Translocated anterior mitral leaflet sparing is a viable treatment option for both degenerative and functional mitral valve disease

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Key findings

• Is the chordal-sparing mitral valve (MV) replacement (CCS-MVR) procedure effective in functional mitral regurgitation and degenerative mitral valve disease?

• Does the CCS-MVR procedure improve left ventricular end-systolic volume and left ventricular end-diastolic volume over time?

• Is the CCS-MVR procedure with anterior leaflet complete translocation suitable for mitral annular disjunction, mitral annular calcification and infective endocarditis with annular abscess?

What is known and what is new?

• There is much discussion around using therapies to treat mitral valve disease in unsuitable repair cases. The American College of Cardiology/American Heart Association suggests the MV-sparing approach may be suitable for surgical replacement (class 2b, level B-R). This recommendation is for patients with coronary artery disease and severe secondary mitral regurgitation, scheduled for MV surgery due to severe symptoms that have not responded to optimal heart failure therapy. CCS-MVR may be a reasonable alternative to downsized annuloplasty repair, but long-term data is lacking.

• This study aims to contribute to existing knowledge by comparing the long-term clinical outcomes of patients who underwent CCS-MVR using a novel approach. This procedure can effectively reduce left ventricle volumes while sparing the apparatus. A larger study is needed to determine the percentage of patients who could benefit.

What is the implication, and what should change now?

• This study offers insights into the most effective treatment for MV disease. CCS-MVR using the entire anterior leaflet translocation may be an effective approach for achieving long-term outcomes. It is hoped that this study will contribute to international guidelines for this procedure and provide data on its efficacy for treating MV disease.

Publication: Nappi F, Salsano A, Abdou I, Gambardella I, Avtaar Singh SS, Alzamil A, Bonnet V, Schoell T, Bonnet N. Translocated anterior mitral leaflet sparing is a viable treatment option for both degenerative and functional mitral valve disease. J Thorac Dis 2025;17(2):707-723. doi: 10.21037/jtd-24-1555