This perspective study has been designed to evaluate the modifications induced on left ventricular contractility by the interruption of annulo-papillary continuity during mitral valve replacement in patients with rheumatic valve disease. Patients with associated cardiac diseases were not admitted to the study. Sixty-nine patients entered the trial, each patient was randomly assigned to mitral valve replacement either with preservation of the annulo-papillary continuity (PAPC) or with excision of all the chordae (EC). Patients with mitral stenosis (MS) and combined mitral disease (MS & R) were considered separately. The four groups were similar regarding pre-operative characteristics including the readioisotopic left ventricular ejection fraction (LVEF). All the patients had the mitral valve replaced with a bileaflet prosthesis fixed by interrupted mattress sutures in the supra-annular position; the methods of anesthesia, cardiopulmonary bypass and myocardial preservation were similar in all patients. In the patients of the two EC groups a complete excision of the mitral valve was performed. In the patients of the PAPC groups a modified Miki's technique was used to preserve annulo-papillary continuity; in eitht cases with heavy calcification of the subvalvular apparatus, after total excision of the mitral valve, PTFE sutures were used to reconnect the annulus to the papillary muscles. After 6 months' follow-up, 2D and Doppler echocardiography was completed in each patient to confirm the absence of any prosthetic leakage and left ventricular out-flow tract obstruction. (LVOT). In the group of MS randomly assigned to EC the radioisotopic LVEF was 51.7 ± 9 preoperatively and 53.7 ± 10 6 months after the operation; this variation was significantly different (P = 0.03) from the corresponding group in which the APC was preserved (45.5 ± 10 preoperatively and 54.1 ± 10 6 months after the the operation). In the group of MS & R the radioisotopic LVEF changed from 56.7 ± 12 to 53.9 ± 12 6 months after the mitral valve replacement in the patients assigned to EC, and from 53.2 ± 9 to 57.4 ± 9 in patients assigned to PAPC; the variation of the LVEF in these two groups was statistically different (P = 0.02).
|Journal||European Journal of Cardio-thoracic Surgery|
|Publication status||Published - 1994|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine