101
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Grbic S, Easley TF, Mansi T, Bloodworth CH, Pierce EL, Voigt I, Neumann D, Krebs J, Yuh DD, Jensen MO, Comaniciu D, Yoganathan AP. Personalized mitral valve closure computation and uncertainty analysis from 3D echocardiography. Med Image Anal 2017; 35:238-249. [DOI: 10.1016/j.media.2016.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 03/22/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
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102
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Filsoufi F, Carpentier A. Principles of Carpentier's Reconstructive Surgery in Degenerative Mitral Valve Disease. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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103
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Chan V, Elmistekawy E, Ruel M, Hynes M, Mesana TG. How Does Mitral Valve Repair Fail in Patients With Prolapse?—Insights From Longitudinal Echocardiographic Follow-Up. Ann Thorac Surg 2016; 102:1459-1465. [DOI: 10.1016/j.athoracsur.2016.08.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 10/20/2022]
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104
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Liu B, Edwards NC, Ray S, Steeds RP. Timing surgery in mitral regurgitation: defining risk and optimising intervention using stress echocardiography. Echo Res Pract 2016; 3:R45-R55. [PMID: 27737905 PMCID: PMC5097142 DOI: 10.1530/erp-16-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/13/2016] [Indexed: 01/24/2023] Open
Abstract
Mitral regurgitation (MR) is the second most common form of valvular disease requiring surgery. Correct identification of surgical candidates and optimising the timing of surgery are key in management. For primary MR, this relies upon a balance between the peri-operative risks and rates of successful repair in patients undergoing early surgery when asymptomatic with the potential risk of irreversible left ventricular dysfunction if intervention is performed too late. For secondary MR, recognition that this is a highly dynamic condition where MR severity may change is key, although data on outcomes in determining whether concomitant valve intervention is performed with revascularisation has raised questions regarding timing of surgery. There has been substantial interest in the use of stress echocardiography to risk stratify patients in mitral regurgitation. This article reviews the role of stress echocardiography in both primary and secondary mitral regurgitation and discusses how this can help clinicians tackle the challenges of this prevalent condition.
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Affiliation(s)
- Boyang Liu
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nicola C Edwards
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Simon Ray
- University Hospital South Manchester, Manchester, UK
| | - Richard P Steeds
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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105
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Wan S, Lee AP, Attaran S, Yu PS, Au SS, Kwok MW, Lau RW, Wong RH, Wan IY, Ng SK, Underwood MJ. Mitral valve repair using a semirigid ring: patient selection and early outcomes. Asian Cardiovasc Thorac Ann 2016; 24:647-52. [PMID: 27448551 DOI: 10.1177/0218492316659970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. METHODS We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative (n = 60) or functional (n = 6) mitral regurgitation had Memo 3D (n = 32) or Memo 3D ReChord (n = 34) rings implanted. RESULTS Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. CONCLUSIONS Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.
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Affiliation(s)
- Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex Pw Lee
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Saina Attaran
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Peter Sy Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sylvia Sw Au
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Micky Wt Kwok
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow Wh Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Randolph Hl Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Yp Wan
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Siu-Keung Ng
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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106
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Benetis R, Orda P, Vaškelytė JJ, Ivanauskas V, Ereminienė E, Jakuška P, Jankauskienė L. Non-ischaemic mitral valve suture annuloplasty: late follow-up results. Perfusion 2016; 31:568-75. [DOI: 10.1177/0267659116645398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate late outcomes after posterior mitral valve (MV) annulus double-suture annuloplasty for degenerative (non-ischaemic) MV insufficiency. Design: Between 2005 and 2011, 138 patients underwent MV repair using posterior MV double-suture annuloplasty and an additional 105 patients underwent tricuspid valve repair. The study protocol included operative mortality, reoperation rate and reasons, as well as echocardiographic parameters at pre- and postoperative and follow-up periods (2-9 years). Results: In-hospital mortality was 2/138 (1.45%). Early post operation, no regurgitation was noted in 74/136 (54.4%) patients, Io regurgitation was observed in 55/136 (40.4%), IIo was observed in 6/136 (4.4%) and IIIo was observed in 1/136 (0.7%); during late follow-up (from 2 to 9 years), no regurgitation was observed in 21.6% patients, Io was observed in 58%, IIo was observed in 17% and IIIo was observed in 3.4%. The mean preoperative anterolateral diameter of the MV annulus was 39.02±4.97 mm and, at late follow-up, it was 27.66±3.94 mm (p=0.000); at these same time points, left ventricular end-diastolic diameter (LVEDD) was 55.74±7.29 mm and 49.17±6.01 mm (p=0.000), respectively, and the left ventricular ejection fraction (LVEF) was 53.08±8.93% and 50.92±6.78%, respectively (p=0.007). Conclusions: This study demonstrates suture annuloplasty to be an effective treatment up to 9 years for degenerative mitral valve disease. This technique enables preservation of the posterior mitral valve annulus diameter with stable long-term (up to 9 years) reduction, a competent (no regurgitation/⩽IIo regurgitation) MV in 96.6% of cases and positive left ventricular (LV) remodelling.
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Affiliation(s)
- Rimantas Benetis
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Orda
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Vytenis Ivanauskas
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Ereminienė
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuška
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Loreta Jankauskienė
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
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107
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Fundarò P, Tartara PM, Villa E, Fratto P, Campisi S, Vitali EO. Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty? Asian Cardiovasc Thorac Ann 2016; 15:351-8. [PMID: 17664215 DOI: 10.1177/021849230701500420] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prosthetic ring annuloplasty is considered the gold standard technique for mitral valve repair, but it has been associated with some drawbacks. Suture annuloplasty is less expensive and may have some physiopathologic advantages. We reviewed the literature to assess clinical results of mitral suture annuloplasty. Thirteen series, each reporting more than 50 patients and published in the last 10 years, were included in the analysis. They comprised 1,648 patients with cumulative follow-up of 5,607 patient-years. Our review suggests that suture annuloplasty is a safe procedure, but a trend toward recurrence of annular dilatation with time was reported. In selected cases, suture annuloplasty is effective, and its mid-term clinical results are encouraging and compare well with those of prosthetic ring repair series. The quality of the results varies according to the particular annuloplasty technique used and to the mitral valve pathology treated. Recent technical modifications have been found to decrease the incidence of repair failure and promise to improve the reproducibility of the procedure. Further investigations are warranted to better assess the long-term results of suture annuloplasty, and to determine whether its theoretical functional advantages translate into a real clinical benefit.
