• Aniek L van Wijngaarden, Anton Tomšič, MertensBart J ABJADivision of Medical Statistics, Department of Biomedical Sciences, Leiden University Medical Center, Leiden, The Netherlands., Federico Fortuni, Victoria Delgado, Jeroen J Bax, KlautzRobert J MRJMDivision of Cardiothoracic Surgeons, Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands., MarsanNina AjmoneNADivision of Cardiac Imaging, Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: n.ajmone@lumc.nl., and Meindert Palmen.
• Division of Cardiac Imaging, Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
• J. Thorac. Cardiovasc. Surg. 2022 Nov 1; 164 (5): 1488-1497.e3.

ObjectivePosterior mitral valve leaflet prolapse repair can be performed by leaflet resection or chordal replacement techniques. The impact of these techniques on left ventricular function remains a topic of debate, considering the presumed better preservation of mitral-ventricular continuity when leaflet resection is avoided. We explored the effect of different posterior mitral valve leaflet repair techniques on postoperative left ventricular function.MethodsIn total, 125 patients were included and divided into 2 groups: leaflet resection (n = 82) and isolated chordal replacement (n = 43). Standard and advanced echocardiographic assessments were performed preoperatively, directly postoperatively, and at late follow-up. In addition, left ventricular global longitudinal strain was measured and corrected for left ventricular end-diastolic volume to adjust for the significant changes in left ventricular volumes.ResultsAt baseline, no significant intergroup difference in left ventricular function was observed measured with the corrected left ventricular global longitudinal strain (resect: 1.76% ± 0.58%/10 mL vs respect: 1.70% ± 0.57%/10 mL, P = .560). Postoperatively, corrected left ventricular global longitudinal strain worsened in both groups but improved significantly during late follow-up, returning to preoperative values (resect: 1.39% ± 0.49% to 1.71% ± 0.56%/10 mL, P < .001 and respect: 1.30% ± 0.45% to 1.70% ± 0.54%/10 mL, P < .001). Mixed model analysis showed no significant effect on the corrected left ventricular global longitudinal strain when comparing the 2 different surgical repair techniques over time (P = .943).ConclusionsOur study showed that both leaflet resection and chordal replacement repair techniques are effective at preserving postoperative left ventricular function in patients with posterior mitral valve leaflet prolapse and significant regurgitation.Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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