Loop Neochord Versus Leaflet Resection Techniques For Minimally Invasive Mitral Valve Repair: Long-Term Results

OBJECTIVES: Non-leaflet resection techniques including loop chordal replacement are being used with increasing frequency, but the long-term results of these techniques are still unknown. The aim of this study was to compare the long-term results of loop neochord replacement with leaflet resection techniques in patients undergoing minimally invasive mitral valve (MV) repair for MV prolapse.METHODS: Between 1999 and 2014, 2134 consecutive MV prolapse patients underwent minimally invasive MV repair with isolated loop (n = 1751; 82.1%) or resection techniques (n = 383, 17.9%) at our institution. Follow-up data were available for 86% of patients with a mean follow-up time of 6.14.3 years.RESULTS: The 30-day mortality was 0.8% for all patients (loop: 0.7%, resection: 1.6%; P = 0.09). Leaflet resection was associated with more moderate or more mitral regurgitation on predischarge echocardiography (P=0.003). The 1-, 5- and 10-year survival rates were 98 +/- 1%, 95 +/- 1% and 86 +/- 2% for the loop technique versus 97 +/- 1%, 92 +/- 1% and 81 +/- 2% for resection patients, respectively (P = 0.003). Significant predictors for late mortality were MV repair technique (P=0.004), left ventricular ejection fraction (P < 0.001), age (P < 0.001) and myocardial infarction (P<0.001). Freedom from MV reoperation at 1, 5 and 10 years was 9 8 +/- 1%, 97 +/- 1%, 97 +/- 1% and 97 +/- 1%, 97 +/- 1%, 96 +/- 1% for patients operated on with the loop technique and leaflet resection (P = 0.4).CONCLUSIONS: In our patient cohort, MV repair with loop chordal replacement is associated with less early recurrent mitral regurgitation and very good long-term results when compared to classical leaflet resection techniques for MV prolapse and is therefore an excellent option for such patients.