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Ann Thorac Surg 1995;60:1652-1658
© 1995 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Exploring Better Methods to Preserve the Chordae Tendineae During Mitral Valve Replacement

Department of Cardiovascular and Thoracic Surgery and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Palo Alto Veterans Affairs Medical Center, Palo Alto, and Department of Cardiovascular Physiology and Biophysics, Research Institute, Palo Alto Medical Foundation, Palo Alto, California

Background. It is not known how best to resuspend the mitral chordae tendineae during mitral valve replacement to optimize postoperative left ventricular (LV) systolic and diastolic function.

Methods. Six different techniques to preserve the chordae during mitral valve replacement were compared in 12 dogs using a nondistorting isovolumic technique: conventional, all chordae severed; anterior, all chordae preserved anteriorly; partial, anterior papillary muscle chordae preserved anteriorly; posterior, all chordae preserved posteriorly; oblique, anterior papillary muscle chordae directed anteriorly and posterior papillary muscle chordae posteriorly; and counter, opposite of oblique chordal direction. Control measurements (no chordal tension) were recorded between each experimental condition.

Results. The oblique method tended to have the best LV systolic function versus the conventional method (E_max = 4.0 ± 1.8 versus 3.3 ± 1.2 mm Hg/mL [mean ± standard deviation]; p = 0.08 by repeated-measures analysis of variance; physiologic intercept E_es100 = 20.3 ± 8.6 mL [p < 0.05 versus control]), with no major change in LV diastolic stiffness. The posterior method had a lower E_max (3.3 ± 1.2 mm Hg/mL) than the oblique method, but a similar E_es100 (20.8 ± 8.1 mL; p < 0.05 versus control) and the best diastolic LV performance (LV diastolic stiffness = 0.46 ± 0.23 mm Hg/mL). The counter method also had good systolic function (E_max = 3.8 ± 1.2 mm Hg/mL; E_es100 = 19.7 ± 7.5 mL; p < 0.05 versus control), but had less favorable diastolic properties (0.65 ± 0.37 mm Hg/mL; p < 0.05 by repeated-measures analysis of variance versus posterior).

Conclusions. In this isovolumic preparation in normal canine hearts, the oblique method of chordal resuspension was associated with the best LV systolic function, whereas the counter technique impaired LV diastolic function. These preliminary results warrant further study in ejecting and failing hearts to determine conclusively which chordal orientation best preserves LV performance after mitral valve replacement.

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Discussion
Ann. Thorac. Surg. 1995 60: 1658. [Extract] [Full Text]

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