Left ventricular function after mitral valve surgery.

Abstract

This study examined the effects of various operative procedures on the mitral valve of patients with mitral regurgitation due to degenerative disease of the mitral valve. A randomized clinical trial on the type of annuloplasty ring used at surgery revealed that early postoperative left ventricular systolic function was better in patients who had a flexible ring than in patients who had a rigid ring. Two years after surgery there were no differences between these groups and most patients were found to have fairly normal left ventricular function. The long term results of mitral valve repair in 184 patients revealed a 10-year actuarial survival of 86% +/- 6%. A randomized trial on the effect of preservation of chordae tendineae during mitral valve replacement revealed that the beneficial effect of this procedure on left ventricular function is a lasting one; five years after surgery patients who had mitral valve replacement with preservation of the chordae tendineae have better exercise capacity, and better left ventricular systolic function and performance. The long term results of mitral valve replacement in 154 patients revealed a 10-year actuarial survival of 69% +/- 5%. Logistic regression analysis indicated that age greater than 65 years and complete excision of the native mitral valve were predictors of late mortality. Of those patients, 70 had had chordal preservation during surgery and 84 did not. These two subgroups were remarkably similar preoperatively, but the 10-year actuarial survival was 80% +/- 6% for patients who had chordal preservation and 63% +/- 6% for those who did not. The mitral valve should be repaired whenever possible; if replacement is necessary it should be performed with preservation of the chordae tendineae.