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Abstract
The role of mitral subvalvular apparatus in LV performance had been proven. Severing the chordae tendinae and papillary muscles adversely affects LV function and has been associated with poor outcome after MVR.
The aim of this study was to compare between different techniques ofMVR in which mitral leaflets are partially preserved, totally preserved or totally excised, and to assess the importance of leaflet preservation on postoperative
outcome. Sixty patients with MS and lor MR were included in this study. Mitral valve replacement was performed with total chordal preservation (group I n=20 patients), posterior chordal preservation (group II, n=20), and total chordal transaction (group III, n=20). Preoperatively, the three groups were comparable as regard age, sex, NYHA functional class, and EF. Group I showed larger LV dimensions and volume.
The mean LAD was 49.23 ± 6.26 mm and the mean LVEDD was 59.44 ± 10.81 mm and the mean LVESD was 39.53 ± 8.69 mm in group I.
MVR was performed through median sternotomy in all cases. We used
antegrade cold crystalloid cardioplegia and approached the mitral valve through conventional left atriotomy in most of our patients. We used bileafelt as well as tilting disc mechanical valves for replacement. No significant difference was found as regard cross clamp and total bypass times among the 3 groups. We inserted appropriate sized prothesis in all patients of the 3 groups with no evidence of high transprosthetic gradient.
Postoperatively, group I and II showed significant improvement in NYHA functional class, LV dimensions and volumes and better LV performance when compared with group III. However, in the total chordal group the degree of reduction ofESD, ESV and EDV was greater than posterior chordal group. Two cases of mortalities were reported in group III.