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Related Experiment Videos

Left ventricular function after mitral valve replacement with or without chordal preservation

Y Okita1, S Miki, Y Ueda

  • 1Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.

The Journal of Heart Valve Disease
|October 1, 1995
PubMed
Summary
This summary is machine-generated.

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Preserving chordae tendinae during mitral valve surgery improves left ventricular performance in patients with mitral regurgitation. This approach benefits those with reduced heart function, unlike conventional replacement or repair methods.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Mechanics
  • Valvular Heart Disease

Background:

  • Mitral valve disease significantly impacts left ventricular (LV) function.
  • The role of chordae tendinae in maintaining LV performance post-mitral valve surgery is crucial.
  • Current surgical techniques vary in their approach to chordae tendinae preservation.

Purpose of the Study:

  • To evaluate the clinical significance of chordae tendinae preservation on postoperative left ventricular performance.
  • To compare LV function after mitral valve replacement with chordal preservation versus conventional replacement or repair.
  • To assess outcomes in patients with mitral regurgitation and mitral stenosis.

Main Methods:

  • Retrospective analysis of 148 patients undergoing mitral valve surgery (replacement with chordal preservation, conventional replacement, or repair).

Related Experiment Videos

  • Comparison of hemodynamic parameters and LV performance using cineangiography, MUGA scans, and echocardiography.
  • Assessment of early and late postoperative LV function (ejection fraction, contractility index, fractional shortening).

    • Main Results:

    • In mitral regurgitation patients, LV ejection fraction remained stable with chordal preservation but decreased with conventional replacement/repair.
    • Chordal preservation demonstrated a better LV contractility index compared to conventional replacement.
    • Late LV function (LVEF, fractional shortening) was significantly higher after chordal preservation or repair versus conventional replacement.
    • Superior LV performance was observed in the chordal preserved group, particularly in mitral regurgitation patients with preoperative depressed LV function (EF < 0.50).
    • No significant differences in outcomes were noted between groups for mitral stenosis patients.

    Conclusions:

    • Maintaining continuity between the mitral annulus and papillary muscles via chordae tendinae preservation positively impacts postoperative LV performance.
    • This benefit is most pronounced in mitral regurgitation patients, especially those with pre-existing impaired LV function.
    • Chordae tendinae preservation has a limited effect on LV performance in patients with mitral stenosis.