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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2017 October;58(5):779-86

DOI: 10.23736/S0021-9509.17.09634-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

A systematic review and meta-analysis of chordal replacement versus leaflet resection for isolated posterior mitral valve prolapse

Christos G. MIHOS 1 , Evin YUCEL 1, Orlando SANTANA 2

1 Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2 Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA


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INTRODUCTION: Chordal replacement (Chord MVr) for isolated posterior mitral valve prolapse allows for preservation of the native mitral valve apparatus. The potential benefits of this approach, as compared with leaflet resection (Resection), are not clearly defined.
EVIDENCE ACQUISITION: A systematic review and meta-analysis was conducted on operative, clinical, and echocardiographic outcomes. Risk ratios (RR) were calculated by the Mantel-Haenszel method under a fixed or random effects model, as appropriate.
EVIDENCE SYNTHESIS: Eight studies were included, with a total of 1922 patients (Chord MVr, N.=835; Resection, N.=1087). Baseline characteristics were similar, except for a higher incidence of atrial fibrillation in the Chord MVr group (15.5% versus 9.9%, P=0.03), and a slightly greater mitral regurgitation grade in the Resection group (3.5 versus 3.4, P=0.008). P2 segment prolapse was the most common pathology, however, patients undergoing Chord MVr had a higher incidence of multi-segment prolapse (32.1% versus 13.9%, P=0.0006). There was no difference in operative mortality (1.1% for both) or perioperative complications. At a mean follow-up of 2.9±2.8 years (median=2.8 years, IQR 1.6-4.4), Chord MVr was associated with a lower risk of reoperation (1.1% versus 4.3%; RR 0.26, 95% CI 0.12-0.56, P=0.0007), and similar survival and recurrence of moderate mitral regurgitation, when compared with Resection. Finally, a lower transmitral gradient (2.5 versus 2.8 mmHg, P=0.0004) and larger orifice area (3.2 versus 3.0 cm2, P=0.002) were observed with Chord MVr.
CONCLUSIONS: At 2.9-year follow-up, Chord MVr for isolated posterior mitral valve prolapse was associated with a lower reoperation rate and favorable valve hemodynamics, when compared with leaflet resection.


KEY WORDS: Mitral valve prolapse - Mitral valve annuloplasty - Cardiac surgical procedures

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Publication History

Issue published online: July 6, 2017
Article first published online: January 25, 2017
Manuscript accepted: January 18, 2017
Manuscript revised: January 17, 2017
Manuscript received: July 20, 2016

Cite this article as

Mihos CG, Yucel E, Santana O. A systematic review and meta-analysis of chordal replacement versus leaflet resection for isolated posterior mitral valve prolapse. J Cardiovasc Surg 2017;58:779-86. DOI: 10.23736/S0021-9509.17.09634-3

Corresponding author e-mail

cmihos@mgh.harvard.edu