| Exploring better methods to preserve the chordae tendineae during mitral valve replacement. | |
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MedLine Citation:
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PMID: 8787458 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 (Emax = 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 Ees100 = 20.3 +/- 8.6 mL [p < 0.05 versus control]), with no major change in LV diastolic stiffness. The posterior method had a lower Emax (3.3 +/- 1.2 mm Hg/mL) than the oblique method, but a similar Ees100 (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 (Emax = 3.8 +/- 1.2 mm Hg/mL; Ees100 = 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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Authors:
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M Komeda; A DeAnda; J R Glasson; A F Bolger; Y Tomizawa; G T Daughters; T L Tye; N B Ingels; D C Miller |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 60 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 1995 Dec |
Date Detail:
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Created Date: 1996-09-24 Completed Date: 1996-09-24 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1652-7; discussion 1658 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, California 94305-5247, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Animals Cardiac Surgical Procedures / methods Chordae Tendineae / surgery* Dogs Heart Valve Prosthesis* Mitral Valve / surgery* Myocardial Contraction Ventricular Function, Left |
| Grant Support | |
ID/Acronym/Agency:
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HL-08928/HL/NHLBI NIH HHS; HL-29589/HL/NHLBI NIH HHS; HL-48837/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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