Bileaflet Preservation in Mitral Valve Replacement for Patients with Severe Mitral Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUJian ,  GUOHui-ming , XIEBin , ZHANGXiao-shen , LUCong , HUANGHuan-lei , ZHUANGJian

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P. R. China;

Corresponding author：

GUOHui-ming, Email: guohuiming@vip.tom.com

Keywords：

Mitral valve replacement; Bileaflet preservation; Mitral regurgitation

DOI：

10.7507/1007-4848.20140126

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Objective To analyze clinical experience and outcomes of bileaflet preservation in mitral valve replace-ment (MVR) for patients with severe mitral regurgitation (MR). Methods We retrospectively analyzed clinical data of 17 patients with severe MR who underwent MVR with bileaflet preservation in the Department of Cardiovascular surgery of Guangdong General Hospital from June 2011 to January 2013. There were 14 males and 3 females with mean age of 63.41±11.82 years (range, 38 to 82 years). There were 13 patients with atrial fibrillation. Preoperatively, 5 patients were in New York Heart Association (NYHA) functional class Ⅲ, and 12 patients were in NYHA class Ⅳ. There were 7 patients with ischemic MR, 9 patients with degenerative MR, and 1 patient with rheumatic MR. Results MVR with bileaflet preservation was performed for all the patients. Concomitant coronary artery bypass grafting was performed for 4 patients. Eleven patients received bioprosthetic MVR, and 6 patients received mechanical MVR. There was no in-hospital death, postoperative low cardiac output syndrome or left ventricular rupture. All the 17 patients were followed up for a mean duration of 16.44±5.02 months (range, 2 to 25 months). During follow-up, 1 patient died of severe paravalvular leak 2 months after surgery. All the other patients had good mitral valve function. None of the patients had anticoagulation or prosthetic valve related complication. Patient's heart function was significantly improved. Eleven patients were in NYHA functional class Ⅰ, 4 patients were in NYHA class Ⅱ, and 1 patient was in NYHA class Ⅲ. Cardiothoracic ratio, left atrial dimension, left ventricular end-diastolic dimension and left ventricular end-systole dimension postoperatively and during follow-up were significantly smaller than preoperative values. Postoperative left ventricular ejection fraction (LVEF) was significantly lower than preoperative LVEF(50.94%±8.78% vs. 55.31%±10.44%, P=0.04), but LVEF during follow-up was not statistically different from preoperative LVEF(55.31%±10.44% vs. 56.13%±9.67%, P=0.73), and LVEF during follow-up was significantly higher than postoperative LVEF(56.13%±9.67% vs. 50.94%±8.78%, P=0.02). There was no statistical difference between postoperative mitral pressure half-time (PHT)and PHT during follow-up (95.06±19.00 ms vs. 94.56±19.19 ms, P=0.91). Conclusion MVR with bileaflet preservation is a safe and effective surgical technique for patients with severe MR, and can significantly improve postoperative left ventricular remodeling and function.

Citation： LIUJian, GUOHui-ming, XIEBin, ZHANGXiao-shen, LUCong, HUANGHuan-lei, ZHUANGJian. Bileaflet Preservation in Mitral Valve Replacement for Patients with Severe Mitral Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 447-450. doi: 10.7507/1007-4848.20140126 Copy

