to-after repair was similar in the two groups of patients, but those undergoing chordal cutting had a greater reductions in tent area (53 +/- 3% vs 41 +/- 3%; P = .01). The chordal-cutting group also had greater mobility of the anterior leaflet, as measured by a reduction in the distance between the free edge of the anterior mitral valve leaflet and the posterior left ventricular wall (24 +/- 3% vs 11 +/- 4%; P = .01). Control patients had more recurrent mitral regurgitation during 2 years of follow-up by univariate (37% vs 15%; P = .03) and multivariate analysis (P = .03). Chordal cutting did not adversely affect postoperative left ventricular ejection fraction (10% +/- 5% relative increase in left ventricular ejection fraction vs 11% +/- 6% in the control group; P = .9). CONCLUSION: Chordal cutting improves mitral valve leaflet mobility and reduces mitral regurgitation recurrence in patients with ischemic mitral regurgitation, without any obvious deleterious effects on left ventricular function.
OBJECTIVE: Division of secondary chords (chordal cutting) has been proposed as a method for decreasing mitral valve leaflet tethering and mitral regurgitation in patients with ischemic mitral regurgitation. However, very little clinical data exist to date for this procedure. METHODS: We compared echocardiographic and clinical data in patients who underwent chordal-cutting mitral valve repair (n = 43) and those undergoing conventional mitral valve repair (control, n = 49) for ischemic mitral regurgitation. RESULTS:Patients who underwent chordal cutting had a higher prevalence of recent myocardial infarction, left main disease, diabetes, and peripheral vascular disease (all P < .05). Left ventricular ejection fraction was lower in the chordal-cutting group (33 +/- 2% vs 44 +/- 2%) (mean +/- SE) and preoperative tent height was greater (11.7 +/- 0.5 vs 9.7 +/- 0.6 mm; both P < .01). In-hospital mortality was 10% in control patients and 9% in the chordal-cutting group (P = .9). Other complication rates were similar for the two groups. The reduction in tent height before-to-after repair was similar in the two groups of patients, but those undergoing chordal cutting had a greater reductions in tent area (53 +/- 3% vs 41 +/- 3%; P = .01). The chordal-cutting group also had greater mobility of the anterior leaflet, as measured by a reduction in the distance between the free edge of the anterior mitral valve leaflet and the posterior left ventricular wall (24 +/- 3% vs 11 +/- 4%; P = .01). Control patients had more recurrent mitral regurgitation during 2 years of follow-up by univariate (37% vs 15%; P = .03) and multivariate analysis (P = .03). Chordal cutting did not adversely affect postoperative left ventricular ejection fraction (10% +/- 5% relative increase in left ventricular ejection fraction vs 11% +/- 6% in the control group; P = .9). CONCLUSION: Chordal cutting improves mitral valve leaflet mobility and reduces mitral regurgitation recurrence in patients with ischemic mitral regurgitation, without any obvious deleterious effects on left ventricular function.
Authors: Robert A Levine; Albert A Hagége; Daniel P Judge; Muralidhar Padala; Jacob P Dal-Bianco; Elena Aikawa; Jonathan Beaudoin; Joyce Bischoff; Nabila Bouatia-Naji; Patrick Bruneval; Jonathan T Butcher; Alain Carpentier; Miguel Chaput; Adrian H Chester; Catherine Clusel; Francesca N Delling; Harry C Dietz; Christian Dina; Ronen Durst; Leticia Fernandez-Friera; Mark D Handschumacher; Morten O Jensen; Xavier P Jeunemaitre; Hervé Le Marec; Thierry Le Tourneau; Roger R Markwald; Jean Mérot; Emmanuel Messas; David P Milan; Tui Neri; Russell A Norris; David Peal; Maelle Perrocheau; Vincent Probst; Michael Pucéat; Nadia Rosenthal; Jorge Solis; Jean-Jacques Schott; Ehud Schwammenthal; Susan A Slaugenhaupt; Jae-Kwan Song; Magdi H Yacoub Journal: Nat Rev Cardiol Date: 2015-10-20 Impact factor: 32.419
Authors: Tomasz A Timek; David T Lai; Wolfgang Bothe; David Liang; George T Daughters; Neil B Ingels; D Craig Miller Journal: J Thorac Cardiovasc Surg Date: 2015-04-25 Impact factor: 5.209