Comparison of early postoperative results between conventional and transapical mitral valve repair.

Introduction: Conventional mitral valve repair (CMVR) is well-established, safe and effective treatment for degenerative mitral regurgitation (MR). Transapical off-pump implantation of artificial chordae (TA) has been introduced into practice and gained interest among surgeons. However, there are no publications comparing the results between TA and CMVR.

Aim: To compare early postoperative outcomes of CMVR with TA in patients with degenerative MR.

Material And Methods: This was a retrospective cohort study. A total of 169 patients who underwent mitral valve repair between 2011 and 2018 were included in this analysis. Patients were divided into two groups: the TA group, = 78 and CMVR group, = 91. The groups were compared for early postoperative outcomes.

Results: Patients in the TA group were younger, 54.2 ±11.1 vs. 59.5 ±12.8 years ( = 0.005). Patients in the CMVR group had more complicated postoperative course with higher incidence of blood transfusion (42.9% vs. 7.8%, = 0.001), atrial fibrillation (25.3% vs. 11.7%, = 0.031), renal insufficiency (15.4% vs. 2.6%, = 0.007) and stroke (2.1% vs. 0%). In the early postoperative period, one patient died in the TA group, and there were no deaths in the CMVR group ( = 0.277). Residual moderate to severe mitral regurgitation was present in nine (11.5%) TA patients, while none of the patients in the CMVR group had moderate or a higher degree of residual regurgitation ( = 0.001).

Conclusions: Off-pump transapical MV repair is a feasible and safe procedure with low postoperative morbidity rates. Higher rates of mitral regurgitation reoccurrence would require a careful and thorough selection of the patients suitable for the TA approach.