Abstract Background: A bespoke procedure for the replacement of the mitral valve (MV) was devised, with the aim of preserving the rescued anterior mitral leaflet (AML). The approach employed involved the implementation of a full chordal-rescue mitral valve replacement (FCR-MVRpl), with the objective of preserving the anatomical configuration of the left ventricle. This technique has been shown to be beneficial for patients suffering from various forms of MV disease, including functional, degenerative, and infectious MV disease, who were previously unable to undergo MV repair. The investigation aimed to determine whether the technique caused procedural complications and if so, whether these resulted in left ventricular (LV) remodelling and how it affected survival rates. Methods: The study population comprised 161 patients, of whom 94 (57.1%) had degenerative mitral valve disease, 58 (36.0%) had functional mitral valve disease, 9 (5.6%) had infective mitral valve disease, and 2 (1.2%) had rheumatic mitral valve disease. In the 93 patients diagnosed with complicated MV disease, massive calcification was observed in 59 cases (36.6%), while 25 (15.5%) cases demonstrated mitral annular disjunction (MAD) and 9 (5.6%) cases presented with endocarditis and posterior annular abscesses. The anterior leaflet was completely rescued and then dislocated from its attachment to the annulus, a condition spanning from the posterior commissure to the anterior commissure. In cases involving excess tissue, a segment of the free edge of the translocated leaflet had to be excised, ensuring the preservation of a small section of the edge and the entire chordae tendineae unit. Results: Within 12 months following FCR-MVRpl, 2 patients (1.2%) experienced procedural-related complications. The freedom from procedural-related complications after FCR-MVRpl was 98.6 ± 0.97% at 12 months after surgery. The 1-year freedom from re-hospitalisation for heart failure was 94.2% ± 1.9%. Multivariable Cox analysis revealed a trend towards higher risk of treatment failure in patients who had a preoperative lower rate of LVEF (hazard ratio: 0.95; 95% CI: 0.92 to 0.99; p = 0.015 by the log-rank test). With the exception of patients who did not reach 12 months of follow-up, 11 (8.0%) patients exhibited a deterioration in their New York Heart Association (NYHA) functional class. However, most patients showed clinical benefits following FCR-MVRpl. Indeed, 112 patients (81.2%) were classified into NYHA Class I. Conclusion: The FCR-MVRpl is considered both safe and effective for a variety of cases without procedural-related complications. This technique preserves the left ventricle from dilatation and is beneficial for patients unable to undergo MV repair. The AML is used to treat severe cases of calcified posterior mitral annulus, complicated Barlow disease and endocarditis involving the posterior annulus. The FCR-MVRpl is not recommended for cases of severe complete MV calcification.
Nappi et al. (Tue,) studied this question.