J. Aagaard et al., MITRAL-VALVE REPLACEMENT WITH TOTAL PRESERVATION OF NATIVE VALVE AND SUBVALVULAR APPARATUS, Journal of heart valve disease, 6(3), 1997, pp. 274-278
Background and aims of the study: Preservation of the mitral valve and
subvalvular apparatus was introduced clinically in the early 1960s, b
ut for two decades the technique for mitral valve replacement included
excision of both leaflets and their attached chordae tendineae. Latel
y, emphasis has been replaced on retaining the mitral subvalvular appa
ratus during valve replacement because of its role in left ventricular
function. Hence, during the past six years, when performing mitral va
lve replacement we have, when possible, preserved the valvular and sub
valvular mitral apparatus. Methods: Between January 1990 and November
1996, complete retention of all mitral tissue in connection with mitra
l valve replacement was performed in 58 patients (23 women and 35 men)
. Mean age was 63 years (range: 23 years to 77 years). Coronary bypass
was a concomitant procedure in 19 patients; both the mitral and aorti
c valve was replaced in four cases. Calcified and/or stenotic valves w
ere not a contraindication for the procedure; calcified plaques were r
emoved. Adhesion between anterior and posterior leaflets was treated w
ith sharp dissection. Valve and subvalvular tissue were preserved. The
leaflets were reefed within the valve-sutures and compressed between
the sewing ring and the native annulus when implanting the valve prost
hesis. Chordal tension on the ventricle is thus maintained and the cho
rdae pulled away from the valve effluent. Results: Six patients died i
n the postoperative period and three had transient neurological sympto
ms. In no patient was death or transient neurological symptoms a conse
quence of the retention of mitral leaflets with subvalvular apparatus,
Conclusions: We find the described technique to be useful not only in
valve insufficiency but also in valve stenosis when preserving the mi
tral leaflets with subvalvular apparatus during valve replacement. The
technique is without procedure-related complications and prevents obs
truction of left ventricular outflow tract.