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

Objectives: In the Canadian Mitral Research Alliance (CAMRA) Trial CardioLink-2 leaflet resection versus preservation techniques for posterior leaflet prolapse was investigated and no difference was shown in their effect on mean mitral gradient at peak exercise at 12 months postoperatively. The purpose of this suba-nalysis was to evaluate the effect of the 2 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 (preopera-tive), predischarge, and 12 months postoperatively, were analyzed in a blinded fashion at a core laboratory. Results: All patients underwent successful mitral repair. At discharge, 3 patients showed moderate mitral regurgitation, whereas the remainder showed mild or less regurgitation. Compared with the baseline echocardiogram, the indexed end diastolic volume was reduced at the discharge echocardiogram (P < .0001) and was further reduced at the 12-month echocardiogram (P = .01). In contrast, the in-dexed end systolic volume did not significantly change from baseline assessed at the predischarge echocardiogram (P = .32) but improved at 12 months postoperatively (P < .0001), resulting in a corresponding improvement in ejection fraction at 12 months (P <.0001). The type of mitral repair strategy had no significant effect on LV reverse remodeling trends. Conclusions: The mitral repair strategies used did not influence postoperative LV reverse remodeling, which occurred in stages. Although LV end diastolic dimen-sions recovered before discharge, improvements in LV end systolic dimension were evident 12 months after repair. (J Thorac Cardiovasc Surg 2023;166:74-83)

Automated summary

This study compared the effects of leaflet resection and preservation techniques on left ventricular reverse remodeling after mitral repair, and found that these strategies did not significantly influence the remodeling trends.