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Affiliation(s)
- Pino Fundarò
- Department of Cardiac Surgery, Ospedale Niguarda Cà Granda, Milan, Italy
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108
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Chan DTL, Chiu CSW, Cheng LC, Au TWK. Mitral Valve Annuloplasty with Carpentier-Edwards Physio Ring: Mid-term Results. Asian Cardiovasc Thorac Ann 2016; 14:382-6. [PMID: 17005884 DOI: 10.1177/021849230601400507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The mid-term results of mitral valve repair with the Carpentier-Edwards Physio annuloplasty ring were assessed in 97 consecutive patients in a single tertiary-referral cardiothoracic surgical center. The mean follow-up time was 3.9 years (range, 1 month to 8.9 years). Most patients were in functional class II and III before the operation. Ejection fraction was < 40% in 8 patients. Causes of mitral regurgitation included degenerative disease (66%), infective endocarditis (13.4%), rheumatic disease (10.3%), and ischemic heart disease (9.3%). Thirty-day mortality was 2.1%. Actuarial survival and freedom from re-operation at 8 years were 91% and 90.8%, respectively. The only significant risk factor for re-operation was residual mitral regurgitation. Four patients suffered thromboembolic complications, giving an overall event-free survival of 93% ± 3.7% during the follow-up period. The Carpentier-Edwards Physio ring provides safe and effective repair of mitral regurgitation on mid-term follow-up.
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Affiliation(s)
- Daniel T L Chan
- Cardiothoracic Surgical Unit, Grantham Hospital, Hong Kong, China
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109
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Bassin L, Weiss B, Cranney G, Gimpel D, Gilhooly P, Smith R, Akhunji Z, Grant P, Wolfenden H. Operative Outcomes with Myxomatous Mitral Valve Repair: Experience with 586 Patients. Heart Lung Circ 2016; 25:870-3. [PMID: 27131928 DOI: 10.1016/j.hlc.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/05/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION American Heart Association (AHA) guidelines recommend mitral valve repair for myxomatous mitral regurgitation whenever possible to prevent LV dysfunction and early mortality. Here we review our early operative outcomes with mitral valve repair for myxomatous mitral regurgitation. METHODS We collected data from 586 consecutive patients that underwent mitral repair for myxomatous disease at the Prince Henry and Prince of Wales Hospitals Sydney between 1997 and 2012. All patients had pre- and postoperative transthoracic echocardiograms. RESULTS In the first 30 days postoperatively there were five deaths (0.9%), four strokes (0.7%) and five transient ischaemic attacks (TIAs) (0.9%). Repair involved resection in 55.5%, neochordal reconstruction in 41.6%, and in 2.9% a combination of both. There was increasing use of neochordae since 2006. At discharge 99% had mitral regurgitation (MR) ≤ mild and ≤ trivial in 79.5%. For posterior leaflet disease neochordae had improved MR at discharge compared with resection (85% vs 78%, P<0.05). Preoperative triscupid regurgitation (TR) and pulmonary hypertension > mild were associated with a greater degree of MR at discharge (P<0.05) for reasons that are unclear. CONCLUSION We have shown excellent early results for mitral repair with very low operative mortality and excellent freedom from significant MR. Successful mitral repairs with low morbidity have resulted in a pattern of early referral in keeping with the current guidelines.
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Affiliation(s)
- L Bassin
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - B Weiss
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia; School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - G Cranney
- Department of Cardiology, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - D Gimpel
- School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - P Gilhooly
- School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - R Smith
- School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - Z Akhunji
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - P Grant
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - H Wolfenden
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia
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Paparella D, Di Mauro M, Bitton Worms K, Bolotin G, Russo C, Trunfio S, Scrofani R, Antona C, Actis Dato G, Casabona R, Colli A, Gerosa G, Renzulli A, Serraino F, Scrascia G, Zaccaria S, De Bonis M, Taramasso M, Delgado L, Tritto F, Marmo J, Parolari A, Myaseodova V, Villa E, Troise G, Nicolini F, Gherli T, Whitlock R, Conte M, Barili F, Gelsomino S, Lorusso R, Sciatti E, Marinelli D, Di Giammarco G, Calafiore AM, Sheikh A, Alfonso JJ, Glauber M, Miceli A, Rotunno C, Beckerman Z, Martinelli L, Lanfranconi M, Foresti D, Varone E, Punta G, Alfieri O, Lapenna E, Ismeno G, Pulcino A, Alamanni F, Dalla Tomba M, Coletti G, Vizzardi E, Lio A, Solinas M, Foschi M. Antiplatelet versus oral anticoagulant therapy as antithrombotic prophylaxis after mitral valve repair. J Thorac Cardiovasc Surg 2016; 151:1302-8.e1. [DOI: 10.1016/j.jtcvs.2015.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/25/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022]
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111
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Badhwar V, Smith AJ, Cavalcante JL. A pathoanatomic approach to the management of mitral regurgitation. Trends Cardiovasc Med 2016; 26:126-34. [DOI: 10.1016/j.tcm.2015.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/17/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
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112
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Roberts N, Morticelli L, Jin Z, Ingham E, Korossis S. Regional biomechanical and histological characterization of the mitral valve apparatus: Implications for mitral repair strategies. J Biomech 2015; 49:2491-501. [PMID: 26787008 DOI: 10.1016/j.jbiomech.2015.12.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 11/15/2022]
Abstract
The aim of this study was to investigate the regional and directional differences in the biomechanics and histoarchitecture of the porcine mitral valve (MV) apparatus, with a view to tailoring tissue-engineered constructs for MV repair. The anterior leaflet displayed the largest directional anisotropy with significantly higher strength in the circumferential direction compared to the posterior leaflet. The histological results indicated that this was due to the circumferential alignment of the collagen fibers. The posterior leaflet demonstrated no significant directional anisotropy in the mechanical properties, and there was no significant directionality of the collagen fibers in the main body of the leaflet. The thinner commissural chordae were found to be significantly stiffer and less extensible than the strut chordae. Histological staining demonstrated a tighter knit of the collagen fibers in the commissural chordae than the strut chordae. By elucidating the inhomogeneity of the histoarchitecture and biomechanics of the MV apparatus, the results from this study will aid the regional differentiation of MV repair strategies, with tailored mitral-component-specific biomaterials or tissue-engineered constructs.
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Affiliation(s)
- Nicholas Roberts
- Institute of Medical and Biological Engineering, University of Leeds, LS2 9JT Leeds, UK
| | - Lucrezia Morticelli
- Institute of Medical and Biological Engineering, University of Leeds, LS2 9JT Leeds, UK; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover 30625, Germany
| | - Zhongmin Jin
- Institute of Medical and Biological Engineering, University of Leeds, LS2 9JT Leeds, UK; State Key Laboratory for Manufacturing System Engineering, Xi׳an Jiaotong University, Xi׳an, China
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, University of Leeds, LS2 9JT Leeds, UK
| | - Sotirios Korossis
- Institute of Medical and Biological Engineering, University of Leeds, LS2 9JT Leeds, UK; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover 30625, Germany; Lower Saxony Centre for Biomedical Engineering Implant Research and Development, Hannover Medical School, Feodor-Lynen-Strasse 31, Hannover 30625, Germany.
