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Bahiraie P, Soleimani H, Heydari N, Najafi K, Karlas A, Avgerinos DV, Samanidis G, Kuno T, Doulamis IP, Ioannis I, Spilias N, Hosseini K, Kampaktsis PN. Mitral Valve Repair of the Anterior Leaflet: Are We There Yet? Hellenic J Cardiol 2024:S1109-9666(24)00025-3. [PMID: 38355045 DOI: 10.1016/j.hjc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/14/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024] Open
Abstract
Mitral regurgitation is one of the most prevalent valvulopathies with a disease burden that incurs significant healthcare costs globally. Surgical repair of the posterior mitral valve leaflet is a standard treatment, but approaches for repairing the anterior mitral valve leaflet are not widely established. Since anterior leaflet involvement is less common and more difficult to repair, fewer studies have investigated its natural history and treatment options. In this review, we discuss surgical techniques for repairing the anterior leaflet and their outcomes, including survival, reoperation, and recurrence of regurgitation. We show that most patients with mitral regurgitation from the anterior leaflet can be repaired with good outcomes if performed at centers with expertise. Additionally, equal consideration for early repair should be given to patients with mitral regurgitation from both anterior and posterior pathology. However, more studies to better evaluate the efficacy and safety of anterior mitral valve leaflet repair are needed.
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Affiliation(s)
- Pegah Bahiraie
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Narges Heydari
- Faculty of medicine, Isfahan University of medical science, Isfahan, Iran.
| | - Kimia Najafi
- Faculty of medicine, Tehran University of medical sciences, Tehran, Iran.
| | - Angelos Karlas
- Institute for Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany; Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
| | | | | | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, NYC, NY.
| | - Ilias P Doulamis
- Department of Surgery, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD.
| | | | - Nikolaos Spilias
- Division of Cardiovascular Medicine, University of Miami Health System, Miami, FL.
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Kehara H, Minakata K, McCarthy J, Sunagawa G, Mangukia C, Brann S, Zhao H, Boova R, Toyoda Y. Early and late results of mitral valve repair with anterior leaflet patch augmentation. Interact Cardiovasc Thorac Surg 2022; 35:6595026. [PMID: 35640545 PMCID: PMC9373942 DOI: 10.1093/icvts/ivac144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/14/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to determine the long-term results of mitral valve (MV) repair with anterior leaflet patch augmentation.
METHODS
Between 2012 and 2015, 45 patients underwent MV repair using the anterior leaflet patch augmentation technique at our institution. The mean age of the patients was 65.9 ± 13.0 years (16 males). We reviewed the MV pathology and the surgical techniques used and assessed the early and late results.
RESULTS
In terms of MV pathology, 43 patients (95.6%) had pure mitral regurgitation (MR) and 2 patients (4.4%) had mixed mitral stenosis and MR. Rheumatic changes were seen in 18 patients (40.0%). Postoperative echocardiography showed that 95.6% of patients had none to mild MR. During a median follow-up period of 5.5 years (range 0.1–8.3 years), there were 8 late deaths. Nine patients (20%) required reoperation. The mean interval between the initial operation and redo operation was 3.7 ± 3.1 years (range: 0.4–7.8 years). The causes of reoperation included patch dehiscence (n = 4), progression of mitral stenosis (n = 2), band dehiscence (n = 1), patch enlargement (n = 1) and unknown (n = 1). Eight patients underwent MV replacement and 1 underwent repeat MV repair. The freedom from reoperation at 3 and 5 years was 85.7 ± 6.7% and 81.2 ± 7.7%, respectively.
CONCLUSIONS
Anterior leaflet patch augmentation can provide excellent early results in the majority of the patients even in the presence of rheumatic pathology; however, we observed late reoperation in 20% of patients. Thus, this technique should be used with caution and careful follow-up with serial echocardiography is essential.
