Ischemic Mitral Regurgitation: Chordal-Sparing Mitral Valve Replacement

Abstract

I n 1964, Lillehei and colleagues introduced the concept of preservation of the attachments between the papillary muscles and mitral annulus during mitral valve replacement to prevent postoperative left ventricular dysfunction. 1 This concept was challenged by other investigators and largely abandoned until 1983 when we reexamined the issue and found that the attachments between the papillary muscles and mitral annulus were important for postoperative ventricular function in patients with mitral insufficiency. 2 This can be accomplished when the mitral insufficiency is corrected by means of mitral valve repair or mitral valve replacement with preservation of the chordae tendineae. 2 We also found that mitral valve replacement with preservation of chordae tendineae reduced operative mortality and enhanced late survival in patients with ischemic mitral insufficiency. 3 This article describes the technique we have used to preserve the attachments between the papillary muscles and mitral annulus during mitral valve replacement for ischemic mitral insufficiency.