Mitral valve replacement with chordal preservation resulted in comparable left ventricular reverse remodeling but significantly lower residual mitral regurgitation fraction (12% vs 21%, p=0.022) at 6 months compared to mitral valve repair in patients with primary mitral regurgitation.
Cohort (n=83)
No
Does mitral valve replacement with chordal preservation improve cardiac reverse remodeling and residual mitral regurgitation compared to mitral valve repair in patients with primary mitral regurgitation?
In patients with primary mitral regurgitation, mitral valve replacement with chordal preservation offers comparable 6-month cardiac reverse remodeling to mitral valve repair, while achieving significantly lower residual mitral regurgitation.
Absolute Event Rate: -37% vs -29%
p-value: p=0.584
BACKGROUND: When feasible, guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) to treat primary mitral regurgitation (MR), based upon historic outcome studies and transthoracic echocardiography (TTE) reverse remodeling studies. Cardiovascular magnetic resonance (CMR) offers reference standard biventricular assessment with superior MR quantification compared to TTE. Using serial CMR in primary MR patients, we aimed to investigate cardiac reverse remodeling and residual MR post-MVr vs MVR with chordal preservation. METHODS: 83 patients with ≥ moderate-severe MR on TTE were prospectively recruited. 6-min walk tests (6MWT) and CMR imaging including cine imaging, aortic/pulmonary through-plane phase contrast imaging, T1 maps and late-gadolinium-enhanced (LGE) imaging were performed at baseline and 6 months after mitral surgery or watchful waiting (control group). RESULTS: respectively, p = 0.545). At 6-months, compared with controls, right ventricular ejection fraction was poorer post-MVr (47 ± 6.1% vs 53 ± 8.0% respectively, p = 0.01) compared to post-MVR (50 ± 5.7% vs 53 ± 8.0% respectively, p = 0.698). MVR resulted in lower residual MR-regurgitant fraction (RF) than MVr (12 ± 8.0% vs 21 ± 11% respectively, p = 0.022). Baseline and follow-up indices of diffuse and focal myocardial fibrosis (Native T1 relaxation times, extra-cellular volume and quantified LGE respectively) were comparable between groups. Stepwise multiple linear regression of indexed variables in the surgical groups demonstrated baseline indexed mitral regurgitant volume as the sole multivariate predictor of left ventricular (LV) end-diastolic reverse remodelling, baseline LVEDVi as the most significant independent multivariate predictor of follow-up LVEDVi, baseline indexed LV end-systolic volume as the sole multivariate predictor of follow-up LV ejection fraction and undergoing MVR (vs MVr) as the most significant (p < 0.001) baseline multivariate predictor of lower residual MR. CONCLUSION: In primary MR, MVR with chordal preservation may offer comparable cardiac reverse remodeling and functional benefits at 6-months when compared to MVr. Larger, multicenter CMR studies are required, which if the findings are confirmed could impact future surgical practice.
Craven et al. (Wed,) conducted a cohort in Primary mitral regurgitation (n=83). Mitral valve replacement (MVR) with chordal preservation vs. Mitral valve repair (MVr) was evaluated on Change in indexed left ventricular end-diastolic volume (LVEDVi) (p=0.584). Mitral valve replacement with chordal preservation resulted in comparable left ventricular reverse remodeling but significantly lower residual mitral regurgitation fraction (12% vs 21%, p=0.022) at 6 months compared to mitral valve repair in patients with primary mitral regurgitation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: