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Burns DJ, Suri RM, Gillinov AM. Targeted triangular resection for repair of degenerative mitral valve disease. JTCVS Tech 2021; 10:47-52. [PMID: 34977704 PMCID: PMC8691865 DOI: 10.1016/j.xjtc.2021.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
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Pasrija C, Tran D, Ghoreishi M, Kotloff E, Yim D, Finkel J, Holmes SD, Na D, Devlin S, Koenigsberg F, Dawood M, Quinn R, Griffith BP, Gammie JS. Degenerative Mitral Valve Repair Simplified: An Evolution to Universal Artificial Cordal Repair. Ann Thorac Surg 2019; 110:464-473. [PMID: 31863753 DOI: 10.1016/j.athoracsur.2019.10.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Resectional and artificial cordal repair techniques are effective strategies for degenerative mitral valve (MV) repair. However, resectional repair requires a tailored approach using various techniques, whereas cordal repair offers a simpler, easily reproducible repair. The approach described in this study approach has evolved from resectional to cordal over time, and outcomes are compared between the eras. METHODS Clinical and echocardiographic outcomes of all patients undergoing MV repair for degenerative mitral regurgitation (MR) from January 2004 to September 2017 were reviewed. Patients were stratified by era: from January 2004 to June 2011 (era 1; n = 405), resectional techniques were used in 62% and artificial cordal techniques were used in 38%. From July 2011 to September 2017 (era 2; n = 438), artificial cordal repair was used in 98% of patients. The primary outcome was repair failure, defined as greater than moderate MR or MV reoperation. RESULTS Of 847 patients with degenerative MR, successful repair was achieved in 843 patients (99.5% repair rate). Leaflet prolapse was posterior in 66%, anterior in 8%, and bileaflet in 26%. Cardiopulmonary bypass time and cross-clamp times were shorter in era 2 (CPB: 109 [IQR, 92-128] minutes vs 97 [IQR, 76-121] minutes; P < .001; cross-clamp: 88 [IQR, 73-106] minutes vs. 79 [IQR, 61-99] minutes; P < .001). Predismissal echocardiography demonstrated no MR or trace MR in 95%, mild MR in 4.7%, and moderate MR in 0.3% of patients. Operative mortality was similar in the eras (0.5% vs 0.5%; P > .999). The rates of 5-year freedom from repair failure (95.1% vs 95.5%; P = .707), stroke (96.8% vs 95.3%; P = .538), and endocarditis (99.3% vs 99.7%; P = .604) were similar between the eras. CONCLUSIONS Artificial cordal repair for all patients with degenerative MR simplifies MV repair and yields equivalent, excellent outcomes compared with a tailored resectional approach.
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Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Douglas Tran
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ethan Kotloff
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David Yim
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joshua Finkel
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sari D Holmes
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David Na
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen Devlin
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Filomena Koenigsberg
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Murtaza Dawood
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rachael Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Chemtob RA, Wierup P, Mick S, Gillinov M. Choosing the “Best” surgical techniques for mitral valve repair: Lessons from the literature. J Card Surg 2019; 34:717-727. [DOI: 10.1111/jocs.14089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Raphaelle A. Chemtob
- Department of Thoracic and Cardiovascular SurgeryHeart and Vascular Institute Cleveland Clinic Cleveland Ohio
| | - Per Wierup
- Department of Thoracic and Cardiovascular SurgeryHeart and Vascular Institute Cleveland Clinic Cleveland Ohio
| | - Stephanie Mick
- Department of Thoracic and Cardiovascular SurgeryHeart and Vascular Institute Cleveland Clinic Cleveland Ohio
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular SurgeryHeart and Vascular Institute Cleveland Clinic Cleveland Ohio
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Chan KL, Chen SY, Mesana T, Lam BK. Development of Mitral Stenosis After Mitral Valve Repair: Importance of Mitral Valve Area. Can J Cardiol 2017; 33:1701-1707. [DOI: 10.1016/j.cjca.2017.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 12/26/2022] Open
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Neochordoplasty versus leaflet resection for ruptured mitral chordae treatment: Virtual mitral valve repair. Comput Biol Med 2017; 90:50-58. [DOI: 10.1016/j.compbiomed.2017.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/23/2022]
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Essandoh M. Intraoperative Echocardiographic Assessment of Mitral Valve Area After Degenerative Mitral Valve Repair: A Call for Guidelines or Recommendations. J Cardiothorac Vasc Anesth 2016; 30:1364-8. [DOI: 10.1053/j.jvca.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 12/27/2022]
