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Experimental evaluation of different chordal preservation methods during mitral valve replacement
M R Moon1, A DeAnda, G T Daughters
1Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, California 94305.
The Annals of Thoracic Surgery
|October 1, 1994
Summary
Chordal-sparing mitral valve replacement (MVR) preserves systolic and diastolic function better than conventional MVR. Both anterior and posterior chordal sparing techniques showed similar results in this canine model.
Area of Science:
- Cardiovascular Surgery
- Cardiac Mechanics
- Surgical Innovation
Background:
- Chordal-sparing mitral valve replacement (MVR) techniques aim to preserve native chordal structures.
- Debate exists regarding optimal chordal reattachment: anterior annulus versus posterior transposition.
Purpose of the Study:
- To compare the functional outcomes of anterior chordal reattachment and posterior chordal transposition in chordal-sparing MVR.
- To evaluate these techniques against conventional MVR involving total chordal excision.
Main Methods:
- Twenty-one dogs underwent tantalum marker implantation for ventricular volume assessment.
- Animals were subjected to conventional MVR, anterior chordal reattachment MVR, or posterior transposition MVR.
- Left ventricular contractility and diastolic function were assessed using multiple physiologic parameters.
Main Results:
- Chordal-sparing MVR (anterior or posterior) maintained left ventricular systolic and diastolic function.
- Conventional MVR resulted in impaired contractility, indicated by increased end-systolic elastance.
- Diastolic function also worsened after conventional MVR, evidenced by an increased end-diastolic pressure-volume relationship slope.
Conclusions:
- Chordal preservation during MVR is crucial for maintaining optimal systolic and diastolic function.
- No significant functional difference was observed between anterior and posterior chordal-sparing techniques in this model.