Impact of the Preservation of the Subvalvular Apparatus of the Anterior Mitral Leaflet on the Left Ventricular Function After Mitral Valve Replacement in Early Post-Operative Period

Abstract

Background:Long-term morbidity and mortality appear to be associated with mitral valve replacement for mitral valve disease. The morbidity rate has not decreased dramatically over the years, despite enhancements in myocardial safety and prosthetic valves. Cardiac failure is the most common cause of death following MVR. Subvalvular apparatus preservation preserves LV function and thus improves survival. Repair, particularly with rheumatic valve disease in young patients and extremely disorganised valves, is not always feasible or effective. The use of smaller valve prothesis was not only the argument of preserving the anterior leaflet, but also that it could cause LVOT obstruction. Methods:A prospective controlled randomized study will include(sixty patients aged from 25 to 55 years of both sexes) They will be divided into two groups of patients: Group I: thirty patients who underwent MVR without preservation of The chordae tendinae of the anterior mitral leaflet and only preserving the posterior mitral leaflet. Group II: thirty patients who underwent MVR with complete or partial Preservation of the chordae tendinaeof the anterior mitral leaflet. Results:The sixty patients were divided into two groups where 30 of them underwent preservation of AML, These patients had a better LV function in the early and the short term postoperative period. Conclusion:Results of this study concluded that preservation of the AML leads to better postoperative outcome. We recommend its application on a greater scale of cases of MVR.

Effectiveness of Preservation of the Mitral Valvular Apparatus During Mitral Valve Replacement Surgery for Rheumatic Severe Mitral Regurgitation

“…We conclude that preservation of the mitral valvular apparatusdidn't modify the postoperative AF results. This comes in agreement with Chowdhury et al [6] who had a higher preoperative AF rate of 72% and 42.4% postoperative AFwith statistically insignificant difference ( p=0.61) and with El-Safty et al [20] who had (13/30) 43.33% preoperative AF and (10/30) 33.33% postoperative AF. But Straub et al [23] contradict our conclusion and confirm the positive effect of preservation of the mitral valvular apparatuson elimination of the postoperative arrhythmias.…”

“…Our cohort's mean age was 30.11±3.98 years: younger than others' cohorts where Natsuaki et al [21] reported a mean age 55±10 years, Okita et al [22] reported a mean age 52.6 years, Chowdhury et al [6] reported a mean age 35.6±19 years and El-Safty et al [20] reported a mean age 31.47±5.60 years. Our cohort comprised 47(59.49%) females: similar high incidence of female sex to other studies where El-Safty et al [20] reported 58% and Okita et al [22] reported 76%. This demographic distribution criteria can be explained based on the high prevalence of rheumatic fever which was 100% positive in our study population.…”

“…Our study included 79 patients: more than others' cohorts. El-Safty et al [20] had 30 patients and David et al [14] had 54 patients. However, Chowdhury et al [6] had 257 patients.…”

“…Our study was conducted on patients with rheumatic severe MR only resembling a homogenous cohort reflecting more realistic conclusions. Other studies comprised mixed mitral pathologies as that of El-Safty et al [20] who had 30 cases; (15/30) 50% with isolated MR, (8/30) 26.67% with isolated mitral stenosis (MS) and (7/30) 23.33% with mixed mitral disease.…”

“…similar to other studies. For example, El-Safty et al [20] had a mean total bypass time of 82.13±6.23min. Again, we had a mean total cross clamping time of 60.35±7.95min.…”