Premeasured Neochordal Replacement for Mitral Valve Regurgitation Is Comparable to Leaflet Resection

Objective Neochordal replacement is a preferred technique for mitral valve repair. We describe a method for neochordal replacement utilizing premeasured neochords and compare outcomes to traditional leaflet resection. Methods This is a single institution retrospective review of all patients who underwent mitral valve repair from February 2008 to April 2024. Patients underwent leaflet resection or neochordal replacement using premeasured neochordae constructed with a chain of square knots based on preoperative echocardiography. The primary outcome was recurrence of moderate to severe mitral regurgitation. Secondary outcomes included all-cause mortality and reoperation. Statistical analyses included propensity score matching and multivariate analyses were performed to control for baseline differences. Results Among 201 patients (neochordal replacement: 154; leaflet resection: 47), median follow-up time was 4.29 years. Kaplan-Meier analysis showed no significant difference in recurrence of moderate to severe mitral regurgitation (HR, 0.82; 95% CI, 0.25-2.69; P = .9), reoperation (HR, 0.98; 95% CI, 0.232-3.576; P = .7), or mortality (HR, 0.41; 95% CI, 0.09-1.88; P = .3). At 5 years, freedom from mitral regurgitation was 84.5% for neochordal replacement and 85.5% for leaflet resection. Multivariate analysis did not identify surgical technique as a significant predictor of recurrence of mitral regurgitation ( P = .86). Conclusions This mitral valve repair technique yields comparable outcomes to leaflet resection and is amenable to minimally invasive approaches.