Mitral valve replacement with preservation of the subvalvular apparatus. Review uri icon

Overview

abstract

  • The introduction of the Starr-Edwards valve allowed complete replacement of diseased left-sided heart valves. With improved cardiopulmonary bypass, myocardial protection, and surgical techniques the mortality rate from aortic valve replacement decreased substantially, whereas the mortality rate from mitral valve replacement remained high, largely because of low cardiac output syndrome. Increasing use of mitral valve repair techniques resulted in a marked decrease in short-term and long-term morbidity and mortality when treating patients with mitral regurgitation. Some believed that this resulted from maintenance of the mitral annular papillary muscle continuity during mitral valve repair. Subsequent experimental and clinical studies have validated the positive short-term and long-term effects of maintaining the integrity of the mitral valve subvalvular apparatus. This article considers the history of the clinical use of preservation of the subvalvular apparatus, the physiologic studies examining this concept, and the clinical data available on its use. It also examines the following: 1) mitral stenosis versus mitral regurgitation and the preservation of the subvalvular apparatus; 2) whether the anterior, posterior, or both areas of the subvalvular apparatus should be preserved; and 3) the surgical techniques for the preservation of the subvalvular apparatus and valve implantation.

publication date

  • March 1, 1999

Research

keywords

  • Chordae Tendineae
  • Heart Valve Prosthesis Implantation
  • Mitral Valve Insufficiency
  • Mitral Valve Stenosis
  • Papillary Muscles

Identity

Scopus Document Identifier

  • 0033025160

Digital Object Identifier (DOI)

  • 10.1097/00001573-199903000-00005

PubMed ID

  • 10191968

Additional Document Info

volume

  • 14

issue

  • 2