IMPROVED REGIONAL LEFT-VENTRICULAR PERFORMANCE IN MITRAL-VALVE REPLACEMENT WITH ORTHOTOPIC REFIXATION OF THE ANTERIOR MITRAL LEAFLET

Background and aims of the study: To investigate the influence of diff erent surgical techniques of chordal preservation in mitral valve repl acement (MVR) on left ventricular size and function, we studied a seri es of 244 patients who underwent mitral valve replacement either with (n = 161) or without (n = 83) preservation of the subvalvular structur es. Results: Preoperatively there were no differences between the two patient groups. Three months postoperatively, echocardiography demonst rated that chordal preservation in MVR resulted in smaller left ventri cular end-systolic diameter (LVESD) and end-diastolic diameter (LVEDD) : preservation versus resection, LVESD: 43.4 +/- 7.8 mm versus 48.8 +/ - 9.2 mm (p <0.05), LVEDD: 57.3 +/- 7.8 mm versus 62.9 +/- 10.5 mm (p <0.05) and a significantly decreased LV-L (long axis) (87.1 +/- 4.2 mm versus 97.5 +/- 5.7 mm; p <0.05). There was no significant difference in cardiac dimensions between the three patient subgroups in whom cho rdal preservation was possible. In addition, left ventricular ejection fraction in the preservation groups was significantly improved compar ed with the resection group (54.2 +/- 11.2% versus 48.1 +/- 12.4%, p < 0.05); there were no differences between the preservation subgroups. R egional wall motion analysis revealed significantly improved segmental myocardial performance in all segments if both leaflets were preserve d or the anterior mitral leaflet was reattached to the anterior mitral annulus.