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113
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da Rocha e Silva JG, Spampinato R, Misfeld M, Seeburger J, Pfanmüller B, Eifert S, Mohr FW, Borger MA. Barlow's Mitral Valve Disease: A Comparison of Neochordal (Loop) and Edge-To-Edge (Alfieri) Minimally Invasive Repair Techniques. Ann Thorac Surg 2015; 100:2127-33; discussion 2133-5. [DOI: 10.1016/j.athoracsur.2015.05.097] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/12/2015] [Accepted: 05/15/2015] [Indexed: 11/29/2022]
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114
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Lee SJ, Yang HS, Kim JS, Shin JK, Son JS, Song MG, Chee HK. Midterm results of mitral valve repair with lifting annuloplasty strip for acute phase infective endocarditis. J Cardiothorac Surg 2015; 10:139. [PMID: 26521229 PMCID: PMC4628241 DOI: 10.1186/s13019-015-0368-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/28/2015] [Indexed: 12/22/2022] Open
Abstract
Background Mitral valve repair is favored over replacement due to superior outcomes. However, extensive infective endocarditis (IE) often has been considered unreconstructable. We retrospectively analyzed the mid-term outcomes of an individualized repair approach using a lifting annuloplasty strip. Methods Between December 2007 and March 2014, 27 consecutive patients with acute single mitral valve IE (age 43 ± 16 years, 11 men) underwent lifting mitral annuloplasty (LMA) with a strip (Mitracon® strip, 28 mm in 4, 32 mm in 10, and 34 mm in 13). Blood culture was positive in 70 % (Streptococcus 10, Staphylococcus 4, HACEK 3, Enterococcus 1, Gram negative bacilli 1). One case (4 %) had a previously repaired mitral valve—the repair was redone. Via right thoracotomy (74 %) or median sternotomy (26 %), repair was performed by removal of vegetation and resection of infected tissue, the defect typically then being repaired using a bovine pericardial patch (81 %). Artificial chordae were formed in 5 patients. Nine (33 %) of them had posterior leaflet augmentation (PLA) to get sufficient coaptation height. Clinical and echocardiographic follow-up were performed. Results Compared with preoperative ones, postoperative echocardiograms revealed decreases of left ventricular (LV) end-diastolic dimensions (57.2 ± 6.3 versus, 45.4 ± 6.2, or 44.8 ± 4.1 mm, all p < 0.01). The LV ejection fraction decreased immediately, but recovered (64.4 ± 9.6 % vs. 54.5 ± 9.8 %, or 65.2 ± 6.1 %, p = 0.002, p = 1.000, respectively). The latest follow-up echocardiograms (median 28 months) universally showed no or minimal regurgitation, with a preserved mitral valve opening area (2.27 ± 0.48 cm2). During the clinical follow-up (median, 54 months), one (3.7 %) death was observed (in-hospital, due to biliary sepsis and pneumonia). There was no reoperation or major cardiovascular event. The 5 year survival rate was 96.3 %. Conclusions The repair technique of LMA and/or PLA in patients with IE achieved good structural and functional outcomes as well as an excellent 5 year survival rate. An individualized repair approach should be recommended in patients with acute phase IE.
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Affiliation(s)
- Sung Jun Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
| | - Hyun Suk Yang
- Department of Cardiovascular medicine, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
| | - Jun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
| | - Je Kyoun Shin
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
| | - Jae Sung Son
- Department of Pediatric Cardiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
| | - Meong Gun Song
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea.
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115
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[Mitral Valve Repair for Patients with Mitral Valve Prolapse]. J UOEH 2015; 37:195-202. [PMID: 26370043 DOI: 10.7888/juoeh.37.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Prosthetic valve replacement has mainly been performed on patients with mitral regurgitation. In such cases, prosthetic valve related complications, such as thromboembolism, bleeding, prosthetic valve infection, and structural valve deterioration, are unavoidable. With valve plasty, however, not only can such complications be avoided, but patients can also have as good a quality of life as healthy people without medications. Although mitral valve plasty requires complicated techniques like chordal reconstruction and has problems of residue, recurrence, and progression of regurgitation, patients with mitral valve prolapse are considered to be good candidates for this procedure. Mitral annuloplasty with a prosthetic ring is the essential and basic procedure of this operation, usually adding to the other techniques. Resection and suture methods of quadrangular resection, triangular resection and the sliding method, by which systolic anterior movement can be avoided, are indicated for patients with posterior leaflets prolapse. The resection and suture method, chordal shortening, and chordal transposition were previously done on patients with anterior leaflets prolapse, but recently chordal reconstruction using ePTFE (expanded polytetrafluoroethylene) is performed. Superior long-term results of mitral valve plasty for patients with mitral valve prolapse compared to prosthetic valve replacement have been reported. The 10-year reoperation rate of mitral valve plasty is only 7-10% as much as valve replacement.
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116
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Imasaka KI, Tayama E, Tomita Y. Left ventricular performance early after repair for posterior mitral leaflet prolapse: Chordal replacement versus leaflet resection. J Thorac Cardiovasc Surg 2015; 150:538-45. [DOI: 10.1016/j.jtcvs.2015.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/19/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
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117
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Rim Y, Choi A, McPherson DD, Kim H. Personalized Computational Modeling of Mitral Valve Prolapse: Virtual Leaflet Resection. PLoS One 2015; 10:e0130906. [PMID: 26103002 PMCID: PMC4477933 DOI: 10.1371/journal.pone.0130906] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/25/2015] [Indexed: 11/23/2022] Open
Abstract
Posterior leaflet prolapse following chordal elongation or rupture is one of the primary valvular diseases in patients with degenerative mitral valves (MVs). Quadrangular resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of posterior leaflet prolapse. Virtual MV repair simulation of leaflet resection in association with patient-specific 3D echocardiographic data can provide quantitative biomechanical and physiologic characteristics of pre- and post-resection MV function. We have developed a solid personalized computational simulation protocol to perform virtual MV repair using standard clinical guidelines of posterior leaflet resection with annuloplasty ring implantation. A virtual MV model was created using 3D echocardiographic data of a patient with posterior chordal rupture and severe mitral regurgitation. A quadrangle-shaped leaflet portion in the prolapsed posterior leaflet was removed, and virtual plication and suturing were performed. An annuloplasty ring of proper size was reconstructed and virtual ring annuloplasty was performed by superimposing the ring and the mitral annulus. Following the quadrangular resection and ring annuloplasty simulations, patient-specific annular motion and physiologic transvalvular pressure gradient were implemented and dynamic finite element simulation of MV function was performed. The pre-resection MV demonstrated a substantial lack of leaflet coaptation which directly correlated with the severe mitral regurgitation. Excessive stress concentration was found along the free marginal edge of the posterior leaflet involving the chordal rupture. Following the virtual resection and ring annuloplasty, the severity of the posterior leaflet prolapse markedly decreased. Excessive stress concentration disappeared over both anterior and posterior leaflets, and complete leaflet coaptation was effectively restored. This novel personalized virtual MV repair strategy has great potential to help with preoperative selection of the patient-specific optimal MV repair techniques, allow innovative surgical planning to expect improved efficacy of MV repair with more predictable outcomes, and ultimately provide more effective medical care for the patient.
