Randomized, prospective, single blind study comparing posterior versus complete chordal preservation during mitral valve replacement in rheumatics

Abstract

Introduction:The early and late hemodynamic benefit of preserving the annulo-papillary continuity during mitral valve replacement has been demonstrated retrospectively. However few prospective studies have been done in this regard.Methods: Forty patients (mean age 28.9 yrs) with rheumatic mitral regurgitation were randomized to undergo either partial (PCP) or total (TCP) chordal preservation. The echocardiographically measured left atrial (LA) size, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF), left ventricular fractional shortening (LVFS), left ventricular systolic internal diameter (LVID (s)), left ventricular diastolic internal diameter (LVID (d)) and left ventricular mass (LVM) values were recorded preoperatively, at discharge and at three months. Between group comparison was made using unpaired student t test. Within group comparison was made using repeated measures of analysis of variance (ANOVA) followed by Tukey's honestly significantly different (HSD) test. All tests were carried at 5% significance.Results: Echocardiogram done at discharge showed decrease in the LA size, ESV, EDV, LVID (d/s) in both groups but it continued to fall at three months only in the TCP group. The EF and LVFS decreased at discharge with PCP and continued to be low at three months whereas in TCP group it fell initially following which there was a marginal improvement at three months. The reduction in the echocardiography parameters did not reach statistical significance at the end of three months in either group, except for the reduction in the LVM. The Left ventricle (LV) mass reduction was noted in both the groups at the time of discharge and at three months. The reduction was however much greater in the TCP group (P < 0.01).Conclusion: TCP results in a greater reduction in the LV Mass and improved EF compared to PCP. However there is no statistically significant reduction in LA size, EDV, ESV, LVID (d), and LVID in both the groups at the end of three months. (Ind J Thorac Cardiovasc Surg, 2007; 23: 231-235) (IND J THORAC CARDIOVASC SURG, 2007; 23: 000-000)