Mitral valve replacement with preservation of the subvalvular structures where possible: an echocardiographic and clinical comparison with cases where preservation was not possible. Surgical technique and early postoperative course.

Mitral valve replacement (MVR) is still associated with a relatively high mortality. To prove the benefits of chordal preservation at mitral valve replacement, we investigated its effects in a series of 65 consecutive MVR patients. Of those patients, in 42 preservation of the mitral subvalvular structures was possible whereas in the other 23 they had to be excised. Both groups showed no differences in age, sex, preoperative NYHA class, and valve pathology. Intra- and postoperative management was similar in both groups. The surgical techniques employed are described and the early postoperative course of both groups are analysed. Clinical, electrocardiographic and echocardiographic investigations, measuring left-atrial and -ventricular diameters, right-ventricular diameters and left-ventricular length, demonstrated that whereas beneficial effects were evident in both groups, the amount of benefits was higher in patients with chordal preservation. Chordal preservation also provided less arrhythmias than chordal resection.