Mitral Kapak Aparatusunun Korunması: Bileaflet ve Monoleaflet Karşılaştırması (Orta Dönem Sonuçları)

Abstract

Objective: The aim of this study was to compare the midterm results in terms of cardiac mechanics and clinical outcomes for monoleaflet versus bileaflet protection in preserving the subvalvular apparatus in patients who underwent mitral valve replacement. Material and Methods: This study consists of the retrospective analysis of 51 consecutive non-randomized patients who underwent mitral valve replacement (MVR) between 2001 and 2007 in our clinic. Twenty five of them had total (group I) and 26 had partial (group II) chordal preservation operation. We compared clinical preoperative and postoperative conditions as well as the characteristics of the valve and left ventricle between the groups. The choice of the chordal preservation method depended on the surgeon's decision. Results: At the end, all patients were in functional class I-II. No in-hospital mortality was observed. Clinical improvement was observed in both groups, but reductions in percentage of (preoperative/mid-term postoperative period) change of left ventricular end-systolic (LVES), left ventricular end-diastolic (LVED), left atrial (LA) diameters (all of p<0.001) and pulmonary artery pressure (PAP) (p<0.01) were more prominent in patients with complete preservation of the mitral apparatus. In-group comparisons showed no significant difference in terms of ejection fraction between percentage of change values in both groups (p=0.144). Conclusion: Although no significant difference was observed in cardiac performance between the two groups, echocardiographically determined superior reductions of LVESD, LVEDD, LAD and PAP in patients with complete preservation of the mitral apparatus may suggest that whenever possible, preservation of whole subvalvular apparatus in mitral valve replacement confers a significant advantage to the patients.