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Affiliation(s)
- Yonghoon Rim
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Ahnryul Choi
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - David D. McPherson
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Hyunggun Kim
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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Yazdchi F, Koch CG, Mihaljevic T, Hachamovitch R, Lowry AM, He J, Gillinov AM, Blackstone EH, Sabik JF. Increasing Disadvantage of “Watchful Waiting” for Repairing Degenerative Mitral Valve Disease. Ann Thorac Surg 2015; 99:1992-2000. [DOI: 10.1016/j.athoracsur.2015.01.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/14/2015] [Accepted: 01/19/2015] [Indexed: 11/16/2022]
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Dumont KA, Karlsen JS, Helle-Valle T, Fiane AE, Lundblad R, Urheim S. Mitral valve analysis adding a virtual semi-transparent annulus plane for detection of prolapsing segments. Cardiovasc Ultrasound 2015; 13:25. [PMID: 25986226 PMCID: PMC4445285 DOI: 10.1186/s12947-015-0019-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background We hypothesized that a novel three-dimensional virtual semi-transparent annulus plane (3D VSAP) presented on a holographic screen can be used to visualize the prolapsing tissue in degenerative mitral valve disease and furthermore, provide us with geometrical data of the mitral valve apparatus. Phantom and patient studies were designed to demonstrate the feasibility of creating a semi-automatic, semi-transparent mitral annulus plane visualized on a holographic display. Methods Ten pipe cleaners mimicking the mitral annulus with different shapes and three types of annuloplasty rings served as phantoms. We obtained 3D transoesophageal examination of the phantoms in a special designed box filled with water. Recordings were converted to the holographic display and a 3D VSAP was created. The ratio of the major and minor axes as well as the non-planar angles were calculated and compared with direct measures of the phantoms. Forty patients with degenerative mitral valve disease were then analyzed with 3D transthoracic echocardiography (TTE) and a 3D VSAP was created on the holographic display. A total of 240 segments were analyzed by two independent observers, one echo expert (observer I), and the other novice with limited echo experience (observer II). The two observers created the 3D VSAP in each patient before suggesting the valve pathology. Results The major/minor axes ratio and non-planar angles by 3D VSAP correlated with direct measurements by r = 0.65, p < 0.02 and r = 0.99, p < 0.0001, respectively. The sensitivity and specificity of the 3D VSAP method in patients was 81 and 97 %, respectively (observer I) and for observer II 77 and 96 %, respectively. The accuracy and precisions were 93.9 and 89.4 %, respectively (observer I), 92.3 and 85.1 % (observer II). Mitral valve analysis adding a 3D VSAP was feasible with high accuracy and precision, providing a quick and less subjective method for diagnosing mitral valve prolapse. This novel method may improve preoperative diagnostics and may relieve a better understanding of the pathophysiology of mitral valve disease. Thus, based on the specific findings in each patient, a tailored surgical repair can be planned and hopefully enhance long-term repair patency in the future.
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Affiliation(s)
- Karl-Andreas Dumont
- Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
| | | | - Thomas Helle-Valle
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Post Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Arnt Eltvedt Fiane
- Department of Cardiothoracic Surgery and Faculty of Medicine in Oslo, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Runar Lundblad
- Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
| | - Stig Urheim
- Department of Cardiology and Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Post Office Box 4950, Nydalen, 0424, Oslo, Norway.
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Lee CH, Zhang W, Liao J, Carruthers CA, Sacks JI, Sacks MS. On the presence of affine fibril and fiber kinematics in the mitral valve anterior leaflet. Biophys J 2015; 108:2074-87. [PMID: 25902446 PMCID: PMC4407258 DOI: 10.1016/j.bpj.2015.03.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/07/2015] [Accepted: 03/10/2015] [Indexed: 11/21/2022] Open
Abstract
In this study, we evaluated the hypothesis that the constituent fibers follow an affine deformation kinematic model for planar collagenous tissues. Results from two experimental datasets were utilized, taken at two scales (nanometer and micrometer), using mitral valve anterior leaflet (MVAL) tissues as the representative tissue. We simulated MVAL collagen fiber network as an ensemble of undulated fibers under a generalized two-dimensional deformation state, by representing the collagen fibrils based on a planar sinusoidally shaped geometric model. The proposed approach accounted for collagen fibril amplitude, crimp period, and rotation with applied macroscopic tissue-level deformation. When compared to the small angle x-ray scattering measurements, the model fit the data well, with an r(2) = 0.976. This important finding suggests that, at the homogenized tissue-level scale of ∼1 mm, the collagen fiber network in the MVAL deforms according to an affine kinematics model. Moreover, with respect to understanding its function, affine kinematics suggests that the constituent fibers are largely noninteracting and deform in accordance with the bulk tissue. It also suggests that the collagen fibrils are tightly bounded and deform as a single fiber-level unit. This greatly simplifies the modeling efforts at the tissue and organ levels, because affine kinematics allows a straightforward connection between the macroscopic and local fiber strains. It also suggests that the collagen and elastin fiber networks act independently of each other, with the collagen and elastin forming long fiber networks that allow for free rotations. Such freedom of rotation can greatly facilitate the observed high degree of mechanical anisotropy in the MVAL and other heart valves, which is essential to heart valve function. These apparently novel findings support modeling efforts directed toward improving our fundamental understanding of tissue biomechanics in healthy and diseased conditions.
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Affiliation(s)
- Chung-Hao Lee
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas
| | - Will Zhang
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas
| | - Jun Liao
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, Starkville, Mississippi
| | | | - Jacob I Sacks
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas
| | - Michael S Sacks
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, Texas.
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Mazine A, Vistarini N, Ghoneim A, Lebon JS, Demers P, Jeanmart H, Pellerin M, Bouchard D. Very high repair rate using minimally invasive surgery for the treatment of degenerative mitral insufficiency. Can J Cardiol 2015; 31:744-51. [PMID: 25913471 DOI: 10.1016/j.cjca.2014.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/14/2014] [Accepted: 12/05/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Minimally invasive mitral valve surgery (MIMVS) is an established alternative to median sternotomy for mitral valve repair. However, this technique has yet to gain widespread adoption, partly because of concerns that this approach might yield lower repair rates or repairs that are less durable than those performed through a sternotomy. The purpose of this study was to report our inaugural experience with MIMVS, with a focus on mitral valve repair rate and midterm outcomes. METHODS Between May 2006 and April 2012, minimally invasive mitral valve repair was attempted in 200 consecutive patients with degenerative mitral disease. The approach used was a 4- to 5-cm right anterolateral minithoracotomy with femorofemoral cannulation for cardiopulmonary bypass. Mean follow-up was 2.9 ± 1.8 years, and follow-up was 99% complete. RESULTS The mitral valve was successfully repaired in all but 2 patients, yielding a repair rate of 99%. Hospital mortality occurred in 2 patients (1%). Intraoperative conversion to sternotomy was necessary in 12 patients (6%), including 1 of the 2 unsuccessful repairs. Mean cardiopulmonary bypass and aortic cross-clamp times were 130.8 ± 41.3 minutes and 104.8 ± 35.6 minutes, respectively. Median hospital stay was 5 days. The 5-year survival and freedom from reoperation were 97.9% ± 1.5% and 98.1% ± 1.3%, respectively. CONCLUSIONS A very high repair rate can be achieved using MIMVS for the treatment of degenerative mitral regurgitation, including during the learning phase. Midterm survival and freedom from valve-related reoperation are excellent. MIMVS is a safe and effective alternative to mitral valve repair through a sternotomy.
