Mitral valve replacement with preservation of papillary muscles and chordae tendineae - revival of a seemingly forgotten concept. I. Preliminary clinical report.

In 45 consecutive patients mitral valve replacement was performed leaving the posterior mitral leaflet and its chordal attachment to both papillary muscles intact (Lillehei's technique). Most patients showed moderate to severe pulmonary hypertension before surgery, 15 of the patients had double valve operations and 4 had a triple valve procedure. All patients survived and were discharged, the postoperative courses being remarkably uneventful with only very limited need of inotropic support in 3 patients and resumption of spontaneous respiration within the first 20 hours after the operation. The clinical courses in these patients seem to indicate that preserving the continuity between papillary muscles and mitral annulus in mitral valve replacement may improve left ventricular function at least early after surgery.