European Journal of Cardiovascular Medicine

Introduction:  Mitral valve (MV) replacement with preservation of subvalvular apparatus aids in maintaining left ventricular (LV) function, but this can be particularly difficult in rheumatic mitral stenosis (MS). The main evidence of this benefit is based on mitral regurgitation (MR), and it is unclear in rheumatic patients with fibrosis and calcification. This study is going to update experience with the Total chordal Preservation in mitral valve replacement in rheumatic mitral valve disease  at our institution.  Methods: This is a single centre retrospective cohort study. To evaluate and compare the risk factors like Clinical and Echocardiographic parameters, and  adverse events who underwent total chordal preservation during  mitral valve replacement in Rheumatic heart disease and follow up till 1 year after surgery (at 6 weeks, at 6 months and at the end of 1 year). Clinical parameters like NYHA class, chronic renal failure, atrial fibrillation. Echocardiographic parameters like left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction, left atrial diameter, pulmonary artery systolic pressure. Adverse events like Low cardiac syndrome, stroke, atrial fibrillation, , sepsis will be compared. All the variables were analyzed with statistical methods. All of them were evaluated for their clinical significance. p<0.05 was considered as statistically significant. Results: Total chordal preservation increases the cross clamp time and CPB time. No chordal preservation increases the chances of low cardiac out put syndrome. LV dimensions like LVESD, LVEDD were increased in no chordal preservation group and decreased in total chordal preservation group during follow up. Significant decrease of LVEF is noted in no preservation group. Significant decrease in LA size is noted in partial and total chordal preservation groups. PASP started decreasing in all the three groups in follow up irrespective of whether chordae is preserved or not.  Conclusion: Total chordal preservation patients have better LV dimensions and EF than partial chordal preservation and no preservation patients in the post operative and follow up period. Partial chordal preservation patients also have better LV dimensions and EF than no preservation patients. It is best to preserve total chordae in mitral valve replacement patients if not possible it is better to do partial preservation (PML preservation).