Total preservation of chordae tendinae in mitral valve replacement (MVR).

Chordal papillary integrity is crucial for a good left ventricular performance following mitral valve surgery. From June 1991-July 1993 (2 years), 200 mitral surgeries were performed by the authors out of which MVR were done by preserving all chordae tendineae in 36 patients (18%), ages 11-64 years (mean 36 +/- 13.2 SD), female to male ratio 3:1, New York Heart Association (NYHA) functional class III-IV. Preoperative workup revealed pure mitral stenosis (MS) in 12 patients (33%), mitral regurgitation (MR) in 16 (44%), MS + MR in 7 (19%), MS + aortic regurgitation (AR) in 4 (11%), MR + secundum atrial septal defect (ASD) in 2 (6%), MR + primum ASD in 1, MR + coronary artery disease (CAD) in 1 (3%) and moderate to severe pulmonary hypertension in all. Twenty-two patients (61%) had MVR only, 4 (11%) had MVR + aortic valve replacement (AVR), 10 (29%) had MVR + tricuspid annuloplasty (TVA), MVR + secundum ASD closure in 2 (6%), MVR+primum ASD closure in 1 (3%) and MVR + coronary artery bypass grafting (CABG) in 1 (3%). Bioprosthesis used were: St. Vincents 17 (47%) and Carpentier Edwards 2 (6%). Mechanical valves used were: St. Jude's 1 (3%), Bjork-Shiley 2 (6%), St. Vincents 5 (14%), CarboMedics 9 (25%). Success of the procedure were accomplished in all (100%) and was judged by extubation period of 6-18 hours, decreased pulmonary artery pressure, good prosthetic function and adequate ventricular performance by subsequent echocardiographic assessments. There were no early (< 30 days) mortality. All patients showed NYHA functional class I-II except in one with Marfan syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)