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Chua YL, Pang PYK, Yap YP, Abdul Salam ZH, Chen YT. Chordal Reconstruction versus Leaflet Resection for Repair of Degenerative Posterior Mitral Leaflet Prolapse. Ann Thorac Cardiovasc Surg 2015; 22:90-7. [PMID: 26727025 DOI: 10.5761/atcs.oa.15-00322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To review our experience of mitral valve repair for degenerative posterior mitral leaflet prolapse, comparing the outcomes of chordal reconstruction and leaflet resection. METHODS From 2000 to 2014, 205 patients underwent successful repair for degenerative posterior mitral leaflet prolapse. One hundred and four (51.5%) underwent leaflet resection (group R) and 98 (48.5%) underwent chordal reconstruction (group C). Follow-up was 96.5% complete with a mean follow-up of 6.1 ± 4.0 years. RESULTS Mean age was 57.0 ± 11.0 years. Males accounted for 73.8%. Ring annuloplasty was performed in 195 (96.5%). There were no operative mortalities within 30 days. Overall survival was 97.8% ± 1.3% at 7 years. Outcomes at 6 years: freedom from severe mitral regurgitation (group R 97.1% ± 2.0%, group C 100%, P = 0.288), freedom from moderate or severe mitral regurgitation (group R 97.1% ± 2.0%, group C 94.4% ± 5.4%, P = 0.541). Group C patients received larger annuloplasty rings and had significantly lower postoperative transmitral gradients. CONCLUSIONS Leaflet resection and chordal reconstruction are effective techniques for repair of degenerative posterior mitral leaflet prolapse. Both techniques result in a low incidence of recurrent mitral regurgitation. Chordal reconstruction accommodates larger annuloplasty rings and is associated with lower transmitral gradients.
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Affiliation(s)
- Yeow Leng Chua
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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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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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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Rim Y, Choi A, Laing ST, McPherson DD, Kim H. Three-dimensional echocardiography-based prediction of posterior leaflet resection. Echocardiography 2014; 31:E300-3. [PMID: 25109487 DOI: 10.1111/echo.12717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Clinical long-term outcomes have shown that partial leaflet resection followed by ring annuloplasty is a reliable and reproducible surgical repair technique for treatment of mitral valve (MV) leaflet prolapse. We report a 61-year-old male for three-dimensional transesophageal echocardiography (3DTEE)-based virtual posterior leaflet resection and ring annuloplasty. Severe mitral regurgitation was found and computational evaluation demonstrated substantial leaflet malcoaptation and high stress concentration. Following virtual resection and ring annuloplasty, posterior leaflet prolapse markedly decreased, sufficient leaflet coaptation was restored, and high stress concentration disappeared. Virtual MV repair strategies using 3DTEE have the potential to help optimize MV repair.
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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
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Pfannmüller B, Seeburger J, Davierwala P, Mohr FW. Repair of the anterior mitral leaflet prolapse. Expert Rev Med Devices 2013; 11:89-100. [PMID: 24308743 DOI: 10.1586/17434440.2014.862034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Repair of anterior mitral leaflet prolapse is one of the most challenging aspects in mitral valve repair surgery. In this review, we discuss the various techniques developed over the past three to four decades for the repair of anterior mitral leaflet prolapse, debate the pros and cons of each and compare their results, keeping reoperation for recurrent mitral regurgitation as the focal point of follow-up. At our center, chordal replacement with artificial expanded polytetrafluoroethylene sutures in the form of premeasured loops is the most commonly used technique for repair of anterior mitral leaflet prolapse for the past decade. We recommend and provide justification for the use of this technique, especially when mitral valve repair is performed through a minimally invasive approach. We believe that the trend towards a minimally invasive approach for mitral valve repair will exponentially increase in the next 5-10 years, at least until percutaneous techniques, if at all, become more reliable and safe.
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Affiliation(s)
- Bettina Pfannmüller
- Department of Cardiac Surgery, University of Leipzig Heart Center, Struempellstrasse 39 04289 Leipzig, Germany
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Nishigawa K, Takiuchi H, Kubo Y, Kubo H, Masaki H, Tanemoto K. Early outcomes of chordal reconstruction for posterior mitral leaflet prolapse. Asian Cardiovasc Thorac Ann 2012; 20:24-9. [PMID: 22371938 DOI: 10.1177/0218492311433774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We retrospectively reviewed 16 patients (7 men and 9 women, aged 36 to 77 years) who underwent mitral valve repair with chordal reconstruction for isolated posterior mitral leaflet prolapse. Preoperative echocardiography demonstrated moderate mitral regurgitation in 1, and severe regurgitation in 15. We routinely used expanded polytetrafluoroethylene sutures as artificial chords, and ring annuloplasty was performed in all cases (mean ring size, 30 ± 2 mm). After implanting the ring, the length of the artificial chords was adjusted repeatedly using saline solution. Early postoperative echocardiography at 7.1 ± 1.1 days after surgery showed mitral regurgitation grades reduced to none or trivial in 15/16 patients. One required reoperation for recurrent mitral regurgitation 1.5 years after surgery. In the other patients, intermediate-term echocardiography at 9.1 ± 10.1 months after surgery demonstrated that residual mitral regurgitation was less than mild. We concluded that chordal reconstruction is an effective and highly reproducible procedure for the repair of isolated posterior mitral leaflet prolapse. Artificial chords for the posterior mitral leaflet should not be too long, to avoid systolic anterior motion or recurrent mitral regurgitation after surgery.
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Affiliation(s)
- Kosaku Nishigawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
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Maslow A, Singh A, Mahmood F, Poppas A. Intraoperative Assessment of Mitral Valve Area After Mitral Valve Repair for Regurgitant Valves. J Cardiothorac Vasc Anesth 2011; 25:486-90. [DOI: 10.1053/j.jvca.2010.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Indexed: 01/16/2023]
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Maslow A, Gemignani A, Singh A, Mahmood F, Poppas A. Intraoperative Assessment of Mitral Valve Area After Mitral Valve Repair: Comparison of Different Methods. J Cardiothorac Vasc Anesth 2011; 25:221-8. [DOI: 10.1053/j.jvca.2010.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Indexed: 01/26/2023]
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Wong RHL, Lee APW, Ng CSH, Wan IYP, Wan S, Underwood MJ. Mitral Valve Repair: Past, Present, and Future. Asian Cardiovasc Thorac Ann 2010; 18:586-95. [DOI: 10.1177/0218492310383916] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mitral valve repair is the operation of choice for mitral valve regurgitation, with appropriate selection. Studies have shown that mitral repair is associated with a decrease in both long-term thromboembolic complications and mortality. Since its initial description, various selection criteria and techniques of mitral valve repair have been discussed in the literature. This review serves as a synopsis of the previous achievements, present status, and possible future directions of mitral valve repair, specifically from an Asian perspective. Vast experience has been amassed in understanding mitral valve pathophysiology, and excellent surgical treatments for mitral regurgitation have been developed. With the efforts of pioneers in the field of mitral valve repair, standard surgical treatment strategies have been proven to restore the life-expectancy of patients with degenerative mitral regurgitation to that of the age-adjusted population. Minimally invasive techniques of mitral valve repair further reduce access trauma, and could potentially benefit patients previously excluded from conventional surgery.
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Affiliation(s)
| | - Alex PW Lee
- Division of Cardiology Department of Medicine Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong, SAR, China
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Hashimoto K. Beginning and development of surgery for acquired valvular heart disease in Japan. Gen Thorac Cardiovasc Surg 2009; 57:573-84. [PMID: 19908111 DOI: 10.1007/s11748-009-0459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Indexed: 11/30/2022]
Abstract
The initiation and development of surgery for acquired valvular heart disease in Japan was reviewed. The first series of attempts at closed valvular surgery were performed in 1951-1952 by collaboration between the brothers Tohru and Shigeru Sakakibara in patients with pulmonary or mitral stenosis. During the popularization of closed valvular surgery, open heart surgery under direct vision was successfully performed by Shigeru Sakakibara with cooling of the body in 1954 and by using cardiopulmonary bypass (CPB) in 1956. With the development of CPB and artificial heart valves, closed valvular heart surgery was replaced by open surgery, which expanded rapidly during the 1960s and 1970s. Along with the serial introduction and improvement of mechanical vales thereafter, bioprosthetic valves were also introduced and were adopted for certain patients. Use of bioprosthetic valves in the aortic position exceeded 50% in 2005, along with the increase of elderly patients. Although trials of mitral valve plasty for mitral regurgitation were first done during the 1950s to 1960s in Japan, interest in valve plasty only increased during the late 1970s. Considering the patient's quality of life and the long-term results, mitral valve plasty became the major procedure (exceeding valve replacement) from 2004. In 2002, the Guideline for Surgical and Interventional Treatment of Valvular Heart Disease was published by a joint committee of the relevant academic societies, and it has made an important contribution to improving surgical outcomes.
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Affiliation(s)
- Kazuhiro Hashimoto
- Department of Cardiac Surgery, Jikei University School of Medicine, Nishishinbashi, Minato-ku, Tokyo, Japan.
