Reply to the Editor:
In their letter to the editor, Rumer and colleagues argue that the lower durability of mitral valve repair (MVr) with chordal replacement compared with leaflet resection in our study1 might be related to the number of implanted neochords. They argue that all case series reporting excellent outcomes after chordal replacement have one thing in common: a high number of implanted neochords.
One of the studies referenced, published by their group, compared outcomes after MVr using leaflet resection and chordal replacement in 2 different eras.2 In era 1, chordal replacement was less common (38%) and in era 2, it was predominately performed (98%). In era 1 and 2, the median number of implanted neochords was 2 and 4, respectively. There was no significant difference in freedom from repair failure at 5 years between the 2 periods. Furthermore, the number of neochords was not a risk factor for repair failure. In comparison, Choi and colleagues3 also used a mean of 4 neochords and compared both techniques using propensity score matching. They reported significantly lower durability of MVr using chordal replacement at 10 years.
Another study mentioned, by David and colleagues,4 reports excellent outcome after MVr using a running loop technique. However, we must consider that 75.1% of cases were corrected using a combination of chordal replacement and leaflet resection. In addition, Adams5 previously commented that he tends to “do belts and suspenders,” meaning combining techniques, to prevent reprolapse attributable to ventricular remodeling after isolated neochordal repair. In conclusion, the reasons for failure of chordal replacement remain unclear and further research is necessary to provide more clarity on this subject.
Conflict of Interest Statement
K.V. reported Medtronic, Astra Zeneca, Edwards Lifesciences, and AtriCure. M.K. reported Sanamedi, Edwards Lifesciences, AtriCure, CytoSorbents, and Novo Nordisk. M.L. reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
References
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