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Affiliation(s)
- Hiromu Kehara
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Kenji Minakata
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - James McCarthy
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Gengo Sunagawa
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Chirantan Mangukia
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Stacey Brann
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Huaqing Zhao
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Robert Boova
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Yoshiya Toyoda
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
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Brescia AA, Watt TMF, Murray SL, Rosenbloom LM, Kleeman KC, Allgeyer H, Eid J, Romano MA, Bolling SF. Rheumatic mitral valve repair or replacement in the valve-in-valve era. J Thorac Cardiovasc Surg 2022; 163:591-602.e1. [PMID: 32620398 PMCID: PMC7655552 DOI: 10.1016/j.jtcvs.2020.04.118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE For degenerative mitral disease, repair is superior to replacement; however, the best operative strategy for rheumatic mitral disease remains unclear. We evaluated the association between decision-making in choosing repair versus replacement and outcomes across 2 decades of rheumatic mitral surgery. METHODS Patients undergoing isolated, first-time rheumatic mitral surgery were identified. Era 1 (1997-2008) and Era 2 (2009-2018) were distinguished by intraoperative assessment of anterior leaflet mobility/calcification (Era 2) in deciding between mitral repair versus replacement. Primary outcome was a composite of death, reoperation, and severe valve dysfunction. RESULTS Among 180 patients, age was 59 ± 14 years, and ejection fraction was 58% ± 10%. A higher proportion in Era 1 (n = 56) compared with Era 2 (n = 124) had preoperative atrial fibrillation (68% vs 46%; P = .006); the groups were otherwise similar. Primary indication was mitral stenosis in 69% (124 out of 180; pure = 35, mixed = 89) and did not differ by era (P = .67). During Era 1, 70% (39 out of 56) underwent repair, compared with 33% (41 out of 124) during Era 2 (P < .001). Freedom from death, reoperation, or severe valve dysfunction at 5 years was higher in Era 2 (72% ± 9%) than Era 1 (54% ± 13%; P = .04). Five-year survival was higher in Era 2 than Era 1, but did not differ between repair versus replacement. Five-year cumulative incidence of reoperation with death as a competing risk did not differ by era, but was higher after repair than replacement. CONCLUSIONS Careful assessment of anterior leaflet mobility/calcification to determine mitral repair or replacement was associated with improved outcomes. This decision-making strategy may alter the threshold for rheumatic mitral replacement in the current valve-in-valve era.
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Affiliation(s)
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- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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4
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Secondary Mitral Regurgitation Repair Techniques and Outcomes: Initial Clinical Experience with Mitral Valve Translocation. JTCVS Tech 2022; 13:53-57. [PMID: 35711194 PMCID: PMC9196134 DOI: 10.1016/j.xjtc.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
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Initial Clinical Experience With Mitral Valve Translocation for Secondary Mitral Regurgitation. Ann Thorac Surg 2021; 112:1946-1953. [PMID: 33440174 DOI: 10.1016/j.athoracsur.2020.12.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/05/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Functional (secondary) mitral regurgitation (FMR) results from altered geometry of the mitral valve apparatus. Repair with restrictive mitral annuloplasty is associated with high rates of recurrent mitral regurgitation (MR). We developed a novel operative repair for FMR that translocates the intact mitral valve towards the apex. METHODS The mitral valve was detached circumferentially and translocated into the ventricle with a frustum-shaped glutaraldehyde-treated autologous pericardial patch. Clinical and echocardiographic follow-up was performed. RESULTS Fifteen consecutive patients with FMR (mean age, 59 years; 67% female) had mitral valve translocation between 2018 and 2020. Preoperative mean ejection fraction, left ventricular end-diastolic dimension, and systolic pulmonary artery pressure were 40% ± 11%, 59 ± 8 mm, and 49 ± 21 mm Hg, respectively; 33% had atrial fibrillation. Cardiomyopathy was ischemic in 4 and nonischemic in 11. Concomitant procedures included tricuspid valve operation (n = 8), coronary artery bypass grafting (n = 4), and atrial fibrillation ablation (n = 5). Post bypass transesophageal echocardiogram demonstrated none/trace MR in all patients and mean gradient of 3 mm Hg (interquartile range, 2-4 mm Hg). Mean leaflet extent of coaptation was 14 ± 2 mm (range, 11-17 mm). There was no postoperative mortality, stroke, or renal failure. Predismissal echocardiography showed none/trace MR in 14 patients and mild MR in 1. One patient underwent successful late rerepair of a suture line leak. Twelve patients were alive at latest follow-up and MR at 1 and 6 months was mild or less in all patients with mean leaflet extent of coaptation of 14 ± 2 mm (range, 12-16 mm) at 6 months. CONCLUSIONS Mitral valve translocation creates a large surface of coaptation and effectively corrects FMR. Further study is needed to demonstrate the long-term durability and clinical utility of this operation.
