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Tabata M, Yanagisawa H. Nonresectional folding repair techniques for posterior leaflet lesions in degenerative mitral regurgitation. JTCVS Tech 2021; 10:68-73. [PMID: 34977707 PMCID: PMC8691861 DOI: 10.1016/j.xjtc.2021.09.052] [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: 07/31/2021] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
- Department of Cardiovascular Surgery, Toranomon Hospital, Tokyo, Japan
- Address for reprints: Minoru Tabata, MD, PhD, MPH, Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu-shi, Chiba 279-0001, Japan.
| | - Hiromi Yanagisawa
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
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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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Gillinov AM, Mihaljevic T, Javadikasgari H, Suri RM, Mick SL, Navia JL, Desai MY, Bonatti J, Khosravi M, Idrees JJ, Lowry AM, Blackstone EH, Svensson LG. Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases. J Thorac Cardiovasc Surg 2018; 155:82-91.e2. [DOI: 10.1016/j.jtcvs.2017.07.037] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 02/07/2023]
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Zanobini M, Ricciardi G, Mammana FL, Kassem S, Poggio P, Di Minno A, Cavallotti L, Saccocci M. The 'respect rather than resect' principle in mitral valve repair: the lateral dislocation of the P2 technique. J Cardiovasc Med (Hagerstown) 2017; 18:687-690. [PMID: 28697003 DOI: 10.2459/jcm.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Leaflet resection represents the reference standard for surgical treatment of mitral valve (MV) regurgitation. New approaches recently proposed place emphasis on respecting, rather than resecting, the leaflet tissue to avoid the drawbacks of the 'resection' approach. OBJECTIVES The lateral dislocation of mid portion of mitral posterior leaflet (P2) technique for MV repair is a nonresectional technique in which the prolapsed P2 segment is sutured to normal P1 segment. Our study evaluates the effectiveness of this technique. PATIENTS AND METHODS We performed the procedure on seven patients. Once ring annular sutures were placed, the prolapsed P2 segment was dislocated toward the normal P1 segment with a rotation of 90° and without any resection. If present, residual clefts between P2 and P3 segments were closed. Once the absence of residual mitral regurgitation is confirmed by saline pressure test, ring annuloplasty was completed. The valve was evaluated using transesophageal echocardiography in the operating room and by transthoracic echocardiography before discharge. RESULTS At the last follow-up visit, transthoracic echocardiography revealed no mitral regurgitation and normal TRANSVALVULAR gradients. CONCLUSION The lateral dislocation of P2 is an easily fine-tuned technique for isolated P2 prolapse, with the advantage of short aortic cross-clamp and cardiopulmonary bypass times. We think it might be very favorable in older and frail patients. Long-term follow-up is necessary to assess the durability of this technique.
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Affiliation(s)
- Marco Zanobini
- Department of Cardiovascular Disease, IRCCS Centro Cardiologico Monzino, Milan, Italy
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Gosev I, Yammine M, Leacche M, McGurk S, Ivkovic V, D'Ambra MN, Cohn LH. Long term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation. Ann Cardiothorac Surg 2015; 4:428-32. [PMID: 26539347 DOI: 10.3978/j.issn.2225-319x.2014.12.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Posterior mitral valve leaflet prolapse due to degenerative mitral valve disease has been treated with tissue sparing repair techniques since 2002. The simplified foldoplasty technique effectively lowers the height of the redundant posterior leaflet and creates an optimal coaptation line for the anterior leaflet that results in excellent long term durability, freedom from reoperation, and return of functional status. METHODS Patient demographics and in-hospital outcome data were extracted from electronic medical records of 229 patients, aged 60.6±13.7 years who underwent the procedure for mitral valve repair (MVR) involving the posterior leaflet from myxomatous disease between 2002 and 2014. Parametric analyses were performed on outcomes data, while long-term survival was assessed by Kaplan-Meier analyses. RESULTS Concomitant coronary bypass surgery was performed on 32/229 (14%) patients, the mean perfusion time was 119±40 min, and the mean cross clamp time was 86±31 min. Post-operative mortality was 2/229 (0.9%), reoperation for bleeding occurred in 4 (1.7%) and postoperative stroke in 4 (1.7%) patients. Long term follow up rate was 100% and the mean study follow-up duration was 6.8±2.3 years. Overall late mortality rate was 24/229 (14.9%), and mitral valve re-intervention was performed on 7 patients (4.3%). NYHA class III/IV and clinically significant MR at follow up were significantly lower compared to preoperative values (both P<0.001). CONCLUSIONS Our results encourage further use of this simple and effective technique in patients with isolated posterior leaflet prolapse.
