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Abstract：
UNASSIGNED: Various techniques have been proposed for the preservation of the subvalvular apparatus (SVA) in mitral valve replacement. This study aimed to compare the midterm results of posterior leaflet preservation with the results of selective preservation of the SVA involving artificial chordae implantation in terms of left ventricular performance in patients undergoing mitral valve replacement.
UNASSIGNED: In total, 127 patients were included in this study. Patients were allocated to 1 of 2 groups according to the techniques used to preserve the SVA. Patients in group 1 underwent posterior leaflet preservation: The anterior leaflet was completely resected, and the posterior leaflet was preserved. In group 2, which comprised patients with severe leaflet extension and subvalvular fusion, the mitral valve was excised completely and substituted with artificial chordae. All relevant preoperative, intraoperative, and postoperative data were recorded.
UNASSIGNED: Mean (SD) ages in groups 1 and 2 were 63.1 (9.65) and 57.1 (12.3) years, respectively (P = .003). Mean (SD) follow-up time was 59.97 (23.63) months (range, 6-99 months). Left ventricular end-diastolic diameter decreased significantly after artificial chordae implantation (P < .001), while the decrease after posterior leaflet preservation was not statistically significant (P = .20). In both groups, there were statistically significant reductions (P < .001) in left ventricular end-systolic diameter and left atrium diameter in the postoperative period compared with respective preoperative levels. During follow-up, left ventricular ejection fraction was found to have increased beyond the preoperative levels in both groups, but the differences were not statistically significant (P > .05).
UNASSIGNED: Results of echocardiographic observations regarding the preservation of the SVA via artificial chordae implantation for mitral valve disease in this sample were satisfactory. Findings suggest that artificial chordae implantation should be considered when posterior leaflet preservation is not suitable.
UNASSIGNED: In total, 127 patients were included in this study. Patients were allocated to 1 of 2 groups according to the techniques used to preserve the SVA. Patients in group 1 underwent posterior leaflet preservation: The anterior leaflet was completely resected, and the posterior leaflet was preserved. In group 2, which comprised patients with severe leaflet extension and subvalvular fusion, the mitral valve was excised completely and substituted with artificial chordae. All relevant preoperative, intraoperative, and postoperative data were recorded.
UNASSIGNED: Mean (SD) ages in groups 1 and 2 were 63.1 (9.65) and 57.1 (12.3) years, respectively (P = .003). Mean (SD) follow-up time was 59.97 (23.63) months (range, 6-99 months). Left ventricular end-diastolic diameter decreased significantly after artificial chordae implantation (P < .001), while the decrease after posterior leaflet preservation was not statistically significant (P = .20). In both groups, there were statistically significant reductions (P < .001) in left ventricular end-systolic diameter and left atrium diameter in the postoperative period compared with respective preoperative levels. During follow-up, left ventricular ejection fraction was found to have increased beyond the preoperative levels in both groups, but the differences were not statistically significant (P > .05).
UNASSIGNED: Results of echocardiographic observations regarding the preservation of the SVA via artificial chordae implantation for mitral valve disease in this sample were satisfactory. Findings suggest that artificial chordae implantation should be considered when posterior leaflet preservation is not suitable.
摘要：
已经提出了各种技术用于在二尖瓣置换中保存瓣膜下装置(SVA)。这项研究旨在比较二尖瓣置换术患者左心室性能方面的后小叶保留的中期结果与选择性保留涉及人工腱索植入的SVA的结果。
■总共，127名患者被纳入本研究。根据用于保存SVA的技术，将患者分为2组中的1组。第1组患者接受后叶保存：前叶完全切除，后小叶被保存。在第2组中，包括严重的小叶扩张和瓣膜下融合的患者，二尖瓣完全切除并用人工腱索代替。所有相关术前，术中,并记录术后数据。
■第1组和第2组的平均（SD）年龄分别为63.1（9.65）和57.1（12.3）岁，分别(P=0.003)。平均(SD)随访时间为59.97(23.63)个月(范围,6-99个月）。左心室舒张末期内径在人工腱索植入后显著下降(P<0.001),而后叶保存后的下降没有统计学意义（P=.20）。在这两组中,与各术前水平相比,术后左心室收缩末期内径和左心房内径均有统计学显著降低(P<.001).随访期间,发现两组左心室射血分数均超过术前水平，但差异无统计学意义(P>.05)。
■关于通过人工腱索植入治疗二尖瓣疾病保存SVA的超声心动图观察结果令人满意。研究结果表明，当不适合保留后叶时，应考虑人工腱索植入。
■总共，127名患者被纳入本研究。根据用于保存SVA的技术，将患者分为2组中的1组。第1组患者接受后叶保存：前叶完全切除，后小叶被保存。在第2组中，包括严重的小叶扩张和瓣膜下融合的患者，二尖瓣完全切除并用人工腱索代替。所有相关术前，术中,并记录术后数据。
■第1组和第2组的平均（SD）年龄分别为63.1（9.65）和57.1（12.3）岁，分别(P=0.003)。平均(SD)随访时间为59.97(23.63)个月(范围,6-99个月）。左心室舒张末期内径在人工腱索植入后显著下降(P<0.001),而后叶保存后的下降没有统计学意义（P=.20）。在这两组中,与各术前水平相比,术后左心室收缩末期内径和左心房内径均有统计学显著降低(P<.001).随访期间,发现两组左心室射血分数均超过术前水平，但差异无统计学意义(P>.05)。
■关于通过人工腱索植入治疗二尖瓣疾病保存SVA的超声心动图观察结果令人满意。研究结果表明，当不适合保留后叶时，应考虑人工腱索植入。
