Conventional versus complete chordal-sparing mitral valve replacement: eff ects on left ventricular function and end-systolic stress

BACKGROUND: This study aims to assess the effects of bileaflet preservation versus conventional technique during mitral valve replacement (MVR) on left ventricular functions and end-systolic stress (ESS). METHODS: Between September 2005 and January 2009, sixty-five patients with mitral regurgitation underwent MVR surgery. In a non-randomized fashion, 34 patients had conventional MVR without chordal/leaflet preservation (group I, c-MVR), and 31 had MVR with total chordal/bileaflet preservation (group II, b-MVR). A prospective clinical and echocardiographic follow-up of patients was performed preoperatively, at 3 months and by 1 year postoperatively. RESULTS: Left ventricular end-systolic/end-diastolic dimensions and volumes decreased by 1 year in the b-MVR group. Left ventricular ESS decreased only in the bileaflet sparing MVR group after surgery, and this decrease was significant by 1 year, compared with the c-MVR group (P = 0.008). Left atrial diameter significantly decreased in both groups. Only one patient died, due to posterior wall rupture after a c-MVR procedure. One patient undergoing a b-MVR procedure needed re-operation because of prosthetic valve endocarditis. CONCLUSION: Bileaflet preservation during MVR has a beneficial effect on left ventricular function, compared with conventional MVR. Left ventricular ESS improves after bileaflet-sparing MVR and may be an important indicator of myocardial function after mitral valve surgery.