Comparative evaluation of left ventricular performance after mitral valve repair or valve replacement with or without chordal preservation.

The clinical importance of preserving the chordae tendineae during mitral valve replacement was assessed by comparing the postoperative left ventricular performances in 68 patients who underwent mitral valve replacement (MVR) with complete chordal preservation (n = 19), conventional MVR (n = 25) or mitral valve repair (n = 24) and had full hemodynamic assessment before and after surgery. The pre- and postoperative left ventricular performances were analyzed using cineangiography, multiple-gated cardiac blood pool scintigraphy (MUGA), and echocardiography. In the early postoperative period, cineangiography revealed that the end-systolic volume index (ESVI) and the end-diastolic pressure were significantly higher in the conventional MVR group. The left ventricular ejection fraction was unchanged in the chordal preservation group, but was decreased in the mitral repair and conventional MVR groups. The end-systolic circumferential left ventricular wall stress (ESS) was significantly decreased in the chordal preservation and mitral repair groups, but was unchanged, and thus higher, in the conventional MVR group. The postoperative left ventricular contractility index (ESS/ESVI) was better in the chordal preservation than in the conventional MVR group. In the late postoperative period, both the left ventricular ejection fraction as measured by MUGA and the left ventricular fractional shortening as measured by echocardiography were significantly higher in the mitral repair and chordal preservation groups than in the conventional MVR group. This study supports the concept that the maintenance of continuity between the mitral annulus and the papillary muscles has a beneficial effect on postoperative left ventricular performance.