Mitral Valve Replacement with Papillary Muscle Resuspension in Rheumatic Mitral Valve Disease

Objective: In this study, we compared two different mitral valve replacement techniques (with and without papillary muscle resuspension via artificial chordae) in patients with rheumatic mitral valve disease; in regard to effects on left ventricular functions and sizes. Material and Methods: The study included 164 patients that underwent mitral valve replacement with the complete resection of the mitral valve and subvalvular apparatus due to rheumatic mitral valve disease between January 2010 and September 2015. First, the patients were classified into two different sections according to severety of mitral insufficiency. Then, those who underwent papillary muscle resuspension were compared with those who didn't in each section. Results: Overall hospital mortality rate was 0.6% with 1 death. Among the patients who have significant mitral insufficiency, there was a significant difference between those with and without resuspension in respect to rates of inotrophic support taking and hospitalization duration times (59.2% versus 26.6%, p=0.033 and 10.59±5.8 versus 7.64±5.5 days , p= 0.036, respectively) in early postoperative period and ejection fractions (increased significantly in patients with resuspension from 56.23±9.1 to 59±6.5, while decreased in patients without resuspension from 58.37±9.9 to 57.07±9.1) during the mid-term postoperative period. Conclusion: In the case of valve replacement in rheumatic mitral valve disease, if there is significant mitral regurgitation preoperatively, performing papillary muscle resuspension affects left ventricular systolic functions positively. So, resuspension of the papillary muscles can be considered as a favorable alternative to other valve sparing technique due to potential advantages of maintaining mitral annulopapillary muscle continuity.