Initial results of the second order chordal-cutting procedure for chronic ischemic mitral regurgitation / 中华胸心血管外科杂志

ABSTRACT

Objective@#To discuss and evaluate the safty and outcome of the second order chordal-cutting.@*Methods@#From Aug 2015 to Mar 2017, 9 chronic IMR patients underwent chordal-cutting procedure, in addition to myocardial revascularization and undersized mitral annuloplasty. The indication was the presence of increased tethering of the anterior leaflet, with a bending angle (BA)<145° and the coaptation depth (CD) less than 10 mm. Pre- and post-procedure clinical data including left ventricular ejection fraction(LVEF), mitral regurgitation grade, New York Heart Association (NYHA) class and dimension of the left ventricle were compared.@*Results@#There was no perioperative death. No patient was lost to follow-up. MR grade decreased from 2.89 ± 0.60 preoperatively to 0.56 ± 0.70 postoperatively. The New York Heart Association class decreased from 2.78 ± 0.70 preoperatively to 1.33 ± 0.50 postoperatively. The BA increased from (136.22 ± 4.55)°preoperatively to (174.22 ± 3.15)°postoperatively. The coaptation depth decreased from (8.59 ± 0.46) mm preoperatively to (1.54 ± 0.68) mm postoperatively. LVEF increased from 0.49±0.07 preoperatively to 0.57±0.05 postoperatively. The diastolic and systolic diameters of left ventricle decreased from (62.78 ± 5.24 )mm to (53.67 ± 2.99)mm and( 44.11 ± 4.62)mm to( 37.22 ± 3.27)mm, respectively.@*Conclusion@#In selected chronic IMR patients with a BA<145° and coaptation depth less than 10 mm, second order chordal-cutting can be a good surgical option, and is related to less MR return or persistence, improved LVEF, and lower New York Heart Association class.