title: Chordal cutting in ischemic mitral regurgitation: a propensity-matched study.
abstract: OBJECTIVE
  The optimal surgical treatment of ischemic mitral regurgitation (MR) has not been well defined. Second-order chordal cutting (CC), in selected patients, can improve surgical outcomes.
  
  
  METHODS
  From 2007 to 2011, 31 patients underwent CC for ischemic MR. The indication was the presence of increased tethering of the anterior leaflet, with a bending angle (BA) <145°. Patients with same echocardiographic characteristics were identified and propensity matched for age, ejection fraction (EF), MR grade, diameters, and BA. Only patients with preoperative and follow-up echocardiograms were included and divided into 2 groups of 26 patients each, CC and no-CC.
  
  
  RESULTS
  Preoperatively, in the CC and no-CC groups, the age was 61 ± 9 and 62 ± 10 years, EF was 31% ± 5% and 29% ± 8%, MR grade (0-4) was 3.6 ± 0.6 and 3.3 ± 0.8, and diastolic and systolic dimension was 56 ± 7 and 43 ± 8 mm and 57 ± 11 and 44 ± 11 mm, respectively. The New York Heart Association class and BA was 2.7 ± 0.6 and 2.6 ± 0.7 and 137° ± 4° and 137° ± 6°, respectively. All patients underwent overreductive annuloplasty. In the CC group, second-order chords were cut using aortotomy. After a mean of 33 ± 15 months, the MR grade was 0.6 ± 0.6 and 1.1 ± 0.8 (P = .014) and the EF was 40% ± 5% and 35% ± 7% (P = .005) in the CC and no-CC groups, respectively. The corresponding diastolic and systolic diameters were 52 ± 5 and 38 ± 8 mm and 53 ± 11 and 41 ± 12 mm (P = NS). The modifications were significant only in the CC group (P = .022 and P = .029 for the diastolic and systolic dimensions, respectively). The corresponding New York Heart Association class decreased to 1.1 ± 0.3 and 1.5 ± 0.6 (P = .004). The BA increased to 182° ± 4° in the CC (P < .001) and remained unchanged (137° ± 6°) in the no-CC group.
  
  
  CONCLUSIONS
  In selected patients with a BA <145° and coaptation depth ≤10 mm, CC is related to less MR return or persistence, improved EF, and lower New York Heart Association class.
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. Electronic address: am.calafiore@gmail.com.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Calafiore
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Reda
authors.initials: R
authors.lastname: Refaie
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. Department of Cardiothoracic Surgery,c Mansoura University, Mansoura, Egypt.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Iacò
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Asif
authors.affiliation: Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Heythem S
authors.initials: HS
authors.lastname: Al Shurafa
authors.affiliation: Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Hussein
authors.initials: H
authors.lastname: Al-Amri
authors.affiliation: Department of Cardiology, University of Catania, Catania, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Romeo
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia; Department of Cardiology, University of L'Aquila, L'Aquila, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
mesh_terms: D000368:Aged; D002815:Chordae Tendineae / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology; D020127:Recovery of Function; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left