| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 828-836, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
HA Hennein, JA Swain, CL McIntosh, RO Bonow, CD Stone and RE Clark
Left ventricular function often deteriorates after mitral valve replacement
for mitral regurgitation. It has been postulated that disruption of the
mitral valve apparatus at operation is a major mechanism of postoperative
dysfunction. The hypothesis tested in this investigation was that chordal
preservation results in more favorable left ventricular function.
Sixty-nine patients with isolated mitral regurgitation who underwent mitral
valve replacement were studied before and 6 months after operation by
treadmill exercise testing, catheterization, echocardiography, and
radionuclide angiography. Nine patients underwent mitral valve replacement
with preservation of the entire mitral apparatus and five with preservation
of the posterior leaflet and attached chordae. The remaining 55 had mitral
valve replacement with complete excision of the native valve.
Preoperatively, there were no differences among groups in age, gender,
exercise capacity, cardiac index, rest or exercise ejection fraction,
fractional shortening, or pulmonary artery pressures. There were four
perioperative deaths (7%) and eight late deaths among the 55 patients with
chordal resection but no early or late deaths of patients whose chordae
were preserved (p = 0.05). In patients in whom the chordae were excised,
exercise capacity, left ventricular systolic dimensions, and cardiac index
did not improve after mitral valve replacement, and left ventricular
function deteriorated, as evidenced by a reduction of both the resting and
exercise ejection fractions (from 46% +/- 13% to 31% +/- 13%, p = 0.0001,
and from 49% +/- 12% to 37% +/- 14%, p = 0.0007, respectively) and
fractional shortening (from 34% +/- 10% to 26% +/- 14%, p = 0.0001). In
contrast, exercise capacity improved after mitral valve replacement in
patients in whom the entire apparatus was spared (by 4 +/- 3 minutes, p =
0.05), left ventricular systolic dimensions decreased (from 44 +/- 8 to 36
+/- 9 mm, p = 0.03), and left ventricular function was maintained or
improved, as evidenced by preservation of the resting ejection fraction
(preoperative, 50% +/- 14%; postoperative, 54% +/- 11%; p = no significant
difference), exercise ejection fraction (46% +/- 16% versus 52% +/- 9%, p =
no significant difference), fractional shortening (from 31% +/- 9% to 28%
+/- 9%, p = no significant difference), and an increase in the cardiac
index (from 2.0 +/- 0.3 to 2.7 +/- 0.5 L/min/m2, p = 0.05). No
statistically significant differences between posterior chordal resection
only and preservation of the entire apparatus were found.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Comparative assessment of chordal preservation versus chordal resection during mitral valve replacement
Surgery Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892.
This article has been cited by other articles:
|
|
 |
|
  2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Deniz, O. Sokullu, S. Sanioglu, M. Sargin, B. Ozay, U. Ayoglu, S. Aykut Aka, and F. Bilgen Risk factors for posterior ventricular rupture after mitral valve replacement: results of 2560 patients Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 780 - 784. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Garcia-Fuster, V. Estevez, O. Gil, S. Canovas, and J. Martinez-Leon Mitral Valve Replacement in Rheumatic Patients: Effects of Chordal Preservation Ann. Thorac. Surg., August 1, 2008; 86(2): 472 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. A. Carabello The Current Therapy for Mitral Regurgitation J. Am. Coll. Cardiol., July 29, 2008; 52(5): 319 - 326. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Athanasiou, A. Chow, C. Rao, O. Aziz, F. Siannis, A. Ali, A. Darzi, and F. Wells Preservation of the mitral valve apparatus: evidence synthesis and critical reappraisal of surgical techniques Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 391 - 401. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Fukuoka, M. Nonaka, S. Masuyama, T. Shimamoto, K. Tambara, H. Yoshida, T. Ikeda, and M. Komeda Chordal "translocation" for functional mitral regurgitation with severe valve tenting: An effort to preserve left ventricular structure and function J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 1004 - 1011. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Yousefnia, M. H. Mandegar, F. Roshanali, F. Alaeddini, and F. Amouzadeh Papillary Muscle Repositioning in Mitral Valve Replacement in Patients With Left Ventricular Dysfunction Ann. Thorac. Surg., March 1, 2007; 83(3): 958 - 963. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Muthialu, S. K Varma, S. Ramanathan, C. Padmanabhan, K M. Rao, and M. Srinivasan Effect of Chordal Preservation on Left Ventricular Function Asian Cardiovasc Thorac Ann, September 1, 2005; 13(3): 233 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. K. Chowdhury, A. S. Kumar, B. Airan, D. Mittal, K. G. Subramaniam, R. Prakash, S. Seth, R. Singh, and P. Venugopal Mitral Valve Replacement With and Without Chordal Preservation in a Rheumatic Population: Serial Echocardiographic Assessment of Left Ventricular Size and Function Ann. Thorac. Surg., June 1, 2005; 79(6): 1926 - 1933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Zegdi, M. Debieche, C. Latremouille, D. Lebied, C. Chardigny, J.-M. Grinda, S. Chauvaud, A. Deloche, A. Carpentier, and J.-N. Fabiani Long-Term Results of Mitral Valve Repair in Active Endocarditis Circulation, May 17, 2005; 111(19): 2532 - 2536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Yun, C. F. Sintek, D. C. Miller, T. A. Pfeffer, G. S. Kochamba, S. Khonsari, and M. R. Zile Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement: Effects on left ventricular volume and function J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 707 - 714. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Bishay, P. M. McCarthy, D. M. Cosgrove, K. J. Hoercher, N. G. Smedira, D. Mukherjee, J. White, and E. H. Blackstone Mitral valve surgery in patients with severe left ventricular dysfunction Eur. J. Cardiothorac. Surg., March 1, 2000; 17(3): 213 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. L. Yun, C. F. Sintek, D. C. Miller, G. T. Schuyler, A. D. Fletcher, T. A. Pfeffer, G. S. Kochamba, S. Khonsari, and M. R. Zile Randomized Trial of Partial Versus Complete Chordal Preservation Methods of Mitral Valve Replacement : A Preliminary Report Circulation, November 9, 1999; 100 (2009): II-90 - II-94. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 j. Cross The Economics of Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1999; 3(4): 227 - 230. [Abstract] [PDF]
|
|
|
|
|
|
S. Y. DeLeon, F. Cetta, T. M. Ravindranath, P. T. Roughneen, and E. A. Fisher Intraatrial mitral valve insertion with native valve preservation in children Ann. Thorac. Surg., November 1, 1999; 68(5): 1843 - 1845. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Skudicky, M. R. Essop, and P. Sareli Time-Related Changes in Left Ventricular Function After Double Valve Replacement for Combined Aortic and Mitral Regurgitation in a Young Rheumatic Population: Predictors of Postoperative Left Ventricular Performance and Role of Chordal Preservation Circulation, February 18, 1997; 95(4): 899 - 904. [Abstract] [Full Text]
|
|
|
|
|
|
E. M. Lee, L. M. Shapiro, and F. C. Wells Importance of Subvalvular Preservation and Early Operation in Mitral Valve Surgery Circulation, November 1, 1996; 94(9): 2117 - 2123. [Abstract] [Full Text]
|
|
|
|
|
|
V. Rao, M. Komeda, R. D. Weisel, J. Ivanov, J. S. Ikonomidis, T. Shirai, and T. E. David Results of Represervation of the Chordae Tendineae During Redo Mitral Valve Replacement Ann. Thorac. Surg., July 1, 1996; 62(1): 179 - 183. [Abstract] [Full Text]
|
|
|
|
|
|
M. Natsuaki, T. Itoh, S. Tomita, K. Furukawa, M. Yoshikai, H. Suda, and H. Ohteki Importance of Preserving the Mitral Subvalvular Apparatus in Mitral Valve Replacement Ann. Thorac. Surg., February 1, 1996; 61(2): 585 - 590. [Abstract] [Full Text]
|
|
|
|
|
|
M. Komeda, A. DeAnda Jr, J. R. Glasson, A. F. Bolger, Y. Tomizawa, G. T. Daughters II, T. L. Tye, N. B. Ingels Jr, and D. C. Miller Exploring Better Methods to Preserve the Chordae Tendineae During Mitral Valve Replacement Ann. Thorac. Surg., December 1, 1995; 60(6): 1652 - 1658. [Abstract] [Full Text]
|
|
|
|
|
|
C. F. Sintek, T. A. Pfeffer, G. S. Kochamba, and S. Khonsari Mitral Valve Replacement: Technique to Preserve the Subvalvular Apparatus Ann. Thorac. Surg., April 1, 1995; 59(4): 1027 - 1029. [Abstract] [Full Text]
|
|
|
|
|
|
M. Enriquez-Sarano, H. V. Schaff, T. A. Orszulak, A. J. Tajik, K. R. Bailey, and R. L. Frye Valve Repair Improves the Outcome of Surgery for Mitral Regurgitation : A Multivariate Analysis Circulation, February 15, 1995; 91(4): 1022 - 1028. [Abstract] [Full Text]
|
|
|
|
|
|
Y. Okita, S. Miki, Y. Ueda, T. Tahata, T. Sakai, and K. Matsuyama Mitral valve replacement with maintenance of mitral annulopapillary muscle continuity in patients with mitral stenosis J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 42 - 51. [Abstract] [Full Text]
|
|
|
|
|
|
G. Prabhakar, N. Kumar, L. Hatle, Z. Al-Halees, and C. M. G. Duran Accelerated failure of bioprosthesis by entrapment in chordal-sparing mitral valve replacement J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 185 - 187. [Full Text]
|
|
|
|
|
|
M. Nagatsu, K. Ishihara, M. R. Zile, H. Tsutsui, H. Tagawa, G. DeFreyte, R. Tanaka, G. Cooper IV, and B. A. Carabello The effects of complete versus incomplete mitral valve repair in experimental mitral regurgitation J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 416 - 423. [Abstract] [Full Text]
|
|
|
|
|
|
E. Gams, S. Hagl, H. Schad, W. Heimisch, N. Mendler, and F. Sebening Importance of the mitral apparatus for left ventricular function: an experimental approach Eur. J. Cardiothorac. Surg., January 1, 1992; 6(suppl_1): S17 - S24. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
