Outcome of Preserved Mitral Valve Apparatus During Mitral Valve Replacement (EarlyOutcome)

Are there differences in outcome of mitral valve replacement with preservation of mitral apparatus among rheumatic and/or ischemic mitral lesions?. Mitral valve replacement with preservation of leaflets, and added coronary artery-bypass surgery, when indicated, is it a feasible and reproducible procedure?. The study was designed to compare outcome after prosthetic mitral replacement with preservation of mitral apparatus for rheumatic valve disease with outcome of replacement for ischemic myocardium and mitral valve disease, The outcomes will be guided by clinical assessment. and echo-cardiograph.

Objectives: The aim is to compare outcome of modified preservation of mitral valve apparatus during prosthetic mitral replacement for rheumatic versus myocardial ischemia &mitral valve disease. Methods ;This prospective cross-sectional comparative study will include 50 patients with isolated rheumatic mitral valve disease (group A) and 50 patients with mitral disease and myocardial ischemia (group B), surgery is expected to be performed between 2017 and 2020 at one center. All patients will have modified preservation of mitral apparatus during prosthetic mitral replacement. Additionally, group B patients will have bypass grafts to left anterior descending and/or posterior descending / right coronary artery. Data will be collected and analyzed. The Institutional Review Board (IRB), Ethics Committee (EC)-approval and consent of each patient were obtained. Criteria for inclusion of patients and exclusion of others were determined according to the guide lines. Statistical analysis:: Qualitative variables and their association among both groups were studied by applying Chi-square test and Fisher Exact test. Quantitative variables among both groups were compared by applying independent samples t-test. P < 0.05 values mean statistically-significant results.

St.Jude bi leaflet prosthetic mitral valve to replace the diseased valve with preservation of both leaflets

St.Jude bi leaflet prosthesis to replace diseased valve with preservation of leaflets with Myocardial re-vascularization, St.Jude prosthetic mitral replacement with preservation of valve apparatus and bypass grafts for associated coronary artery disease

St.Jude prosthetic(FDA approved) mitral valve replacement with or without coronary artery bypass grafts

:if score is 8 or less it is good for balloon valvo-plasty, if > 8 surgery is recommended ( leaflet mobility, thickness and calcification. Fourthly, sub-valvular thickening., higher scores = more deterioration

Left atrioventricular outflow stenosis, prosthetic dysfunction due to preservation of valve apparatus

: Low Fractional Shortening < 28% , Ejection fraction < 40%,, increased left ventricular dimensions and volume

Adjust dose of oral anticoagulant.( between double and half to three times the control) Dose usually ranges between 1 and 11 mg warfarin tablet daily.

Inclusion Criteria:: Mitral stenosis (MS) symptoms are severely limiting and cannot be managed with diuresis and heart rate control. Mitral regurgitation(MR): * acute severe MR require surgical correction for hemo-dynamics and relief of symptoms . Chronic primary mitral regurgitation: * rheumatic heart disease: replacement before irreversible changes occur can be curative. Mixed Mitral Stenosis and Mitral Regurgitation: If beta blockers and diuretics do not relieve symptoms, replacement should be performed only in patients who have severe limiting symptoms. Myocardial ischemia associating or complicated with miral valve disease. Exclusion criteria Patients showing good response to medical therapy, and Cases complicated by: ineffective endocarditis, previous myocardial re-vascularization ischemic ventricular septal defect, left ventricular aneurysm, Ruptured papillary muscles of mitral apparatus.

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by H. D. Elayouty, H. S. Hassan and S.A. Elhafeez. The first draft of the manuscript was written by A. H.Elayouty and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.