title: Mitral valve replacement with chordae tendineae preservation, traction and fixation in end-stage dilated cardiomyopathy.
abstract: OBJECTIVE
  This study aimed at evaluating results of mitral valve replacement using a new technique of complete chordae tendineae adjustment for left ventricular remodeling.
  
  
  METHODS
  Twenty end-stage idiopathic dilated cardiomyopathy patients with severe functional mitral valve regurgitation underwent mitral valve replacement. Seventeen (85%) were in functional class IV. Both anterior and posterior leaflets of the mitral valve were divided to obtain 4 pillars of chordae tendineae. These were displaced with traction toward the left atrium and anchored between the mitral annulus and a valvular prosthesis. To evaluate the left ventricular remodeling, Doppler echocardiography was performed. For statistical analysis, variance analysis and the Friedman's test were employed.
  
  
  RESULTS
  Two (10%) early deaths occurred. Kaplan-Meyer showed survival at one year post-operative was 85%, 2 years it was 44%, at 3 years 44%, at 4 years 44% and at 5 years it was 44%. In the 48- and 54-month follow-ups, the McNemar test showed improvement in the functional class (p<0.001). In the third month of follow-up, variance analysis showed improvement in the ejection fraction (p=0.008) and reductions of the end diastolic diameter (p=0.038), end systolic diameter (p=0.008), end systolic volume (p=0.029) and end diastolic volume (p=0.009). No statistical differences were noted in the systolic volume. Comparing pre-operative and third- and six-month follow-ups, the Friedman test showed no statistical differences for all studied variables. Variance analyses between pre, three-month and final evaluations showed no significant differences.
  
  
  CONCLUSIONS
  This technique of mitral valve replacement improved the left ventricle ejection fraction and decreased the end diastolic and systolic diameters and the end systolic diastolic volumes up to the third month of follow-up. From then on the variables stabilized.
authors.affiliation: Heart Institute of the Medicine School,University de São Paulo, São Paulo, SP. fgaiotto@ajato.com.br
authors.forename: Fabio Antonio
authors.initials: FA
authors.lastname: Gaiotto
authors.forename: Luiz Boro
authors.initials: LB
authors.lastname: Puig
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
authors.forename: Fábio
authors.initials: F
authors.lastname: Fernandes
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Tossuniam
authors.forename: Miriam Magalhães
authors.initials: MM
authors.lastname: Pardi
authors.forename: Luis A O
authors.initials: LA
authors.lastname: Dallan
authors.forename: Sérgio Almeida
authors.initials: SA
authors.lastname: de Oliveira
authors.forename: José F
authors.initials: JF
authors.lastname: Ramires
authors.forename: Pablo M A
authors.initials: PM
authors.lastname: Pomerantzeff
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001705:Bioprosthesis; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000601:surgery*; D002417:Cattle; D002815:Chordae Tendineae / Q000601:surgery; D003971:Diastole; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011474:Prosthesis Design; D012720:Severity of Illness Index; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*