Mitral valve replacement in patients with severe mitral regurgitation and impaired left ventricular function

We have studied short- and mid-term effects of preservation and excision of the mitral subvalvar support during mitral valve replacement in 40 patients, who had developed moderate to severe degree of left ventricular function impairment, secondary to pure severe mitral regurgitation. These patients had valve replacement, because valve anatomy was unsuitable for reconstructive procedures. Mitral subvalvar support was excised and valve replaced with a Björk-Shiley prosthesis, in 10 patients with moderately impaired left ventricular ejection fraction (mean 32% +/- 1.2%) and in 18 patients with severely impaired left ventricular function (left ventricular ejection fraction: 22% +/- 0.8%). In 12 patients with severely impaired left ventricular function (left ventricular ejection fraction: 20% +/- 1%) posterior subvalvar apparatus was preserved and valve replaced with a bioprosthesis. Prognosis of patients with moderately impaired left ventricular function was not influenced by the loss of chordopapillary support. Actuarial survival at 8 and 10 years was 46% +/- 7.8% for patients with severely impaired left ventricular function with chordopapillary support excised and 70% +/- 10% for patients with severely impaired left ventricular function with chordopapillary support preserved (p less than 0.01). Preservation of mitral subvalvar support is important in patients with severely impaired left ventricular function (left ventricular ejection fraction less than 25%).