Chordal Reconstruction versus Leaflet Resection for Repair of Degenerative Posterior Mitral Leaflet Prolapse

Objective: To review our experience of mitral valve repair for degenerative posterior mitral leaflet prolapse, comparing the outcomes of chordal reconstruction and leaflet resection. Methods: From 2000 to 2014, 205 patients underwent successful repair for degenerative posterior mitral leaflet prolapse. One hundred and four (51.5%) underwent leaflet resection (group R) and 98 (48.5%) underwent chordal reconstruction (group C). Follow-up was 96.5% complete with a mean follow-up of 6.1 +/- 4.0 years. Results: Mean age was 57.0 +/- 11.0 years. Males accounted for 73.8%. Ring annuloplasty was performed in 195 (96.5%). There were no operative mortalities within 30 days. Overall survival was 97.8% +/- 1.3% at 7 years. Outcomes at 6 years: freedom from severe mitral regurgitation (group R 97.1% +/- 2.0%, group C 100%, P = 0.288), freedom from moderate or severe mitral regurgitation (group R 97.1% +/- 2.0%, group C 94.4% +/- 5.4%, P = 0.541). Group C patients received larger annuloplasty rings and had significantly lower postoperative transmitral gradients. Conclusions: Leaflet resection and chordal reconstruction are effective techniques for repair of degenerative posterior mitral leaflet prolapse. Both techniques result in a low incidence of recurrent mitral regurgitation. Chordal reconstruction accommodates larger annuloplasty rings and is associated with lower transmitral gradients.