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Falk V, Seeburger J, Czesla M, Borger MA, Willige J, Kuntze T, Doll N, Borger F, Perrier P, Mohr FW. How does the use of polytetrafluoroethylene neochordae for posterior mitral valve prolapse (loop technique) compare with leaflet resection? A prospective randomized trial. J Thorac Cardiovasc Surg 2008; 136:1205; discussion 1205-6. [DOI: 10.1016/j.jtcvs.2008.07.028] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 07/09/2008] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
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Gazoni LM, Fedoruk LM, Kern JA, Dent JM, Reece TB, Tribble CG, Smith PW, Lisle TC, Kron IL. A Simplified Approach to Degenerative Disease: Triangular Resections of the Mitral Valve. Ann Thorac Surg 2007; 83:1658-64; discussion 1664-5. [PMID: 17462375 DOI: 10.1016/j.athoracsur.2007.01.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 01/15/2007] [Accepted: 01/16/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Only 40% of patients with mitral valve (MV) regurgitation undergo operative repair rather than replacement. Quadrangular resection combined with ring annuloplasty has been the most common method of repair for degenerative posterior leaflet disease. Techniques such as sliding annuloplasty and artificial chord usage have increased the complexity of repair. These techniques have been perceived to be difficult and have possibly reduced the incidence of MV repair. We present our experience with a simplified approach to MV repair utilizing a triangular resection and larger rings. METHODS Retrospective review of all MV repairs over a 7-year period (1999 to 2006) revealed 154 patients who underwent triangular resection for degenerative disease. Patients who underwent ring annuloplasty without leaflet resection and patients who had artificial chords or quadrangular resections were excluded. RESULTS Of 154 patients who underwent triangular resection, isolated posterior leaflet resection was performed on 130 patients. Isolated anterior and combined anterior and posterior leaflet triangular resections were performed on 16 and 8 patients, respectively. Thirty-day postoperative mortality was 0%. Five-year freedom from reoperation for recurrent mitral regurgitation was 99.0%. No patients who had intended leaflet resection were converted to MV replacement. Intraoperative transesophageal echocardiogram revealed trace to 1+ mitral regurgitation. Mild systolic anterior motion was noted in 7.1% of cases initially, but resolved with volume loading in all. CONCLUSIONS Triangular leaflet resection of the mitral valve produces durable results and can be safely and efficiently performed with minimal morbidity and mortality. This technique should allow increased utilization of MV repair for degenerative disease.
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Affiliation(s)
- Leo M Gazoni
- Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
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Calafiore AM, Contini M, Iacò AL, Di Mauro M, Bivona A, Weltert L. Mitral valve repair for degenerative mitral regurgitation. J Cardiovasc Med (Hagerstown) 2007; 8:114-8. [PMID: 17299293 DOI: 10.2459/01.jcm.0000260212.67488.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mitral valve repair for degenerative mitral regurgitation is nowadays one of the most common valvular procedures. Different technical modifications were added to the original Carpentier's method, trying to maximise the stability of the results and to reduce the incidence of immediate complications and of late failure of the correction. Survival is good, even if recent reports showed that recurrence of mitral regurgitation can be higher than expected. Prolapse of the anterior leaflet remains challenging and is related to higher reintervention rates. Nevertheless, the overall success rate is high, and the increasing experience of the different surgical teams approaching this procedure will help maintain satisfactory and stable long-term results.
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Sakamoto Y, Hashimoto K, Okuyama H, Ishii S, Taguchi S, Kagawa H, Yoshitake M. Midterm results of mitral valve repair with the Carpentier-Edwards rigid ring. ACTA ACUST UNITED AC 2006; 54:56-60. [PMID: 16519129 DOI: 10.1007/bf02744601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Prosthetic annuloplasty rings play an important role in mitral valve repair. This clinical study was undertaken to evaluate the midterm results obtained with the Carpentier-Edwards rigid ring. METHODS Between October 1991 and March 2005, 112 patients (mean age 53.0 years) underwent mitral valve repair with a Carpentier-Edwards rigid ring at our institution. Degenerative disease was the most frequent cause and a small number had other conditions such as endocarditis and rheumatic disease. Ten patients were in Carpentier's functional class Type I, 101 patients in Type II and 1 patient in Type III, based on valve pathology. Ischemic mitral regurgitation was excluded. The mean follow-up time was 5.3+/-3.6 years (range: 8 days to 12.3 years). All patients were completely followed by echocardiography. RESULTS The rigid ring ranged from 26 to 36 mm in diameter and the most common size was 30 mm. Although the mitral orifice area was decreased after mitral valve repair in all patients, none of them required reoperation because of mitral stenosis or left ventricular outflow tract obstruction (systolic anterior motion). Reduction of both systolic and diastolic left ventricular volumes was observed postoperatively. Ejection fractions were preserved in all cases. The actuarial survival rate was 92.0+/-3.0% at 10 years and the reoperation-free rate at 10 years was 96.0+/-2.0%. CONCLUSION The rigid ring has produced promising midterm results in terms of reoperation-free and survival rates.
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Affiliation(s)
- Yoshimasa Sakamoto
- , Department of Cardiovascular Surgery, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan
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