Mitral valve repair versus replacement with preservation of the entire subvalvular apparatus

Kisamori, Eiri; Otani, Satoru; Yamamoto, Tsuyoshi; Nishiki, Michiru; Yamada, Yoshiaki; Matsumoto, Taichiro

doi:10.1007/s11748-018-1039-2

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Some researchers believed that total preservation of sub-valvular apparatus prolongs the time of surgery & implantation of small size prothesis 15 , but findings of our study contradict with the reported evidence as there was no statistically significant difference noted in cardiopulmonary bypass time & cross clamp time (p<0.05) as shown in table-II. Millers et al reported a significant decrease in mortality of patients with preservation of posterior leaflet & sub-valvular apparatus 16 .…”

Section: S719contrasting

confidence: 94%

EARLY MORTALITY & MORBIDITY IN MITRAL VALVE REPLACEMENT WITH TOTAL SUB-VALVULAR APPARATUS PRESERVATION, PARTIAL PRESERVATION AND NO PRESERVATION - A COMPARATIVE STUDY

Ashfaq

Nasir

Janjua

et al. 2021

PAFMJ

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Objective: To compare the early morbidity & mortality of total sub-valvular apparatus preservation technique vs partial preservation technique and no preservation technique in mitral valve replacement. Study Design: Cross-sectional comparative study. Place and Duration of Study: Department of Cardiac Surgery, Armed Forces Institute of Cardiology Rawalpindi, from Jan 2017 to Dec 2018. Methodology: One hundred fifty seven patients who underwent Mitral valve replacement were included in study. These patients were divided into three groups; group “A” comprised of those patients with total subvalvular apparatus preservation (n1=46), group “B” comprised of those patients with partial sub-valvular apparatus preservation (n2=70), group “C” comprised of those patients with no sub-valvular apparatus preservation(n3=41). Results: There were no statistical difference in the pre-operative data of the patients. No statistical difference noted in cross clamp & bypass time (p>0.05). The early morbidity in terms of ICU stay, Ventilation time, Inotropic supports, post-operative bleeding, Blood transfusion, postoperative rhythm abnormality & Re-exploration were statically significant (p<0.05). The mortality rate of patients with total sub-valvular apparatus preservation was 2.17% which is significantly less than those with partial preservation (2.85%) & no preservation (9.75%). Conclusions: Mitral valve replacement with total subvalvular apparatus preservation had low postoperative morbidity & mortality in comparison with partial and no preservation techniques.

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Section: S719contrasting

confidence: 94%

EARLY MORTALITY & MORBIDITY IN MITRAL VALVE REPLACEMENT WITH TOTAL SUB-VALVULAR APPARATUS PRESERVATION, PARTIAL PRESERVATION AND NO PRESERVATION - A COMPARATIVE STUDY

Ashfaq

Nasir

Janjua

et al. 2021

PAFMJ

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“…It is states that the preservation of chords only from the posterior cusp is enough. As the reason for this, some researchers indicate such disadvantages as technical difficulties in preserving the subvalvular apparatus of both valves that prolongs the operation, the possibility of implanting a smaller prosthesis and the possibility of disrupting the outflow pathways from the LV and the contact between the prosthesis and subvalvular structures (18,19). This literature review showed the existing evidence for the advantages of complete preservation of subvalvular structures in valve replacement in the concept of improving immediate results and reducing the risk of dilated cardiomyopathy in the long-term period.…”

mentioning

confidence: 99%

“…This literature review showed the existing evidence for the advantages of complete preservation of subvalvular structures in valve replacement in the concept of improving immediate results and reducing the risk of dilated cardiomyopathy in the long-term period. According to the actuarial survival curve and the risk of developing heart failure, MVR with complete preservation of the subvalvular structures is not inferior to the results obtained with valve repair (18,19). Even so, the methods of complete preservation of subvalvular structures are still not routinely used and are not included in clinical guidelines.…”

mentioning

confidence: 99%

Strategy of complete preservation of the subvalvular structures in the mitral valve replacement

Toktosunova¹

2019

HVT

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Complete preservation of leaflets for mitral valve replacement to maintain geometry and the function of left ventricle in the near and distant period is necessary. The aim of study was to analyze these procedures. Bileaflet preservation of the anatomical architectonics of the left ventricle in combination with the surgical reduction of the enlarged left atrium will allow to optimize the postoperative geometry and to improve the remodeling of all the left heart along with improved long-term results of patients with mitral valve replacement.

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Early Patient Outcome and Left Ventricular Function After Mitral Valve Replacement Using a Tilting Disc Mechanical Valve With Total Preservation of Mitral Valvular Apparatus

Goyal,

Pahade,

Varshney

2024

Cureus

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Introduction The study aimed to retrospectively evaluate the early patient outcome and left ventricular function after mitral valve replacement with a tilting disc valve and total preservation. Patients and methods This retrospective observational study includes patients who underwent mitral valve replacement using a tilting disc valve with total preservation of mitral valvular and subvalvular apparatus from July 2021 to August 2022 at a single center. Results The data were reviewed retrospectively for age, sex, comorbidities, operating time, aortic cross-clamp time, cardiopulmonary bypass time, preoperative and postoperative left ventricular ejection fraction, mean gradient across the mitral valve, left ventricular diameter, left atrial size, atrial fibrillation, complications, mortality, and early patient outcome. Echocardiographic and clinical data were compared for the preoperative and postoperative periods. A significant difference in the preoperative and postoperative left atrial size, pulmonary arterial pressure, New York Heart Association class, and mean gradient across the mitral valve was found. However, the difference between the preoperative and postoperative ejection fraction and left ventricular diameter in systole and diastole was not significant. Conclusion Early patient outcome after mitral valve replacement with a tilting disc valve and total preservation of mitral valvular apparatus gives good results with minimal morbidity and mortality. Favorable patient outcomes in this study lay to rest any skepticism regarding total preservation while using a tilting disc valve. The technique of total preservation is safe while using a tilting disc valve, and it helps in the preservation of the left ventricular ejection fraction and gives a low gradient across the valve.

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Mitral valve repair versus replacement with preservation of the entire subvalvular apparatus

Cited by 3 publications

References 17 publications

EARLY MORTALITY & MORBIDITY IN MITRAL VALVE REPLACEMENT WITH TOTAL SUB-VALVULAR APPARATUS PRESERVATION, PARTIAL PRESERVATION AND NO PRESERVATION - A COMPARATIVE STUDY

EARLY MORTALITY & MORBIDITY IN MITRAL VALVE REPLACEMENT WITH TOTAL SUB-VALVULAR APPARATUS PRESERVATION, PARTIAL PRESERVATION AND NO PRESERVATION - A COMPARATIVE STUDY

Strategy of complete preservation of the subvalvular structures in the mitral valve replacement

Early Patient Outcome and Left Ventricular Function After Mitral Valve Replacement Using a Tilting Disc Mechanical Valve With Total Preservation of Mitral Valvular Apparatus

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