Preservation of the posterior leaflet during mechanical valve replacement for ischemic mitral regurgitation and complete myocardial revascularization

Goor, Daniel A.; Mohr, Rephael; Lavee, Jacob; Sérraf, Alain; Smolinsky, Aram

doi:10.1016/s0022-5223(19)35267-5

Cited by 30 publications

(4 citation statements)

References 14 publications

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“…As there are no published studies comparing HRQoL (utility) following conventional MVR and SAP, HRQoL following MVR was estimated using data on post-operative New York Heart Association (NYHA) class. 8 studies, including non-randomised studies, reported postoperative NYHA class [ 17 - 24 ]. Data was not used from 3 [ 22 - 24 ] as the study groups where not matched preoperatively according to NYHA class and consequently we could not ensure postoperative differences in NYHA class were due to a treatment effect.…”

Section: Methodsmentioning

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: Methodsmentioning

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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“…Resection of the chordopapillary apparatus during mitral valve replacement has been associated with a negative impact on survival and, on the contrary, more favourable outcomes have been observed with the use of subvalvular preservation techniques. However, most studies do not have probabilistic samples with sufficient sizes to demonstrate results with good power and/or good confidence intervals, which makes results be seen as not conclusive [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Rationalementioning

confidence: 99%

Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement: a meta-analysis of 3835 patients

Sá

Ferraz

Escobar

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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Resection of the chordopapillary apparatus during mitral valve replacement has been associated with a negative impact on survival. Mitral valve replacement with the preservation of the mitral valve apparatus has been associated with better outcomes, but surgeons remain refractory to its use. To determine if there is any real difference in preservation vs non-preservation of mitral valve apparatus during mitral valve replacement in terms of outcomes, we performed a systematic review and meta-analysis using MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles to search for clinical studies that compared outcomes (30-day mortality, postoperative low cardiac output syndrome or 5-year mortality) between preservation vs non-preservation during mitral valve replacement from 1966 to 2011. The principal summary measures were odds ratios (ORs) with 95% confidence interval and P-values (that will be considered statistically significant when <0.05). The ORs were combined across studies using a weighted DerSimonian-Laird random-effects model. The meta-analysis was completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ, USA). Twenty studies (3 randomized and 17 non-randomized) were identified and included a total of 3835 patients (1918 for mitral valve replacement preservation and 1917 for mitral valve replacement non-preservation). There was significant difference between mitral valve replacement preservation and mitral valve replacement non-preservation groups in the risk of 30-day mortality (OR 0.418, P <0.001), postoperative low cardiac output syndrome (OR 0.299, P <0.001) or 5-year mortality (OR 0.380, P <0.001). No publication bias or important heterogeneity of effects on any outcome was observed. In conclusion, we found evidence that argues in favour of the preservation of mitral valve apparatus during mitral valve replacement.

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Section: Introductionmentioning

confidence: 99%

“…1 Since the 1964 landmark study by Lillehei et al 2 which reported the preservation of papillary muscles and chordae tendineae in MVR reduced postoperative mortality, low cardiac output syndrome and improved haemodynamic function, MV preservation techniques in MVR have quickly been adopted. Partial preservation of the mitral apparatus through preservation of the posterior leaflet (MVR-P) has been proven to significantly reduce perioperative mortality 3 and is generally regarded as the gold standard when MVR is indicated. However, it is hypothesized that complete preservation of the mitral apparatus with preservation of both the anterior and posterior leaflets (MVR-C) might lend to superior postoperative haemodynamic function as compared to MVR-P by allowing the complete preservation of ideal LV geometry during systole and in maintaining LV diastolic dimensions.…”

mentioning

confidence: 99%

The impact of complete versus partial preservation of the sub‐valvular apparatus on left ventricular function in mitral valve replacement

Ling

Demir

Bleetman

et al. 2022

Journal of Cardiac Surgery

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Introduction In mitral valve replacement (MVR), sudden increases in afterload and disruption of the annular‐chordal‐papillary‐left‐ventricular wall causes left ventricular (LV) dysfunction in the early postoperative period. Preservation of the posterior mitral leaflet apparatus (MVR‐P) has a favorable outcome on LV function. However, there is paucity of data on the impact of complete preservation of the sub‐valvular apparatus (MVR‐C). Objective We investigated the impact of MVR‐P and MVR‐C on baseline and 3‐months postoperative LV ejection fraction (EF) and global longitudinal strain (GLS). Methods We retrospectively analyzed a cohort of 29 MVR‐P and 19 MVR‐C patients with complete echocardiography data at our unit, who were operated between 2008 and 2017. Between‐group changes in LVEF and GLS were compared using independent sample T‐test. Results Median age was 59 years (IQR 50–69 years). Baseline LVEF was 58% (51%– 60%). Baseline GLS was −18.4 (−21.2 to −15.5). There were no significant between‐group differences between all baseline demographics and echocardiographic markers. There was significantly higher absolute postoperative LVEF in MVR‐C patients (p = 0.029). There was also significant worsening in LVEF (p = 0.0121) and GLS (p < 0.0001) after MVR‐P and not MVR‐C, suggesting no reduction in LV function post‐MVR‐C but a reduction post‐MVR‐P. There was significantly less postoperative worsening of GLS per patient in MVR‐C group as compared to the MVR‐P group (p = 0.023), indicating better preservation of LV function. There was also a smaller decline in LVEF per patient in the MVR‐C as compared to the MVR‐P group, although not statistically significant (p = 0.23). Conclusion MVR with complete preservation of the sub‐valvular apparatus shows a favorable impact on the longitudinal function of the heart at 3 months. Further studies with larger patient numbers are indicated to investigate the long‐term results of this surgical approach.

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Preservation of the posterior leaflet during mechanical valve replacement for ischemic mitral regurgitation and complete myocardial revascularization

Cited by 30 publications

References 14 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

Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement: a meta-analysis of 3835 patients

The impact of complete versus partial preservation of the sub‐valvular apparatus on left ventricular function in mitral valve replacement

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