Postoperative assessment of chordal preservation and changes in cardiac geometry following mitral valve replacement

Abstract

Mitral valve replacement (MVR) is still associated with a relatively high mortality. To investigate the influence of chordal preservation in MVR on left ventricular size and function, we studied a series of 82 patients who underwent MVR either with (group A n = 50) or without (group B n = 32) preservation of the subvalvular structures and compared the two groups. Echocardiography was performed preoperatively, and 7 days and 3 months postoperatively. Echocardiographic investigations included left atrial and ventricular diameters, right ventricular diameters and left ventricular length. Preoperatively there were no difference between the two groups of patients. Intraoperative and postoperative management was similar in the groups. Three months postoperatively echocardiographic examinations demonstrated that chordal preservation in MVR resulted in smaller left ventricular systolic and diastolic diameters (LVESD: gr. A 43.4 +/- 7.8 mm vs gr. B 48.8 +/- 9.2 mm P < 0.05, LVEDD: 57.3 +/- 7.8 mm vs 62.9 +/- 10.5 mm P < 0.05) and a significantly decreased left ventricular length (87.1 +/- 4.2 mm in gr. A vs 97.5 +/- 5.7 mm in gr. B P < 0.05). In addition, left ventricular ejection fraction in group A was significantly improved compared to group B (54.2 +/- 11.2% vs 48.1 +/- 12.4%, P < 0.05). We conclude that chordal preservation in MVR improves left ventricular function and reduces left ventricular diameters and volumes compared to resection of the mitral subvalvular appartus and that these beneficial effects can be maintained in the postoperative course.

Mitral valve replacement for mitral stenosis: A 15-year single center experience

“…The study concluded that complete retention of the subvalvular apparatus during MVR in comparison to posterior chordal preservation resulted in improved ejection performance. Many other studies have demonstrated that subvalvular apparatus preservation is superior to complete excision in MVR [11], [12], [13], [14].…”

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.…”

Importance of preservation of chordal apparatus in mitral valve replacement

“…MVR-P patients had higher LVEF and fractional shortening on late follow-up. Straub's group concluded that MVR with chordal preservation resulted in patients having statistically significant less LVESD, LVEDD and LV length, and greater LVEF at 3-months follow-up compared with a group with all chordae transected [39]. David found that patients with MVR-P had a better exercise capacity at 5-years follow-up and better LV function.…”