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.

Comparison of modified total leaflet preservation, posterior leaflet preservation, and no leaflet preservation techniques in mitral valve replacement – a retrospective study

“…Studies have demonstrated that the integrity of the mitral valve also plays a key role in maintaining right ventricular function [6]. After Lillehei et al reported good results with the posterior leaflet preservation technique in 1964 [1], subsequent studies demonstrated that the anterior leaflet and subvalvular tissue are equally important in protecting the left ventricular function when compared to the posterior leaflet [7, 8]. Gomes conducted a study of both leaflet preservation techniques [9].…”

Immediate and Long-Term Outcomes After Bioprosthetic Mitral Valve Replacement With the Preservation of the Subvalvular Apparatus

“…Таким образом, необходимость максимального сохранения нативного митрального комплекса вполне очевидна. Итогом реализации представленного хирургического подхода, помимо восстановления замыкательной функции МК, является обеспечение фазы изоволюмического сокращения, что, согласно результатам ряда исследований, приводит к улучшению или полной нормализации региональной и общей сократимости ЛЖ [18,19]. Вместе с тем, следует отметить некоторые моменты, ограничивающие возможности широкого использования данной методики митрального протезирования.…”

EARLY MORTALITY & MORBIDITY IN MITRAL VALVE REPLACEMENT WITH TOTAL SUB-VALVULAR APPARATUS PRESERVATION, PARTIAL PRESERVATION AND NO PRESERVATION - A COMPARATIVE STUDY

“…Postoperative bleeding was another morbidity in our study leading to requirement of RCC transfusion was significantly high in the nonpreservation group; group A <group B <group C. Similar high level of postoperative bleeding was reported in previous resereach 3 . The concept of preservation was highly recommended in the recent era of cardiovascular surgery, not only preservation of the posterior leaflet & apparatus but the anterior leaflet & its subvalvular apparatus is also important for the improvement of LV functions 18 .…”