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Jaworek M, Mangini A, Maroncelli E, Lucherini F, Rosa R, Salurso E, Votta E, Antona C, Fiore GB, Vismara R. Ex Vivo Model of Functional Mitral Regurgitation Using Deer Hearts. J Cardiovasc Transl Res 2020; 14:513-524. [PMID: 32959169 PMCID: PMC8219575 DOI: 10.1007/s12265-020-10071-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
Transcatheter therapies are emerging for functional mitral regurgitation (FMR) treatment, however there is lack of pathological models for their preclinical assessment. We investigated the applicability of deer hearts for this purpose. 8 whole deer hearts were housed in a pulsatile flow bench. At baseline, all mitral valves featured normal coaptation. The pathological state was induced by 60-minutes intraventricular constant pressurization. It caused mitral annulus dilation (antero-posterior diameter increase from 31.8 ± 5.6 mm to 39.5 ± 4.9 mm, p = 0.001), leaflets tethering (maximal tenting height increase from 7.3 ± 2.5 mm to 12.7 ± 3.4 mm, p < 0.001) and left ventricular diameter increase (from 67.8 ± 7.5 mm to 79.4 ± 6.5 mm, p = 0.004). These geometrical reconfigurations led to restricted mitral valve leaflets motion and leaflet coaptation loss. Preliminary feasibility assessment of two FMR treatments was performed in the developed model. Deer hearts showed ability to dilate under constant pressurization and have potential to be used for realistic preclinical research of novel FMR therapies. Graphical abstract figure legend: Deer heart mitral valve fiberscopic and echocardiographic images in peak systole at baseline and after inducing the pathological conditions representing functional mitral regurgitation. In the pathological conditions lack of coaptation between the leaflets, enlargement of the antero-posterior distance (red dashed line) and the left ventricular diameter (orange dashed line) were observed. ![]()
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Affiliation(s)
- Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy. .,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.
| | - Andrea Mangini
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.,Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
| | - Edoardo Maroncelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Rubina Rosa
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.,Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy
| | - Eleonora Salurso
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carlo Antona
- ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy.,Cardiovascular Surgery Department, ASST Fatebenefratelli Luigi Sacco University Hospital, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Golgi 39, 20133, Milan, Italy.,ForcardioLab - Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
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7
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Long-term Performance of Fresh Autologous Pericardium for Mitral Valve Leaflet Repair. Ann Thorac Surg 2020; 109:36-41. [DOI: 10.1016/j.athoracsur.2019.05.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/12/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
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8
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Fukunaga N, Sakata R, Koyama T. Reoperative analysis after mitral valve repair with glutaraldehyde-treated autologous pericardium. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Kelley TM, Kashem M, Wang H, McCarthy J, Carroll ND, Moser GW, Guy TS. Anterior Leaflet Augmentation With CorMatrix Porcine Extracellular Matrix in Twenty-Five Patients: Unexpected Patch Failures and Histologic Analysis. Ann Thorac Surg 2017; 103:114-120. [DOI: 10.1016/j.athoracsur.2016.05.090] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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10
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A Systematic Review of Mitral Valve Repair With Autologous Pericardial Leaflet Augmentation for Rheumatic Mitral Regurgitation. Ann Thorac Surg 2016; 102:1400-5. [PMID: 27319989 DOI: 10.1016/j.athoracsur.2016.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/27/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
Abstract
A systematic review was conducted to assess the efficacy of mitral valve repair using glutaraldehyde-treated autologous pericardial leaflet augmentation for rheumatic mitral regurgitation (MR). Five retrospective studies were identified, which included 196 patients with moderate or greater MR. There was 1 operative death (0.5%). At a mean follow-up of 3.2 ± 2.2 years, moderate or greater MR reoccurred in 22 patients (11.2%), reoperation was required in 9 (4.6%), and the cumulative survival was 98.9%. Finally, outcomes were similar between the patients who underwent augmentation of the anterior vs the posterior mitral leaflet. Pericardial leaflet augmentation is a viable technique for the treatment of rheumatic MR.
