Mitral Valve Replacement with Preservation of the Subvalvular Structures Where Possible: an Echocardiographic and Clinical Comparison with Cases Where Preservation Was Not Possible

Abstract

Mitral valve replacement (MVR) is still associated with a relatively high mortality. To prove the benefits of chordal preservation at mitral valve replacement, we investigated its effects in a series of 65 consecutive MVR patients. Of those patients, in 42 preservation of the mitral subvalvular structures was possible whereas in the other 23 they had to be excised. Both groups showed no differences in age, sex, preoperative NYHA class, and valve pathology. Intra- and postoperative management was similar in both groups. The surgical techniques employed are described and the early postoperative course of both groups are analysed. Clinical, electrocardiographic and echocardiographic investigations, measuring left-atrial and -ventricular diameters, right-ventricular diameters and left-ventricular length, demonstrated that whereas beneficial effects were evident in both groups, the amount of benefits was higher in patients with chordal preservation. Chordal preservation also provided less arrhythmias than chordal resection.

Preservation of the mitral valve apparatus: evidence synthesis and critical reappraisal of surgical techniques

“…The literature search identified 24 [11][12][13][14]18,28,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] comparative studies matching the selection criteria including 2933 patients (1603 (55%) MVR-P, 1330 (45%) MVR-NP). Two groups namely David et al [11][12][13][14]47] and Straub et al [38,[48][49][50] each published multiple studies reporting on the same outcomes, but were included because they reported these outcomes at different follow-up periods in each of these studies.…”

“…Two groups namely David et al [11][12][13][14]47] and Straub et al [38,[48][49][50] each published multiple studies reporting on the same outcomes, but were included because they reported these outcomes at different follow-up periods in each of these studies. This paper therefore reports on the results of 17 groups over the 24 studies as shown in Table 1.…”