title: A systematic review and meta-analysis of chordal replacement versus leaflet resection for isolated posterior mitral valve prolapse.
abstract: BACKGROUND
  Chordal replacement (Chord MVr) for isolated posterior mitral valve prolapse allows for preservation of the native mitral valve apparatus. The potential benefits of this approach, as compared with leaflet resection (Resection), are not clearly defined.
  
  
  METHODS
  A systematic review and meta-analysis was conducted on operative, clinical, and echocardiographic outcomes. Risk ratios (RR) were calculated by the Mantel-Haenszel method under a fixed or random effects model, as appropriate.
  
  
  RESULTS
  Eight studies were included, with a total of 1922 patients (Chord MVr, N.=835; Resection, N.=1087). Baseline characteristics were similar, except for a higher incidence of atrial fibrillation in the Chord MVr group (15.5% versus 9.9%, P=0.03), and a slightly greater mitral regurgitation grade in the Resection group (3.5 versus 3.4, P=0.008). P2 segment prolapse was the most common pathology, however, patients undergoing Chord MVr had a higher incidence of multi-segment prolapse (32.1% versus 13.9%, P=0.0006). There was no difference in operative mortality (1.1% for both) or perioperative complications. At a mean follow-up of 2.9±2.8 years (median=2.8 years, IQR 1.6-4.4), Chord MVr was associated with a lower risk of reoperation (1.1% versus 4.3%; RR 0.26, 95% CI 0.12-0.56, P=0.0007), and similar survival and recurrence of moderate mitral regurgitation, when compared with Resection. Finally, a lower transmitral gradient (2.5 versus 2.8 mmHg, P=0.0004) and larger orifice area (3.2 versus 3.0 cm2, P=0.002) were observed with Chord MVr.
  
  
  CONCLUSIONS
  At 2.9-year follow-up, Chord MVr for isolated posterior mitral valve prolapse was associated with a lower reoperation rate and favorable valve hemodynamics, when compared with leaflet resection.
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA - cmihos@mgh.harvard.edu.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Evin
authors.initials: E
authors.lastname: Yucel
authors.affiliation: Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002815:Chordae Tendineae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome