Is posterior leaflet preservation in the surgical treatment of rheumatic mitral insufficiency without left ventricular dysfunction necessary?

Preservation of the mitral valve leaflet and tensor apparatus during valve replacement is believed to maintain left ventricular performance. To determ ine the effect of posterior leaflet preservation in pure severe mitral insu fficiency without left ventricular dysfunction 56 patients were operated on between 1993 and 2000. Twenty-three patients underwent mitral valve replac ement with posterior chordal preservation and 33 patients underwent mitral valve replacement with chordal transection. Preoperative data in the both g roups were similar. After 30 days there were no mortalities observed. Dimen sions of the left ventricle had significantly decreased within one group, b ut there was no difference in the other group, The improvement of the funct ional and cardiac performance in all patients was significant without any d ifference between the two groups. Actuarial freedom from death was not sign ificantly different at 6 yr (P = 0.23). To preserve left ventricular functi on in pure severe mitral regurgitation without left ventricular dysfunction , mitral valve replacement is very effective with or without posterior leaf let preservation. But, it is difficult to suggest that posterior leaflet pr eservation alone can increase cardiac performance. (C) 2001 The Internation al Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. A ll rights reserved.