Mid and long term comparison of the effect of chordal preservation techniques on left ventricular functions in mitral valve replacement surgery

Subvalvular apparatus of the mitral valve which is a part of fibrous skeleton of the heart has a key role on the both systolic and diastolic functions of the left ventricle. Complete chordal loss during the mitral valve replacement may be the reason of decreased left ventricle performance, dyssynergia in contraction, and dyskinesia on the papillary muscle-left ventricle connection. We aimed in our study to determine the effects of these chordal preservation techniques on the left ventricle functions. We performed both mitral valve replacement and mitral valve replacement together with other cardiac procedures to 634 consecutive patients between May 2002 and June 2010 in Gaziantep University Cardiovascular Surgery Department. Mitral valve replacement was carried out conventional, with total liflet preservation, and with posterior liflet preservation in 358 (56.5 %), 121 (19.1 %), and 155 (24.4 %) patients, respectively. Patients were excluded who underwent to valve replacement whilst planning valve repair and had non-critical coronary stenosis. Mid and long term results were compared between the groups by statistical analysis. There were 212 (33.4 %) male and 422 (66.6 %) female patients. Mean age was 45.6±14.7 (12-82). All patients were in class 3-4 according to the NYHA functional classification. Mitral valvular insufficiency was grade 3 and 4 in all patients. Patients with mitral valve stenosis were symptomatic and had mitral valve area lesser than 1.5 cm2. Preoperative rhythm, NYHA classification, left ventricle end diastolic diameter, left ventricle end systolic diameter, left ventricle end diastolic volume, left ventricle end systolic volume, and ejection fraction values compared with the last interview of the patients. We observed in our study that liflet preservation in mitral valve replacement has positive effects on the patient's clinical situation and echocardiographic parameters. Performing left ventricular preservation techniques in mitral valve surgery significantly improves the left ventricle diameters and ejection fraction in mid and long term follow-up.We think that chorda preservation techniques significantly have positive effects on the left ventricle functions after mitral valve replacement. Particularly, preservation of the chorda and the apparatus would have positive effects on the left ventricle functions.