TITLE:
Impact of Preservation of Mitral Valve Apparatus on Outcomes of Prosthetic Mitral Valve Replacement for Severe Mitral Valve Regurgitation
AUTHORS:
Hamdy D. Elayouty, Hassan Salah Hassan, Mohamed Sami Hamed, Ahmed Hamdy Elayouty
KEYWORDS:
Preservation of Mitral Apparatus during Mitral Replacement, Intra-Operative TEE during Mitral Replacement, Mitral Replacement for Degenerative Mitral Valve Lesions, Mitral Replacement for Rheumatic Mitral Lesions, Mitral Replacement for Ischemic Mitral Lesions
JOURNAL NAME:
Open Journal of Thoracic Surgery,
Vol.15 No.4,
December
31,
2025
ABSTRACT: Objectives: To assess the impact of valve pathology on the outcome of the modified preservation of the mitral valve apparatus during mitral valve replacement. Hypothesis: Preservation of mitral valve apparatus will improve outcomes of prosthetic mitral valve replacement for severe mitral valve regurgitation. Methods: This prospective analytic cohort study included 100 patients in two main groups: 50 patients with rheumatic mitral valve disease (group A) and non-rheumatic (group B): B1:25 patients with ischemic mitral lesions and B2:25patients with selected degenerative valve lesions admitted between 1st March 2022 and 28th Feb. 2024 at one but a good flow rate-center. All patients had modified preservation of the mitral apparatus during prosthetic mitral replacement. Additionally, Group B1 had bypass grafts to diseased coronary arteries. Group B2 had chordal transposition, folding or reattachment. Results: Pre-operative data did not show significant differences between groups (p > 0.05) but the smoking index was much higher in group B. Intraoperative Trans-Esophageal Echocardiography showed free mobility of prosthetic leaflets, left ventricular outflow tract free of any obstruction and freedom from any valve-related complications in the groups. Cross-clamp and recovery times were shorter in group A (p = 0.0001) & early mortality of 2patients. Group B: post-operative inotrope requirements were significantly larger; three died after failure of weaning from the intra-aortic balloon pump. Three others needed a coronary angiogram and stenting due to the occlusion of one of the grafts 3 and 7 months after surgery. One in group A and another in group B died after thrombo-embolic events. Improved left ventricular functions were reported 6, 12 and 24 months after surgery. Left ventricular and atrial dimensions were reduced among all patients. Mean follow-up period = 34 + 7.5 months. Conclusions: This technique is feasible and reproducible for rheumatic and selected cases of non-rheumatic valve lesions due to freedom from mid-term reoperation, preserved ventricular functions and acceptable value-related complication rates.