ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2022 August;63(4):498-506

DOI: 10.23736/S0021-9509.22.12065-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Modified chordal sparing mitral valve replacement as effective technique for both stenotic and insufficient mitral valves

Sergey L. DZEMESHKEVICH ¹, Sergey V. KOROLEV ², Vladimir V. GRAMOVICH ², Yulia V. FROLOVA ¹, Alexey N. LUGOVOY ¹, Anna V. DOMBROVSKAYA ¹, Maxim A. BABAEV ³, Elena V. ZAKLYAZMINSKAYA ⁴ ✉

¹ Department of Cardiovascular Surgery, B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia; ² Department of Cardiosurgery, National Medical Research Center of Cardiology, Moscow, Russia; ³ Department of Critical Care and Cardiac Resuscitation, B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia; ⁴ Laboratory of Medical Genetics, B.V. Petrovsky Russian Research Center of Surgery, Moscow, Russia

BACKGROUND: Chordal apparatus preservation is important for preserving left ventricular (LV) function in the long-term perspective. We present results of originally modified chordal-sparing mitral valve replacement (MVR) successfully used in patients with mitral stenosis and mitral insufficiency.
METHODS: The modified surgical method involves preserving only four strut chords with portions of the mitral valve leaflets, which are later fixed to the fibrous ring. The rest of the leaflets and marginal chords are removed.
RESULTS: Starting from 1998, 484 modified universal chordal-sparing MVR were performed including 270 (55.79%) in patients with rheumatic mitral stenosis and 214 (44.21%) in patients with mitral valve insufficiency. Overall, 116 patients underwent isolated MVR, and 368 patients underwent MRV with concomitant surgical procedures. The overall in-hospital mortality was 2.5% (12 patients). Long-term efficiency was assessed in patients discharged after isolated MVR (114 patients), average follow-up period was 3.1±0.6 years. Preservation of strut chords ensured normalization of intraventricular anatomy and prevented LV dilatation; the LV Sphericity Index is maintained at 0.44-0.63. Heart failure functional class (NYHA) was improved in all patients. Non-fatal prosthesis-related complications were observed in 11 patients (9.65%). Three patients (2.63%) died due to extracardiac causes.
CONCLUSIONS: The proposed modification of the strut chordal-sparing mitral valve replacement technique allows preserving functionally complete annulo-papillary apparatus, regardless of the nature of valvular dysfunction, and provides parallel movement to the mechanical prosthesis. This modified surgical technique is safe and effective and eliminates the risk of jamming of the prosthesis disk and left ventricular outflow tract obstruction.

KEY WORDS: Transcatheter aortic valve replacement; Mitral valve stenosis; Mitral valve insufficiency