Initial results of the chordal-cutting operation for ischemic mitral regurgitation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 133; no. 6; pp. 1483 - 1492.e1
• Main Authors: Borger, Michael A., MD, PhD, Murphy, Patricia M., MD, Alam, Asim, MD, Fazel, Shafie, MD, PhD, Maganti, Manjula, MSc, Armstrong, Susan, MSc, Rao, Vivek, MD, PhD, David, Tirone E., MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.06.2007; AATS/WTSA; Elsevier
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Case-Control Studies; Chi-Square Distribution; Chordae Tendineae - surgery; Comorbidity; Echocardiography; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Myocardial Ischemia - surgery; Postoperative Complications; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surveys and Questionnaires; Treatment Outcome; 35; MR; mitral regurgitation; myocardial infarction; MV; LV; IMR; TEE; ischemic mitral regurgitation; mitral valve; transesophageal echocardiography; left ventricular; MI; Heart; Cutting; Mitral valve; Treatment; Ischemia; Cardiac valvular disease; Surgery; Mitral regurgitation; Cardiovascular disease; Thorax; Operation; Result
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2007.01.064

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.