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Artificial Chordae Vs. Loops For Chordal Replacement In Minimally Invasive Mitral Valve Repair: A Comprehensive Long-term Comparison
Felix Naegele1, Daniel Hoefer
1, Can Gollmann-Tepeköylü
1, Leo Poelzl
1, Lukas Stastny
1, Alexander Lu
2, Michael Graber
1, Clemens Engler
1, Jakob Hirsch
1, Simone Gasser
1, Juliane Kilo
1, Johannes Holfeld
1, Ludwig Mueller
1, Michael Grimm
1, Nikolaos Bonaros
1;
1MUI, Innsbruck, Austria,
2Center for Cardiovascular Regeneration, Houston Methodist Research Institute,, Houston, TX, USA
ObjectiveBoth chordal replacement and leaflet resection techniques are highly versatile and achieve excellent results in treating mitral leaflet prolapse. Premeasured loops (loop technique) offer a more standardized approach than traditional artificial chordae (freehand technique) and allow an even distribution of forces at the free edge of the leaflets. A comprehensive comparison between both techniques remains underexplored. In this study, we aimed to identify the difference between both techniques regarding perioperative success and safety and determine their impact on long-term survival and reoperation rates.
MethodsBetween March 2001 and November 2023, a total of 1186 consecutive patients (mean age: 60.6±12.6 years, 61.6% male) underwent MIMVS at the University Hospital Innsbruck, Austria. Surgery was performed via anterolateral thoracotomy, either with 2D or 3D endoscopy, and 581 patients received a chordal replacement due to mitral valve prolapse. Patients were followed up via phone conversations, and details regarding survival were obtained from the Austrian national death registry, achieving an overall data completeness rate of over 90%.
ResultsWe allocated a total of 581 patients undergoing MIMVS with chordal replacement (mean age: 59.6 ± 12.3 years, 69% male) to 2 groups according to the technique: freehand (n=151) or loops (n=430). Procedural safety (90.7% overall) and procedural success (88.9% overall) rates were excellent in both groups. CPB (cardiopulmonary bypass) and X-Clamp (cross-clamp) times were significantly reduced in the loops group (200 [165;234·5] vs. 173 [147;210] minutes, p<0.001 and 121 [94.5;138.5] vs. 100 [80;122] minutes, p<0.001, respectively). The patients were followed for 5.8 ± 4.6 years. The actuarial survival was 98.4%, 95.4%, and 92.7% at 1, 5, and 10 years, respectively. There was no difference in event-free survival between chordal replacement stratified by technique during MIMVS (log-rank, p=0.5).
ConclusionsThis single-center experience on long-term outcomes of different chordal replacement techniques for mitral valve prolapse shows excellent results in a real-life cohort. Traditional artificial chordae and loops do not differ regarding short- and long-term safety and success. The impact of a center’s experience seems to outweigh technical advancements.
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