1.	Garcia-Fuster R, Estevez V, Gil O, et al. Mitral valve replacement in rheumatic patients:effects of chordal preservation. Ann Thorac Surg, 2008, 86 (2):472-481.
2.	Chowdhury UK, Kumar AS, Airan B, et al. Mitral valve replacement with and without chordal preservation in a rheumatic population:serial echocardiographic assessment of left ventricular size and function. Ann Thorac Surg, 2005, 79 (6):1926-1933.
3.	Athanasiou T, Chow A, Rao C, et al. Preservation of the mitral valve apparatus:evidence synthesis and critical reappraisal of surgical techniques. Eur J Cardiothorac Surg, 2008, 33 (3):391-401.
4.	Morishita A, Shimakura T, Nonoyama M, et al. Mitral valve replace-ment in ischemic mitral regurgitation. Preservation of both anterior and posterior mitral leaflets. J Cardiovasc Surg (Torino), 2002, 43 (2):147-152.
5.	肖巍, 张健群, 肖明第, 等.保留后瓣及瓣下结构的二尖瓣置换术临床分析.中国胸心血管外科临床杂志, 2012, 19 (3):240-243.
6.	孙文宇, 李守先, 宋惠民.二尖瓣置换术保留与不保留瓣下结构对术后早期血流动力学的影响.中国胸心血管外科临床杂志, 1999, 6 (2):77-79.
7.	Okita Y, Miki S, Ueda Y, et al. Left ventricular function after mitral valve replacement with or without chordal preservation. J Heart Valve Dis, 1995, 4 (Suppl 2):S181-S193.
8.	Wasir H, Choudhary S K, Airan B, et al. Mitral valve replacement with chordal preservation in a rheumatic population. J Heart Valve Dis, 2001, 10 (1):84-89.
9.	Muthialu N, Varma SK, Ramanathan S, et al. Effect of chordal preservation on left ventricular function. Asian Cardiovasc Thorac Ann, 2005, 13 (3):233-237.
10.	Yu Y, Gao C, Li G, et al. Mitral valve replacement with complete mitral leaflet retention:operative techniques. J Heart Valve Dis, 1999, 8 (1):44-46.
11.	Miki S, Kusuhara K, Ueda Y, et al. Mitral valve replacement with preservation of chordae tendineae and papillary muscles. Ann Thorac Surg, 1988, 45 (1):28-34.
12.	Lillehei CW, Levy MJ, Bonnabeau RJ Jr. Mitral valve replacement with preservation of papillary muscles and chorade tendineae. J Thorac Cardiovasc Surg, 1964, 47:532-543.
13.	Yun KL, Sintek CF, Miller DC, et al. Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement:effects on left ventricular volume and function. J Thorac Cardiovasc Surg, 2002, 123 (4):707-714.
14.	Sa MP, Escobar RR, Ferraz PE, et al. Complete versus partial preservation of mitral valve apparatus during mitral valve replacement:meta-analysis and meta-regression of 1535 patients. Eur JCardiothorac Surg, 2013, 44 (5):905-912.
15.	Le Tourneau T, Grandmougin D, Foucher C, et al. Anterior chordal transection impairs not only regional left ventricular function but also regional right ventricular function in mitral regurgitation. Circulation, 2001, 104 (12 Suppl 1):I41-I46.
16.	Garcia FR, Vazquez A, Pelaez AG, et al. Factors for development of late significant tricuspid regurgitation after mitral valve replacement:the impact of subvalvular preservation. Eur J Cardiothorac Surg, 2011, 39 (6):866-874.
17.	De Canniere D, Jansens JL, Unger P, et al. Left ventricular outflow tract obstruction after mitral valve replacement. Ann Thorac Surg, 1997, 64 (6):1805-1806.
18.	Steuer K, Papadopoulos N, Moritz A, et al. Mitral valve surgery in patients with extensively calcified mitral annulus:long-term echocardiographic and clinical follow-up. Herz, 2012, 37 (7):762-769.
19.	Sasaki H, Ihashi K. Chordal-sparing mitral valve replacement:pitfalls and techniques to prevent complications. Eur J Cardiothorac Surg, 2003, 24 (4):650-652.

