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Chordal cutting does not adversely affect left ventricle contractile function.

Emmanuel Messas1, Chaim Yosefy, Miguel Chaput

  • 1Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France. emmanuel.messas@free.fr

Circulation
|July 6, 2006
PubMed
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Severing specific heart valve chords to treat mitral regurgitation does not acutely impair left ventricle (LV) function. This study found no negative changes in global or regional LV contractility after chord cutting.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Physiology
  • Medical Imaging

Background:

  • Ischemic mitral regurgitation (MR) can be improved by severing anterior leaflet chordae.
  • Concerns exist regarding potential negative impacts on left ventricle (LV) function.
  • This study investigates the acute effects of chord cutting on cardiac function.

Purpose of the Study:

  • To evaluate the impact of severing second-order chordae on regional and global left ventricle (LV) function.
  • To assess changes in cardiac contractility and hemodynamics following chordal ablation in a beating heart model.

Main Methods:

  • Utilized a sheep model with pre-instrumented chords for radiofrequency ablation.
  • Assessed LV function using invasive sonomicrometry and noninvasive Doppler tissue velocity and strain rate.

Related Experiment Videos

  • Measured hemodynamic parameters including LV volumes, ejection fraction, and systolic elastance under constant load conditions.

    • Main Results:

    • No significant changes were observed in LV end-diastolic volume, end-systolic volume, or ejection fraction post-chord cutting.
    • Systolic ventricular elastance, preload-recruitable stroke work, and LVdP/dt remained unchanged.
    • Segmental contractility, Doppler tissue velocities, and strain rates around papillary muscles showed no significant alterations; no MR developed.

    Conclusions:

    • Chordal cutting does not acutely decrease global or segmental LV contractility.
    • Findings support the clinical practice of chord cutting in valve repair procedures.
    • The absence of adverse effects aligns with positive long-term clinical outcomes.