• Saad Bader Zakai
  • Salman -Ur-Rehman Khan
  • Fazle Rabbi
  • Habiba Tasneem


Background: Convention mitral valve (MV) replacement is known to cause deterioration in theleft ventricle function, the major mechanism responsible being disruption of the annulo-papillarycontinuity, thus favoring preservation of the mitral subvalvular apparatus. The aim of this studywas to compare the early and midterm results, in terms of cardiac mechanics and clinicaloutcomes, of preserving the subvalvular apparatus (partial/complete) verses resection duringmitral valve replacement. Methods: This was a prospective non randomised trial. One hundredand twenty-two patients (mean age 40.36±14.27 years) admitted for MV replacement fromJanuary 2009 to September 2009 were included in the study. They were divided into 3 groups:complete excision of the subvalvular apparatus (group 1=32); preservation of the posterior leaflet(group 2=54) and total chordal preservation (group 3=36). Echocardiography was donepreoperatively, at discharge, and at 6 months follow-up. Results: The preservation groups 2, 3revealed marked improvements with respect to the End-diestolic Volume (EDV) and End-SystolicVolume (ESV) as compared to the non-preservation group 1 at discharge from hospital. At followup, the preservation groups showed improved EDV and ESV in contrast to the non-preservationgroup, where the ventricular volumes had a declining pattern. Ejection fraction remained belowthe baseline preoperative level in all three groups at discharge from hospital. In the follow-up,chordal preservation groups showed significant improvements in the ejection fraction as comparedto the resection group. An interesting finding was that of PA pressures and LA size between thegroups. It was significantly improved in the preservation groups as compared to the resectiongroup. At follow-up, 43.5% of patients in group 1 were in AF compared with 27.5% in group 2and 21.4% in group 3. More patients in group 1 were in NYHA functional class III or IV atfollow-up: 30.4% versus 7.5% and 7.1% respectively. Conclusion: Preservation of the mitralsubvalvular apparatus resulted in a greater decrease of ventricular dimensions at discharge whichwas maintained at follow-up; complete resection resulted in ventricular dilatation at follow-up.Furthermore, the ejection fraction improved in the preservation groups compared to the completeresection group which showed a decline at follow-up.Keywords: Mitral valve, MV preservation, MV replacement, chordal preservation, MV surgery,subvalvular apparatus


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