Minimally invasive edge-to-edge mitral repair with or without artificial chordae.

Background: This study aims to analyze the midterm outcomes of minimally invasive edge-to-edge mitral valve repair (MVR) with artificial chords (CHORD) or without artificial chords (noCHORD) in patients with mitral regurgitation (MR).

Methods: Records of all patients undergoing edge-to-edge MVR through minithoracotomy at a single institution over a 7-year period were retrospectively reviewed.

Results: A total of 186 patients underwent edge-to-edge MVR through minithoracotomy. Disease etiology was posterior prolapse in 73 (39%) and bileaflet prolapse in 77 (41%). Edge-to-edge sutures were used at A1-P1 in 20 patients (11%), A2-P2 in 136 (73%), and A3-P3 in 30 (16%). Annuloplasty rings were placed in 184 patients (99%), with a mean size of 36±5 mm. Mean follow-up was 2 years (range, 0 to 6), with mean mitral gradient 4±2 mm Hg, MR mild or less in 179 of 186 (96%), 4 (2%) late reoperations, and 1 (0.5%) late death. The CHORD patients (n=71) were more likely than the noCHORD patients (n=115) to have extensive posterior leaflet pathology (p<0.01), had longer clamp and pump times (p<0.01) and were less likely to need leaflet resection (p=0.002), but had similar postoperative courses. At 3 years, freedom from moderate MR was less in CHORD versus noCHORD patients (88±6 versus 100%, p=0.001), but freedom from reoperation was similar (96%±3% versus 99%±1%, p=not significant).

Conclusions: Early results suggest that edge-to-edge MVR can be safe and effective in patients with mitral regurgitation. Edge-to-edge MVR combined with artificial chordae may be useful in selected patients, but with some risk of recurrent moderate MR.