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Affiliation(s)
- Amine Mazine
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada
| | - Nicola Vistarini
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada; Department of Cardiac Surgery, Pavia University School of Medicine, Pavia, Italy
| | - Aly Ghoneim
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada
| | - Jean-Sébastien Lebon
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Anesthesiology, Montreal Heart Institute, Montreal, Québec, Canada
| | - Philippe Demers
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada
| | - Hugues Jeanmart
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada
| | - Michel Pellerin
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada
| | - Denis Bouchard
- Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada.
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Functional and Biomechanical Effects of the Edge-to-Edge Repair in the Setting of Mitral Regurgitation: Consolidated Knowledge and Novel Tools to Gain Insight into Its Percutaneous Implementation. Cardiovasc Eng Technol 2014; 6:117-40. [PMID: 26577231 DOI: 10.1007/s13239-014-0208-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
Mitral regurgitation is the most prevalent heart valve disease in the western population. When severe, it requires surgical treatment, repair being the preferred option. The edge-to-edge repair technique treats mitral regurgitation by suturing the leaflets together and creating a double-orifice valve. Due to its relative simplicity and versatility, it has become progressively more widespread. Recently, its percutaneous version has become feasible, and has raised interest thanks to the positive results of the Mitraclip(®) device. Edge-to-edge features and evolution have stimulated debate and multidisciplinary research by both clinicians and engineers. After providing an overview of representative studies in the field, here we propose a novel computational approach to the most recent percutaneous evolution of the edge-to-edge technique. Image-based structural finite element models of three mitral valves affected by posterior prolapse were derived from cine-cardiac magnetic resonance imaging. The models accounted for the patient-specific 3D geometry of the valve, including leaflet compound curvature pattern, patient-specific motion of annulus and papillary muscles, and hyperelastic and anisotropic mechanical properties of tissues. The biomechanics of the three valves throughout the entire cardiac cycle was simulated before and after Mitraclip(®) implantation, assessing the biomechanical impact of the procedure. For all three simulated MVs, Mitraclip(®) implantation significantly improved systolic leaflets coaptation, without inducing major alterations in systolic peak stresses. Diastolic orifice area was decreased, by up to 58.9%, and leaflets diastolic stresses became comparable, although lower, to systolic ones. Despite established knowledge on the edge-to-edge surgical repair, latest technological advances make its percutanoues implementation a challenging field of research. The modeling approach herein proposed may be expanded to analyze clinical scenarios that are currently critical for Mitraclip(®) implantation, helping the search for possible solutions.
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Coutinho GF, Garcia AL, Correia PM, Branco C, Antunes MJ. Long-term follow-up of asymptomatic or mildly symptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function. J Thorac Cardiovasc Surg 2014; 148:2795-801. [DOI: 10.1016/j.jtcvs.2014.06.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/13/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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De Bonis M, Lapenna E, Taramasso M, La Canna G, Buzzatti N, Pappalardo F, Alfieri O. Very long-term durability of the edge-to-edge repair for isolated anterior mitral leaflet prolapse: Up to 21 years of clinical and echocardiographic results. J Thorac Cardiovasc Surg 2014; 148:2027-32. [DOI: 10.1016/j.jtcvs.2014.03.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/11/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
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Weiner MM, Hofer I, Lin HM, Castillo JG, Adams DH, Fischer GW. Relationship among surgical volume, repair quality, and perioperative outcomes for repair of mitral insufficiency in a mitral valve reference center. J Thorac Cardiovasc Surg 2014; 148:2021-6. [DOI: 10.1016/j.jtcvs.2014.04.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/02/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
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Coutinho GF, Correia PM, Antunes MJ. Concomitant aortic and mitral surgery: To replace or repair the mitral valve? J Thorac Cardiovasc Surg 2014; 148:1386-1392.e1. [DOI: 10.1016/j.jtcvs.2013.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/29/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
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Shimizu A, Kasegawa H, Tabata M, Fukui T, Takanashi S. Long-term outcomes of mitral valve repair for isolated commissural prolapse: up to 17-year experience. Ann Thorac Surg 2014; 99:43-7. [PMID: 25223917 DOI: 10.1016/j.athoracsur.2014.04.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mitral valve repair has been shown to be effective for degenerative mitral regurgitation (MR). However, outcomes of mitral valve repair for commissural prolapse has not been well defined. Commissural prolapse has been often categorized into the groups of posterior leaflet prolapse or bileaflet prolapse, and outcomes and prognosis of isolated commissural prolapse has been rarely reported. We aimed to determine clinical and echocardiographic outcomes of mitral valve repair for isolated commissural lesion. METHODS Between 1992 and 2010, 1,112 patients underwent mitral valve repair for degenerative MR at our institution. Among those, we reviewed 122 patients with isolated commissural prolapse. We analyzed operative outcomes, long-term survival rate, freedom from reoperation rate, and freedom from recurrent moderate or severe MR rate. RESULTS The mean age was 57.0 ± 14.4 years old, 83 patients (68.0%) were men, 16 patients (13.1%) had infective endocarditis, 43 patients (35.2%) had atrial fibrillation, 27 patients (22.1%) had anterolateral commissural prolapse, 91 (74.6%) had posteromedial commissural prolapse, and 4 (3.3%) had bilateral commissural prolapse. We performed leaflet resection in 111 (91.0%) (concomitant sliding plasty in 43), chordal replacement in 94 (77.0%), and ring annuloplasty in 121 patients (99.2%). Residual mild MR was confirmed in 7 patients (5.7%) on predischarge echocardiography. No patients had moderate or severe MR at the time of discharge. Fifteen-year survival and freedom from mitral reoperation were 87.6% and 93.0%, respectively. Freedom from recurrent moderate or severe MR at 15 years was 87.4%. CONCLUSIONS Mitral valve repair for isolated commissural prolapse demonstrated excellent early and late outcomes.
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Affiliation(s)
- Atsushi Shimizu
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Hitoshi Kasegawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
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Chandran KB, Kim H. Computational mitral valve evaluation and potential clinical applications. Ann Biomed Eng 2014; 43:1348-62. [PMID: 25134487 DOI: 10.1007/s10439-014-1094-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/09/2014] [Indexed: 01/15/2023]
Abstract
The mitral valve (MV) apparatus consists of the two asymmetric leaflets, the saddle-shaped annulus, the chordae tendineae, and the papillary muscles. MV function over the cardiac cycle involves complex interaction between the MV apparatus components for efficient blood circulation. Common diseases of the MV include valvular stenosis, regurgitation, and prolapse. MV repair is the most popular and most reliable surgical treatment for early MV pathology. One of the unsolved problems in MV repair is to predict the optimal repair strategy for each patient. Although experimental studies have provided valuable information to improve repair techniques, computational simulations are increasingly playing an important role in understanding the complex MV dynamics, particularly with the availability of patient-specific real-time imaging modalities. This work presents a review of computational simulation studies of MV function employing finite element structural analysis and fluid-structure interaction approach reported in the literature to date. More recent studies towards potential applications of computational simulation approaches in the assessment of valvular repair techniques and potential pre-surgical planning of repair strategies are also discussed. It is anticipated that further advancements in computational techniques combined with the next generations of clinical imaging modalities will enable physiologically more realistic simulations. Such advancement in imaging and computation will allow for patient-specific, disease-specific, and case-specific MV evaluation and virtual prediction of MV repair.
