UNIVERSAL CHORD-SAVING MITRAL VALVE REPLACEMENT AS A FACTOR OF LONG-TERM FUNCTIONAL IMPROVEMENT

Aim. To assess short — and 5-year long-term results of the universal chord-saving mitral valve replacement.
Material and methods. Totally 103 patients included, who during 2009-2014 у at the department of myocardium dysfunction and heart failure of FSBSI "Russian Scientific Center for Surgery n.a. Petrovsky B. P." underwent a surgical cord-saving mitral valve replacement. The age of the patients varied from 21 to 75 у and the mean was 55,2±0,9 у Among the operated 51 (49,5%) were male and 52 (50,5%) female. Results. Of 103 patients 101 were discharged. Long-term results were collected from 98 patients that is 97% of all discharged. Follow-up period lasted for 3 month — 5 years. Functional results are more than satisfying: I functional class have 66 patients (67,3%) of the discharged, II - 26 (26,5%), III - 3 (3,06%), died 3 patients (3,06%). In 89 patients (90,8%) there is an increase of the functional class by 2 or even 3 steps. During long-term follow-up in 25,5% cases (25 patients) had atrial fibrillation paroxysms. In 19 patients sinus rhythm was reversed with drugs and only in 6 (6,1%) atrial fibrillation became permanent. Sinus rhythm returned in 15 patients having atrial fibrillation before the operation. Bleedings of different localization developed in 10 (10,2%) cases and were related to miscompliance for anticoagulant drugs. After INR correction bleeding did not repeat. Complications, more or less related to indirect anticoagulants (prosthesis thrombosis, left atrium thrombosis, myocardial infarction, transient ischemic attack of the brain) were registered in 11 patients that is 11,2% of all cases in long-term period. Conclusion. The universal chord-saving valve replacement fulfills the main criteria for the method of mitral valve replacement: simplicity of performing, save of left ventricle contraction physiology, safety for the patient and stability of good results in long-term period. This method can be recommended for implementation in mitral regurgitation and stenosis as well. Saving of normal intracardiac anatomy of the left ventricle makes it to improve its contractility and to increase functional class of the patient in long-term period after operation.

1. Korolev SV. Universal chorda-presen/ing prosthetics mitral valve. Diss. Cand. Med. Sciences. Moscow, 2002: 3-111 Russian (Королев С. В. Универсальное хордосох-раняющее протезирование створок митрального клапана. Дисс. Канд. Мед. наук. Москва, 2002: 3-111).

2. Dzemeshkevich SL, Stevenson LW. Disease mitral valve. Function, diagnostics, treatment. 2nd ed., ext. M., GEOTAR-MED, 2015. 352p. Russian (ДземешкевичС.Л., Стивенсон/1.У. Болезни митрального клапана. Функция, диагностика, лечение. 2-е изд., доп. М.: ГЭОТАР-Медиа,2015. 352 с).

3. Sokolov W. Implantation prostheses mitral valve preservation subvalvular structures. Abstract Diss. Cand. Med. Sciences. Moscow, 1990. Russian (Соколов В. В. Имплантация протезов митрального клапана с сохранением подклапанных структур. Автореф. дисс. Канд. Мед. наук, Москва, 1990).

4. Athanasiou T, Chow A, Rao С, et al. Preservation of the mitral valve apparatus: evidence synthesis and critical reappraisal of surgical techniques. Eur. J. Cardiothorac Surg. 2008 Mar; 33(3): 391-401.

5. Chen L, Chen B, Hao J, et al. Complete preservation of the mitral valve apparatus during mitral valve replacement for rheumatic mitral regurgitation in patients with an enlarged left ventricular chamber. Heart Surg Forum. 2013 Jun; 16(3): E137-43. doi: 10.1532/ HSF98.20121128.

6. Chowdhury UK, Kumar AS, Airan B, et al. Mitral valve replacement with and without chordal preservation in a rheumatic population: serial echocardiographic assessment of left ventricular size and function. Ann Thorac Surg. 2005 Jun; 79(6): 1926-33.

7. Garcia-Fuster R, Estevez V, Gil 0, et al. Mitral valve replacement in rheumatic patients: effects of chordal preservation. Ann Thorac Surg. 2008 Aug; 86(2): 472-81.

8. Muthialu N, Varma SK, Ramanathan S, et al. Effect of chordal preservation on left ventricular function. Asian Cardiovasc Thorac Ann. 2005 Sep; 13(3): 233-7.

9. OzdemirAC, Emrecan B, Baltalarli A. Bileaflet versus posterior-leaflet-only preservation in mitral valve replacement. Tex Heart Inst J. 2014 Apr 1; 41(2): 165-9.

10. Rao C, Hart J, Chow A, et al. Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study. J Cardiothorac Surg. 2008 Apr 23; 3: 17.

11. Ucak A, Ugur M, Onan B, et al. Conventional versus complete chordal-sparing mitral valve replacement: effects on left ventricular function and end-systolic stress. Ada Cardiol. 20110ct; 66(5): 627-34.