Conventional versus complete chordal-sparing mitral valve replacement: effects on left ventricular function and end-systolic stress.
BACKGROUND
This study aims to assess the effects of bileaflet preservation versus conventional technique during mitral valve replacement (MVR) on left ventricular functions and end-systolic stress (ESS).


METHODS
Between September 2005 and January 2009, sixty-five patients with mitral regurgitation underwent MVR surgery. In a non-randomized fashion, 34 patients had conventional MVR without chordal/leaflet preservation (group I, c-MVR), and 31 had MVR with total chordal/bileaflet preservation (group II, b-MVR). A prospective clinical and echocardiographic follow-up of patients was performed preoperatively, at 3 months and by 1 year postoperatively.


RESULTS
Left ventricular end-systolic/end-diastolic dimensions and volumes decreased by 1 year in the b-MVR group. Left ventricular ESS decreased only in the bileaflet sparing MVR group after surgery, and this decrease was significant by 1 year, compared with the c-MVR group (P = 0.008). Left atrial diameter significantly decreased in both groups. Only one patient died, due to posterior wall rupture after a c-MVR procedure. One patient undergoing a b-MVR procedure needed re-operation because of prosthetic valve endocarditis.


CONCLUSIONS
Bileaflet preservation during MVR has a beneficial effect on left ventricular function, compared with conventional MVR. Left ventricular ESS improves after bileaflet-sparing MVR and may be an important indicator of myocardial function after mitral valve surgery.
Department of Cardiovascular Surgery, GATA Haydarpasa Education Hospital, Istanbul, Turkey.
Alper
A
Ucak
Murat
M
Ugur
Burak
B
Onan
Gökhan
G
Arslan
Ibrahim
I
Alp
Eralp
E
Ulusoy
Ahmet Turan
AT
Yilmaz
D000328:Adult; D000465:Algorithms; D002815:Chordae Tendineae / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D013599:Systole; D014463:Ultrasonography; D016277:Ventricular Function, Left