Chordal cutting in ischemic mitral regurgitation: A propensity-matched study

Objective: The optimal surgical treatment of ischemic mitral regurgitation (MR) has not been well defined. Second-order chordal cutting (CC), in selected patients, can improve surgical outcomes. Methods: From 2007 to 2011, 31 patients underwent CC for ischemic MR. The indication was the presence of increased tethering of the anterior leaflet, with a bending angle (BA) <145 degrees. Patients with same echocardiographic characteristics were identified and propensity matched for age, ejection fraction (EF), MR grade, diameters, and BA. Only patients with preoperative and follow-up echocardiograms were included and divided into 2 groups of 26 patients each, CC and no-CC. Results: Preoperatively, in the CC and no-CC groups, the age was 61 +/- 9 and 62 +/- 10 years, EF was 31% +/- 5% and 29% +/- 8%, MR grade (0-4) was 3.6 +/- 0.6 and 3.3 +/- 0.8, and diastolic and systolic dimension was 56 +/- 7 and 43 +/- 8 mm and 57 +/- 11 and 44 +/- 11 mm, respectively. The New York Heart Association class and BA was 2.7 +/- 0.6 and 2.6 +/- 0.7 and 137 degrees +/- 4 degrees and 137 degrees +/- 6 degrees, respectively. All patients underwent overreductive annuloplasty. In the CC group, second-order chords were cut using aortotomy. After a mean of 33 +/- 15 months, the MR grade was 0.6 +/- 0.6 and 1.1 +/- 0.8 (P=.014) and the EF was 40% +/- 5% and 35% +/- 7%(P=.005) in the CC and no-CC groups, respectively. The corresponding diastolic and systolic diameters were 52 +/- 5 and 38 +/- 8 mm and 53 +/- 11 and 41 +/- 12 mm (P NS). The modifications were significant only in the CC group (P=.022 and P=.029 for the diastolic and systolic dimensions, respectively). The corresponding New York Heart Association class decreased to 1.1 +/- 0.3 and 1.5 +/- 0.6 (P=.004). The BA increased to 182 degrees +/- 4 degrees in the CC (P<.001) and remained unchanged (137 degrees +/- 6 degrees) in the no-CC group. Conclusions: In selected patients with a BA <145 degrees and coaptation depth <= 10 mm, CC is related to less MR return or persistence, improved EF, and lower New York Heart Association class.