1. Garcia-Fuster R, Estevez V, Gil O, et al. Mitral valve replacement in rheumatic patients:effects of chordal preservation. Ann Thorac Surg, 2008, 86 (2):472-481.
2. Chowdhury UK, Kumar AS, Airan B, et al. Mitral valve replacement with and without chordal preservation in a rheumatic population:serial echocardiographic assessment of left ventricular size and function. Ann Thorac Surg, 2005, 79 (6):1926-1933.
3. Athanasiou T, Chow A, Rao C, et al. Preservation of the mitral valve apparatus:evidence synthesis and critical reappraisal of surgical techniques. Eur J Cardiothorac Surg, 2008, 33 (3):391-401.
4. Morishita A, Shimakura T, Nonoyama M, et al. Mitral valve replace-ment in ischemic mitral regurgitation. Preservation of both anterior and posterior mitral leaflets. J Cardiovasc Surg (Torino), 2002, 43 (2):147-152.
5. 肖巍, 张健群, 肖明第, 等.保留后瓣及瓣下结构的二尖瓣置换术临床分析.中国胸心血管外科临床杂志, 2012, 19 (3):240-243.
6. 孙文宇, 李守先, 宋惠民.二尖瓣置换术保留与不保留瓣下结构对术后早期血流动力学的影响.中国胸心血管外科临床杂志, 1999, 6 (2):77-79.
7. Okita Y, Miki S, Ueda Y, et al. Left ventricular function after mitral valve replacement with or without chordal preservation. J Heart Valve Dis, 1995, 4 (Suppl 2):S181-S193.
8. Wasir H, Choudhary S K, Airan B, et al. Mitral valve replacement with chordal preservation in a rheumatic population. J Heart Valve Dis, 2001, 10 (1):84-89.
9. Muthialu N, Varma SK, Ramanathan S, et al. Effect of chordal preservation on left ventricular function. Asian Cardiovasc Thorac Ann, 2005, 13 (3):233-237.
10. Yu Y, Gao C, Li G, et al. Mitral valve replacement with complete mitral leaflet retention:operative techniques. J Heart Valve Dis, 1999, 8 (1):44-46.
11. Miki S, Kusuhara K, Ueda Y, et al. Mitral valve replacement with preservation of chordae tendineae and papillary muscles. Ann Thorac Surg, 1988, 45 (1):28-34.
12. Lillehei CW, Levy MJ, Bonnabeau RJ Jr. Mitral valve replacement with preservation of papillary muscles and chorade tendineae. J Thorac Cardiovasc Surg, 1964, 47:532-543.
13. Yun KL, Sintek CF, Miller DC, et al. Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement:effects on left ventricular volume and function. J Thorac Cardiovasc Surg, 2002, 123 (4):707-714.
14. Sa MP, Escobar RR, Ferraz PE, et al. Complete versus partial preservation of mitral valve apparatus during mitral valve replacement:meta-analysis and meta-regression of 1535 patients. Eur JCardiothorac Surg, 2013, 44 (5):905-912.
15. Le Tourneau T, Grandmougin D, Foucher C, et al. Anterior chordal transection impairs not only regional left ventricular function but also regional right ventricular function in mitral regurgitation. Circulation, 2001, 104 (12 Suppl 1):I41-I46.
16. Garcia FR, Vazquez A, Pelaez AG, et al. Factors for development of late significant tricuspid regurgitation after mitral valve replacement:the impact of subvalvular preservation. Eur J Cardiothorac Surg, 2011, 39 (6):866-874.
17. De Canniere D, Jansens JL, Unger P, et al. Left ventricular outflow tract obstruction after mitral valve replacement. Ann Thorac Surg, 1997, 64 (6):1805-1806.
18. Steuer K, Papadopoulos N, Moritz A, et al. Mitral valve surgery in patients with extensively calcified mitral annulus:long-term echocardiographic and clinical follow-up. Herz, 2012, 37 (7):762-769.
19. Sasaki H, Ihashi K. Chordal-sparing mitral valve replacement:pitfalls and techniques to prevent complications. Eur J Cardiothorac Surg, 2003, 24 (4):650-652.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Bileaflet Preservation in Mitral Valve Replacement for Patients with Severe Mitral Regurgitation

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