Mitral Valve Replacement with Modified Anterior Leaflet Preservation Technique_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIJi-yong , ZHANGJian-qun , BOPing , ZHANGFu-en , ZHAOShuang

Department of Cardiac Surgery, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

LIJi-yong, Email: lihengtao@sina.com

Keywords：

Mitral valve replacement; Anterior leaflet preservation; Short-term result

DOI：

10.7507/1007-4848.20140056

Video：

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Objective To summarize clinical outcomes of mitral valve replacement (MVR) with modified anterior leaflet preservation technique,improve therapeutic effects and reduce postoperative mortality and morbidity. Methods From May 2005 to December 2012,128 patients underwent MVR with modified anterior leaflet preservation technique (modified group) in Beijing Anzhen Hospital,among whom 14 patients received concomitant aortic valve replacement. There were 49 male and 79 female patients in the modified group with their age of 45.0±12.3 years. Another 128 patients who underwent routine MVR during the same period were also included in this study as the control group,including 55 male and 73 female patients with their age of 48.0±8.4 years. There was no statistical difference in preoperative clinical characteristics between the 2 groups (P>0.05). Results In the modified group,there was no perioperative death. Postoperatively,6 patients received reexploration for bleeding,4 patients had low cardiac output syndrome,5 patients had pulmonary infection,1 patient received tracheostomy,and 3 patients had acute kidney failure (AKI). In the control group,5 patients died postoperatively including 3 patients with left ventricular rupture and 2 patients with severe low cardiac output syndrome. Postoperatively,5 patients received reexploration for bleeding,12 patients had low cardiac output syndrome,4 patients had pulmonary infection,and 6 patients had AKI. Echocardiography at 6th month during follow-up showed that left ventricular ejection fraction (LVEF) left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) of modified group patients were improved compared with control group patients. There was statistical difference in LVEF and LVESD between the 2 groups (P<0.05). There was no statistical difference in LVEDD between the 2 groups (P>0.05). LVEF,LVEDD and LVESD of modified group patients during follow-up were statistically different from preoperative values (P<0.05). LVEDD of control group patients during follow-up was statistically different from preoperative LVEDD (P<0.05). LVEF and LVESD of control group patients during follow-up was not statistically different from preoperative values (P>0.05). Conclusion MVR with modified anterior leaflet preservation technique is simple to perform with satisfactory short-term results. This technique is suitable for various types of mitral valve diseases especially degenerative mitral valve disease and infective endocarditis.

Citation： LIJi-yong, ZHANGJian-qun, BOPing, ZHANGFu-en, ZHAOShuang. Mitral Valve Replacement with Modified Anterior Leaflet Preservation Technique. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 189-193. doi: 10.7507/1007-4848.20140056 Copy

1.	张宝仁,徐志云,邢建洲,等.单纯二尖瓣置换术3416例疗效分析.中华胸心血管外科杂志,2005,21 (4):196-198.
2.	王崇,韩林,张冠鑫,等.心脏瓣膜手术在院死亡风险预测模型及评分标准的建立.中国胸心血管外科临床杂志,2011,18 (1):2-10.
3.	肖巍,张健群,肖明第,等.保留后瓣及瓣下结构的二尖瓣置换术临床分析.中国胸心血管外科临床杂志,2012,19 (3):240-243.
4.	Sá MP,Ferraz PE,Escobar RR,et al.Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement:a meta-analysis of 3835 patients.Interact Cardiovasc Thorac Surg,2012,15 (6):1033-1039.
5.	杨守国,王春生,丁文军,等.二尖瓣置换术中保留二尖瓣前叶致左心室流出道梗阻一例.中国胸心血管外科临床杂志,2005,12 (1):60-60.
6.	Lillehei CW,Levy MJ,Bonnabeau RJ.Mitral valve replacement with preservationg of papillary muscles and chordae tendineae.J Thorac Cardiovasc Surg,1964,47 (3):532-543.
7.	Deniz H,Sokullu O,Sanioglu S,et al.Risk factors for posterior ventricular rupture after mitral valve replacement:results of 2560 patients.Eur J Cardiothorac Surg,2008,34 (4):780-784.
8.	Athanasiou T,Chow A,Rao C,et al.Preservation of the mitral valve apparatus:evidence synthesis and critical reappraisal of surgical techniques.Eur J Cardiothorac Surg,2008,33 (3):391-401.
9.	Patel H,Antoine SM,Funk M,et al.Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet.Rev Cardiovasc Med,2011,12 (1):48-51.
10.	Sasaki H,Ihashi K.Chordal-sparing mitral valve replacement:pitfalls and techniques to prevent complications.Eur J Cardiothorac Surg,2003,24 (4):650-652.
11.	周方,陈胜喜,罗万俊,等.纽扣状转移保留二尖瓣全装置瓣膜置换及其对左心功能的影响.实用医学杂志,2008,24 (23):4031-4033.
12.	Soga Y,Nishimura K,Yamazaki K,et al.Simplified chordal Reconstruction:‘oblique’ placement of artificial chordae tendineae in mitral valve replacement.Eur J Cardiothorac Surg,2003,24 (4):653-655.
13.	Kuralay E,Demirkiliç U,Günay C,et al.Mitral valve replacement with bileaflet preservation:a modified technique.Eur J Cardiothorac Surg,2002,22 (4):630-632.
14.	García-Fuster R,Estevez V,Gil O,et al.Mitral valve replacement in rheumatic patients:effects of chordal preservation.Ann Thorac Surg,2008,86 (2):472-481.
15.	Ucak A,Ugur M,Onan B,et al.Conventional versus complete chordal-sparing mitral valve replacement:effects on left ventricular function and end-systolic stress.Acta Cardiol,2011,66 (5):627-634.

