Minimally Invasive Mitral Valve Repair for Posterior Leaflet Prolapse Comparison of Surgical Techniques

Objectives: The aim of this study was to compare outcomes of neochordae implantation versus triangular resection in posterior leaflet (P2) prolapse, in the setting of minimally invasive surgery (MIS).

Methods: A total of 933 patients received video assisted MIS mitral repair, via right anterior mini thoracotomy, between January 2010 and December 2014, at our institution from this cohort, 462 presented with P2 prolapse, off those 307 patients received neochordae implantation with pre-measured Goretex “loops” and 155 received triangular resection. All patient data were prospectively entered into the data base Echocardiographic and clinical outcomes were evaluated at 30 days.

Results: 30-day mortality was 1.9% (n = 3) in the neochord group (NG) versus 1.6% (n = 5) resection group (RG) (p = 0.7). Cross clamp times were 84 ± 32 minute (NG) versus 93 ± 32.1 minute (RG). Intra-operative revision of mitral valve repair, due to mitral regurgitation ≥ II, was comparable between the groups at 1.6% (NG) versus 1.3% (RG).

Systolic anterior motion occurred in 2.6% (NG) versus 6.5% (RG). Mean annuloplasty ring diameters were 32 mm (NG) versus 30 mm (RG).

Conclusion: Mitral valve reconstruction can be performed by minimal invasive access with good results using both techniques. The use of pre-measured neochords results in significantly improved hemodynamics. In our experience, the ease of the neochord technique is particularly attractive for surgeons performing mitral valve repair through a minimally invasive approach.