title: Bileaflet versus posterior-leaflet-only preservation in mitral valve replacement.
abstract: In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.
authors.affiliation: Department of Cardiac and Vascular Surgery (Drs. Baltalarli and Ozdemir), Ozel Denizli Cerrahi Hospital, 20020 Denizli; and Department of Cardiac and Vascular Surgery (Dr. Emrecan), Pamukkale University, 20070 Denizli; Turkey.
authors.forename: Ahmet Coskun
authors.initials: AC
authors.lastname: Ozdemir
authors.affiliation: Department of Cardiac and Vascular Surgery (Drs. Baltalarli and Ozdemir), Ozel Denizli Cerrahi Hospital, 20020 Denizli; and Department of Cardiac and Vascular Surgery (Dr. Emrecan), Pamukkale University, 20070 Denizli; Turkey.
authors.forename: Bilgin
authors.initials: B
authors.lastname: Emrecan
authors.affiliation: Department of Cardiac and Vascular Surgery (Drs. Baltalarli and Ozdemir), Ozel Denizli Cerrahi Hospital, 20020 Denizli; and Department of Cardiac and Vascular Surgery (Dr. Emrecan), Pamukkale University, 20070 Denizli; Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Baltalarli
mesh_terms: D000328:Adult; D000368:Aged; D057186:Comparative Effectiveness Research; D004452:Echocardiography / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000453:epidemiology; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D016277:Ventricular Function, Left
keywords: Chordae tendineae/surgery; heart valve prosthesis implantation; mitral valve insufficiency; mitral valve stenosis; mitral valve/surgery; papillary muscles/surgery; postoperative complications/prevention & control; retrospective studies; rheumatic heart disease; treatment outcome; ventricular function, left