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

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.

Keywords

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