title: Ventricular energetics early after surgery for chronic mitral regurgitation: repair versus replacement.
abstract: OBJECTIVE
  The study aim was to compare the effects of mitral valve (MV) repair and replacement with partial (posterior leaflet only) chordal preservation on left ventricular (LV) performance in chronic degenerative mitral regurgitation (MR) by assessing ventricular energetics.
  
  
  METHODS
  Contractility (end-systolic elastance), afterload (effective arterial elastance), and ventricular efficiency (ventriculoarterial coupling and the ratio of stroke work to pressure-volume area were determined using transthoracic echocardiography data obtained before and at one month after surgery in 29 patients undergoing MV repair, and in 12 patients undergoing partial chordal-sparing MV replacement. A two-way analysis of variance with repeated measures was used for comparisons among patients who underwent MV surgery (valve repair versus valve replacement).
  
  
  RESULTS
  The LV diastolic volume index was decreased significantly in both groups (p<0.0001), whereas the LV systolic volume index did not change significantly (p=0.956). Despite the similar remarkable decrease in ejection fraction (p<0.0001) in both groups, end-systolic elastance remained unchanged (p=0.312). Effective arterial elastance was increased significantly in both groups (p<0.0001). Ventriculoarterial coupling and the ratio of stroke work to pressure-volume area deteriorated similarly in both groups (p<0.0001 and p<0.0001).
  
  
  CONCLUSIONS
  Compensation of LV geometry after correction of chronic MR preserved ventricular contractility. Furthermore, the results of MV repair were not superior to those of MV replacement with partial chordal preservation in the early postoperative period. This suggested that partial chordal-sparing MV replacement is an effective method for the treatment of chronic MR in selected patients.
authors.affiliation: Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Imasaka
authors.affiliation: Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka.
authors.forename: Yuma
authors.initials: Y
authors.lastname: Motomatsu
authors.affiliation: Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Hori
authors.affiliation: Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka.
authors.forename: Takanori
authors.initials: T
authors.lastname: Kono
authors.affiliation: Cardiovascular Surgery, Kyushu University, Fukuoka, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tanoue
authors.affiliation: Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka.
authors.forename: Eiki
authors.initials: E
authors.lastname: Tayama
authors.affiliation: Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Tomita
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004548:Elasticity; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D009200:Myocardial Contraction; D018579:Patient Selection; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left; D017725:Ventricular Pressure; D020257:Ventricular Remodeling