Clinical Outcomes of Preservation of Posterior Leaflet and Subvalvular Structures in Mitral Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Wei , ZHANG Jianqun , XIAO Mingdi

1. Department of CardiovascularSurgery，Beijing An Zhen Hospital，Capital University of Medical Science，Beijing 100029，P. R. China ;;
2. ShanghaiYODAK Cardiothoracic Hospital，Shanghai 200235，P. R. China;

Corresponding author：

Keywords：

Mitral valve replacement; Preservation of posterior leaflet; Left ventricular rupture; Mitral stenosis; Mitral regurgitation

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Abstract： Objective To summarize our experience and clinical outcomes of preservation of posterior leaflet and subvalvular structures in mitral valve replacement（MVR）. Methods We retrospectively analyzed the clinical data of 1 035 patients who underwent MVR in Beijing An Zhen Hospital from January 2006 to March 2011. There were 562 male patients and 473 female patients with their age of 37-78（53.84±13.13）years old. There were 712 patients with rheumatic valvular heart disease and 323 patients with degenerative valve disease, 389 patients with mitral stenosis and 646 patients with mitral regurgitation. No patient had coronary artery disease in this group. For 457 patients in non-preservation group, bothleaflets and corresponding chordal excision was performed, while for 578 patients in preservation group, posterior leafletand subvalvular structures were preserved. There was no statistical difference in demographic and preoperative clinical characteristics between the two groups. Postoperative mortality and morbidity, and left ventricular size and function were compared between the two groups. Results There was no statistical difference in postoperative mortality（2.63% vs. 1.21%, P =0.091）and morbidity （8.53% vs. 7.44%, P=0.519）between the non-preservation group and preservation group, except that the rate of left ventricular rupture of non-preservation group was significantly higher than that of preservation group（1.09% vs. 0.00%, P=0.012）. The average left ventricular end-diastolic dimension （LVEDD）measured by echocardiography 6 months after surgery decreased in both groups, but there was no statistical difference between the two groups. The average left ventricular ejection fraction (LVEF) 6 months after surgery was significantly improved compared with preoperative average LVEF in both groups. The average LVEF 6 months after surgery in patients with mitral regurgitation in the preservation group was significantly higher than that in non-preservation group （56.00%±3.47% vs. 53.00%±3.13%，P =0.000）, and there was no statistical difference in the average LVEF 6 months after surgery in patients with mitral stenosis between the two groups（57.00%±5.58% vs. 56.00%±4.79%，P =0.066）. Conclusion Preservation of posterior leaflet and subvalvular structures in MVR is a safe and effective surgical technique to reduce the risk of left ventricle rupture and improve postoperative left ventricular function．

Citation： XIAO Wei,ZHANG Jianqun,XIAO Mingdi,et al .. Clinical Outcomes of Preservation of Posterior Leaflet and Subvalvular Structures in Mitral Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 240-243. doi: Copy

1.	Lillehei CW， Levy MJ， Bonnabeau RC Jr. Mitral valve replacement with preservationg of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg， 1964， 47 （3）：532-543.
2.	Spencer FC. Surgical treatment of valvular heart disease. V. Prosthetic replacement of the mitral valve. Am Heart J， 1968， 76 （4）：576-580.
3.	Zhurba? ZhN， Novikov VK， Gordeev ML. Mitral valve replacement with preservation of subvalvular structures. Vestn Khir Im Ⅱ Grek， 2010， 169 （6）：97-100.
4.	De Bonis M， Ferrara D， Taramasso M， et al. Mitral replacement or repair for functional mitral regurgitation in dilated and ischemic cardiomyopathy：Is it really the same? Ann Thorac Surg， 2012， 20. [Epub ahead of print].
5.	Rozich JD， Carabello BA， Usher BW， et al. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance. Circulation， 1992， 86 （6）：1718-1726.
6.	Kirali K， Tuncer A， Uyar I， et al. Is posterior leaflet preservation in the surgical treatment of rheumatic mitral insufficiency without left ventricular　dysfunction necessary? Cardiovasc Surg， 2001， 9 （1）：58-63.
7.	李巅远，吕锋，吴清玉，等. 二尖瓣置换术后左室破裂. 中华外科杂志， 2003， 39 （5）：362-363.
8.	孟旭，赵铁夫，主编. 二尖瓣的结构特点与病理生理. 北京：北京出版社， 2007. 63-84.
9.	凌风东，林奇，主编. 心脏的生物力学. 西安：陕西科学技术出版社， 2006.134-150.
10.	朱晓东，主编. 心脏外科基础图解. 北京：中国协和医科大学出版社， 2002. 87-102.
11.	Cobbs BW Jr， Hatcher CR Jr， Craver JM， et al. Transverse midventricular disruption after mitral valve replacement. Am Heart J， 1980， 99 （1）： 33-50.
12.	宋惠民，崔东哲，毕研文，等. 二尖瓣置换术后左心室后壁破裂例. 中华胸心血管外科杂志， 2008， 17 （4）：248-249.
13.	张怀军，许建屏，胡盛寿. 二尖瓣置换术后左心室破裂. 中国循环杂志， 2002， 17 （5）： 67-69.
14.	修宗谊，谷天祥，谷春久，等. 二尖瓣置换术后左心室破裂. 中华外科杂志， 2006， 44 （6）：427-428.
15.	赖轶权，黄建，尤文俊，等. 风湿性心脏病瓣膜置换术216例临床分析. 中国心血管病研究， 2009， 3 （11）：345-346.
16.	Alhan C， Kayacioglu I， Tayyareci G， et al. Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis. J Heart Valve Dis， 1995， 4 （5）：453-458.
17.	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， 2. [Epub ahead of print].

