title: Left ventricular performance early after repair for posterior mitral leaflet prolapse: Chordal replacement versus leaflet resection.
abstract: OBJECTIVE
  To review hemodynamic performance early after valve repair with chordal replacement versus leaflet resection for posterior mitral leaflet prolapse.
  
  
  METHODS
  Between April 2006 and September 2014, 72 consecutive patients underwent valve repair with chordal replacement (30 patients) or leaflet resection (42 patients) for isolated posterior mitral leaflet prolapse. Left ventricular ejection fraction, end-systolic elastance, effective arterial elastance, and ventricular efficiency were noninvasively measured by echocardiography and analyzed preoperatively and ∼ 1 month postoperatively. Mitral valve repair was accomplished in all patients, and no regurgitation (including trivial) was observed postoperatively.
  
  
  RESULTS
  Chordal replacement resulted in significantly less reduction in left ventricular ejection fraction, and significantly greater increase in end-systolic elastance than leaflet resection (left ventricular ejection fraction, 4.8% vs 16.7% relative decrease [P = .005] and end-systolic elastance, 19.0% vs -1.3% relative increase [P = .012]). Despite comparable preoperative ventricular efficiency between the groups, the postoperative ventricular efficiency in the chordal replacement group was superior to that in the leaflet resection group (ventriculoarterial coupling, 32.0% vs 89.3% relative increase [P = .007] and ratio of stroke work to pressure-volume area, 4.3% vs 13.4% relative decrease [P = .008]). In multivariate analysis, operative technique was a significant determinant of left ventricular ejection fraction and ratio of stroke work to pressure-volume area (P = .030 and P = .030, respectively).
  
  
  CONCLUSIONS
  Chordal replacement might provide patients undergoing valve repair for posterior mitral leaflet prolapse with better postoperative ventricular performance than leaflet resection. Longer follow-up is required to compare long-term outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital, Organization Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Imasaka
authors.affiliation: Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital, Organization Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Eiki
authors.initials: E
authors.lastname: Tayama
authors.affiliation: Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital, Organization Kyushu Medical Center, Fukuoka, Japan. Electronic address: ytomita@kyumed.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Tomita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002815:Chordae Tendineae / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016277:Ventricular Function, Left
keywords: chordal replacement; leaflet resection; left ventricular performance; mitral valve repair