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11
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Maslow A. Mitral Valve Repair: An Echocardiographic Review: Part 2. J Cardiothorac Vasc Anesth 2015; 29:439-71. [DOI: 10.1053/j.jvca.2014.03.013] [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: 03/16/2014] [Indexed: 12/12/2022]
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12
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Late Results of Mitral Valve Repair With Glutaraldehyde-Treated Autologous Pericardium. Ann Thorac Surg 2013; 95:2000-5. [DOI: 10.1016/j.athoracsur.2013.02.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/20/2022]
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13
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Dillon J, Yakub MA, Nordin MN, Pau KK, Krishna Moorthy PS. Leaflet extension in rheumatic mitral valve reconstruction. Eur J Cardiothorac Surg 2013; 44:682-9. [PMID: 23407161 DOI: 10.1093/ejcts/ezt035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Type IIIa mitral regurgitation (MR) due to rheumatic leaflet restriction often renders valve repair challenging and may predict a less successful repair. However, the utilization of leaflet mobilization and extension with the pericardium to increase the surface of coaptation may achieve satisfactory results. We reviewed our experience with leaflet extension in rheumatic mitral repair with emphasis on the technique and mid-term results. METHODS Between 2003 and 2010, 62 of 446 rheumatic patients had leaflet extension with glutaraldehyde-treated autologous pericardium as part of their mitral repair procedure. Their clinical and echocardiographic data were prospectively analysed. RESULTS The mean age of the rheumatic patients was 20.2 ± 11.7 years; range 3-60 years. Fourty-eight (77.4%) patients had predominant MR, while 22.6% had mixed mitral stenosis and mitral regurgitation (MS/MR). Leaflet extension was performed in the posterior, anterior and both leaflets in 77, 13 and 10% of patients, respectively. Additional repair procedures included neo-chordal replacement, chordal transfer/shortening/fenestration/resection, commissurotomy and papillary muscle splitting. All repairs were stabilized with annuloplasty rings. The follow-up was complete in all patients with a mean follow-up of 36.5 ± 25.6 months. There was no mortality in this series. At the latest follow-up, the MR grade was none/trivial in 64.5 of patients, mild in 22.6, moderate in 6.5, moderately severe in 4.8 and severe in 1.6%. Two patients had redo mitral surgery. At 5 years postoperatively, the estimated rates of freedom from reoperation and valve failure were 96.8 and 91.6%, respectively. CONCLUSIONS Repair with leaflet extension in rheumatic disease resulted in good early and mid-term outcomes. A wider utilization of this technique may increase the feasibility and durability of repair in complex rheumatic mitral valve disease.
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Affiliation(s)
- Jeswant Dillon
- Department of Cardiothoracic Surgery, National Heart Institute, Kuala Lumpur, Malaysia
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14
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Okada Y. Surgical management of mitral annular calcification. Gen Thorac Cardiovasc Surg 2013; 61:619-25. [DOI: 10.1007/s11748-013-0207-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Indexed: 11/24/2022]
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15
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Ostli B, Vester-Petersen J, Askov JB, Honge JL, Levine RA, Hagège A, Nielsen SL, Hasenkam JM, Nygaard H, Jensen MO. In Vitro System for Measuring Chordal Force Changes Following Mitral Valve Patch Repair. Cardiovasc Eng Technol 2012; 3:263-268. [PMID: 26273417 DOI: 10.1007/s13239-012-0098-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Attention towards optimization of mitral valve repair methods is increasing. Patch augmentation is one strategy utilized to correct functional mitral regurgitation or systolic anterior motion in complex mitral valve repairs. This article describes a system for investigating the redistribution of chordae tendineae tension as a reflection of altered stress distribution of the valve leaflet following patch augmentation. METHODS AND MATERIALS An in vitro test setup was constructed to hold native porcine mitral valves containing an annulus and papillary muscle positioning system. The alterations caused by patch augmentation should be visual from both the atrial and ventricular views. Ventricular pressure was regulated stepwise in a range of 0-150 mmHg. To test the system, the anterior mitral leaflet was extended by a pericardial patch sutured to the mid/basal part of the leaflet, and the chordae tendineae force was measured as the ventricular pressure was applied. RESULTS The system demonstrated the capacity to hold native porcine mitral valves and introducing patch repairs according to clinical practice. The porcine mitral valve test setup indicated strong correlation between the forces in the mitral valve secondary chordae tendineae and the applied transvalvular pressure (R2 = 0.95). CONCLUSION This test setup proved the ability to obtain normal mid-systolic mitral valve function, secondary chordae force measurements, and important preservation of the visual access: Hence, obtaining the pressure-force relationship as well as identifying any shift of the secondary chordae insertion point on the anterior leaflet relative to the coaptation zone was made possible.
