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Reviews

Preservation of the mitral valve apparatus: evidence synthesis and critical reappraisal of surgical techniques

^a Department of Cardiothoracic Surgery, St. Mary's Hospital, London, UK
^b Department of Biosurgery and Surgical Technology, Imperial College London, UK
^c Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
^d MRC Biostatistics Unit, Cambridge, UK

Received 21 August 2007; received in revised form 22 November 2007; accepted 3 December 2007.

^_* Corresponding author. Address: Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor QEQM Building, St. Mary's Hospital, London W2 1NY, UK. Tel.: +44 207 886 1310; fax: +44 207 886 1810. (Email: tathan5253{at}aol.com).

Sub-valvular apparatus preservation after mitral valve replacement is not a new concept, yet to date there has been no quantification of its clinical effectiveness as a procedure and no consensus as to which surgical preservation technique should be adopted to achieve the best immediate and midterm clinical outcomes. This systematic review of current available literature aims to use an evidence synthesis and meta-analytic approach to compare outcomes following replacement of the mitral valve with (MVR-P) or without preservation (MVR-NP) of its apparatus. It considers all the relevant anatomical, experimental, echocardiographic, and clinical studies published in the literature and appraises all reported mitral valve sub-valvular apparatus preservation techniques. The results of this review strongly suggest that MVR-P is superior to MVR-NP with regards to the incidence of early postoperative low-cardiac output requiring inotropic support, and early or mid-term survival. They also suggest that the operative decision should be individualised based on patient's anatomy, pathology and ventricular function and therefore surgeons should be familiar with more than one surgical preservation technique. Finally, this paper highlights the need for further high quality research focusing particularly on the long-term assessment of quality of life and health utility following MVR-P.

Abbreviations: AL = anterior leaflet • CI = confidence intervals • OR = odds ratio • LCO = low cardiac output • LVOTO = left ventricular outflow obstruction • PL = posterior leaflet • SAP = sub-valvular apparatus preservation • MVR = mitral valve replacement • MVR-BL = mitral valve replacement with bileaflet preservation of valve apparatus • MVR-P = mitral valve replacement with preservation of the valve apparatus • MVR-PL = mitral valve replacement with preservation of posterior valve apparatus • MVR-NP = mitral valve replacement with no preservation of valve apparatus • HR = hazard ratio

Key Words: Meta-analysis • Chordal preservation • Mitral valve replacement

This article has been cited by other articles:

				P. K. Ghosh, A. Kogan, and E. Raanani Mitral valve replacement and Takotsubo syndrome. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 466 - 466. [Full Text] [PDF]

				C. Rao and T. Athanasiou Reply to ghosh et Al. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 467 - 467. [Full Text] [PDF]