Preservation of the left ventricle contractility while performing of the combined mitral-aortal failure correction

Keywords: translocation of the anterior flap chords; the mitral valve prosthesis; preservation of the mitral valve posterior flap; preservation of the undervalvular structures.

Abstract

Objective. The studying of possibilities of procedures, directed on preservation of left ventricle while doing a mitral valve prosthesis in operative correction of combined mitral-aortal failure.

Materials and methods. In the analysis the results of surgical treatment of 340 patients, suffering combined mitral-aortal failure and a left-sided ventriculomegaly, who were operated in N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, were included. In all the patients a mitral valve prosthesis in combination with the aortal failure correction (prosthesis) was performed. In 83 patients the mitral valve prosthesis with complete preservation of posterior flap (Group A) was conducted, in 97 - with translocation of chords with papillar muscles of anterior flap in combination with posterior flap (Group B), in 160 - without preservation of the undervalvular apparatus (Group C). Definitely-systolic index of left ventricle in Groups A, B and C have constituted (87.4 ± 10.5), (88.4 ± 11.1) and (89.4 ± 11.5) ml/m2 accordingly; left ventricular ejection fraction have constituted 0.51 ± 0.03, 0.5 ± 0.03 and 0.51 ± 0.03 accordingly.

Results. In Group A on a hospital stage 2 (2.5%) patients died, in Group B - 2 (2.1%) patients, and in Group C - 5 (3.1%). Definitely-systolic index of left ventricle on the tenth-eleventh postoperative day in Groups A, B and C have constituted (74.3 ± 9.8), (69.4 ± 8.2) and (76.4 ± 9.2) ml/m2 accordingly, while in late follow-up period - (55.4 ± 8.4), (49.4 ± 7.2) and (62.4 ± 7.2) ml/m2 accordingly. The left ventricle ejection fraction on the tenth-eleventh postoperative day in Groups A, B and C have constituted 0.54 ± 0.03, 0.55 ± 0.03 and 0.53 ± 0.03 accordingly, and in late follow-up period - 0.55 ± 0.03, 0.57 ± 0.03 and 0.54 ± 0.03 accordingly.

Conclusion. In the left-sided ventriculomegaly and combined mitral-aortal failure the a maximal preservation of undervalvular structures of mitral valve, while its prosthesis performance, constitutes a serious component, which leads to improvement of morphometric indices of left ventricle on hospital stage and in follow-up period as well.

Author Biographies

A. A. Bolshak, N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, Kyiv

Bolshak O., MD, PhD, Senior Researcher
Department of surgery of acquired heart diseases
Amosov National Institute of Cardiovascular surgery
6 M. Amosova str., Kyiv, 03680, Ukraine
+380971947998
e-mail bolshak2077@gmail.com
https://orcid.org/0000-0002-6089-9594,

V. Zh. Boukarim, N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, Kyiv

Boukarim V., Researcher
Department of surgery of acquired heart diseases
Amosov National Institute of Cardiovascular surgery
6 M. Amosova str., Kyiv, 03680, Ukraine
+380672311350
VLB8284@hotmail.com

https://orcid.org/0000-0002-3895-1894

K. E. Vakulenko, Poltava Regional Clinical Cardiological Dispensary

Vakulenko K. MD, PhD(Med)
Chief of the Poltava Regional Clinical Cardiology Dispensary, Poltava
+380505582810
https://orcid.org/0000-0003-1349-0400

R. M. Vitovskiy, Shupik National Medical Academy of Postgraduate Education, Kyiv

Vitovskiy R.M. MD, PhD, Professor
Department of Heart and Great Vessels Surgery
P. L. Shupyk National University of Health Care of Ukraine, Kyiv, Ukraine,
https://orcid.org/0000-0001-5318-6708
+380677034293

Yu. V. Bakhovska, N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, Kyiv

Bakhovska Yulia, MD, Cardiologist,
Department of the Consultative Polyclinic
Amosov National Institute of Cardiovascular surgery
6 N. Amosova str., Kyiv, 03680, Ukraine
+380969561183
Dyakyuliya439@gmail.com
https://orcid.org/0000-0003-0338-4479

N. I. Volkova, N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, Kyiv

Volkova N., MD, PhD(Med), Cardiologist,
Chief of the Department of the Consultative Polyclinic
Amosov National Institute of Cardiovascular surgery
6 M. Amosova str., Kyiv, 03680, Ukraine
+380503824024
ndilova@ukr.net

E. V. Yuvchik, N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, Kyiv

Yuvchik O., MD, Doctor
Department of Ultrasound Diagnostics
Amosov National Institute of Cardiovascular surgery
6 M. Amosova str., Kyiv, 03680, Ukraine
+380675020132

V. V. Popov, N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, Kyiv

Popov Volodymyr V., MD, DSci(Med), Professor
Chief of Department of surgery of acquired heart diseases
Amosov National Institute of Cardiovascular surgery
6 M. Amosova str., Kyiv, 03680, Ukraine
+ 38(044) 475-27-88,
vladpopov@ukr.net
https://orcid.org/0000-0002-2851-5589

V. V. Lazorishinets, N. M. Amosov National Institute of Cardio-Vascular Surgery NAMS of Ukraine, Kyiv

Lazorishinets V., MD, DSci(Med), Professor,
Director of the National Amosov Institute of Cardiovascular Surgery
6 N. Amosova str., Kyiv, 03680, Ukraine
https://orcid.org/0000-0002-1748-561X

References

Beshlyaga VM, Popov VV. Echocardiographic assessment of left heart remodeling after mitral valve replacement with preservation of the valve apparatus and left atrial plasty. Cardio-vascular surgery herald. 2004;12:215. Ukrainian.

