MIDTERM RESULTS OF MITRAL-VALVE REPLACEMENT COMBINED WITH CHORDAE TENDINEAE REPLACEMENT IN PATIENTS WITH MITRAL-STENOSIS

Background and aims of the study: Although many studies have found tha t preservation of the continuity between the mitral annulus and the pa pillary muscles during mitral valve replacement improves postoperative left ventricular performance in patients with mitral regurgitation, m uch less research has been done in this respect in patients with mitra l stenosis. We reviewed our experience with mitral valve replacement c ombined with chordae tendineae replacement in 29 patients with mitral disease, 26 of whom had mitral stenosis. Methods: During mitral valve replacement, continuity between the papillary muscle and annulus was r estored with expanded polytetrafluoroethylene (ePTFE) mattress sutures , which were threaded into the compact portion of each papillary muscl e and placed at the 2, 4, 8 and 10 o'clock positions in the mitral ann ulus. Postoperatively, the patients were followed by echocardiographic assessment and exercise (stress) radionuclide angiography testing. Th e stress test results were compared with those in patients who had und ergone traditional mitral valve replacement, and also those in normal people. Results: There were no hospital deaths, complications, or card iac deaths or events during a median follow up of two-and-a-half years . Echocardiography showed no postoperative cardiac dilatation. The str ess tests found no significant differences between the ejection fracti on in mitral stenosis patients who underwent conventional mitral valve replacement and in those who had valve replacement combined with ePTF E chordae tendineae replacement. Conclusions: A direct advantage of ch ordae-preserving mitral valve replacement over conventional replacemen t with respect to postoperative global left ventricular performance in patients with mitral valve stenosis has not been demonstrated. Howeve r, postoperative regional left ventricular contraction in patients wit h mitral stenosis has been observed to be better among those who have undergone the chordae-preserving procedure. Additional investigations are needed to elucidate the effects of this procedure in mitral stenos is, but we believe that the technique improves left ventricular perfor mance and may decrease the risk of left ventricular rupture.