| Objectives.Leaflet resection and chordal replacement are two established techniques in treatment of posterior leaflet prolapse in mitral valve regurgitation.In this study,we assessed and compared the evolution of postoperative transmitral gradient and the morphological restoration after two procedures.Methods.We retrospectively investigated 232 patients who underwent mitral valve repair for posterior leaflet prolapse at our institution between 2007 and 2013.Mid-term survival,incidences of mitral valve-related reoperation and readmission for heart failure,and transthoracic echocardiographic parameters were followed-up to identify risk factors that might be associated with increased transmitral gradient.In 46 patients and 60 subjects without valvular disease,data of transesophageal echocardiography were collected and reconstructed into three-dimensional datasets.The pre-and postoperative three-dimensional parameters were compared.Results.The median follow-up time was 57 months after surgery.Sixty-seven pairs were matched according to the propensity scores.Survival,incidences of mitral valve-related reoperation and readmission for heart failure,echocardiographic parameters and transmitral gradient were comparable,both in the unmatched and matched groups.Subgroup analysis showed that prosthetic size indexed by body surface area and full ring annuloplasty were two important risk factors for late increase in transmitral gradient.The intergroup difference in three-dimensional parameters were not significant before surgery.After surgery,the exposed posterior leaflet area and posterior leaflet ratio were significantly lower in patients undergoing leaflet resection,but were better restored to normal values than chordal replacement.Conclusions.Leaflet resection and chordal replacement had similar mid-term increase in transmitral gradient,in the presence of similar use of annuloplasty device.Compared with its non-resectional counterpart,leaflet resection is more capable of normalizing the position of coaptation lines. |
