Mitral repair with leaflet preservation versus leaflet resection and ventricular reverse remodeling from a randomized trial

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 166; no. 1; pp. 74 - 83.e2
• Main Authors: Hibino, Makoto, Dhingra, Nitish K., Verma, Subodh, Chan, Vincent, Quan, Adrian, Gregory, Alexander J., Chu, Michael W.A., Ong, Geraldine, Teoh, Hwee, Mazer, C. David, Tsang, Wendy, Messika-Zeitoun, David, Leong-Poi, Howard, Connelly, Kim A., Ali, Faeez Mohamad, de Varennes, Benoit E., Bouchard, Denis, Whitlock, Richard P., Latter, David A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2023
• Subjects: mitral repair; Mitral valve prolapse; ventricular reverse remodeling; CAMRA; Mitral valve prolapse; mitral repair; MR; LVEF; LVESV; LV; LVEDV; LVESD; ventricular reverse remodeling
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2021.08.081

In the Canadian Mitral Research Alliance (CAMRA) Trial CardioLink-2 leaflet resection versus preservation techniques for posterior leaflet prolapse was investigated and no difference was shown in their effect on mean mitral gradient at peak exercise at 12 months postoperatively. The purpose of this subanalysis was to evaluate the effect of the 2 strategies on left ventricular (LV) reverse remodeling after repair.
A total of 104 patients were randomized to either a leaflet resection or leaflet preservation strategy. Echocardiograms, performed at baseline (preoperative), predischarge, and 12 months postoperatively, were analyzed in a blinded fashion at a core laboratory.
All patients underwent successful mitral repair. At discharge, 3 patients showed moderate mitral regurgitation, whereas the remainder showed mild or less regurgitation. Compared with the baseline echocardiogram, the indexed end diastolic volume was reduced at the discharge echocardiogram (P < .0001) and was further reduced at the 12-month echocardiogram (P = .01). In contrast, the indexed end systolic volume did not significantly change from baseline assessed at the predischarge echocardiogram (P = .32) but improved at 12 months postoperatively (P < .0001), resulting in a corresponding improvement in ejection fraction at 12 months (P < .0001). The type of mitral repair strategy had no significant effect on LV reverse remodeling trends.
The mitral repair strategies used did not influence postoperative LV reverse remodeling, which occurred in stages. Although LV end diastolic dimensions recovered before discharge, improvements in LV end systolic dimension were evident 12 months after repair.
[Display omitted]