Effect of the preservation of annulo-papillary continuity on left ventricular ejection fraction after mitral valve replacement *1A clinical randomized study on patients affected by rheumatic valve disease

1994 ◽  
Vol 8 (9) ◽  
pp. 478-481 ◽  
Author(s):  
G TARELLI ◽  
A MUSAZZI ◽  
F SEMERARO ◽  
L CERIANI ◽  
E RESPIGHI
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Randomized Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Rheumatic Valve Disease

scholarly journals Bileaflet versus Posterior-Leaflet-Only Preservation in Mitral Valve Replacement

2014 ◽  
Vol 41 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Ahmet Coskun Ozdemir ◽  
Bilgin Emrecan ◽  
Ahmet Baltalarli
Keyword(s):  
Mitral Valve ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Posterior Leaflet ◽  
Ventricular Ejection Fraction

In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.

scholarly journals Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Thomas Walther ◽  
Claudia Walther ◽  
Volkmar Falk ◽  
Anno Diegeler ◽  
Ralf Krakor ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Maximum Flow ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Papillary Muscles ◽  
Valve Repair ◽  
Promising Alternative ◽  
Ventricular Ejection Fraction

Background —A new quadricusp stentless mitral bioprosthetic valve (QMV) is evaluated and compared with current standards. Methods and Results —Since August 1997, 67 patients were prospectively evaluated: 23 patients received a QMV, 23 had mitral valve repair (MVR), and 21 received conventional mitral valve replacement (MVP). Patient age was 69±8, 64±10, and 62±9 years for QMV, MVR, and MVP treatment, respectively. The underlying pathology was mitral stenosis, incompetence, and mixed disease in a corresponding 8, 9, and 6 patients for QMV, 1, 22, and 0 patients for MVR, and 2, 12, and 7 patients for MVP. The papillary muscles were sufficient in all QMV cases to suspend the valve. Cross-clamp time was 59±19 minutes for QMV implantation. In-hospital mortality for QMV, MVR, and MVP was 1, 0, and 0 patients, respectively, and thoracotomy had to be performed again in 1, 1, and 2 patients, respectively (these outcomes were not valve related). At baseline transthoracic echocardiography, respective maximum flow velocities were 1.6, 1.4, and 1.7 m/s, and valve orifice area was 2.6, 3.5, and 3.4 cm 2 . Mild transvalvular reflux was seen in 8, 7, and 2 patients; moderate reflux, in 1, 1, and 1 patients. Left ventricular ejection fraction was 52%, 54%, and 51% in the respective treatment groups. At follow-up, hemodynamic parameters had further improved in all groups. Conclusions —One year after clinical implantation, the QMV appears to function well and has no additional risks compared with MVR or MVP. The subvalvular apparatus is preserved by suspending the QMV at the papillary muscles; this arrangement is hemodynamically advantageous. Echocardiography reveals an excellent valve performance that resembles native mitral valve morphology and hemodynamic function. The QMV is a promising alternative for biological mitral valve replacement.

scholarly journals Single versus bilateral chordo-papillary apparatus preservation in mitral valve replacement: a hemodynamic study

2020 ◽  
Vol 2 (2) ◽  
pp. 62-69
Author(s):  
Mostafa Alaaeldin Abdelfatah Shalaby ◽  
Haytham Mohamed Abd el.Moaty ◽  
Mohamed Hossiny Mahmoud ◽  
Mohamed S H Abdallah
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Geometry ◽  
Ventricular Ejection Fraction ◽  
Group Iii ◽  
Group I ◽  
Single Versus

Background: It has been postulated that disruption of the mitral valve apparatus at the time of mitral valve replacement (MVR) is a risk factor for postoperative ventricular dysfunction. The aim of this study was to evaluate the effect of single versus bilateral chordo-papillary preservation on the left ventricular function in comparison to no preservation. Methods: This study was conducted from 2015 to 2018 on sixty patients who had MVR. The patients were classified into group I included 20 patients who underwent MVR with complete excision of the subvalvular chordae and tips of papillary muscles, group II: included 20 patients who underwent MVR with preservation of posterior chordo-papillary apparatus, and group III: included 20 patients who underwent MVR with preservation of both posterior and anterior chordo-papillary apparatus. Results: There were 20 males (33.3%), and the mean age was 48.76± 8.91 years. Patients in group III were significantly older (37.15 ±4.92, 39.8 ± 5.49, and 57.25 ± 6.93 years in groups I, II, and III, respectively; p< 0.001). The left ventricular end-diastolic (5.40 ±0.34, 4.96 ± 0.43, and 4.44 ± 0.55 mm in group I, II and III, respectively, p<0.001) and end-systolic diameter (4.33 ±0.48, 3.58 ±0.43 and 3.20 ±0.43 mm in group I, II and III; respectively, p<0.001) were significantly reduced in partial and complete preservation groups after 6 months. Left ventricular ejection fraction improved in the bilateral preservation and partial preservation groups after 6 months (45.32 ±9.78, 56.79 ±10.14, and 56.60 ±11.68 % in groups I, II and III respectively, p<0.001). Mechanical ventilation was significantly longer in group I (24.10 ± 6.6, 16.80 ± 5.97, and 15.80 ± 5.24 hours in groups I, II and III, respectively, p<0.001) and the duration of ICU stay was significantly longer in group I (78.65 ± 15.32, 65.40 ± 14.21, and 60.20 ± 12.58 hours in groups I, II and III, respectively, p<0.001). Conclusion: Preservation of the annulo-papillary continuity may preserve left ventricular geometry and performance. Total preservation of chordae could be superior to partial preservation with better left ventricular remodeling and improvement in the left ventricular functions.

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