Left Ventricular Function After Resection of the Papillary Muscles in Patients With Total Mitral Valve Replacement

Bjoerk, V O; L, Bjoerk; Malers, E

doi:10.1016/s0022-5223(19)33386-0

Cited by 29 publications

(3 citation statements)

References 2 publications

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“…Despite existing evidence suggesting that SAP reduces morbidity and mortality [ 9 - 17 ] the sub-valvular apparatus is not always preserved often because it is not possible to preserve them. It is argued that the preserved sub-valvular apparatus prevent an adequately sized prosthetic valve from being used, and cause left ventricular outflow tract obstruction, by interfering with prosthetic valve function [ 26 , 57 - 60 ]. Whilst techniques to eliminate outflow tract obstruction following sub-valvular apparatus preservation have been described [ 27 ], it is reported that some of the preservation techniques cause alteration of the left ventricular geometry, causing rupture of the papillary muscles, systemic embolization and dehiscence of the mitral leaflets from their transposed positions as well as increasing ischemic time [ 26 , 56 - 60 ].…”

Section: Discussionmentioning

confidence: 99%

Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

Rao

Hart

Chow

et al. 2008

J Cardiothorac Surg

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Background: Techniques to preserve the sub-valvular apparatus in order to reduce morbidity and mortality following mitral valve replacement have been frequently reported. However, it is uncertain what impact sub-valvular apparatus preservation techniques have on long-term outcomes following mitral valve replacement. This study investigated the effect of sub-valvular apparatus preservation on long-term survival and quality of life following mitral valve replacement.

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Section: Discussionmentioning

confidence: 99%

Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

Rao

Hart

Chow

et al. 2008

J Cardiothorac Surg

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“…Chordal preservation was initially introduced by Lillehei and colleagues 2 in 1964 but did not gain popularity because of the potentially detrimental effects reported by Bjoerk and colleagues. 3 Its re-emergence was largely due to David and colleagues 4 who described it as an important method of preserving LV function after MVR.…”

Section: Discussionmentioning

confidence: 99%

Effect of Chordal Preservation on Left Ventricular Function

Muthialu

Varma

Ramanathan

et al. 2005

Asian Cardiovasc Thorac Ann

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Chordopapillary apparatus preservation was compared with valve-excising mitral valve replacement in a retrospective analysis of 360 patients, of whom 98 had total or partial chordal preservation and 262 had the conventional operation. No significant differences were seen in age, sex, pathology, crossclamp or cardiopulmonary bypass times between the 3 groups. Left ventricular fractional shortening decreased significantly in patients whose valves had been excised completely, whereas it remained unchanged in patients with either partial or total chordal conservation. There was a survival benefit for patients undergoing leaflet preservation (92% vs. 80% for conventional excision at 5 years; p=0.001). Chordal preservation during valve replacement for mitral valve disease improves survival, enhances functional status, preserves left ventricular geometry and function, and improves overall cardiac performance. Preservation of the posterior leaflet alone offers excellent results that are comparable to those of patients with total chordal preservation.

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“…Their results confirmed the functional importance of the subvalvar apparatus, showing a significant reduction in operative mortality of patients operated on by the team. These results, however, were immediately contested by Bjoerk et al [4] and Rastelli et al [5] in independent studies. However, after the results of Carpentier [6] and stimulated by the studies of Miller et al [7] and David et al [8][9][10][11], mitral operations with partial or total preservation of the cuspids and papillary muscles continued [12,13].…”

Section: Introductionmentioning

confidence: 91%

<![CDATA[<B>New technical approach for crossed papillopexy in mitral valve replacement surgery</B>: <B>short term results</B>]]>

Gomes¹,

Gomes²,

Filho³

et al. 2005

Braz. j. cardiovasc. surg.

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RBCCV 44205-769 Nova abordagem técnica para papilopexia cruzada em operação de substituição valvar mitral: resultados imediatosNew technical approach for crossed papillopexy in mitral valve replacement surgery: short term results Abstract Objective: To present the crossed papillopexy technique and its initial results in the preservation of papillary muscles in mitral valve replacement and ventricular remodeling surgeries for heart failure (CHF).Method: Ten patients, 70% male, with ages between 15 and 75 years old (mean 44.4 ± ± ± ± ± 18.7 years old), suffering from rheumatic mitral valve disease (50%), mitral valve prolapse (10%) or dilated cardiomyopathy (40%), were studied. After opening the left atrium and adequate exposure of the mitral valve, the anterior leaflet already free of its annulus fixation was centrally divided and each half, with its cordae tendineae complex fixed to the commissure on the opposite side. Following this, mechanical (seven cases) or biological (three cases) prostheses were implanted using single sutures in the valve annuli, with reduction of the mitral valve annulus for better ventricular remodeling in CHF cases.Results: All patients were discharged from hospital in good clinical conditions. Additionally all presented with great improvement in the cardiac performance at the end of the first month of follow-up, with significant reductions in the left ventricular and left atrium systolic diameters (p<0.05) and mean increases in the left ventricle ejection fraction of from 46.7 to 56.4 % (p<0.05).Conclusion: The crossed papillopexy technique in valve replacement surgeries for mitral valve lesions and CHF presented significant increases in the left ventricular function and improvement of ventricular remodeling in the studied postoperative period. Descriptors: Mitral valve, surgery. Papillary muscles, surgery. Heart valve prosthesis. Resumo Objetivo: Apresentar a técnica de papilopexia cruzada e seus resultados iniciais na preservação dos músculos papilares em operações de substituição valvar mitral e remodelamentoDescritores: Valva mitral, cirurgia. Músculos papilares, cirurgia. Prótese das valvas cardíacas.

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Left Ventricular Function After Resection of the Papillary Muscles in Patients With Total Mitral Valve Replacement

Cited by 29 publications

References 2 publications

Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

Effect of Chordal Preservation on Left Ventricular Function

<![CDATA[<B>New technical approach for crossed papillopexy in mitral valve replacement surgery</B>: <B>short term results</B>]]>

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