Non-resection and resection techniques for correcting type II mitral insufficiency: comparison of long-term results

Aim: To compare the long-term results reconstructive non-resection and resection techniques in mitral valve prolapse.

Material and methods: 75 adult patients – 60 patients in non-resection techniques group (mean age 57 (49;64) years, 21 female) and 15 patients in resection technique group (mean age 57 (48;67) years, 4 female) with severe degenerative mitral regurgitation (ERO 43,5 (31;50) mm²) underwent mitral valve repair – were included in the retrospective study. Most of patients (96%) were in NYHA class II-III before surgery. Propensity score matching was performed due to retrospective study type. Mean follow-up period was 8,2 (±2,5) year. Ultrasound system Vivid E95 (GE Healthcare) with EchoPAC (version 204) was used for our investigation.

Results: Both groups had comparable ultrasound parameters of mitral leaflets and annulus with bigger ring size implantation tendency in non-resection group (32 ± 1,7 mm versus 30,8 ± 1,8 mm, р=0,07). Also the groups were comparable in volume and functional characteristics of left ventricle. However, there was a difference between groups in left atrial strain during cardiac cycle: 22,5 (13;26)% versus 14,5 (12;16)% in reservoir phase, р=0,04; -13,5 (-10;-19)% versus -10 (-9;-13)% in conduit phase,  р=0,03; -6,5 (-3;-10)% versus -4 (-2;-6)% in contractile phase, р=0,04 in non-resection group and resection group accordingly. Statistically significant difference was detected in non-planar angle (171 (164;177) deg. – 162 (158;169) deg., р=0,02) and cardiac index (4,2 (3,7;4,7) l/min/m² – 3,8 (3,4;4,1) l/min/m², р=0,03). Patients in both groups had not recurrent MR more than 2 degree (38,6% with MR 1 degree, 5% with MR 2 degree).

Conclusion: Non-resection and resection reconstructive techniques are comparable in postoperative parameters of mitral leaflets, annulus and left ventricle with bigger ring size implantation tendency in non-resection group, but there are differences between groups in left atrial strain, non-planar angle, cardiac index in long-term period. However, larger studies are still needed.

Conflict of interest: Authors have nothing to disclose with regard to commercial support.

Identifying number of the investigation: The investigation has identifying number NCT03674593 on ClinicalTrials.com.

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