September 2024

CARDIOVASCULAR

LATE RESULTS OF CHORD TRANSFER AND OTHER TECHNIQUES FOR ANTERIOR LEAFLET REPAIR WITHOUT NEOCHORDS

Featuring: Patrick M. McCarthy, MD, and Sarah Nisivaco, MD​
A recent study published in the Journal of Thoracic and Cardiovascular Surgery aimed to assess the outcomes of mitral valve repair techniques for anterior and bileaflet degenerative mitral regurgitation (DMR) without the use of neochord repair. The study included a large cohort of 2,368 patients who underwent mitral valve surgery, with 1,160 patients presenting with DMR.

Their primary objective was to evaluate:
  • Repair success rate
  • Long-term survival
  • Freedom from mitral valve reintervention
  • Freedom from moderate or severe mitral regurgitation

The results showed a high repair success rate of 98%, with most patients experiencing a significant reduction in mitral regurgitation severity. The mean mitral regurgitation grade decreased from 3.8 preoperatively to 0.07 at discharge, indicating successful repair outcomes. Notably, the study found no significant difference in long-term survival rates among different repair techniques, suggesting that various approaches can yield comparable outcomes.

Furthermore, the freedom from mitral valve reintervention was excellent, with an overall rate of 99.4%. This indicates that the repaired valves remained durable and did not require further intervention in most cases. Additionally, the freedom from moderate or severe mitral regurgitation was high, with an overall rate of 98.3%. These findings highlight the effectiveness of the repair techniques employed in mitigating mitral regurgitation and maintaining valve function.

Importantly, the study emphasized that complex anterior leaflet prolapse repairs can be successfully achieved without neochord implantation. While neochords are commonly used, this study suggests that alternative repair methods can yield favorable outcomes without requiring extensive judgment and experience.
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Learn more about the study >
Patrick M. McCarthy, MD, Executive Director, Northwestern Medicine Bluhm Cardiovascular Institute
Sarah Nisivaco, MD, PGY4 Resident, Thoracic Surgery at Northwestern Medicine
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