Echocardiographic Assessment Of Long-term Left Ventricular Function In Mitral Valve Replacement With Preservation Of Subvalvular Apparatus

Objective:The purpose of this study is to evaluate the influence of long-term left ventricular function in mitral valve replacement with or without preservation of subvalvular apparatus.Methods:The clinical and echocardiographic data of mitral valve replacement consisted of 211 cases with over 5-years follow-up from January 2002 to December 2012 were collected and retrospectively analyzed.All was divided into 3 groups according to various techniques of preservation of subvalvular apparatus during mitral valve replacement:total preservation of subvalvular apparatus(group A=20),preservation of posterior subvalvular apparatus(group B=96),and complete excision of the subvalvular apparatus(group C=95).Echocardiography of each case was performed within 1 week before and after the operation,then 5 years afterward respectively,to obtain the data of left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left ventricular fractional shortening(LVFS).The clinical variables were divided into continuous variables and categorical variables respectively.The differences among variables and groups were analyzed by one-way ANOVA and chi-square test.Data were analyzed with statistical software to identify the between-group and intra-group difference.Multiple linear regression analysis was subjected to evaluate the factors influencing the long-term left ventricular function of mitral valve replacement.Results:It is demonstrated there was no significant improvement in left ventricular function at5 years postoperatively between groups of preservation of subvalvular apparatus(group A and B)(p>0.05).LVEDD and LVESD at 5 years were showed to be slightly lower in the group A with statistical significance(p < 0.05).The analysis of Group B and C indicated no significant reduction of LVEDD and LVESD at 5 years postoperatively(p>0.05).No significant fractional change of postoperative LVEF and LVFS was revealed among all groups(p>0.05).However the long-term left ventricular function of mitral valve replacement is associated with age,left ventricular function and complication of atrial fibrillation preoperatively,with statistical significance(p<0.05).Conclusions:Preservation of subvalvular apparatus during mitral valve replacement of rheumatic valves does not affect the long-term left ventricular function.The long-term left ventricular function of mitral valve replacement is associated with age,left ventricular function and complication of atrial fibrillation preoperatively.