Chordae Tendineae Sparing during Mitral Valve Replacement: A Comparative Study

Ahmed M Abdelazim; Ashraf  Mostafa Elnahas; Yousry Elsaid Rizk; Hany Mohammed Elrakhawy; Mahmoud Mohammed Abdel Azeem Mubarak; Mahmoud Ahmed Al-Shafiey

Ahmed M Abdelazim Department of Cardiothoracic Surgery, Banha University Hospital, Banha, Egypt
Ashraf Mostafa Elnahas Department of Cardiothoracic Surgery, Banha University Hospital, Banha, Egypt
Yousry Elsaid Rizk Department of Cardiothoracic Surgery, Banha University Hospital, Banha, Egypt
Hany Mohammed Elrakhawy Department of Cardiothoracic Surgery, Banha University Hospital, Banha, Egypt
Mahmoud Mohammed Abdel Azeem Mubarak Department of Cardiothoracic Surgery, Banha University Hospital, Banha, Egypt
Mahmoud Ahmed Al-Shafiey Department of Cardiothoracic Surgery, Banha University Hospital, Banha, Egypt

Keywords: Chordae Tendineae, Sparing, Mitral valve replacement, MVR

Abstract

Background: Mitral valve replacement (MVR) with chordal sparing could improve ventricular function in patients with mitral regurgitation. This study aimed to compare the outcomes of prosthetic MVR with and without chordae tendineae sparing.

Methods: This prospective, single-blinded, randomized study was executed on 60 patients undergoing prosthetic MVR with or without chordae tendineae sparing. Patients were divided into two equal groups: Group A (n= 30) included patients who underwent MVR with complete chordae tendineae sparing, and Group B (n= 30) included patients who underwent mitral valve replacement without chordae tendineae sparing.

Results: Patients who underwent chordae tendineae sparing demonstrated significantly lower total bypass time (median = 67 vs. 110 min, P < 0.001), total cross-clamp time (median = 40 vs. 80 min, P < 0.001), inotropic support (30% vs. 96.7%, P < 0.001), and arrhythmia (6.7% vs. 86.7%, P < 0.001) than those who did not undergo chordal sparing. Additionally, patients who underwent sparing demonstrated a significantly lower 6-month left ventricle end-systolic diameter (3 ±0.8 vs. 3.9 ±0.5 cm, P < 0.001), 6-month left ventricle end-diastolic diameter (4.4 ±0.7 vs. 5.3 ±0.5 cm, P < 0.001), 3-month left atrium diameter (4.5 ±0.8 vs. 5.1 ±0.6 cm, P < 0.001), and 6-month left atrium diameter (4.3 ±0.8 vs. 5.4 ±0.6 cm, P < 0.001).

Conclusion: This technique of MVR might enhance cardiac function and structural parameters and lower the end-diastolic and systolic diameters and the end-systolic and diastolic volumes up to the sixth month of follow-up.