Early evidence of beneficial effects of chordal preservation in mitral valve replacement on left ventricular dimensions

Ghosh, Piyali; Shah, Shaunak; Das, Anjan; Chandra, Mukul; Agarwal, Saket; Mittal, Payal

doi:10.1016/1010-7940(92)90190-9

Cited by 14 publications

(8 citation statements)

References 24 publications

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“…2 In our study, patients undergoing MVR with resection of the anterior leaflet and its chordae (P-MVR group) had an increase in ESV, which differs from the 2 previous investigations. 16,23 Although Ghosh and colleagues 23 reported a fall in the median LV end-systolic dimension in 37 patients undergoing posterior chordal-sparing MVR, the difference was Ͻ5%. In a smaller cohort of 5 patients who underwent a similar type of MVR procedure, Hannein and associates 16 demonstrated a significant decrease in LV end-systolic dimension from 50 to 34 mm.…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Partial Versus Complete Chordal Preservation Methods of Mitral Valve Replacement : A Preliminary Report

Yun¹,

Sintek²,

Miller³

et al. 1999

Circulation

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Background-The merits of retaining the subvalvular apparatus during mitral valve replacement for chronic mitral regurgitation have been demonstrated in numerous clinical and laboratory investigations. In this preliminary report, we analyzed the early effects of complete versus partial chordal preservation on left ventricular mechanics. Methods and Results-Fifty patients undergoing isolated surgical correction of mitral insufficiency were prospectively randomized to either total or partial chordal-sparing mitral valve replacement. Of the first 19 patients studied, 8 had preservation of the posterior leaflet only, and 11 had complete preservation of all chordal structures. A comparison group consisted of 6 patients who had primary mitral valve repair. Echocardiography was performed preoperatively and at discharge from the hospital to determine dimensions, wall stress, and ejection fraction. Preservation of the posterior leaflet only resulted in a reduction in end-diastolic volume, an increase in end-systolic volume (Pϭ0.058), a rising trend in end-systolic stress, a decrease in long-axis fractional shortening, and a fall in ejection fraction from 0.68Ϯ0.16 to 0.46Ϯ0.19 (Pϭ0.001). Although patients who had preservation of all chordal structures also had decreased end-diastolic volume, long-axis fractional shortening, and ejection fraction (0.60Ϯ0.13 to 0.52Ϯ0.07, Pϭ0.01), end-systolic stress fell and end-systolic volume decreased instead of increased. Compared with the posterior leaflet preservation group, those in the group with completely preserved chordal structures had a larger decline in end-diastolic volume and smaller decreases in long-axis fractional shortening and ejection fraction. Changes in end-systolic volume and stress were also statistically different between the 2 cohorts. No differences were detected between the group with total preserved chordal structures and the mitral repair group in any of the measured parameters. Conclusions-Comparedwith posterior chordal preservation only, complete retention of the subvalvular apparatus during mitral valve replacement resulted in improved ejection performance and smaller chamber volumes due to reduced systolic wall stress. These hemodynamic advantages are comparable to those observed with primary mitral reconstruction. (Circulation. 1999;100[suppl II]:II-90 -II-94.)

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Section: Discussionmentioning

confidence: 99%

Randomized Trial of Partial Versus Complete Chordal Preservation Methods of Mitral Valve Replacement : A Preliminary Report

Yun¹,

Sintek²,

Miller³

et al. 1999

Circulation

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“…Ghosh et al [26] studied 79 patients undergoing MVR with complete chordal transection or posterior chordal preservation. The latter was found to be superior in terms of end systolic and diastolic dimensions.…”

Section: Human Echocardiographic (Physiological) Studiesmentioning

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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“…The conventional valve-replacement technique involves excision, with concomitant loss of the continuity between the valve annulus, valve tissue, chordae, and the ventricular wall. Clinical studies have shown, however, that preservation of the subvalvular apparatus plays an important role in maintaining ventricular performance after valve replacement [David 1983;Hennein 1990;Ghosh 1992]. Besides, the long-term outcome in corrected transposition of the great arteries is mainly determined by the function of the systemic ventricle, and consideration should be given to replacing the systemic atrioventricular valve at the earliest signs of progressive ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic Valve Implantation with Preservation of the Entire Valvular and Subvalvular Apparatus of the Tricuspid Valve in Congenitally Corrected Transposition of the Great Arteries

Ergenoglu¹,

Yerebakan²,

Özveren³

et al. 2011

HSF

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Congenitally corrected transposition of the great arteries, which is characterized by atrioventricular and ventriculoarterial discordance, is a rare congenital heart disease. Most of the cases are diagnosed in childhood, owing to associated cardiac anomalies, such as ventricular septal defect, pulmonary stenosis or pulmonary atresia, and Ebstein-like malformation of the tricuspid valve. We present a patient with congenitally corrected transposition of the great arteries who underwent surgical replacement of the tricuspid valve with a bioprosthesis and reconstruction of the left ventricular outflow tract with bovine conduit.

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Early evidence of beneficial effects of chordal preservation in mitral valve replacement on left ventricular dimensions

Cited by 14 publications

References 24 publications

Randomized Trial of Partial Versus Complete Chordal Preservation Methods of Mitral Valve Replacement : A Preliminary Report

Randomized Trial of Partial Versus Complete Chordal Preservation Methods of Mitral Valve Replacement : A Preliminary Report

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

Prosthetic Valve Implantation with Preservation of the Entire Valvular and Subvalvular Apparatus of the Tricuspid Valve in Congenitally Corrected Transposition of the Great Arteries

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