A Single-Institution Comparison of Resectional and Preservational Mitral Valve Repair Techniques
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP002
Submission Type:
Abstract Submission
Authors:
Connor Barrett (1), Cameron Ekanayake (1), Fanny Lodge (1), Matthew Clynes (1), Anna Lampe (1), Riley Sevensky (1), Hannah N. W. Weinstein (1), Alexandra Dionne (1), David Morales (1), Hiroo Takayama (1), Koji Takeda (1), Yuji Kaku (1), Isaac George (1), Craig Smith, MD (1), Paul Kurlansky, MD (1), Michael Argenziano (1)
Institutions:
(1) Columbia University Medical Center, New York, NY
Submitting Author:
Connor Barrett
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Columbia University Medical Center
Co-Author(s):
Cameron Ekanayake
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Columbia University Medical Center
Fanny Lodge
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Columbia University Medical Center
Matthew Clynes
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Columbia University Medical Center
Anna Lampe
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Columbia University Medical Center
Columbia University Medical Center
Riley Sevensky
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Columbia University Medical Center
Columbia University Medical Center
Hannah N. W. Weinstein
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Columbia University Medical Center
Alexandra Dionne
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Columbia University Medical Center
David Morales
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Columbia University Medical Center
*Hiroo Takayama
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Columbia University Medical Center
*Koji Takeda
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Columbia University Medical Center
Columbia University Medical Center
Yuji Kaku
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Columbia University Medical Center
*Isaac George
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Columbia University Medical Center
*Craig Smith
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Columbia University Medical Center
Columbia University Medical Center
*Paul Kurlansky, MD
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Columbia University Medical Center
*Michael Argenziano
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Columbia University Medical Center
Presenting Author:
Connor Barrett
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Columbia University Medical Center
Abstract:
Objective: To compare intra-operative details and post-operative outcomes in resectional vs. preservational mitral repair (MVr) techniques for degenerative mitral regurgitation (DMR).
Methods: Between 2015 and 2020, 567 adult patients underwent MVr at our institution. Of these, 136 were isolated repairs of DMR, with no concomitant procedures. Resectional repairs included quadrangular or triangular resections with annular reduction or sliding plasty, and preservational techniques employed construction of neo-chordae. Data was collected retrospectively from the Society of Thoracic Surgeons database and our institutional EMR. Analysis was conducted in Microsoft Excel and SPSS with two-sided t-tests, assuming unequal variances and Pearson's Chi-square test.
Results: One hundred and one patients with degenerative mitral valve disease had isolated resectional MVr (Group R) and 35 patients received preservational MVr (Group P). Preoperative demographics were similar in each group. Leaflet pathology was posterior or bileaflet in 96.0% of Group R cases, and 71.3% of Group P (p < 0.001). Minimally invasive approaches were employed in 32.7% of Group R cases, compared to 77.1% of Group P cases (p < 0.001). Median cross-clamp time in Group R was 61 minutes, IQR of 50 – 72 minutes, vs. a median of 95 minutes, IQR of 70 – 108 minutes, in Group P (p < 0.001. This difference was independent of incisional approach or leaflet pathology. Post-procedure intra-operative MR on TEE was reduced to mild or less in 100% and 97.1% of R and P patients, respectively (p = 0.257). There were no differences in postoperative morbidity as demonstrated in Table 1 and there was no mortality in either group.
Conclusions: In patients undergoing isolated repair of degenerative MR, resectional and preservational techniques were equally safe and effective. Preservational repair techniques required significantly longer aortic cross-clamp and cardiopulmonary bypass times, although this difference did not influence postoperative morbidity. Preservational techniques were more commonly employed in minimally invasive approaches and for anterior leaflet pathology, and may be helpful in these settings. However, when minimization of operative time is important, either due to patient comorbidity or case complexity, resectional techniques may be more expeditious.
Methods: Between 2015 and 2020, 567 adult patients underwent MVr at our institution. Of these, 136 were isolated repairs of DMR, with no concomitant procedures. Resectional repairs included quadrangular or triangular resections with annular reduction or sliding plasty, and preservational techniques employed construction of neo-chordae. Data was collected retrospectively from the Society of Thoracic Surgeons database and our institutional EMR. Analysis was conducted in Microsoft Excel and SPSS with two-sided t-tests, assuming unequal variances and Pearson's Chi-square test.
Results: One hundred and one patients with degenerative mitral valve disease had isolated resectional MVr (Group R) and 35 patients received preservational MVr (Group P). Preoperative demographics were similar in each group. Leaflet pathology was posterior or bileaflet in 96.0% of Group R cases, and 71.3% of Group P (p < 0.001). Minimally invasive approaches were employed in 32.7% of Group R cases, compared to 77.1% of Group P cases (p < 0.001). Median cross-clamp time in Group R was 61 minutes, IQR of 50 – 72 minutes, vs. a median of 95 minutes, IQR of 70 – 108 minutes, in Group P (p < 0.001. This difference was independent of incisional approach or leaflet pathology. Post-procedure intra-operative MR on TEE was reduced to mild or less in 100% and 97.1% of R and P patients, respectively (p = 0.257). There were no differences in postoperative morbidity as demonstrated in Table 1 and there was no mortality in either group.
Conclusions: In patients undergoing isolated repair of degenerative MR, resectional and preservational techniques were equally safe and effective. Preservational repair techniques required significantly longer aortic cross-clamp and cardiopulmonary bypass times, although this difference did not influence postoperative morbidity. Preservational techniques were more commonly employed in minimally invasive approaches and for anterior leaflet pathology, and may be helpful in these settings. However, when minimization of operative time is important, either due to patient comorbidity or case complexity, resectional techniques may be more expeditious.
Mitral Conclave:
Mitral Repair Techniques & Strategies
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