Analysis of left ventricular performance after mitral valve replacement with a technique of preservation of all chordae tendineae : Comparison with conventional mitral valve replacement or mitral valve repair : Chairperpons remarks

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.

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The Effect of Chordal Shortening Associated with Mitral Valve Replacement on the Left Ventricular Performance. An Ex-Vivo Study in Dogs.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.22.271 ◽

1993 ◽

Vol 22 (3) ◽

pp. 271-273

Author(s):

H. Okazaki

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Ex Vivo ◽

Left Ventricular ◽

Left Ventricular Performance ◽

Ventricular Performance ◽

Ex Vivo Study

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Chordae Tendineae Rupture in the United States: Trends of Outcomes, Costs and Surgical Interventions

The Heart Surgery Forum ◽

10.1532/hsf.1625 ◽

2017 ◽

Vol 20 (1) ◽

pp. 019

Author(s):

Elena V. Dolmatova ◽

Kasra Moazzami ◽

James Maher ◽

Marc Klapholz ◽

Justin Sambol ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

International Classification Of Diseases ◽

The United States ◽

Valve Repair ◽

Chordae Tendineae ◽

Surgical Interventions ◽

Comorbidity Index

Objectives: To describe national trends in the incidence and outcomes of patients with chordae tendineae rupture (CTR).Methods: Patients who were diagnosed with CTR between 2000 and 2012 were identified in National (Nationwide) Inpatient Sample (NIS) registry. CTR was defined using validated International Classification of Diseases, 9th Edition, Clinical Modification diagnosis (ICD9-CM) codes. Results: A total of 37,287 (14,833 mitral valve repair, 7780 mitral valve replacement) CTR cases were identified. Overall, in-hospital mortality in CTR decreased by 3% from 2000 to 2012 (P < 0.001). From 2000 to 2012, the rate of mitral valve repair increased from 27.2% to 46.4%, (P < 0.001) with a concurrent decrease in the rate of mitral valve replacement (from 27.8 to 17.7%, P < 0.001). After multivariate adjustment, patient age (OR = 1.04, 95% CI 1.03-1.06, P < 0.001), congestive heart failure (CHF) (OR = 2.08, 95% CI 1.19-3.64, P = 0.01), myocardial infarction (MI) (OR = 3.58, 95% CI 2.10-6.11, P < 0.001), Deyo/Charlson comorbidity index (OR = 1.23, 95% CI 1.07-1.41, P < 0.003) and use of the intra aortic balloon pump (IABP) (OR = 4.81 95% CI 2.71-8.55, P < 0.001) were found to be independently associated with greater odds of mortality in these patients. Additionally, mitral valve replacement was significantly associated with higher costs of hospitalization (coefficient 15693, 95% CI 12638-18749, P < 0.001)Conclusion: Mitral valve repair is associated with reduced inpatient mortality and costs compared with mitral valve replacement. A substantial increase in the percentage of cases undergoing mitral valve repair with a concurrent decrease in cases undergoing mitral valve replacement were observed. Increasing age and comorbidity index, history of CHF and MI, and use of IABP were identified as factors that could increase the risk of mortality in patients with CTR.

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