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Related Experiment Videos

Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement: effects on left

Kwok L Yun1, Colleen F Sintek, D Craig Miller

  • 1Department of Cardiac Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027, USA. Kwok.L.Yun@kp.org

The Journal of Thoracic and Cardiovascular Surgery
|May 3, 2002
PubMed
Summary

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Complete chordal preservation during mitral valve replacement improves left ventricular mechanics and ejection performance compared to partial preservation. This approach leads to better long-term outcomes in patients with mitral regurgitation.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Mechanics
  • Valvular Heart Disease

Background:

  • Retrospective studies suggest benefits of retaining the subvalvular apparatus during mitral valve replacement for chronic mitral regurgitation.
  • Lack of randomized studies to confirm the advantages of complete versus partial chordal preservation on left ventricular mechanics.

Purpose of the Study:

  • To analyze the early and late effects of complete versus partial chordal preservation on left ventricular mechanics.
  • To compare total chordal-sparing mitral valve replacement (C-MVR) with posterior leaflet preservation only (P-MVR).

Main Methods:

  • Prospective randomized study of 47 patients undergoing isolated mitral insufficiency correction.
  • 36 patients with complete data were analyzed: 15 in P-MVR group, 21 in C-MVR group.

Related Experiment Videos

  • Echocardiography assessed dimensions, wall stress, left ventricular mass, and ejection function preoperatively, at discharge, and after 1 year.

    • Main Results:

    • C-MVR group showed sustained decrease in end-diastolic and end-systolic volumes, unlike the P-MVR group.
    • Ejection fraction improved over time in C-MVR, returning to preoperative levels, while it declined in P-MVR.
    • Left ventricular mass was reduced in C-MVR, with no change in P-MVR; C-MVR also reduced end-systolic stress.

    Conclusions:

    • Complete mitral subvalvular apparatus retention significantly reduces left ventricular size and systolic afterload compared to partial preservation.
    • Total chordal preservation facilitates favorable left ventricular remodeling, leading to improved ejection performance over time.
    • Complete chordal preservation offers early and sustained advantages in left ventricular mechanics after mitral valve replacement.