Additional procedures
Edge-to-edge repair was performed in all patients in Group 2.
There were 25 cases with one edge-to-edge repair in Group 2 (4 cases with edge-to-edge at anterior and posterior leaflets, 11 cases at posterior and septal leaflets, 9 cases at anterior and septal leaflets, and 1 case at posterior and posterior leaflets). There were 6 cases with 2 edge-to-edge repairs in Group 2 (3 cases with edge to edge at the anterior-posterior leaflet and posterior-septal leaflet, 2 cases at the anterior-septal leaflet and posterior-septal leaflet, and 1 case at the anterior-septal leaflet and posterior-posterior leaflet). One patient in Group 2 underwent three edge-to-edge repairs at the anterior-septal leaflet, anterior-posterior leaflet, and posterior-septal leaflet.
In all patients in both groups, TR was controlled, confirmed by the intraoperative saline test. The 1-week postoperative TR score in all 141 patients decreased, confirmed by echocardiography. TR score improved from 1.6 ± 0.7 to 0.7 ± 0.32 (p<0.0001) in Group 1 and from 2.1 ± 0.78 to 0.88 ± 0.49 (p<0.0001) in Group 2.
Postoperative transthoracic echocardiographic data (Table 3)
All patients underwent transthoracic echocardiography 1 week after surgery. There was no statistically significant difference in the cardiac dimensions between the two groups. The postoperative TR score (0.88 ± 0.49 vs. 0.7 ± 0.32; p=0.043) and the TRPG (24 ± 14 mmHg vs. 19 ± 11 mmHg; p=0.05) were higher in Group 2 than in Group 1, respectively.
Predictors of additional procedures (Table 4)
Table 4 shows the results of the univariate and multivariate logistic regression analyses to identify the predictors of the need for additional procedures. In the model using echocardiographic data and clinical data, the preoperative TR score (odds ratio, 1.8; 95% confidence interval, 1.0–3.4; p=0.042) and the presence of a TV with two posterior leaflets (odds ratio, 2.6; 95% confidence interval, 1.1–6.1; p=0.033) were independent predictors of additional procedures, according to the multivariate analysis
Comparison of echocardiographic parameters for each number of posterior leaflets (Table 5)
There was no significant difference between patients with one posterior valve leaflet and patients with two posterior valve leaflets regarding cardiac dimension in perioperative periods. Patients with two posterior valve leaflets had better cardiac LV contraction than those with one posterior valve leaflet before operation (58% ± 9.2% vs. 53% ± 12%, respectively; p=0.014). There were also no significant differences in the TRPG, the number of patients with pulmonary hypertension and the TV diameter. However, the presence of two posterior valve leaflets was associated with a higher preoperative TR score than one posterior valve leaflet (1.9 ± 0.81 vs. 1.6 ± 0.67, respectively; p=0.032). Regarding echocardiographic parameters after operation, there was no difference of TR score just after surgery between groups, but two posterior leaflets cases had higher TR score than one posterior leaflet cases one year after operation (0.95 ± 0.43 vs. 0.7 ± 0.3, respectively; p=0.0075).