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Affiliation(s)
- Igor Gosev
- 1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Maroun Yammine
- 1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marzia Leacche
- 1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Siobhan McGurk
- 1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Vladimir Ivkovic
- 1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael N D'Ambra
- 1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lawrence H Cohn
- 1 Division of Cardiac Surgery, 2 Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Ben Zekry S, Spiegelstein D, Sternik L, Lev I, Kogan A, Kuperstein R, Raanani E. Simple repair approach for mitral regurgitation in Barlow disease. J Thorac Cardiovasc Surg 2015; 150:1071-7.e1. [DOI: 10.1016/j.jtcvs.2015.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 07/27/2015] [Accepted: 08/09/2015] [Indexed: 11/25/2022]
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Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:252-7; discussion 257. [PMID: 26360980 DOI: 10.1097/imi.0000000000000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although effective, Carpentier technique for mitral regurgitation presents two "Achille's heel": the resection of the whole prolapsing section of posterior mitral leaflet (PML) including chordae tendinae and the annular distortion due to plication. An alternative technique of limited PML resection, which preserves mitral anatomy decreasing the impact on valve function, and 9-year outcome are presented. METHODS Since April 2005 till March 2014, of 205 patients affected by mitral prolapse scheduled for repair (mitral valve repair), 54 patients have been included in the study. The rationale of the new technique was to limit PML resection to achieve a fair reduction of the prolapsing scallop(s) height, to avoid leaflet and annular distortion, and to spare the coaptation surface and other substantial structures. According to the observation that the posterior smooth zone of PML is quite free from chordal insertions, an elliptical slice of tissue was resected from this area. Annuloplasty and neochordal insertion when indicated completed the procedure. RESULTS Up to 9 years of follow-up was 98% complete. One in-hospital death, two late noncardiac deaths, one redo operation due to endocarditis were reported. On late follow-up, 92% patients were on New York Heart Association class I. Late echocardiography showed stability of repair (regurgitation grade of ≤1 in 92% of patients). Nearly two third of valves preserved good PML mobility. CONCLUSIONS The parannular elliptical posterior leaflet resection, providing excellent stable midterm results, seems to be a safe alternative method for repair of PML prolapse. It avoids distortion and weakening of annulus and leaflet, and it allows restoring a proper coaptation surface and maintains a satisfactory PML motion.
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Da Col U, Perticoni S, Ramoni E. Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000406] [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]
Affiliation(s)
- Uberto Da Col
- Department of Cardiac Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Simone Perticoni
- Department of Cardiac Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Enrico Ramoni
- Department of Cardiac Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
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A simple approach to mitral valve repair: Posterior leaflet height adjustment using a partial fold of the free edge. J Thorac Cardiovasc Surg 2014; 148:2780-6. [DOI: 10.1016/j.jtcvs.2014.06.075] [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: 03/25/2014] [Revised: 06/02/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022]
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Feins EN, Yamauchi H, Marx GR, Freudenthal FP, Liu H, Del Nido PJ, Vasilyev NV. Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model. J Thorac Cardiovasc Surg 2014; 147:783-90; discussion 790-1. [PMID: 24210830 PMCID: PMC3947119 DOI: 10.1016/j.jtcvs.2013.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 09/12/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Recently, there has been increased interest in minimally invasive mitral valve prolapse repair techniques; however, these techniques have limitations. A new technique was developed for treating mitral valve prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip's efficacy was tested in an animal model. METHODS Yorkshire pigs (n = 7) were placed on cardiopulmonary bypass (CPB), and mitral valve prolapse was created by cutting chordae supporting the P2 segment of the posterior leaflet. Animals were weaned off CPB and mitral regurgitation (MR) was assessed echocardiographically. CPB was reinitiated and the plication clip was applied under direct vision to the P2 segment to eliminate the prolapse. The animals survived for 2 hours. Epicardial echocardiography was obtained before and after prolapse creation and 2 hours after clip placement to quantify MR grade and vena contracta area. Posterior leaflet mobility and coaptation height were analyzed before and after clip placement. RESULTS There were no cases of clip embolization. Median MR grade increased from trivial (0-1.5) to moderate-severe after MR creation (2.5-4+) (P < .05), and decreased to mild after clip placement (0-3+) (P < .05). Vena contracta area tended to increase after cutting the chordae and decrease after clip placement: 0.08 ± 0.10 cm(2) versus 0.21 ± 0.15 cm(2) versus 0.16 ± 0.16 cm(2) (P = .21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51 ± 0.07 cm versus 0.44 ± 0.18 cm (P = 1.0). CONCLUSIONS The leaflet plication clip can treat mitral valve prolapse in an animal model, restoring coaptation height without affecting leaflet mobility. This approach is a simple technique that may improve the effectiveness of beating-heart and minimally invasive valve surgery.
