{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:45:25Z","timestamp":1789184725813,"version":"build-2803163510"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2020,10,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Equipoise exists between the use of leaflet resection and preservation for surgical repair of mitral regurgitation caused by prolapse. We therefore performed a randomized, controlled trial comparing these 2 techniques, particularly in regard to functional mitral stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>One hundred four patients with degenerative mitral regurgitation surgically amenable to either leaflet resection or preservation were randomized at 7 specialized cardiac surgical centers. Exclusion criteria included anterior leaflet or commissural prolapse, as well as a mixed cause for mitral valve disease. Using previous data, we determined that a sample size of 88 subjects would provide 90% power to detect a 5\u2013mm\u2009Hg difference in mean mitral valve gradient at peak exercise, assuming an SD of 6.7 mm with a 2-sided test with \u03b1=5% and 10% patient attrition. The primary end point was the mean mitral gradient at peak exercise 12 months after repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Patient age, proportion who were female, and Society of Thoracic Surgeons risk score were 63.9\u00b110.4 years, 19%, and 1.4\u00b12.8% for those who were assigned to leaflet resection (n=54), and 66.3\u00b110.8 years, 16%, and 1.9\u00b12.6% for those who underwent leaflet preservation (n=50). There were no perioperative deaths or conversions to replacement. At 12 months, moderate mitral regurgitation was observed in 3 subjects in the leaflet resection group and 2 in the leaflet preservation group. The mean transmitral gradient at 12 months during peak exercise was 9.1\u00b15.2 mm\u2009Hg after leaflet resection and 8.3\u00b13.3 mm\u2009Hg after leaflet preservation (\n                      <jats:italic>P<\/jats:italic>\n                      =0.43). The participants had similar resting peak (8.3\u00b14.4 mm\u2009Hg versus 8.4\u00b12.6 mm\u2009Hg;\n                      <jats:italic>P<\/jats:italic>\n                      =0.96) and mean resting (3.2\u00b11.9 mm\u2009Hg versus 3.1\u00b11.1 mm\u2009Hg;\n                      <jats:italic>P<\/jats:italic>\n                      =0.67) mitral gradients after leaflet resection and leaflet preservation, respectively. The 6-minute walking distance was 451\u00b1147 m for those in the leaflet resection versus 481\u00b195 m for the leaflet preservation group (\n                      <jats:italic>P<\/jats:italic>\n                      =0.27).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this adequately powered randomized trial, repair of mitral prolapse with either leaflet resection or leaflet preservation was associated with similar transmitral gradients at peak exercise at 12 months postoperatively. These data do not support the hypothesis that a strategy of leaflet resection (versus preservation) is associated with a risk of functional mitral stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier NCT02552771.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.120.046853","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T14:00:41Z","timestamp":1601906441000},"page":"1342-1350","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet Resection Versus Leaflet Preservation on Functional Mitral Stenosis"],"prefix":"10.1161","volume":"142","clinical-trial-number":[{"clinical-trial-number":"nct02552771","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2407-9177","authenticated-orcid":true,"given":"Vincent","family":"Chan","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)."},{"name":"School of Epidemiology, Public Health and Preventive Medicine (V.C.), University of Ottawa, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. David","family":"Mazer","sequence":"additional","affiliation":[{"name":"Department of Anesthesia (C.D.M.), Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital, Toronto, ON, Canada."},{"name":"Department of Anesthesiology and Pain Medicine (C.D.M.), University of Toronto, ON, Canada."},{"name":"Department of Physiology (C.D.M.), University of Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faeez Mohamad","family":"Ali","sequence":"additional","affiliation":[{"name":"Division of Cardiology (F.M.A., W.T., H.L.-P.), Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital, Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8008-028X","authenticated-orcid":true,"given":"Adrian","family":"Quan","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital, Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0487-1319","authenticated-orcid":true,"given":"Marc","family":"Ruel","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)."},{"name":"Department of Cellular and Molecular Medicine (M.R.), University of Ottawa, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit E.","family":"de Varennes","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montr\u00e9al, QC, Canada (B.E.d.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3483-7952","authenticated-orcid":true,"given":"Alexander J.","family":"Gregory","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, AB, Canada (A.J.G.)."},{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Libin Cardiovascular Institute of Alberta, Calgary, Canada (A.J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Bouchard","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Montreal Heart Institute and Universit\u00e9 de Montr\u00e9al, QC, Canada (D.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-5884","authenticated-orcid":true,"given":"Richard P.","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery (R.P.W.), McMaster University, Hamilton, ON, Canada."},{"name":"Department of Health Research Methods, Evidence and Impact (R.P.W.), McMaster University, Hamilton, ON, Canada."},{"name":"Population Health Research Institute, Hamilton, ON, Canada (R.P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9872-399X","authenticated-orcid":true,"given":"Michael W.A.","family":"Chu","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, London Health Sciences Center, University of Western Ontario, Canada (M.W.A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksander","family":"Dokollari","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital, Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Mesana","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., 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