Lillehei CW, Levy MJ, Bonnabeau RC Jr. Mitral valve replacement with preservation of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg. 1964 Apr;47:532-43. PMID: 14180754.

Deniz H, Sokullu O, Sanioglu S, Sargin M, Ozay B, Ayoglu U, et al. Risk factors for posterior ventricular rupture after mitral valve replacement: results of 2560 patients. Eur J Cardiothorac Surg. 2008 Oct;34(4):780-4. doi: 10.1016/j.ejcts.2008.06.009. Epub 2008 Jul 14. PMID: 18621539.

Popov VV. Mitral valve replacement with preservation of the subvalvular apparatus. Klin hir. 2002:(5-6):96-7. Russian.

Chen L, Chen B, Hao J, Wang X, Ma R, Cheng W, 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. PMID: 23803236.

Yousefnia MA, Mandegar MH, Roshanali F, Alaeddini F, Amouzadeh F. Papillary muscle repositioning in mitral valve replacement in patients with left ventricular dysfunction. Ann Thorac Surg. 2007 Mar;83(3):958-63. doi: 10.1016/j.athoracsur.2006.08.045. PMID: 17307440.

Ucak A, Ugur M, Onan B, Arslan G, Alp I, Ulusoy E, et al. Conventional versus complete chordal-sparing mitral valve replacement: effects on left ventricular function and end-systolic stress. Acta Cardiol. 2011 Oct;66(5):627-34. doi: 10.1080/ac.66.5.2131089. PMID: 22032058.

Topal AE, Eren MN, Celik Y. Left ventricle and left atrium remodeling after mitral valve replacement in case of mixed mitral valve disease of rheumatic origin. J Card Surg. 2010 Jul;25(4):367-72. doi: 10.1111/j.1540-8191.2010.01062.x. Epub 2010 May 30. PMID: 20529156.

Benfatti RA, Pontes JC, Gomes OM, Dias AE, Gomes Júnior JF, et al. Mitral valve replacement with crossed papillopexy and annular constriction in heart failure patients. Rev Bras Cir Cardiovasc. 2008 Jul-Sep;23(3):372-7. English, Portuguese. doi: 10.1590/s0102-76382008000300014. PMID: 19082326.

Fattouch K, Castrovinci S, Murana G, Dioguardi P, Guccione F, Nasso G, et al. Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results. J Thorac Cardiovasc Surg. 2014 Nov;148(5):1947-50. doi: 10.1016/j.jtcvs.2014.02.047. Epub 2014 Feb 20. PMID: 24656671.

Abd Elaziz ME, Ibrahim IM. Reversal of Left Ventricular Functions in Chronic Mitral Regurgitation after Mitral Valve Replacement. Heart Surg Forum. 2016 Aug 19;19(4):E160-4. doi: 10.1532/hsf.1440. PMID: 27585192.

Petrone G, Bellitti R, Pascarella C, Nappi G, Signoriello G, Santé P. Effects of Surgical Techniques on Long-Term Results in Patients with Degenerative Mitral Valve Bileaflet Prolapse. J Heart Valve Dis. 2016 Nov;25(6):716-23. PMID: 28290171.

Popov V, Pukas K, Lazorishinetz V. Reconstruction of left part of the heart for mitral valve diseases. J Cardiovasc Surg. 2018;59(3 Suppl 2):9.

Ozdemir AC, 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. doi: 10.14503/THIJ-13-3164. PMID: 24808776; PMCID: PMC4004467.

Guo Y, He S, Wang T, Chen Z, Shu Y. Comparison of modified total leaflet preservation, posterior leaflet preservation, and no leaflet preservation techniques in mitral valve replacement - a retrospective study. J Cardiothorac Surg. 2019 Jun 7;14(1):102. doi: 10.1186/s13019-019-0918-7. PMID: 31174558; PMCID: PMC6555925.

Zakai SB, Khan SU, Rabbi F, Tasneem H. Effects of mitral valve replacement with and without chordal preservation on cardiac function: early and mid-term results. J Ayub Med Coll Abbottabad. 2010 Jan-Mar;22(1):91-6. PMID: 21409914.

Grant RP. Notes on the muscular architecture of the left ventricle. Circulation. 1965 Aug;32:301-8. doi: 10.1161/01.cir.32.2.301. PMID: 14340958.

Published
2020-12-28
How to Cite
Bolshak, A. A., Boukarim, V. Z., Vakulenko, K. E., Vitovskiy, R. M., Bakhovska, Y. V., Volkova, N. I., Yuvchik, E. V., Popov, V. V., & Lazorishinets, V. V. (2020). Preservation of the left ventricle contractility while performing of the combined mitral-aortal failure correction. Klinicheskaia Khirurgiia, 87(11-12), 10-14. https://doi.org/10.26779/2522-1396.2020.11-12.10
Section
General Problems of Surgery