Mitral Valve Replacement with Papillary Muscle Resuspension in Rheumatic Mitral Valve Disease

Abstract

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In this study, we compared two different mitral valve replacement techniques (with and without papillary muscle resuspension via artificial chordae) in patients with rheumatic mitral valve disease; in regard to effects on left ventricular functions and sizes. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The study included 164 patients that underwent mitral valve replacement with the complete resection of the mitral valve and subvalvular apparatus due to rheumatic mitral valve disease between January 2010 and September 2015. First, the patients were classified into two different sections according to severety of mitral insufficiency. Then, those who underwent papillary muscle resuspension were compared with those who didn't in each section. R Re es su ul lt ts s: : Overall hospital mortality rate was 0.6% with 1 death. Among the patients who have significant mitral insufficiency, there was a significant difference between those with and without resuspension in respect to rates of inotrophic support taking and hospitalization duration times (59.2% versus 26.6%, p=0.033 and 10.59±5.8 versus 7.64±5.5 days , p= 0.036, respectively) in early postoperative period and ejection fractions (increased significantly in patients with resuspension from 56.23±9.1 to 59±6.5, while decreased in patients without resuspension from 58.37±9.9 to 57.07±9.1) during the mid-term postoperative period. C Co on nc cl lu us si io on n: : In the case of valve replacement in rheumatic mitral valve disease, if there is significant mitral regurgitation preoperatively, performing papillary muscle resuspension affects left ventricular systolic functions positively. So, resuspension of the papillary muscles can be considered as a favorable alternative to other valve sparing technique due to potential advantages of maintaining mitral annulopapillary muscle continuity. K Ke ey y W Wo or rd ds s: : Rheumatic heart disease; heart valve prosthesis implantation; chordae tendineae Ö ÖZ ZE ET T A Am ma aç ç: : Biz bu çalışmada romatizmal mitral kapaklı hastalarda iki farklı mitral kapak replasman tekniğini (yapay korda ile papiller kas resüspansiyonu yapılan ve yapılmayan) sol ventrikül fonksiyon ve boyutlarına etkileri bakımından karşılaştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya Ocak 2010-Eylül 2015 arasında romatizmal mitral kapak hastalığı nedeni ile mitral kapak ve subvalvuler yapılar tamamen rezeke edilerek kapak replasmanı yapılan 164 olgu dahil edildi. İlk olarak hastalar preoperatif önemli mitral yetersizlik olup olmamasına göre 2 gruba ayrıldı. Sonra her grup içinde papiller kas resüspansiyonu yapılanlar yapılmayanlar ile karşılaştırıldı. B Bu ul lg gu ul la ar r: : Total mortalite 1 ölüm ile %0,6 idi. Önemli mitral yetersizliği olan hastalardan resüspansiyon yapılan ve yapılmayanlar arasında inotropik destek ihtiyacı ve hastanede kalış süreleri bakımından anlamlı farklılık vardı (%59,2'ye karşı %26,6, p=0,033 ve 10,59±5,8'e karşı 7.64±5.5 gün, p...