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Affiliation(s)
- Krishnan B Chandran
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, 52242, USA
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Yoo JS, Kim JB, Jung SH, Kim DH, Choo SJ, Chung CH, Lee JW. Mitral durability after robotic mitral valve repair: analysis of 200 consecutive mitral regurgitation repairs. J Thorac Cardiovasc Surg 2014; 148:2773-9. [PMID: 25173122 DOI: 10.1016/j.jtcvs.2014.07.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/17/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The study objective was to review a single-center experience on robotic mitral valve repair to treat mitral regurgitation, with a specific focus on midterm echocardiographic mitral durability. No data assessing the quality or durability of repaired mitral valves are currently available. METHODS A total of 200 patients who underwent robotic mitral regurgitation repair using the da Vinci system (Intuitive Surgical, Inc, Sunnyvale, Calif) between August 2007 and December 2012 were evaluated. Serial echocardiographic results and operative and procedural times were analyzed. RESULTS Mitral regurgitation repairs were successfully performed, and no or mild residual mitral regurgitation developed in 98.0% of patients, with no conversion to sternotomy. No in-hospital deaths occurred. Follow-up was completed in 96.5% of patients with a median of 31.4 months (interquartile range, 12.4-42.3 months). During follow-up, 4 late deaths, 2 strokes, 1 low cardiac output, 1 newly required dialysis, and 1 reoperation for mitral regurgitation occurred. Freedom from major adverse cardiac events at 5 years was 87.7% ± 5.1%. Regular echocardiographic follow-up (>6 months) was achieved in 187 patients (93.5%). At a median of 29.6 months (interquartile range, 14.9-45.8 months), 21 patients (10.5%) demonstrated moderate or greater mitral regurgitation. Freedom from moderate or greater mitral regurgitation at 5 years was 87.0% ± 2.6%. Mean cardiopulmonary bypass and crossclamping times were 182.9 ± 48.4 minutes and 110.9 ± 34.1 minutes, respectively, demonstrating a significant decrease in both times according to the chronologic date of surgery. CONCLUSIONS Robotic mitral regurgitation repair is technically feasible and efficacious, demonstrating favorable midterm mitral durability and improved procedural times as experience increases.
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Affiliation(s)
- Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
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Guarracino F, Baldassarri R, Ferro B, Giannini C, Bertini P, Petronio AS, Di Bello V, Landoni G, Alfieri O. Transesophageal Echocardiography During MitraClip® Procedure. Anesth Analg 2014; 118:1188-96. [DOI: 10.1213/ane.0000000000000215] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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De Bonis M, Lapenna E, Taramasso M, Pozzoli A, La Canna G, Calabrese MC, Alfieri O. Is commissural closure associated with mitral annuloplasty a durable technique for the treatment of mitral regurgitation? A long-term (≤15 years) clinical and echocardiographic study. J Thorac Cardiovasc Surg 2014; 147:1900-6. [DOI: 10.1016/j.jtcvs.2013.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/18/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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Pragliola C, Chello M, Gaudino M, Mazza A, Cellini C, Spadaccio C, Covino E. Long-term results of an open flexible prosthetic band for mitral insufficiency. Asian Cardiovasc Thorac Ann 2014; 22:811-5. [PMID: 24585286 DOI: 10.1177/0218492314520747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND use of a prosthetic ring is an integral part of any mitral valve repair and can influence the long-term stability of the results. We evaluated the long-term results of the AnnuloFlex ring implanted as an open flexible band in patients affected by degenerative mitral disease. METHODS between 2001 and 2010, 82 patients (52 women, 30 men) with a mean age of 62 years, underwent repair of a prolapsing mitral valve with an AnnuloFlex band. One patient was reoperated on for a technical error and received a mechanical prosthesis, 3 were missing at follow-up, and the other 78 were prospectively followed up with clinical interviews and transthoracic echocardiography. RESULTS the mean follow-up was 7.0 ± 1.8 years. Six patients died; 2 deaths were considered valve-related. The overall survival estimate at 10 years was 88.6% (95% confidence interval: 76.1%-94.8%). Freedom from endocarditis was 97.1% (95% confidence interval: 89.1%-98.5%). Freedom from thrombosis or hemorrhage was 93.7% (95% confidence interval: 81.6%-97.9%). Freedom from new or increased regurgitation was 93.1% (95% confidence interval: 87.3%-97.3%). The cumulative freedom from any valve-related event was 78.6% (95% confidence interval: 69.7%-97.1%). A single case of systolic anterior motion occurred before hospital discharge. CONCLUSION the long-term results of the AnnuloFlex band are excellent and stable.
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Affiliation(s)
- Claudio Pragliola
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Chello
- Division of Cardiac Surgery, Università Campus Biomedico, Rome, Italy
| | - Mario Gaudino
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Cellini
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Elvio Covino
- Division of Cardiac Surgery, Università Campus Biomedico, Rome, Italy
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 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; 129:2440-92. [PMID: 24589852 DOI: 10.1161/cir.0000000000000029] [Citation(s) in RCA: 1015] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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135
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:e521-643. [PMID: 24589853 DOI: 10.1161/cir.0000000000000031] [Citation(s) in RCA: 867] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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136
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Off-Pump Transapical Implantation of Artificial Neo-Chordae to Correct Mitral Regurgitation. J Am Coll Cardiol 2014; 63:914-9. [DOI: 10.1016/j.jacc.2013.07.090] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 06/24/2013] [Accepted: 07/13/2013] [Indexed: 11/24/2022]
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137
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Jung HJ, Yu GY, Seok JH, Oh C, Kim SH, Yoon TG, Kim TY. Usefulness of intraoperative real-time three-dimensional transesophageal echocardiography for pre-procedural evaluation of mitral valve cleft: a case report. Korean J Anesthesiol 2014; 66:75-9. [PMID: 24567819 PMCID: PMC3927007 DOI: 10.4097/kjae.2014.66.1.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 11/13/2022] Open
Abstract
A precise pre-procedural evaluation of mitral valve (MV) pathology is essential for planning the surgical strategy for severe mitral regurgitation (MR) and preparing for the intraoperative procedure. In the present case, a 38-year-old woman was scheduled to undergo MV replacement due to severe MR. She had a history of undergoing percutaneous balloon valvuloplasty due to rheumatic mitral stenosis during a previous pregnancy. A preoperative transthoracic echocardiography suggested a tear in the mid tip of the anterior mitral leaflet. However, the "en face" view of the MV in the left atrial perspective using intraoperative real time three-dimensional transesophageal echocardiography (RT 3D-TEE) provided a different diagnosis: a torn cleft in the P2-scallop of the posterior mitral leaflet (PML) with rupture of the chordae. Thus, surgical planning was changed intraoperatively to MV repair (MVRep) consisting of patch closure of the PML, commissurotomy, and lifting annuloplasty. The present case shows that intraoperative RT 3D-TEE provides more precise and reliable spatial information of MV for MVRep and facilitates critical surgical decision-making.
