Comparison of Early and Late Postoperative Outcomes Between Chordal Reconstruction and Quadrangular Resection in Patients with Posterior Mitral Valve Prolapse: A Single-center Retrospective Study

Abstract

Background: To compare the early and late postoperative outcomes of chordal reconstruction (CR) and quadrangular resection (QR) in patients with posterior mitral valve prolapse (PMPL).Methods: Between January 2008 and December 2018, 305 patients with PMPL who underwent mitral valve plasty (MVP) were included in this retrospective analysis. The CR procedure was used in 169 patients (CR group), and the QR procedure was used in 136 patients (QR group). Early and late postoperative outcomes were compared between the groups. Results: Follow-up was complete in 96.4% (294/305) of patients, with a mean follow-up of 81.2±30.4 months. No 30-day mortality was observed in any of the patients. The success rate of the mitral valve repair was similar in both groups (99.4% vs. 98.5%, p=0.850). The incidence of early postoperative hemolysis was lower in the CR group than that in the QR group (0.00% vs. 3.0%, p=0.024). Postoperative left ventricular end-diastolic diameter (LVEDD) decreased more significantly in the CR group than in the QR group at 3 months (8.15 [1.30,12.65] vs. 3.25 [-0.05, 8.75] mm, p<0.001). During follow-up, the overall survival rates were 95.1% and 94.6%, respectively. The incidence of reoperation for moderate or severe mitral regurgitation (MR) was similar in both groups (4.3% vs.5.4%, p=0.653), but the time interval between the initial operation and reoperation was shorter in the QR group than in the CR group (84.3±36.1 vs. 120.9±27.6 months, p=0.026). The LVEDD enlargement was more significant in the QR group than in the CR group (4.5 [3.6, 4.5] vs. 2.4 [1.3, 2.8] mm, p<0.001). Conclusions: CR and QR are effective techniques for patients with PMPL. Both techniques resulted in a low incidence of recurrent MR. However, CR can reduce early postoperative hemolysis and LVEDD more significantly. During the long-term follow-up, reoperations due to recurrent MR were performed at a longer interval after the initial operation. LVEDD expansion was better avoided in the CR group.