Effect of chordal preservation on left ventricular function.

Chordopapillary apparatus preservation was compared with valve-excising mitral valve replacement in a retrospective analysis of 360 patients, of whom 98 had total or partial chordal preservation and 262 had the conventional operation. No significant differences were seen in age, sex, pathology, crossclamp or cardiopulmonary bypass times between the 3 groups. Left ventricular fractional shortening decreased significantly in patients whose valves had been excised completely, whereas it remained unchanged in patients with either partial or total chordal conservation. There was a survival benefit for patients undergoing leaflet preservation (92% vs. 80% for conventional excision at 5 years; p=0.001). Chordal preservation during valve replacement for mitral valve disease improves survival, enhances functional status, preserves left ventricular geometry and function, and improves overall cardiac performance. Preservation of the posterior leaflet alone offers excellent results that are comparable to those of patients with total chordal preservation.