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J Thorac Cardiovasc Surg 2007;133:1483-1492
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Initial results of the chordal-cutting operation for ischemic mitral regurgitation

Michael A. Borger, MD, PhD*, Patricia M. Murphy, MD, Asim Alam, MD, Shafie Fazel, MD, PhD, Manjula Maganti, MSc, Susan Armstrong, MSc, Vivek Rao, MD, PhD, Tirone E. David, MD

Division of Cardiovascular Surgery and Department of Anesthesia, Toronto General Hospital, University Health Network, and University of Toronto, Toronto, Ontario, Canada.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication May 14, 2006; revisions received January 7, 2007; accepted for publication January 29, 2007.

* Address for reprints: Michael A. Borger, MD, Division of Cardiovascular Surgery, Toronto General Hospital, 4N-451, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. (Email: michael.borger{at}med.uni-leipzig.de).

Objective: Division of secondary chords (chordal cutting) has been proposed as a method for decreasing mitral valve leaflet tethering and mitral regurgitation in patients with ischemic mitral regurgitation. However, very little clinical data exist to date for this procedure.

Methods: We compared echocardiographic and clinical data in patients who underwent chordal-cutting mitral valve repair (n = 43) and those undergoing conventional mitral valve repair (control, n = 49) for ischemic mitral regurgitation.

Results: Patients who underwent chordal cutting had a higher prevalence of recent myocardial infarction, left main disease, diabetes, and peripheral vascular disease (all P < .05). Left ventricular ejection fraction was lower in the chordal-cutting group (33 ± 2% vs 44 ± 2%) (mean ± SE) and preoperative tent height was greater (11.7 ± 0.5 vs 9.7 ± 0.6 mm; both P < .01). In-hospital mortality was 10% in control patients and 9% in the chordal-cutting group (P = .9). Other complication rates were similar for the two groups. The reduction in tent height before-to-after repair was similar in the two groups of patients, but those undergoing chordal cutting had a greater reductions in tent area (53 ± 3% vs 41 ± 3%; P = .01). The chordal-cutting group also had greater mobility of the anterior leaflet, as measured by a reduction in the distance between the free edge of the anterior mitral valve leaflet and the posterior left ventricular wall (24 ± 3% vs 11 ± 4%; P = .01). Control patients had more recurrent mitral regurgitation during 2 years of follow-up by univariate (37% vs 15%; P = .03) and multivariate analysis (P = .03). Chordal cutting did not adversely affect postoperative left ventricular ejection fraction (10% ± 5% relative increase in left ventricular ejection fraction vs 11% ± 6% in the control group; P = .9).

Conclusion: Chordal cutting improves mitral valve leaflet mobility and reduces mitral regurgitation recurrence in patients with ischemic mitral regurgitation, without any obvious deleterious effects on left ventricular function.

Abbreviations and Acronyms IMR = ischemic mitral regurgitation; LV = left ventricular; MI = myocardial infarction; MR = mitral regurgitation; MV = mitral valve; TEE = transesophageal echocardiography




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