Both Leaflet Preservation During Mitral Valve Replacement:. Modified Anterior Leaflet Preservation Technique

Cingoz, Faruk; Günay, Celalettin; Kuralay, Erkan; Yıldırım, Vedat; Kılıç, Selim; Demirkılıç, Ufuk; Arslan, Mehmet; Tatar, Harun

doi:10.1111/j.0886-0440.2004.200306.x

Cited by 19 publications

(22 citation statements)

References 31 publications

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“…Patients with chordal preservation (anterior, posterior, or complete) had superior left ventricular end systolic and diastolic volumes, as well as end-systolic stress and ejection fraction. More recently, these results have been confirmed by Cingoz et al [28] in 94 patients using a complete chordal preservation technique during MVR.…”

Section: Human Echocardiographic (Physiological) Studiessupporting

confidence: 54%

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: Human Echocardiographic (Physiological) Studiessupporting

confidence: 54%

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 the current analysis, 2 studies [9,10] reported isolated MV repair with a perioperative stroke rate of 3.12% and a summary OR of 9.36, and one study with isolated MVR [11] . The remaining studies involved one or more associated procedures like CABG, maze procedures, or aortic valve procedures depending on the patients' associated symptoms or the surgeons' judgment and restricted further subgroup analyses.…”

Section: Discussionmentioning

confidence: 89%

“…The calculated summary OR was 9.3686 (95% CI 1.302-67.401, p = 0.0263). One primary study [11] involved isolated MVR with a perioperative stroke rate of 1.06%. Majority of MV procedures were performed concurrently with other valvular or coronary artery procedures or atrial fibrillation surgery and this lack of adequate patients undergoing isolated MV procedures limited an extensive analysis of perioperative outcomes.…”

Section: Subgroup Analysismentioning

confidence: 99%

Perioperative Strokes Following Surgical Correction of Mitral Valves: A Systematic Review and Meta-Analysis

Udesh

Natarajan²,

Jeevanantham³

et al. 2017

Eur Neurol

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“…However, this issue has not yet been clarified. 12 Both techniques (bileaflet preservation and posteriorleaflet-only preservation) result in significant decreases in LVES and LVED dimensions during the postoperative period. Such a decrease in LV size introduces the possibility, in cases of bileaflet preservation, of contact between subvalvular structures and the mechanical prosthetic valve leaflets, and of consequent LVOT obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the lack of complications associated with bileaflet preservation in the present study, there are many reports of LVOT obstruction and hindered prosthetic-valve-leaflet function. 4,5,12 Bileaflet preservation should be chosen to prevent further decrease in LVEF in patients who present with substantially impaired LV function, on the condition that the technical difficulties and postoperative risks of bileaflet preservation are considered. In this manner, the risk of adverse sequelae to bileaflet preservation can be reduced.…”

Section: Discussionmentioning

confidence: 99%

Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

Özdemir

Emrecan

Baltalarlı³

2014

Texas Heart Institute Journal

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In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.

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Both Leaflet Preservation During Mitral Valve Replacement:. Modified Anterior Leaflet Preservation Technique

Abstract: Leaflet preserving MVR operation not only improves the left ventricular performance but also reduces the mortality and morbidity after MVR. LVEF increases both at rest and during exercise. Risk of LVOT obstruction can be completely eliminated with our simple technique.

Cited by 19 publications

References 31 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

Perioperative Strokes Following Surgical Correction of Mitral Valves: A Systematic Review and Meta-Analysis

Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

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