Mid-term echocardiographic comparison of chordal preservation method of mitral valve replacement in patients with mitral stenosis.

Background And Aim Of The Study: The efficacy of chordal-preserved mitral valve replacement (MVR) on left ventricular function was investigated in patients with mitral stenosis.

Methods: Eighty patients (25 males, 55 females; mean age 64.5 +/- 8.7 years) with pure mitral stenosis who underwent MVR between January 1999 and May 2008 were studied retrospectively. Of these patients, 20 had total chordal-preserved MVR (group I), 36 had posterior leaflet-preserved MVR (group II), and 24 had MVR without chordal preservation (group III). Echocardiographic assessments were performed preoperatively and at four years postoperatively.

Results: Both, preoperatively and intraoperatively, there were no significant differences between the three groups. Mid-term echocardiography showed significant improvements in the left ventricular ejection fraction (LVEF) of the chordal preservation groups (group I, 55 +/- 12% to 60 +/- 7%, p = 0.017; group II, 56 +/-10% to 61 +/- 8%, p = 0.025), whereas the LVEF was significantly decreased after non-chordal-preserved MVR (group III, 56 +/- 7% to 49 +/- 11%, p = 0.036). Furthermore, the non-chordal preservation group demonstrated a significant increase in left ventricular volumes (end-diastolic volume, from 92 +/- 15 ml/m2 to 107 +/- 23 ml/m2, p = 0.005, end-systolic volume, from 43 +/- 7 ml/m2 to 58 +/- 20 ml/m2, p < 0.001) and a spherical change in left ventricular geometry (sphericity index, from 1.6 +/- 0.2 to 1.3 +/- 0.2, p < 0.001).

Conclusion: Chordal preservation during MVR resulted in an improved ejection performance and the maintenance of left ventricular volume in mitral stenosis. However, these hemodynamic advantages were similar after total chordal preservation and posterior leaflet preservation.