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Affiliation(s)
- Eric N Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Haruo Yamauchi
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | | | - Hua Liu
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Nikolay V Vasilyev
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
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Off-pump transapical implantation of artificial chordae to correct mitral regurgitation: Early results of a single-center experience. J Thorac Cardiovasc Surg 2014; 147:95-9. [DOI: 10.1016/j.jtcvs.2013.08.012] [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] [Received: 04/28/2013] [Revised: 07/21/2013] [Accepted: 08/01/2013] [Indexed: 11/20/2022]
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Holubec T, Sündermann SH, Jacobs S, Falk V. Chordae replacement versus leaflet resection in minimally invasive mitral valve repair. Ann Cardiothorac Surg 2013; 2:809-13. [PMID: 24349986 DOI: 10.3978/j.issn.2225-319x.2013.10.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/27/2013] [Indexed: 11/14/2022]
Abstract
For many years, the quadrangular resection technique first proposed by Carpentier has become the gold standard for repair of posterior leaflet prolapse of the mitral valve (MV). Although this "resection" technique and its modifications are safe and very effective, they do not respect the anatomy of the MV and the physiological role of the posterior leaflet. Therefore some new techniques, aiming to preserve MV leaflets to a different extent, have been proposed. With the use of expanded polytetrafluoroethylene (ePTFE), neochordae leaflet preserving techniques for posterior MV prolapse treatment have emerged. The aim of these techniques is to support the free edge of the prolapsing segments and thereby restore the physiologic function of the MV. A simplified modification of this technique using premeasured ePTFE loops ("loop technique") was successfully introduced to ease the implantation of neochordae, especially in the setting of minimally invasive MV surgery. While "resection" techniques are associated with excellent long-term results, there is evolving evidence in favor of "non-resection" techniques supporting the concept of a "respect rather than resect" approach.
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Affiliation(s)
- Tomas Holubec
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Simon H Sündermann
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Jacobs
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Tsukui H, Umehara N, Saito H, Saito S, Yamazaki K. Early outcome of folding mitral valve repair technique without resection for mitral valve prolapse in 60 patients. J Thorac Cardiovasc Surg 2012; 145:104-8; discussion 108-9. [PMID: 23127369 DOI: 10.1016/j.jtcvs.2012.08.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 08/01/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Leaflet resection represents the reference standard for mitral valve regurgitation. However, the resection technique is irreversible and requires leaflet cutting and reapproximation. Folding mitral valve repair is a nonresectional technique with inversion of the prolapsed segment into the left ventricle. The present study evaluated the effectiveness of this technique. METHODS The prolapsed segment was inverted into the left ventricle vertically. A pilot suture was placed at the free edge of the leaflet. After confirming no mitral valve regurgitation with a pressure test, additional sutures were placed toward the annulus. If the test still showed mitral valve regurgitation, the suture was removed and repositioned. Ring annuloplasty was performed in all patients, except those with active infectious endocarditis. The repaired mitral valve was evaluated using echocardiography. RESULTS A total of 60 patients (37 men; mean age, 62.4 years) underwent folding mitral valve repair from January 2007 to September 2011. Of these patients, 38 (63%) had moderate and 18 (30%) had severe mitral valve regurgitation preoperatively. Folding mitral valve repair was applied to the anterior leaflet and posterior leaflet. The mean cardiopulmonary bypass time and crossclamp time were 148 and 90 minutes, respectively. No patient had systolic anterior motion. Postoperative echocardiography revealed no mitral valve regurgitation to trivial mitral valve regurgitation in 48 and mild mitral valve regurgitation in 12 patients. No patient required reoperation for recurrent mitral valve regurgitation. CONCLUSIONS Folding mitral valve repair is an easily fine-tuned technique with a pilot suture, which can be easily removed and repositioned, if unsatisfactory. This reversibility is a significant advantage of this technique. Long-term follow-up is necessary to assess the durability of this technique.
