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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 1999 April;40(2):183-90
Ventricular performance following valve replacement for chronic mitral regurgitation: importance of chordal preservation
Popovic Z., Barac I., Jovic M., Panic G., Miric M., Bojic M.
From the Institute of Cardiovascular Diseases Dedinje Belgrade, Yugoslavia
Objective. To assess immediate and late changes in left ventricular performance after mitral valve replacement (MVR) for mitral regurgitation with or without preservation of chordae tendineae. Experimental design: a prospective, one year follow-up, study. Setting: university cardiosurgical hospital. Patients’ fourteen patients with symptomatic chronic mitral regurgitation were divided into Group A (n=7), which underwent MVR with chordal preservation, and Group B (n=7) which underwent MVR with chordal transection.
Methods. Transesophageal echocardiography, obtained simultaneously with radial artety and pulmonary capillary wedge pressures over a range of loading conditions, was used to estimate left ventricular elastance (Eps), calculated as the slope of peak systolic pressure/end-systolic volume relation, and preload recruitable stroke work (PRSW). Measurements were taken intraoperatively before and after cardiopulmonary bypass, 6 hours later and 10 days later. Transthoracic echocardiography follow-up data were obtained after 3 months and one year.
Results. Eps significantly decreased immediately after MVR (p=0.018), with no difference among 2 groups. Eps gradually increased to preoperative levels 10 days after surgery. PRSW also significantly decreased after MVR (p=0.01). The decrease was significantly larger in Group B (p=0.038). During follow-up, Group A showed a significantly better ejection fraction (p=0.008), and a smaller end-systolic volume index (p=0.01) and left ventricular mass index (p=0.04), than Group B.
Conclusions. These data support the hypothesis that chordal preservation during MVR has beneficial effects on left ventricular performance.