Mitral valve repair versus replacement with preservation of the entire subvalvular apparatus

  • Eiri Kisamori
  • Satoru Otani
  • Tsuyoshi Yamamoto
  • Michiru Nishiki
  • Yuki Yamada
  • Taichiro Matsumoto
Original Article



This study aimed to evaluate the outcomes of mitral valve (MV) repair versus MV replacement with preservation of the entire subvalvular apparatus.


We retrospectively searched our dedicated in-hospital database for patients who underwent MV surgery between 2012 and 2017.


A total of 82 patients were divided into a group that underwent MV replacement (n = 35) and a group that underwent MV repair (n = 47). Patients undergoing MV replacement were significantly older (p < 0.01). Mortality at 30 days was not significantly different [MV replacement: n = 1 (2.9%), MV repair: n = 0 (0%); p = 0.43]. The single case of 30-day mortality after MV replacement was due to acute aortic dissection. The total cohort did not show significant differences in long-term survival (p = 0.07). There were no cardiac-related deaths in this cohort. Postoperative left ventricular end-diastolic diameter (MV replacement: 45.4 ± 6.2 mm, MV repair: 45.6 ± 5.8 mm; p = 0.89), left ventricular end-systolic diameter (MV replacement: 29.6 ± 7.1 mm, MV repair: 29.4 ± 5.2 mm; p = 0.89), and ejection fraction (MV replacement: 59.2 ± 11.4%, MV repair: 62.0 ± 6.8%; p = 0.17) were not significantly different.


This study found that MV replacement had operative mortality, long-term survival, and complication rates similar to those of MV repair. There were no cardiac-related deaths in this cohort. MV replacement with preservation of the entire subvalvular apparatus does not seem to be inferior to MV repair.


Mitral valve repair Mitral valve replacement Subvalvular apparatus preservation 


Compliance with ethical standards

Conflict of interest

The authors declare no funding source, no conflicts, and no competing interests.


  1. 1.
    Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases. Lancet. 2006;368:1005–11.CrossRefGoogle Scholar
  2. 2.
    Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231–43.CrossRefGoogle Scholar
  3. 3.
    Enriquez-Sarano M, Avierinos J-F, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352:875–83.CrossRefGoogle Scholar
  4. 4.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:e650.Google Scholar
  5. 5.
    Lazam S, Vanoverschelde J-L, Tribouilloy C, Grigioni F, Suri RM, Avierinos J-F, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: analysis of a large, prospective, multicenter, international registry. Circulation. 2017;135:410–22.CrossRefGoogle Scholar
  6. 6.
    Mori T, Asano M, Ohtake H, Bitoh A, Sekiguchi S, Matsuo Y, et al. Anticoagulant therapy after prosthetic valve replacement -optimal PT-INR in Japanese patients-. Ann Thorac Cardiovasc Surg. 2002;8(8):3–7.Google Scholar
  7. 7.
    Uetsuka Y, Hosoda S, Kasanuki H, Aosaki M, Murasaki K, Ooki K, et al. Optimal therapeutic range for oral anticoagulants in Japanese patients with prosthetic heart valves: a preliminary report from a single institution using conversion from thrombotest to PT-INR. Heart Vessels. 2000;15:124–8.CrossRefGoogle Scholar
  8. 8.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–86.CrossRefGoogle Scholar
  9. 9.
    Silaschi M, Chaubey S, Aldalati O, Khan H, Uzzaman MM, Singh M, et al. Is mitral valve repair superior to mitral valve replacement in elderly patients? Comparison of short- and long-term outcomes in a propensity-matched cohort. J Am Heart Assoc. 2016: e003605.Google Scholar
  10. 10.
    Natsuaki M, Itoh T, Tomita S, Furukawa K, Yoshikai M, Suda H, et al. Importance of preserving the mitral subvalvular apparatus in mitral valve replacement. Ann Thorac Surg. 1996;61:585–90.CrossRefGoogle Scholar
  11. 11.
    Sénéchal M, MacHaalany J, Bertrand OF, O’Connor K, Parenteau J, Dubois-Sénéchal I-N, et al. Predictors of left ventricular remodeling after surgical repair or replacement for pure severe mitral regurgitation caused by leaflet prolapse. Am J Cardiol. 2013;112:567–73.CrossRefGoogle Scholar
  12. 12.
    Rozich JD, Carabello BA, Usher BW, Kratz JM, Bell AE, Zile MR. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance. Circulation. 1992;86:1718–26.CrossRefGoogle Scholar
  13. 13.
    Yun KL, Sintek CF, Miller DC, Pfeffer TA, Kochamba GS, Khonsari S, et al. Randomized trial comparing partial versus complete chordal-sparing mitral valve replacement: effects on left ventricular volume and function. J Thorac Cardiovasc Surg. 2002;123:707–14.CrossRefGoogle Scholar
  14. 14.
    Watanabe T, Arai H, Nagaoka E, Oi K, Hachimaru T, Kuroki H, et al. Influence of procedural differences on mitral valve configuration after surgical repair for functional mitral regurgitation: in which direction should the papillary muscle be relocated? J Cardiothorac Surg. 2014;9:185.CrossRefGoogle Scholar
  15. 15.
    Akiyama K, Nakamura N, Itatani K, Naito Y, Kinoshita M, Shimizu M, et al. Flow-dynamics assessment of mitral-valve surgery by intraoperative vector flow mapping. Interact Cardiovasc Thorac Surg. 2017;24:869–75.CrossRefGoogle Scholar
  16. 16.
    Jamieson WRE, Burr LH, Janusz MT, Munro AI, Hayden RI, Miyagishima RT, et al. Carpentier-Edwards standard and supraannular porcine bioprostheses: comparison of technology. Ann Thorac Surg. 1999;67:10–7.CrossRefGoogle Scholar
  17. 17.
    Neville PH, Aupart MR, Diemont FF, Sirinelli AL, Lemoine EM, Marchand MA. Carpentier-Edwards pericardial bioprosthesis in aortic or mitral position: a 12-year experience. Ann Thorac Surg. 1998; 66; S14307.Google Scholar
  18. 18.
    Marchand MA, Aupart MR, Norton R, Goldsmith IRA, Pelletier LC, Pellerin M, et al. Fifteen-year experience with the mitral Carpentier-Edwards PERIMOUNT pericardial bioprosthesis. Ann Thorac Surg. 2001;71:236–9.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  • Eiri Kisamori
    • 1
  • Satoru Otani
    • 1
  • Tsuyoshi Yamamoto
    • 1
  • Michiru Nishiki
    • 1
  • Yuki Yamada
    • 1
  • Taichiro Matsumoto
    • 1
  1. 1.Department of Cardiovascular SurgeryNational Hospital Organization Iwakuni Clinical CenterIwakuniJapan

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