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Affiliation(s)
- Hiroyuki Tsukui
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
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Smith CR, Stamou SC, Boeve TJ, Patzelt LH. Folding mitral valvuloplasty without posterior leaflet resection for calcified mitral annulus. Interact Cardiovasc Thorac Surg 2011; 14:143-5. [PMID: 22159235 DOI: 10.1093/icvts/ivr017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mitral valve annular calcification has long been a challenge in repairing posterior mitral valve prolapse. Folding valvuloplasty of the posterior leaflet without resection provides a means of circumventing common procedural complications. This report demonstrates the success of folding valvuloplasty without resection in the treatment of mitral valve prolapse and severe annular calcification.
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Affiliation(s)
- Craig R Smith
- Division of Thoracic and Cardiovascular Surgery, Spectrum Health, Butterworth Hospital, Meijer Heart Center, Grand Rapids, USA.
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Cevasco M, Myers PO, ElBardissi AW, Cohn LH. Foldoplasty: A New and Simplified Technique for Mitral Valve Repair That Produces Excellent Medium-Term Outcomes. Ann Thorac Surg 2011; 92:1634-7; discussion 1637-8. [DOI: 10.1016/j.athoracsur.2011.05.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/24/2011] [Accepted: 05/31/2011] [Indexed: 10/15/2022]
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Vergnat M, Jackson BM, Cheung AT, Weiss SJ, Ratcliffe SJ, Gillespie MJ, Woo YJ, Bavaria JE, Acker MA, Gorman RC, Gorman JH. Saddle-shape annuloplasty increases mitral leaflet coaptation after repair for flail posterior leaflet. Ann Thorac Surg 2011; 92:797-803. [PMID: 21803330 DOI: 10.1016/j.athoracsur.2011.04.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/05/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The primary goal of surgical mitral repair is the reestablishment of normal leaflet coaptation. Surgical techniques that maintain or restore leaflet geometry promote leaflet coaptation. Recent 3-dimensional (3D) echocardiographic studies have shown that saddle-shaped annuloplasty has a salutary influence on leaflet geometry. Therefore we hypothesized that saddle-shaped annuloplasty would improve leaflet coaptation in cases of repair for flail posterior leaflet segments. METHODS Sixteen patients with flail posterior segment and severe mitral regurgitation had valve repair using standard techniques. Eight patients received saddle-shaped annuloplasty and 8 patients received flat annuloplasty. Real-time 3D transesophageal echocardiography was performed before and after repair. Images were analyzed using custom software to calculate mitral annular area (MAA), septolateral dimension (SLD), intercommissural width (CW), total leaflet area (TLA), and leaflet coaptation area (LCA). RESULTS Postrepair MAA (flat, 588.6±26.5 mm2; saddle, 628.0±35.3 mm2; p=0.12) and TLA (flat, 2198.5±151.6 mm2; saddle, 2303.9±183.8 mm2; p=0.67) were similar in both groups. Postrepair LCA was significantly greater in the saddle group than in the flat group (226.8±24.0 mm2 and 154.0±13.0 mm2, respectively; p=0.02). CONCLUSIONS Real-time 3D echocardiography and novel imaging software provide a powerful tool for analyzing mitral leaflet coaptation. When compared with flat annuloplasty, saddle-shaped annuloplasty improves LCA after mitral valve repair for severe mitral regurgitation secondary to flail posterior leaflet segment. Use of saddle-shaped annuloplasty devices may increase repair durability.
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Affiliation(s)
- Mathieu Vergnat
- Gorman Cardiovascular Research Group, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kassem S, Moasis GA, Biglioli P. Tent-shape technique: another procedure to repair P2 of posterior leaflet of mitral valve. Eur J Cardiothorac Surg 2010; 39:1064-6. [PMID: 21111628 DOI: 10.1016/j.ejcts.2010.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 11/26/2022] Open
Abstract
In this report, we describe a new procedure to repair the prolapsing high mid-scallop of the mitral valve (MV) posterior leaflet (P2) with detailed consideration of the anatomy and physiology of the MV. A new artificial chord is implanted in the body of the P2 at the same height of non-prolapsing P1 and P3, and the remaining part of the prolapsing P2 is anchored to the artificial chord taking the shape of a tent.
