Long-term outcome after mitral valve replacement with preservation of continuity between the mitral annulus and the papillary muscle in patients with mitral stenosis.

Background And Aim Of The Study: The effect on left ventricular performance of mitral valve replacement (MVR) with preservation of continuity between the mitral annulus and papillary muscle was studied in patients with mitral stenosis (MS).

Methods: Forty patients with MS who underwent MVR between 1986 and 1995 and had long-term echocardiographic follow up were studied retrospectively. Eighteen patients had conventional MVR (CMVR group), and 22 (PMVR group) had either preservation of autologous chordae tendineae (n = 6) or replacement of the chordae with expanded polytetrafluoroethylene sutures (n = 16).

Results: Preoperatively, there were no significant differences between the two groups in age, body surface area, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), fractional shortening (FS) or ejection fraction (EF). At 3.1-6.5 years after surgery, periodic echocardiography showed significant differences (p <0.05) in LVESD (35.8 versus 31.6 mm, respectively, in the CMVR and PMVR groups) and FS (31.8% versus 38.1%). At 6.6-9.7 years postoperatively, no significant differences were observed between the two groups in FS, but LVESD was significantly greater in the CMVR group than in the PMVR group (37.3 versus 31.5 mm).

Conclusion: In the long term, MVR with preservation of continuity between the mitral annulus and papillary muscle improves systolic left ventricular performance in patients with MS.