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Affiliation(s)
- B Ostli
- Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark
| | - J Vester-Petersen
- Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark
| | - J B Askov
- Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark ; Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - J L Honge
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - R A Levine
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - A Hagège
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology; University Paris Descartes; INSERM U 633; Paris, France
| | - S L Nielsen
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - J M Hasenkam
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - H Nygaard
- Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark ; Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - M O Jensen
- Dept. of Biomedical Engineering, Engineering College of Aarhus, Aarhus, Denmark ; Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
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16
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Granier M, Jensen MO, Honge JL, Bel A, Menasché P, Nielsen SL, Carpentier A, Levine RA, Hagège AA. Consequences of mitral valve prolapse on chordal tension: ex vivo and in vivo studies in large animal models. J Thorac Cardiovasc Surg 2011; 142:1585-7. [PMID: 21955468 DOI: 10.1016/j.jtcvs.2011.08.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/15/2011] [Accepted: 08/25/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Mathieu Granier
- Laboratory of Biosurgical Research, Foundation Alain Carpentier, Paris, France
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17
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Shin H, Mori M, Yamabe K, Iwanaga S. Reconstruction of the free margin of the anterior mitral leaflet with autologous pericardium in active infected endocarditis. Eur J Cardiothorac Surg 2011; 39:784-5. [PMID: 20932770 DOI: 10.1016/j.ejcts.2010.08.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/13/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022] Open
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18
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Gupta A, Gharde P, Kumar AS. Anterior mitral leaflet length: predictor for mitral valve repair in a rheumatic population. Ann Thorac Surg 2011; 90:1930-3. [PMID: 21095338 DOI: 10.1016/j.athoracsur.2010.07.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 07/11/2010] [Accepted: 07/14/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The length and mobility of the anterior mitral leaflet (AML) are considered important for mitral valve reparability. In this study, we looked at AML length as a predictor of mitral valve reparability in a rheumatic population. METHODS Between May and November 2008, 44 patients underwent mitral valve repair for pure mitral regurgitation, pure mitral stenosis, and mixed lesions. The mean age was 26.5 ± 10.4 years (range, 9 to 50; median 23.5), and 15 patients were less than 20 years old. There were 28 female patients. The mean body surface area was 1.37 ± 0.13 (range, 0.97 to 1.62). In all patients, we measured AML length at the A2 segment, both by transesophageal echocardiography and intraoperative direct measurement. These measurements were indexed to the body surface area. RESULTS Thirty-five patients had successful repair. Nine patients underwent mitral valve replacement after failed repair. The AML lengths were significantly higher in the successful repair group as compared with the failed repair group (AML length measured by transesophageal echocardiography was 31.4 ± 4.9 mm versus 24.1 ± 2.2 mm, p = 0.001; AML length measured intraoperatively was 30.8 ± 4.4 mm versus 22.3 ± 1.5 mm, p = 0.001). An intraoperatively measured AML length of 26 mm or more predicts reparability with 97.1% sensitivity and 100% specificity. Transesophageal echocardiography can reliably judge AML length and can also predict reparability. Indexed AML lengths are an even stronger predictor of mitral valve reparability, especially in a pediatric population. CONCLUSIONS Indexed AML length is a strong predictor of mitral valve reparability. With a value of 18 mm/m(2) or more, repair can be accomplished in all cases.
