Mitral valve replacement with preservation of chordae tendineae and papillary muscles

Miki, Shigehito; Kusuhara, K; Ueda, Yuichi; Komeda, Masashi; Ohkita, Y; Tahata, T

doi:10.1016/s0003-4975(95)00163-8

Cited by 19 publications

(17 citation statements)

References 6 publications

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“…Many such methods have been published. 8,9,[13][14][15] In the present instance, we divided the anterior leaflet into 2 parts and attached each to a point on the annulus close to the commissure-on the same side, in order to prevent LVOT obstruction. Thus, the subvalvular structures were moved away from the prosthetic valve leaflets.…”

Section: Discussionmentioning

confidence: 99%

Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

Özdemir

Emrecan

Baltalarlı³

2014

Texas Heart Institute Journal

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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.

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Section: Discussionmentioning

confidence: 99%

Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

Özdemir

Emrecan

Baltalarlı³

2014

Texas Heart Institute Journal

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“…5,22,23 Several different subvalvular-preservation techniques have been described. [6][7][8][9] Some authors advocate complete preservation of the mitral valve apparatus over partial preservation. 16,24 In an experimental study, Hansen and associates 25 proposed that the apparatus of the anterior leaf let is more important than that of the posterior leaf let; however, another experimental study found no substantial difference between anterior and posterior chordal-sparing techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Various approaches to subvalvular apparatus preservation have been developed. [6][7][8][9] Papillary muscle repositioning (PMR) is a subvalvular apparatus-sparing method that can be applied to both the anterior and posterior mitral annulus. In patients with LV dysfunction and mitral regurgitation, several studies 10,11 have shown favorable effects of papillary muscle repositioning on LV remodeling; however, the effect of subvalvular-apparatus-sparing surgery (including PMR) on LV mechanics has not yet been fully elucidated in patients who have isolated mitral stenosis and preserved LV function.…”

mentioning

confidence: 99%

Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

Lafçı¹,

Çağlı²,

Çiçek³

et al. 2014

Texas Heart Institute Journal

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Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes andM itral valve replacement (MVR) with a mechanical or a bioprosthetic valve is one of the most performed cardiac surgical procedures. Although in recent years valve repair has usually been preferred to replacement, MVR is inevitable when repair is not feasible. After MVR, low cardiac output syndrome develops in some patients, because the subvalvular apparatus has not been spared. 1Because the subvalvular apparatus provides continuity between the mitral annulus and the left ventricular (LV) wall through the leaflets, chordae tendineae, and papillary muscles, it plays an important role in LV function.2 Several studies 3-5 have shown that protection of the subvalvular apparatus during MVR can decrease the risk of low cardiac output syndrome, reduce the operative mortality rate, and improve postoperative LV systolic function. Various approaches to subvalvular apparatus preservation have been developed. [6][7][8][9] Papillary muscle repositioning (PMR) is a subvalvular apparatus-sparing method that can be applied to both the anterior and posterior mitral annulus. In patients with LV dysfunction and mitral regurgitation, several studies 10,11 have shown favorable effects of papillary muscle repositioning on LV remodeling; however, the effect of subvalvular-apparatus-sparing surgery (including PMR) on LV mechanics has not yet been fully elucidated in patients who have isolated mitral stenosis and preserved LV function.

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“…In 1988, Miki et al 19 proposed preservation of the chordae tendineae and the division of the anterior leaflet into 2 segments, that were displaced and reattached to the mitral annulus of their respective commissural areas. Buffolo et al 4 proposed that, in the treatment of DCM, the anterior leaflet chordae could be anchored in commissural areas to reduce the LV longitudinal axis and reestablish its elliptical shape.…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation: Initial Results

Lb¹,

Gaiotto

et al. 2002

Arq. Bras. Cardiol.

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Objective -This study evaluated the effects of a new method of mitral valve replacement on left ventricular (LV) remodeling and heart failure functional class. Methods -Eight patients (6 men) Original ArticleFunctional mitral insufficiency (FMI) is not a rare complication of advanced dilated cardiomyopathy (DCM). It reflects changes in left ventricular (LV) geometry, the subvalvular apparatus, the mitral valve area and transvalvular pressures. Patients with DCM and FMI have refractory congestive heart failure and high mortality when in functional class (FC) III or IV. Blondhein et al 1 reported survival rates over 32 months of 59% in patients with DCM without FMI, 26% in those with DCM and discrete FMI, and 17% in patients with DCM and moderate-to-severe FMI.Although heart transplantation is the standard treatment for advanced DCM, the few available donor hearts are insufficient to supply all patients awaiting the organ. Stevenson et al 2 reported a mortality rate of 46% per year in patients with an indication for cardiac transplantation who were waiting for a donor. Others are excluded from the organ waiting list because of advanced age or clinical contraindications.Alternatives to heart transplantation have been proposed to improve quality of life and decrease mortality in these patients. FMI reflects the worst clinical evolution of DCM, and 2 techniques have been used to correct it. The first technique, mitral valve reconstruction, was proposed by Bolling et al 3 . This technique involves reduction of the dilated mitral annulus, thus, LV remodeling because of a decrease in the base diameter. The second technique, mitral valve replacement, was proposed by Buffolo et al 4 . This technique corrects valvular insufficiency and decreases LV base diameter. It involves implanting a small-diameter prosthesis and anchoring the 2 anterior valve hemileaflets, with their respective chordae tendineae, to the mitral annulus to assist the remodeling process.We used mitral valve replacement to treat patients with DCM and FMI in this study. Our primary objective was to evaluate the short-term effects of valve replacement with new positioning of the chordae tendineae on LV remodeling and FC. First, we altered the subvalvular apparatus to isolate 4 pillars with chordae tendineae, 2 from the anterior leaflet

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Mitral valve replacement with preservation of chordae tendineae and papillary muscles

Cited by 19 publications

References 6 publications

Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation: Initial Results

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