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Year : 2013  |  Volume : 2  |  Issue : 1  |  Page : 55-61

The impact of sub-valvular apparatus preservation on prosthetic valve dysfunction during mitral valve replacement

1 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center; Tehran University of Medical Sciences, Tehran, IR Iran
2 Echocardiograghy Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, IR Iran

Correspondence Address:
Yalda Mirmesdagh
Rajaie Cardiovascular Medical and Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Niayesh Blvd, Tehran
IR Iran
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Source of Support: None, Conflict of Interest: None

DOI: 10.5812/cardiovascmed.8054

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Background: Sub-valvular apparatus preservation (SAP) during mitral valve replacement (MVR) is not a new concept. Some surgeons prefer to excise the apparatus. Objectives: The aim of this study was to reduce the risk of prosthetic valve dysfunction. Materials and Methods: This retrospective study included 151 patients with the mean age of 46 years who underwent MVR (Female/male = 93/58). In the group I consisting of 39 patients, MVR with chordae preservation was performed (Bi-leaflet preservation = 20; posterior leaflet preservation = 19). In the group II consisting of 112 patients, sub-valvular apparatus was resected completely during MVR. Preoperative patients' characteristics, including age, sex, functional status, left ventricular ejection fraction, and end-diastolic or end-systolic dimensions were statistically similar in both groups. Mean follow-up period was 60.3 ± 26 months. Results: The improvement of functional status was seen in almost all survivors but was more obvious in the group I. In early follow-up, 56.4% of group I cases and 44.1% of group II patients were classified as New York Heart Association class I. These rates were 84.2% and 71.2% in mid-term follow-up, respectively (P < 0.001). Mortality rate was significantly lower in the group I (2.6%) compared to the group II (8.9%) (P = 0.03). There was a trend for higher frequency of postoperative atrial fibrillation in the group II compared to that in the group I (52.7% vs. 38.5%, P = 0.12).The incidence of prosthetic valve dysfunction (PVD) was 5.1% in the group I and 4.5% in the group II, but this difference was not statistically significant (P = 0.56). Conclusions: Preservation of mitral annulus and papillary muscle continuity may enhance post- MVR cardiac performance with low mortality and morbidity rates. The risk of PVD was not significantly higher than conventional MVR in our series.

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