title: Preservation of normal left ventricular geometry during mitral valve replacement.
abstract: The role of the subvalvular apparatus in preserving left ventricular (LV) systolic function, regional LV mechanics and three-dimensional contraction synergy has now been generally accepted. We have developed techniques for maintaining the mitral annulopapillary muscle continuity during mitral valve replacement (MVR) to preserve the normal geometry of the left ventricle. From January 1990 through February 1995, a total of 375 patients underwent MVR. In 183 patients, the entire subvalvular apparatus was retained or the mitral annulo-papillary muscle continuity was reconstructed with Gore-tex sutures. There were 100 males and the average patient age was 64 (24-84) years. One hundred and forty-seven patients had mechanical bileaflet valves implanted and the remaining 36 received bioprostheses. One hundred and nine patients underwent isolated MVR with an operative mortality of three (2.8%), 52 patients had combined MVR and coronary surgery with four deaths (7.7%), 15 patients had multiple valve procedures with one death (6.7%) and seven patients had MVR combined with miscellaneous procedures with no operative deaths. All patients underwent transesophageal echocardiography evaluation intra-operatively. In addition, transthoracic echocardiograms performed during the follow up period (3 mo.-5 yrs.) have demonstrated preservation of global LV function with no evidence of LV outflow tract obstruction. We conclude that preserving the LV geometry by normal anatomical chordal preservation or replacement during MVR is a safe technique resulting in gratifying intermediate term results.
authors.affiliation: Department of Cardiac Surgery, Southern California Regional Center, Kaiser Permanente Medical Center, Los Angeles 90027, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Sintek
authors.forename: T A
authors.initials: TA
authors.lastname: Pfeffer
authors.forename: G
authors.initials: G
authors.lastname: Kochamba
authors.forename: A
authors.initials: A
authors.lastname: Fletcher
authors.forename: S
authors.initials: S
authors.lastname: Khonsari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D002815:Chordae Tendineae; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000379:methods* / Q000401:mortality; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D016276:Ventricular Function; D016277:Ventricular Function, Left