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Affiliation(s)
- Anubhav Gupta
- Department of Cardiovascular and Thoracic Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Inafuku H, Morishima Y, Nagano T, Arakaki K, Yamashiro S, Kuniyoshi Y. A three-decade experience of radical open endvenectomy with pericardial patch graft for correction of Budd-Chiari syndrome. J Vasc Surg 2009; 50:590-3. [PMID: 19700095 DOI: 10.1016/j.jvs.2009.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/18/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We previously reported the value of our operative procedure for Budd-Chiari syndrome (BCS) that comprised reconstruction of the occluded or severely stenosed inferior vena cava (IVC) using an autologous pericardium patch and reopening as many occluded hepatic veins as possible. Here, we present the long-term durability and efficacy of the autologous pericardium patch for reconstruction of the IVC in BCS. METHODS We retrospectively analyzed a series of 53 consecutive patients (mean age, 48.4 +/- 12.8 years; range, 24-76 years; 34 men) who underwent surgical treatment for BCS at our institution from 1979 to 2008. Patency of the IVC and hepatic veins was examined by venography at discharge. Patients attended an outpatient clinic every 1 or 2 months for follow-up. The reconstructed IVC was evaluated by enhanced computed tomography every 1 or 2 years. RESULTS Two in-hospital (operative mortality, 3.7%) and 15 late deaths occurred. During a mean follow-up of 7.6 +/- 6.5 years (range, 0.08-24.1 years), the reconstructed IVC became totally obstructed in three patients, of whom two underwent reoperation, and severely stenosed in two patients, who required percutaneous transvenous balloon venoplasty (PTV). The 5- and 10-year patency rates without reoperation or PTV for the reconstructed IVC were 90.5% and 84.3%, respectively. The cumulative 5- and 10-year survival rates were 89.8% and 70.7%, respectively. CONCLUSION The autologous pericardium patch is effective and durable for reconstructing a diseased IVC in BCS.
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Affiliation(s)
- Hitoshi Inafuku
- Department of Cardiovascular Surgery, Thoracic and Cardiovascular Surgery Division, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
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Tang H, Xu Z, Zou L, Han L, Lu F, Lang X, Song Z. Valve repair with autologous pericardium for organic lesions in rheumatic tricuspid valve disease. Ann Thorac Surg 2009; 87:726-30. [PMID: 19231380 DOI: 10.1016/j.athoracsur.2008.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 11/29/2008] [Accepted: 12/01/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical repair of pathologic tricuspid valve disease often fails because of severe anatomic distortion of the valve apparatus, particularly in patients with rheumatic heart disease. This usually leads to tricuspid valve replacement despite the associated prosthesis-related complications. This study examines our experience of tricuspid valve repair with autologous pericardium for organic rheumatic tricuspid valve disease. METHODS From 1996 to 2007, 31 patients underwent repairs for rheumatic tricuspid valve disease characterized by retracted leaflets and inadequate leaflet area. The patients, aged 14 to 56 years, had a mean New York Heart Association (NYHA) class of 2.9 +/- 0.6. All patients presented with severe tricuspid regurgitation and coexisting left-sided heart valve disease. Glutaraldehyde-treated autologous pericardial patch was used to augment tricuspid valve leaflets. Other techniques were applied as needed, including commissurotomy, leaflet mobilization, annuloplasty, and prosthetic ring implantation. Concomitant operations included left-sided valve replacement in all, and left atrial thrombus removal in 3 patients. Follow-up duration was 4 to 126 months. RESULTS No deaths or late reoperations occurred. All patients demonstrated clinical improvements on follow-up. Echocardiographic studies before hospital discharge showed less than mild tricuspid regurgitation in all patients. The most recent echocardiographic follow-up showed no tricuspid regurgitation in 10 patients (32.3%), trivial regurgitation in 12 (38.7%), mild regurgitation in 8 (25.8%), and moderate regurgitation in 1 (3.2%). CONCLUSIONS In selected patients, organic rheumatic tricuspid valve disease can be treated with pericardial patch to augment the retracted leaflets in combination with other techniques. Follow-up reveals excellent tricuspid valve function.
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Affiliation(s)
- Hao Tang
- Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
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Calafiore AM, Iacò AL, Bivona A, Bosco P, Di Mauro M. La insuficiencia mitral isquémica crónica: el dilema quirúrgico de esta década. CIRUGIA CARDIOVASCULAR 2009. [DOI: 10.1016/s1134-0096(09)70167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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