Improved regional left ventricular performance in mitral valve replacement with orthotopic refixation of the anterior mitral leaflet.
OBJECTIVE
To investigate the influence of different surgical techniques of chordal preservation in mitral valve replacement (MVR) on left ventricular size and function, we studied a series of 244 patients who underwent mitral valve replacement either with (n = 161) or without (n = 83) preservation of the subvalvular structures.


RESULTS
Preoperatively there were no differences between the two patient groups. Three months postoperatively, echocardiography demonstrated that chordal preservation in MVR resulted in smaller left ventricular end-systolic diameter (LVESD) and end-diastolic diameter (LVEDD): preservation versus resection, LVESD: 43.4 +/- 7.8 mm versus 48.8 +/- 9.2 mm (p < 0.05), LVEDD: 57.3 +/- 7.8 mm versus 62.9 +/- 10.5 mm (p < 0.05) and a significantly decreased LV-L (long axis) (87.1 +/- 4.2 mm versus 97.5 +/- 5.7 mm; p < 0.05). There was no significant difference in cardiac dimensions between the three patient subgroups in whom chordal preservation was possible. In addition, left ventricular ejection fraction in the preservation groups was significantly improved compared with the resection group (54.2 +/- 11.2% versus 48.1 +/- 12.4%, p < 0.05); there were no differences between the preservation subgroups. Regional wall motion analysis revealed significantly improved segmental myocardial performance in all segments if both leaflets were preserved or the anterior mitral leaflet was reattached to the anterior mitral annulus.
Straub
U J
UJ
Department of Thoracic and Cardiovascular Surgery, University of the Saarland, Homburg/Saar, Germany.
Huwer
H
H
Kalweit
G
G
Volkmer
I
I
Gams
E
E
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000379:methods; D018618:Echocardiography, Doppler, Color; D005069:Evaluation Studies as Topic; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*