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

ABSTRACT Objectives The Canadian Mitral Research Alliance CardioLink-2 study investigated leaflet resection versus preservation techniques for posterior leaflet prolapse and found no difference in their effect on mean mitral gradient at peak exercise 12-months postoperatively. The purpose of this sub-analysis is to evaluate the impact of the two strategies on left ventricular (LV) reverse remodeling after repair. Methods A total of 104 patients were randomized to either a leaflet resection or leaflet preservation strategy. Echocardiograms, performed at baseline (preoperative), pre-discharge, and 12 months postoperatively, were analyzed in a blinded fashion at a core laboratory. Results All patients underwent successful mitral repair. At discharge, three patients demonstrated moderate mitral regurgitation, whilst the remainder showed mild or less regurgitation. Compared to the baseline echocardiogram, the indexed end diastolic volume was reduced at the discharge echocardiogram (p Conclusions The mitral repair strategies used did not influence postoperative LV reverse remodeling, which occurred in stages. While LV end diastolic dimensions recovered before discharge, improvements in LV end systolic dimension were evident 12 months after repair.