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Affiliation(s)
- Hyun Ju Jung
- Department of Anesthesiology and Pain Medicine, Uijongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Ga-Yon Yu
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea
| | - Jung-Ho Seok
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea
| | - Chungsik Oh
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea
| | - Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea
| | - Tae-Gyoon Yoon
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea
| | - Tae-Yop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk Universrity School of Medicine, Seoul, Korea
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Siregar S, de Heer F, Groenwold RH, Versteegh MI, Bekkers JA, Brinkman ES, Bots ML, van der Graaf Y, van Herwerden LA. Trends and outcomes of valve surgery: 16-year results of Netherlands Cardiac Surgery National Database†. Eur J Cardiothorac Surg 2014; 46:386-97; discussion 397. [DOI: 10.1093/ejcts/ezu017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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139
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Rodrigues ES, Lynch JJ, Suri RM, Burkhart HM, Li Z, Mauermann WJ, Rehfeldt KH, Nuttall GA. Robotic Mitral Valve Repair: A Review of Anesthetic Management of the First 200 Patients. J Cardiothorac Vasc Anesth 2014; 28:64-68. [DOI: 10.1053/j.jvca.2013.05.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Indexed: 11/11/2022]
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140
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Bellitti R, Petrone G, Buonocore M, Nappi G, Santé P. Anatomic Reconstruction in Degenerative Mitral Valve Bileaflet Prolapse: Long-Term Results. Ann Thorac Surg 2014; 97:563-8. [DOI: 10.1016/j.athoracsur.2013.08.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/26/2013] [Accepted: 08/27/2013] [Indexed: 11/26/2022]
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141
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Gaur P, Kaneko T, McGurk S, Rawn JD, Maloney A, Cohn LH. Mitral valve repair versus replacement in the elderly: short-term and long-term outcomes. J Thorac Cardiovasc Surg 2014; 148:1400-6. [PMID: 24589201 DOI: 10.1016/j.jtcvs.2014.01.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/07/2014] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the short-term and long-term outcomes of mitral valve repair (MVP) versus mitral valve replacement (MVR) in elderly patients. METHODS All patients, age 70 years or greater, with mitral regurgitation who underwent MVP or MVR with or without coronary artery bypass graft (CABG), tricuspid valve surgery, or a maze procedure between 2002 and 2011 were retrospectively identified. Patients with a rheumatic cause or who underwent concomitant aortic valve or ventricular-assist device procedures were excluded. RESULTS Overall, 556 patients underwent MVP and 102 patients underwent MVR. The mean age of the patients in the MVR group was 78 years versus 77 years for those in the MVP group (P<.02). The patients in the MVR group had a better mean left ventricular ejection fraction than those in the MVP group (60% vs 55%, P=.04). The incidence of concomitant CABG, tricuspid valve operations, and atrial fibrillation ablation procedures was similar in both groups, but perfusion time was significantly longer for the MVR group (median 177 minutes vs 146 minutes for MVP, P=.001). Postoperatively, patients in the MVR group had a higher incidence of stroke (6% vs 2%, P<.10) and significantly longer intensive care unit stay (median 86 hours vs 55 hours, P=.001) and hospital stay (9 days vs 8 days, P<.01). Operative mortality of patients was significantly higher for the MVR group (8.8% vs 3.6%, P=.03) and remained significant long-term on Kaplan-Meier analysis. Cox regression analysis of all 658 patients and propensity-matched analysis of 96 patients also confirmed these results. CONCLUSIONS Elderly patients with mitral regurgitation who undergo MVP have better postoperative outcomes, lower operative mortality, and improved long-term survival than those undergoing MVR. MVP is a safe and more effective option for the elderly with mitral regurgitation.
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Affiliation(s)
- Puja Gaur
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - James D Rawn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ann Maloney
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Lawrence H Cohn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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142
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Risk-adjusted mortality rate cumulative sum analysis based on the Japan SCORE represents a learning curve in mitral valve reparative surgery. Surg Today 2014; 44:1253-7. [DOI: 10.1007/s00595-013-0827-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 06/18/2013] [Indexed: 10/25/2022]
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143
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Abstract
Degenerative mitral regurgitation (MR), the leading cause of organic MR in western countries, is primarily characterized by mitral valve prolapse but encompasses a wide spectrum of anatomic lesions from fibroelastic deficiency (localized prolapse segment often associated with ruptured chordae) to diffuse myxomatous degeneration (Barlow's disease, diffuse excessive tissue with multiple valvular segments involved). Echocardiography is the method of choice to evaluate patients with degenerative MR and plays a crucial role in clinical management. It allows accurate assessment of MR severity, left ventricular and atrial consequences, etiology, mechanisms and anatomic lesions and consequently defines the probability of mitral valve repair.
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144
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Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:43-8. [DOI: 10.1097/imi.0000000000000039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective A concern with the initiation of totally endoscopic robotic mitral valve repair (TERMR) programs has been the risk for the learning curve. To minimize this risk, we initiated a TERMR program with a defined team and structured learning approach before clinical implementation. Methods A dedicated team (two surgeons, one cardiac anesthesiologist, one perfusionist, and two nurses) was trained with clinical scenarios, simulations, wet laboratories, and “expert” observation for 3 months. This team then performed a series of TERMRs of varying complexity. Results Thirty-two isolated TERMRs were performed during the first programmatic year. All operations included mitral valve repair, left atrial appendage exclusion, and annuloplasty device implantation. Additional procedures included leaflet resection, neochordae insertion, atrial ablation, and papillary muscle shortening. Longer clamp times were associated with number of neochordae ( P < 0.01), papillary muscle procedures ( P < 0.01), and leaflet resection ( P = 0.06). Sequential case number had no impact on cross-clamp time ( P = 0.3). Analysis of nonclamp time demonstrated a 71.3% learning percentage ( P < 0.01; ie, 28.7% reduction in nonclamp time with each doubling of case number). There were no hospital deaths or incidences of stroke, myocardial infarction, unplanned reoperation, respiratory failure, or renal failure. Median length of stay was 4 days. All patients were discharged home. Conclusions Totally endoscopic robotic mitral valve repair can be safely performed after a pretraining regimen with emphasis on experts’ current practice and team training. After a pretraining regimen, cross-clamp times were not subject to learning curve phenomena but were dependent on procedural complexity. Nonclamp times were associated with a short learning curve.
