Full chordal-sparing mitral valve replacement preserved the anterior mitral leaflet and achieved 98.6% freedom from procedural complications at 12 months in adults with complex mitral valve pathology.
Observational (n=161)
Yes
Does a customised full chordal-sparing mitral valve replacement (FCS-MVRpl) technique safely improve outcomes and preserve left ventricular geometry in patients with complex mitral valve pathology?
The customised full chordal-sparing mitral valve replacement technique is safe and effective for patients with complex mitral valve pathology, demonstrating 98.6% freedom from procedural complications at 1 year.
Mitral valve replacement (MVR) in patients with complex mitral valve (MV) pathology often necessitates excision of the anterior mitral leaflet (AML), potentially compromising left ventricular (LV) geometry and function. We describe a customised full chordal-sparing mitral valve replacement (FCS-MVRpl) technique that preserves the AML and subvalvular apparatus, aiming to maintain LV architecture and improve postoperative outcomes in patients unsuitable for MV repair. Between 2014 and 2023, 161 consecutive patients underwent FCS-MVRpl. MV pathology included degenerative (n = 94, 57.1%), functional (n = 58, 36.0%), infective (n = 9, 5.6%), and rheumatic (n = 2, 1.2%) disease. Among these, 93 patients (57.8%) exhibited complex MV pathology: massive annular calcification (n = 59, 36.6%), mitral annular disjunction (MAD; n = 25, 15.5%), and posterior annular abscesses due to endocarditis (n = 9, 5.6%). The AML was fully mobilised and translocated, preserving the entire chordal apparatus. In cases with excess leaflet tissue, partial excision of the free edge was performed to facilitate prosthesis seating while maintaining chordal integrity. At 12 months, freedom from procedural complications was 98.6% ± 0.97%, with only two adverse events (1.2%) directly attributable to the technique. Freedom from heart failure-related rehospitalisation was 94.2% ± 1.9%. Multivariable Cox regression identified reduced preoperative left ventricular ejection fraction (LVEF) as a predictor of treatment failure (HR: 0.95; 95% CI: 0.92–0.99; p = 0.015). NYHA functional class improved in the majority of patients: 112 (81.2%) were classified as Class I at follow-up, while 11 (8.0%) experienced deterioration. FCS-MVRpl is a safe and effective alternative for patients with complex MV pathology who are not candidates for repair. Preservation of the AML and subvalvular apparatus supports LV geometry and functional recovery. The technique is particularly beneficial in cases of posterior annular calcification, Barlow disease with excess leaflet tissue, and infective endocarditis involving the posterior annulus. However, it is contraindicated in cases of circumferential MV calcification. Further prospective studies are warranted to validate long-term outcomes and broader applicability.
Nappi et al. (2026) conducted an observational in Adults with complex mitral valve pathology undergoing customized full chordal-sparing mitral valve replacement (FCS-MVRpl), including degenerative, functional, infective, and rheumatic mitral valve disease with a high prevalence of mitral annular calcification and mitral annular disjunction (n=161). Full chordal-sparing mitral valve replacement (FCS-MVRpl) with anterior mitral leaflet translocation and preservation of subvalvular apparatus was evaluated on Freedom from procedural-related complications within 12 months (including prosthesis mismatch, interference with prosthesis function, LVOT obstruction, structural/non-structural valve deterioration, cardiac rupture) (95% CI ±0.97%). Full chordal-sparing mitral valve replacement preserved the anterior mitral leaflet and achieved 98.6% freedom from procedural complications at 12 months in adults with complex mitral valve pathology.