1. 张宝仁,徐志云,邢建洲,等.单纯二尖瓣置换术3416例疗效分析.中华胸心血管外科杂志,2005,21 (4):196-198.
2. 王崇,韩林,张冠鑫,等.心脏瓣膜手术在院死亡风险预测模型及评分标准的建立.中国胸心血管外科临床杂志,2011,18 (1):2-10.
3. 肖巍,张健群,肖明第,等.保留后瓣及瓣下结构的二尖瓣置换术临床分析.中国胸心血管外科临床杂志,2012,19 (3):240-243.
4. Sá MP,Ferraz PE,Escobar RR,et al.Preservation versus non-preservation of mitral valve apparatus during mitral valve replacement:a meta-analysis of 3835 patients.Interact Cardiovasc Thorac Surg,2012,15 (6):1033-1039.
5. 杨守国,王春生,丁文军,等.二尖瓣置换术中保留二尖瓣前叶致左心室流出道梗阻一例.中国胸心血管外科临床杂志,2005,12 (1):60-60.
6. Lillehei CW,Levy MJ,Bonnabeau RJ.Mitral valve replacement with preservationg of papillary muscles and chordae tendineae.J Thorac Cardiovasc Surg,1964,47 (3):532-543.
7. Deniz H,Sokullu O,Sanioglu S,et al.Risk factors for posterior ventricular rupture after mitral valve replacement:results of 2560 patients.Eur J Cardiothorac Surg,2008,34 (4):780-784.
8. Athanasiou T,Chow A,Rao C,et al.Preservation of the mitral valve apparatus:evidence synthesis and critical reappraisal of surgical techniques.Eur J Cardiothorac Surg,2008,33 (3):391-401.
9. Patel H,Antoine SM,Funk M,et al.Left ventricular outflow tract obstruction after bioprosthetic mitral valve replacement with preservation of the anterior leaflet.Rev Cardiovasc Med,2011,12 (1):48-51.
10. Sasaki H,Ihashi K.Chordal-sparing mitral valve replacement:pitfalls and techniques to prevent complications.Eur J Cardiothorac Surg,2003,24 (4):650-652.
11. 周方,陈胜喜,罗万俊,等.纽扣状转移保留二尖瓣全装置瓣膜置换及其对左心功能的影响.实用医学杂志,2008,24 (23):4031-4033.
12. Soga Y,Nishimura K,Yamazaki K,et al.Simplified chordal Reconstruction:‘oblique’ placement of artificial chordae tendineae in mitral valve replacement.Eur J Cardiothorac Surg,2003,24 (4):653-655.
13. Kuralay E,Demirkiliç U,Günay C,et al.Mitral valve replacement with bileaflet preservation:a modified technique.Eur J Cardiothorac Surg,2002,22 (4):630-632.
14. García-Fuster R,Estevez V,Gil O,et al.Mitral valve replacement in rheumatic patients:effects of chordal preservation.Ann Thorac Surg,2008,86 (2):472-481.
15. Ucak A,Ugur M,Onan B,et al.Conventional versus complete chordal-sparing mitral valve replacement:effects on left ventricular function and end-systolic stress.Acta Cardiol,2011,66 (5):627-634.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mitral Valve Replacement with Modified Anterior Leaflet Preservation Technique

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