Valve replacement in rheumatic mitral incompetence: total versus posterior chordal preservation

Hassouna, Ahmed

doi:10.1016/s0967-2109(97)00144-0

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…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.…”

Section: Studies Includedmentioning

confidence: 99%

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

Athanasiou¹,

Chow²,

Rao³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Sub-valvular apparatus preservation after mitral valve replacement is not a new concept, yet to date there has been no quantification of its clinical effectiveness as a procedure and no consensus as to which surgical preservation technique should be adopted to achieve the best immediate and midterm clinical outcomes. This systematic review of current available literature aims to use an evidence synthesis and meta-analytic approach to compare outcomes following replacement of the mitral valve with (MVR-P) or without preservation (MVR-NP) of its apparatus. It considers all the relevant anatomical, experimental, echocardiographic, and clinical studies published in the literature and appraises all reported mitral valve sub-valvular apparatus preservation techniques. The results of this review strongly suggest that MVR-P is superior to MVR-NP with regards to the incidence of early postoperative low-cardiac output requiring inotropic support, and early or mid-term survival. They also suggest that the operative decision should be individualised based on patient's anatomy, pathology and ventricular function and therefore surgeons should be familiar with more than one surgical preservation technique. Finally, this paper highlights the need for further high quality research focusing particularly on the long-term assessment of quality of life and health utility following MVR-P.

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Section: Studies Includedmentioning

confidence: 99%

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

Athanasiou¹,

Chow²,

Rao³

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…In terms of mortality, only Chowdhury et al 13 detected greater (2‐year) survival in the MVR‐C group. Many other studies found no translation of significant differences in haemodynamic benefit into significant differences in perioperative mortality 9,11,14 . Other studies did not find any differences in mean 9‐ 20 and 20‐month 21 mortality.…”

Section: Discussionmentioning

confidence: 97%

“…Residual subvalvular tissue in MVR‐C in patients with rheumatic MV disease could cause recurrent rheumatic fever. However, some studies purely on a rheumatic population have demonstrated both haemodynamic 11,13,14 and mortality 13 benefits with MVR‐C, with modifications in surgical technique and exclusion of patients with active rheumatic disease. Another risk in MVR‐C would be the need to undersize the prostheses, which can cause paravalvular leakage 22 .…”

Section: Discussionmentioning

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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“…It became popular only when David and colleagues demonstrated the benefits 2 . Although first reported in patients with mitral regurgitation 3,4 , chordal preservation can be adopted when destruction of the leaflets and subvalvar apparatus is not extensive. Rheumatic lesions should not be considered a deterrent to valve tissue preservation.…”

Section: Discussionmentioning

confidence: 99%

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

Katewa

Kumar

Srivastava

et al. 2007

Indian J Thorac Cardiovasc Surg

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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)

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Valve replacement in rheumatic mitral incompetence: total versus posterior chordal preservation

Cited by 5 publications

References 14 publications

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

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

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

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

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