Comparative assessment of immediate results of mitral valve repair according to the classical technique with posterior leaflet preservation

We comparatively assessed the results of mitral valve repair according to the classical technique either with complete removal of leaflets or with the preservation of the posterior leaflet and the chordal-papillary apparatus. Depending on the variant of the operation, all patients were divided into two groups. Group One consisted of 23 patients in whom the posterior leaflet with the chordal-papillary apparatus was preserved, and Group Two comprised 23 patients in whom the mitral valve was removed completely. In the immediate postoperative period, Group One patients were found to have a decrease in the left ventricular end-systolic and end-diastolic dimensions and volumes. Similar dynamics was observed in relation to the left-atrial dimension, with a decrease in the pressure gradient across the mitral valve, pulmonary artery systolic pressure, and the degree of systolic shortening of the anterior-posterior size of the left ventricle. Group Two patients also demonstrated positive dynamics in relation to the left ventricular size and volume, the size of the left atrium and the right ventricle. The left-ventricular ejection fraction in the immediate postoperative period decreased averagely from 59.0±9.8% to 56.1±9.4%, accompanied and followed by a decrease in the pressure gradient across the mitral valve and pulmonary artery systolic pressure. The degree of systolic shortening of the anterior-posterior size of the left ventricle remained unchanged postoperatively. A conclusion was drawn that preserving the annulo-papillary continuity after mitral valve repair made it possible to achieve better functional results, normalization of the intracardiac haemodynamics, and improvement of the left-ventricle myocardial contractility. Complete removal of the subvalvular structures resulted in decreased contractility of the left ventricular myocardium.