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Affiliation(s)
- Samer Kassem
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy.
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Da U, Ramoni E, Di Lazzaro D. Posterior mitral leaflet: new anatomical insight and review of nomenclature (mitral valve anatomy). J Cardiovasc Med (Hagerstown) 2010; 11:820-6. [DOI: 10.2459/jcm.0b013e32833cdc17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nakajima M, Tsuchiya K, Honda Y, Koshiyama H. Midterm outcome of leaflet folding plasty for mitral regurgitation due to posterior leaflet prolapse. Gen Thorac Cardiovasc Surg 2010; 58:271-5. [PMID: 20549455 DOI: 10.1007/s11748-009-0559-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 10/23/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Leaflet folding plasty was introduced as an effective technique to avoid systolic anterior motion (SAM) after mitral valve repair. The purpose of this study was to investigate the midterm outcome of leaflet folding plasty following a review of our 10-year experience. METHODS Between October 1997 and May 2008, a total of 45 patients with mitral valve regurgitation due to posterior leaflet prolapse were operated on using leaflet folding plasty (63% of posterior leaflet repair and 28% of overall mitral valve repair during the same period). The group comprised 29 men and 16 women, with a mean age of 63.2 years. There were 44 patients with degenerative valve disease and 1 with healed infective endocarditis. The prolapsed scallop were P1 in 1, P2 in 33, and P3 in 11 patients. Anterior mitral leaflet involvement was seen in two patients. RESULTS Mitral valve repair was performed in all patients. SAM with residual mitral regurgitation was observed in two patients, with one requiring intraoperative revision. The 30-day mortality was 2.2% (one patient died from intestinal complications). The mean follow-up period for survivors was 38.1 months (range 1-127 months). The 1- and 5-year actuarial survival rates were 97.8% and 93.7%, respectively. None of the patients required reoperation during follow-up. CONCLUSION Midterm outcome of leaflet folding plasty for mitral valve repair was satisfactory. This technique accomplishes mitral valve repair safely in patients with mitral regurgitation due to posterior prolapse, with acceptable intermediate-term freedom from reintervention.
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Affiliation(s)
- Masato Nakajima
- Department of Cardiovascular Surgery, Yamanashi Central Hospital, Kofu, Yamanashi, Japan.
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A Novel Method of Leaflet Reconstruction After Triangular Resection for Posterior Mitral Valve Prolapse. Ann Thorac Surg 2010; 89:e53-6. [DOI: 10.1016/j.athoracsur.2010.03.071] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 01/19/2010] [Accepted: 03/16/2010] [Indexed: 11/22/2022]
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Schwartz CF, Grossi EA, Ribakove GH, Ursomanno P, Mirabella M, Crooke GA, Galloway AC. Ten-Year Results of Folding Plasty in Mitral Valve Repair. Ann Thorac Surg 2010; 89:485-8. [DOI: 10.1016/j.athoracsur.2009.10.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 10/21/2009] [Accepted: 10/23/2009] [Indexed: 10/19/2022]
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Bär H, Siegmund A, Wolf D, Hardt S, Katus HA, Mereles D. Prevalence of asymptomatic mitral valve malformations. Clin Res Cardiol 2009; 98:305-9. [DOI: 10.1007/s00392-009-0004-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 02/10/2009] [Indexed: 10/21/2022]
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23
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Early and Midterm Outcomes of Folding Valvuloplasty Without Leaflet Resection for Myxomatous Mitral Valve Disease. Ann Thorac Surg 2008; 86:1388-90. [DOI: 10.1016/j.athoracsur.2008.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 04/01/2008] [Accepted: 04/02/2008] [Indexed: 11/18/2022]
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24
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Robotic “Haircut” Mitral Valve Repair: Posterior Leaflet-Plasty. Ann Thorac Surg 2008; 85:1460-2. [DOI: 10.1016/j.athoracsur.2007.10.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 09/13/2007] [Accepted: 10/09/2007] [Indexed: 11/23/2022]
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