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(Circulation. 2006;114:I-524 – I-528.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Chordal Cutting Does Not Adversely Affect Left Ventricle Contractile Function

Emmanuel Messas, MD, PhD; Chaim Yosefy, MD; Miguel Chaput, MD; J. Luis Guerrero, BS; Suzanne Sullivan, BS; Philippe Menasché, MD, PhD; Alain Carpentier, MD, PhD; Michel Desnos, MD; Albert A. Hagege, MD, PhD; Gus J. Vlahakes, MD; Robert A. Levine, MD

From Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Departments of Cardiology and Cardiovascular Surgery (E.M., P.M., A.C., M.D., A.A.H.), Hôpital Européen Georges Pompidou, Paris, France; Cardiac Ultrasound Laboratory (C.Y., M.C., L.G., S.S., G.J.V., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Emmanuel Messas, Cardiology Department, Hôpital Européen Georges Pompidou, INSERM U 633, Hôpital Broussais, 6 rue Didot, 75014 Paris, France. E-mail emmanuel.messas{at}free.fr

Background— Severing a limited number of second-order chordae to the anterior leaflet can improve ischemic mitral regurgitation (MR). Some concerns have been raised regarding possible influence on regional and global left ventricle (LV) function. We evaluated changes in cardiac function in 5 normal sheep with cutting of pre-instrumented chords in the beating heart to maintain constant load.

Methods and Results— Under cardiopulmonary bypass, wires were placed around the 2 central basal chordae and brought outside the heart, which was restarted. Hemodynamic and imaging data were collected before and after chordal cutting by radiofrequency ablation using those wires. Segmental contractility was assessed invasively using sonomicrometers and noninvasively using Doppler tissue velocity and strain rate (with strain rate viewed as less load-dependent than ejection fraction) at 6 sites: base, mid-ventricle, and apex along the anteroseptal and posterolateral walls. We found no changes from before to after chordal cutting in LV end-diastolic volume (47.2±3.3 after cutting versus 48.4±4.6 mL before cutting, P=0.66), end-systolic volume (21.5±1.2 versus 22.3±2.8 mL, P=0.68), ejection fraction (54.2±1.8 versus 54.2±2.7%, P=0.96), systolic ventricular elastance (7.28±1.68 versus 7.66±2.11 mm Hg/mL, P=0.64), preload-recruitable stroke work (46.6±7.7 versus 50.2±10.7 mm Hg, P=0.76), and LVdP/dt (1480±238 versus 1392±250 mm Hg/s, P=0.45). Doppler tissue velocities and longitudinal strain rates surrounding the papillary muscles were unchanged, as were sonomicrometer longitudinal and mediolateral absolute strains. No wall motion abnormalities were visible around the papillary muscles, and no MR developed.

Conclusion— We find no evidence for acutely decreased global or segmental LV contractility with chordal cutting. This absence of adverse effects is consistent with long-term clinical experience with cutting these chords in valve repair.

Key Words: chordae • echocardiography • mitral valve • regurgitation