Impact of Surgical Techniques Used for Mitral Valve Repair on Hemodynamic Performance

Abstract: AbstractBackground Mitral regurgitation (MR) has many etiologies; the most common is degenerative disease. If not corrected, severe MR may cause left and right ventricular heart failure. Mitral valve (MV) repair is the gold standard for treatment of MR. All repair techniques include MV annuloplasty, but various techniques are employed to repair the valvular apparatus. The classical technique of leaflet resection is associated with excellent results, but repair using artificial chordae is gaining popularity and has been shown to achieve similar results.Aims (1) Does MV repair with artificial chordae correct the morphology and function of the MV better than leaflet resection? (2) How common are MR at rest and systolic anterior motion (SAM) when these techniques are comparedat rest and during physical exercise? (3) To what extent is the right ventricular function restored in patients with chronic MR after MV repair? (4) Is MV repair preferable for the surgical treatment of MV infective endocarditis?Methods Study I: Retrospective study conducted in two centers that compares the results of MV repair using two different surgical techniques.Studies II and III: Prospective studies of resting and exercise echocardiography in patients that had undergone MV repair with either artificial chordae or leaflet resection. Study III compares the hemodynamics and left ventricularfunction of the repaired MV. Study IV evaluates the right ventricular function at rest and during exercise.IV: Retrospective study of long term outcomes of patients with MV infective endocarditis (IE) who underwent surgical repair in Lund with different surgical techniques.Results and importanceI: Both evaluated techniques for repair the MV were associated with good long-term survival and low incidence of recurrent MR, reoperation, IE and thromboembolism. No significant differences were detected between the groups.II: Both surgical techniques were associated with low pressure gradients over the MV at rest and during exercise without any significant difference between the groups. The left ventricular function was well preserved and both groups had good exercise capacity.III: At follow up, patients who underwent mitral valve repair had significantly worse RV function at rest and peak exercise than did healthy individuals.IV: Mortality following surgery for mitral IE is high. Independent predictors of poor outcome are the preoperative symptoms of persisting fever, clinical stroke and heart failure and infection with S. aureus, diabetes mellitus, renalfailure and age. The surgical method (i.e. repair or prosthesis implantation) did not influence survival of IE.