Mitral Valve Replacement With or Without Subvalvular Apparatus Preservation

Background: Mitral Valve Replacement (MVR) for mitral valve disease continues to be associated with long-term morbidity and mortality. Despite improvements in myocardial protection and prosthetic valves, the rate of morbidity has not decreased significantly over the years. The most common cause of death following MVR is cardiac failure. Preservation of the subvalvular apparatus maintains Left Ventricle (LV) function and thus improves survival. Repair is not always feasible or successful, particularly with rheumatic valve disease in young patients and severely disorganized valves. A claim against preservation of the Anterior Mitral Leaflet (AML) was that only undersized valve prosthesis could be implanted. Another argument against preservation of the anterior leaflet is that it might cause obstruction of the Left Ventricular Outflow Obstruction (LVOT). Objective: Of this study was to assess the immediate and short-term (6 months) changes in LV performance after MVR with preservation of chordea tendinea of AML. Methods: This study was done in department of Cardio-thoracic Surgery at Kasr Al-Aini Faculty of Medicine after approval of the local ethical committee from 2011 to 2013. Sixty patients with severe mitral disease were included in the study for operative and short term postoperative results to evaluate the impact of SVP during surgery on the operative and postoperative outcome. Results: The sixty patients were divided into two groups where 30 of them underwent preservation of AML, these patients had better LV function in the early and the short term postoperative period. Conclusion: Results of this study concluded that SVP of AML leads to better postoperative outcome. We recommend its application on a greater scale of cases of MVR.