Effect of preservation of posterior versus total mitral valve component on the outcomes of mitral valve replacement

Background: Valvular heart disease represents a considerable percentage of cardiac surgery candidates. The causes of valvular lesions are congenital, ischemic, infective endocarditis, traumatic, collagen diseases, and rheumatic heart disease, which remains the main cause of valvular lesions. Aim: The purpose of this study is to evaluate the early impact of various chordal preservation techniques on clinical outcome and left ventricular (LV) function during mitral valve replacement (MVR). Subjects and methods: This Prospective comparative study was conducted on 50 patients who underwent mitral valve (MV) surgery in cardiothoracic surgery departments at Al-Azhar University hospitals from March 2023 to March 2025. They were split into two equal groups according to the method of sub-valvular component preservation. Results: Preserving the chordal tissue after mitral valve replacement for mitral disease increases cardiac performance, functional status, survival, and preservation of left ventricular geometry and function. When compared to individuals who undergo comprehensive chordal preservation, those whose posterior leaflets are preserved alone have superior outcomes. Conclusion: Preservation of the total MV component had a beneficial impact on the LV dimensions and function. Additionally, the two major debates of total chordae preservation, which are left ventricle outflow tract obstruction (LVOT) obstruction and inability to implant an appropriate valve size, were abolished with the technique we used in this study. As LVOT obstruction was prevented by trimming of the redundant non-chordal attached leaflet and the T-shaped incision of the anterior leaflet, which was then sutured away from the LVOT. To add, for a larger-sized valve, a slit incision can be done in the posterior leaflet between P1, P2, and P3 to accommodate the appropriate valve size.