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Category: Volume 07 Issue 05 May 2019
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Title: Total versus partial chordal preservation in mitral valve replacement: Early results

Authors: Dr Sunil Dhar MC.h CTVS, Dr Sistla. V.P.L. Chandra Kumar MC.h CTVS,  Dr Madhur Kumar MC.h, Dr Anubhav Gupta-H.O.D.CTVS, Dr Ajit Kumar Padhy

 DOI: https://dx.doi.org/10.18535/jmscr/v7i5.129

Abstract

Introduction

The annulo-papillary continuity in mitral valve withstands the hydrostatic force during systole as the chords relay the engendered forces between the leaflets and ventricular wall via contracted papillary muscles. It maintains the structural integrity of tensioned ventricular mass, disruption of which results in deterioration of left ventricular functions in patients undergoing mitral valve replacement.

It has been widely emphasised by authors that the post operative functional outcomes are better with chordal preservation techniques. It is seldom performed in institutions routinely during mitral valve surgery due to the technical complexities involving longer operating time, severe subvalvular calcifications, left ventricular outflow tract obstruction (LVOTO).1-5. Patients with septal hypertrophy undergoing anterior leaflet preservation may develop LVOTO as preserved tissue interferes with prosthetic valve functions6.

In the similar line, we have studied the varied early outcomes of chordal preservation strategy during mitral valve replacement.

Methods

This is a retrospective study of 168 patients who underwent mitral valve replacement (MVR) for both chronic rheumatic mitral stenotic and regurgitant lesions at our institution from January 2016 to January 2018.Dataobtained from patient files and outpatient follow-up were evaluated. The patients were divided into 3 groups: Group A (n=37) where total excision of leaflets done with no chordal preservation. Group B (n=87) where posterior leaflet along with its subvalvular structures preserved  and Group C (n=44) where total chordal preservation done with partial excision of anterior leaflet.

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Corresponding Author

Dr Ajit Kumar Padhy

Department of Cardiothoracic and Vascular Surgery, VMMC and Safdarjung Hospital, Delhi, India