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145
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Yaffee DW, Loulmet DF, Kelly LA, Ward AF, Ursomanno PA, Rabinovich AE, Neuburger PJ, Krishnan S, Hill FT, Grossi EA. Can the Learning Curve of Totally Endoscopic Robotic Mitral Valve Repair be Short-Circuited? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David W. Yaffee
- Departments of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY USA
| | - Didier F. Loulmet
- Departments of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY USA
| | - Lauren A. Kelly
- Departments of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY USA
| | - Alison F. Ward
- Departments of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY USA
| | | | | | | | | | - Frederick T. Hill
- Extracorporeal Services, NYU Langone Medical Center, New York, NY USA
| | - Eugene A. Grossi
- Departments of Cardiothoracic Surgery, NYU Langone Medical Center, New York, NY USA
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146
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Dayan V, Soca G, Cura L, Mestres CA. Similar survival after mitral valve replacement or repair for ischemic mitral regurgitation: a meta-analysis. Ann Thorac Surg 2013; 97:758-65. [PMID: 24370200 DOI: 10.1016/j.athoracsur.2013.10.044] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ischemic mitral regurgitation (IMR) occurs in 20% of patients after myocardial infarction. There is no agreement as to the best surgical option. With no prospective randomized controlled trials available, our objective was to perform a meta-analysis comparing replacement and repair. METHODS A literature search was performed in PubMed, EMBASE, Ovid, and Google Scholar. The following keywords were included: "ischemic mitral regurgitation" and "repair or replacement." Inclusion and exclusion criteria were used to reflect current surgical practice (subvalvular preservation, ring annuloplasty). Primary outcomes of interest were operative mortality and survival. Secondary outcomes analyzed were change in ejection fraction (EF), left ventricular (LV) dimensions, New York Heart Association (NYHA) class, reoperation rate, and 2+ or greater recurrence of mitral regurgitation. RESULTS Of 280 articles, only 12 satisfied all inclusion and exclusion criteria. These articles included 2,508 patients, 64% of whom received valve replacement. Operative mortality was lower after repair (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.38-0.85; p = 0.001); no difference was found when only articles with patients operated on mainly after 1998 were included (OR, 0.70; 95% CI, 0.44 -1.12; p = 0.14). Survival was similar (hazard ratio [HR], 0.86; 95% CI, 0.66-1.13; p = 0.28). No differences in EF, ventricular dimensions, NYHA class, and reoperation were found. Regurgitation recurrence was higher in the repair group (OR, 7.51; 95% CI, 3.7-15.23; p < 0.001). CONCLUSIONS Mitral valve repair is associated with lower operative mortality but higher recurrence of regurgitation in patients with ischemic mitral regurgitation. No differences were found regarding survival, NYHA class, and functional indicators.
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Affiliation(s)
- Victor Dayan
- Centro Cardiovascular, Hospital de Clinicas, Facultad de Medicina, Montevideo, Uruguay.
| | - Gerardo Soca
- Centro Cardiovascular, Hospital de Clinicas, Facultad de Medicina, Montevideo, Uruguay
| | - Leandro Cura
- Centro Cardiovascular, Hospital de Clinicas, Facultad de Medicina, Montevideo, Uruguay
| | - Carlos A Mestres
- Department of Cardiovascular Surgery, Hospital Clinico, University of Barcelona, Barcelona, Spain
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147
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Chan KL, Chen SY, Chan V, Hay K, Mesana T, Lam BK. Functional Significance of Elevated Mitral Gradients After Repair for Degenerative Mitral Regurgitation. Circ Cardiovasc Imaging 2013; 6:1041-7. [DOI: 10.1161/circimaging.112.000688] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Kwan Leung Chan
- From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shin-Yee Chen
- From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vincent Chan
- From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Karen Hay
- From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thierry Mesana
- From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Buu Khanh Lam
- From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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148
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Jassar AS, Vergnat M, Jackson BM, McGarvey JR, Cheung AT, Ferrari G, Woo YJ, Acker MA, Gorman RC, Gorman JH. Regional annular geometry in patients with mitral regurgitation: implications for annuloplasty ring selection. Ann Thorac Surg 2013; 97:64-70. [PMID: 24070698 DOI: 10.1016/j.athoracsur.2013.07.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional annular geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral annular shape is markedly distorted in patients with diseased valves. METHODS Real-time 3-dimensional echocardiography was performed in 20 patients with normal mitral valves, 10 with ischemic mitral regurgitation, and 20 with myxomatous mitral regurgitation (MMR). Thirty-six annular points were defined to generate a 3-dimensional model of the annulus. Regional annular parameters were measured from these renderings. Left ventricular inner diameter was obtained from 2-dimensional echocardiographic images. RESULTS Annular geometry was significantly different among the three groups. The annuli were larger in the MMR and in the ischemic mitral regurgitation groups. The annular enlargement was greater and more pervasive in the MMR group. Both diseases were associated with annular flattening, although though the regional distribution of that flattening was different between groups. Left ventricular inner diameter was increased in both groups. However, relative to the Left ventricular inner diameter, the annulus was disproportionately dilated in the MMR group. CONCLUSIONS Patients with MMR and ischemic mitral regurgitation have enlarged and flattened annuli. In the case of MMR, annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal annular saddle shape and that the use of flexible, partial, and flat rings may be ill advised.
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Affiliation(s)
- Arminder S Jassar
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mathieu Vergnat
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin M Jackson
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R McGarvey
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Albert T Cheung
- Department of Anesthesia University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giovanni Ferrari
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Y Joseph Woo
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Acker
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.
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149
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Boekstegers P, Hausleiter J, Baldus S, von Bardeleben RS, Beucher H, Butter C, Franzen O, Hoffmann R, Ince H, Kuck KH, Rudolph V, Schäfer U, Schillinger W, Wunderlich N. Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system. Clin Res Cardiol 2013; 103:85-96. [DOI: 10.1007/s00392-013-0614-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/21/2013] [Indexed: 01/05/2023]
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150
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Boudoulas KD, Ravi Y, Garcia D, Saini U, Sofowora GG, Gumina RJ, Sai-Sudhakar CB. Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery. Open Cardiovasc Med J 2013; 7:104-9. [PMID: 24339838 PMCID: PMC3856389 DOI: 10.2174/1874192420130902001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/20/2013] [Accepted: 08/26/2013] [Indexed: 12/31/2022] Open
Abstract
Aim: While the incidence of rheumatic heart disease has declined dramatically over the last half-century, the number of valve surgeries has not changed. This study was undertaken to define the most common type of valvular heart disease requiring surgery today, and determine in-hospital surgical mortality and length-of-stay (LOS) for isolated aortic or mitral valve surgery in a United States tertiary-care hospital. Methods: Patients with valve surgery between January 2002 to June 2008 at The Ohio State University Medical Center were studied. Patients only with isolated aortic or mitral valve surgery were analyzed. Results: From 915 patients undergoing at least aortic or mitral valve surgery, the majority had concomitant cardiac proce-dures mostly coronary artery bypass grafting (CABG); only 340 patients had isolated aortic (n=204) or mitral (n=136) valve surgery. In-hospital surgical mortality for mitral regurgitation (n=119), aortic stenosis (n=151), aortic insufficiency (n=53) and mitral stenosis (n=17) was 2.5% (replacement 3.4%; repair 1.6%), 3.9%, 5.6% and 5.8%, respectively (p=NS). Median LOS for aortic insufficiency, aortic stenosis, mitral regurgitation, and mitral stenosis was 7, 8, 9 (replacement 11.5; repair 7) and 11 days, respectively (p<0.05 for group). In-hospital surgical mortality for single valve surgery plus CABG was 10.2% (p<0.005 compared to single valve surgery).
Conclusions: Aortic stenosis and mitral regurgitation are the most common valvular lesions requiring surgery today. Surgery for isolated aortic or mitral valve disease has low in-hospital mortality with modest LOS. Concomitant CABG with valve surgery increases mortality substantially. Hospital analysis is needed to monitor quality and stimulate improvement among Institutions.
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