1. 　Lillehei CW， Levy MJ， Bonnabeau RC Jr. Mitral valve replacement with preservationg of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg， 1964， 47 （3）：532-543.
2. 　Spencer FC. Surgical treatment of valvular heart disease. V. Prosthetic replacement of the mitral valve. Am Heart J， 1968， 76 （4）：576-580.
3. 　Zhurba? ZhN， Novikov VK， Gordeev ML. Mitral valve replacement with preservation of subvalvular structures. Vestn Khir Im Ⅱ Grek， 2010， 169 （6）：97-100.
4. 　De Bonis M， Ferrara D， Taramasso M， et al. Mitral replacement or repair for functional mitral regurgitation in dilated and ischemic cardiomyopathy：Is it really the same? Ann Thorac Surg， 2012， 20. [Epub ahead of print].
5. 　Rozich JD， Carabello BA， Usher BW， et al. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance. Circulation， 1992， 86 （6）：1718-1726.
6. 　Kirali K， Tuncer A， Uyar I， et al. Is posterior leaflet preservation in the surgical treatment of rheumatic mitral insufficiency without left ventricular　dysfunction necessary? Cardiovasc Surg， 2001， 9 （1）：58-63.
7. 　李巅远，吕锋，吴清玉，等. 二尖瓣置换术后左室破裂. 中华外科杂志， 2003， 39 （5）：362-363.
8. 　孟旭，赵铁夫，主编. 二尖瓣的结构特点与病理生理. 北京：北京出版社， 2007. 63-84.
9. 　凌风东，林奇，主编. 心脏的生物力学. 西安：陕西科学技术出版社， 2006.134-150.
10. 　朱晓东，主编. 心脏外科基础图解. 北京：中国协和医科大学出版社， 2002. 87-102.
11. 　Cobbs BW Jr， Hatcher CR Jr， Craver JM， et al. Transverse midventricular disruption after mitral valve replacement. Am Heart J， 1980， 99 （1）： 33-50.
12. 　宋惠民，崔东哲，毕研文，等. 二尖瓣置换术后左心室后壁破裂例. 中华胸心血管外科杂志， 2008， 17 （4）：248-249.
13. 　张怀军，许建屏，胡盛寿. 二尖瓣置换术后左心室破裂. 中国循环杂志， 2002， 17 （5）： 67-69.
14. 　修宗谊，谷天祥，谷春久，等. 二尖瓣置换术后左心室破裂. 中华外科杂志， 2006， 44 （6）：427-428.
15. 　赖轶权，黄建，尤文俊，等. 风湿性心脏病瓣膜置换术216例临床分析. 中国心血管病研究， 2009， 3 （11）：345-346.
16. 　Alhan C， Kayacioglu I， Tayyareci G， et al. Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis. J Heart Valve Dis， 1995， 4 （5）：453-458.
17. 　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， 2. [Epub ahead of print].

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Preservation of Posterior Leaflet and Subvalvular Structures in Mitral Valve Replacement

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