Conventional versus complete chordal-sparing mitral valve replacement: eff ects on left ventricular function and end-systolic stress

Abstract

Background This study aims to assess the eff ects of bileafl et 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-fi ve patients with mitral regurgitation underwent MVR surgery. In a non-randomized fashion, 34 patients had conventional MVR without chordal/leafl et preservation (group I, c-MVR), and 31 had MVR with total chordal/bileafl et 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 bileafl et sparing MVR group after surgery, and this decrease was signifi cant by 1 year, compared with the c-MVR group (P= 0.008). Left atrial diameter signifi cantly 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.

Conclusion Bileafl et preservation during MVR has a benefi cial eff ect on left ventricular function, compared with conventional MVR. Left ventricular ESS improves after bileafl et-sparing MVR and may be an important indicator of myocardial function after mitral valve surgery.

Key Words:

• Left ventricular end-systolic stress
• mitral valve replacement
• bileafl et preservation
• chordal preservation