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The Journal of Cardiovascular Surgery 1999 April;40(2):183-90

language: English

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


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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.

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