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Aihara S, Nakayama Y, Nakajima Y, Tsujimoto T, Akiyama K. Patch Dehiscence After Mitral Valve Repair by Posterior Mitral Leaflet Augmentation at Weaning From Cardiopulmonary Bypass. Cureus 2024; 16:e62872. [PMID: 39044872 PMCID: PMC11262915 DOI: 10.7759/cureus.62872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 07/25/2024] Open
Abstract
The treatment for ischemic mitral regurgitation (MR) involves a combination of medical management and, in certain cases, surgical intervention. The approach depends on the severity of the condition, underlying causes, and the patient's overall health. A 76-year-old male with heart failure refractory to medical management because of ischemic MR was considered for a mitral valve repair surgery with a posterior mitral leaflet augmentation technique. Following the repair of the mitral valve and the cessation of the initial cardiopulmonary bypass (CPB), a prolapse of the posterior mitral leaflet, which had not been detected before the surgery, was revealed by intraoperative transesophageal echocardiography (TEE). A thorough inspection of the repaired mitral valve after cardiac arrest during the second CPB unveiled a loose suture at the edge of the valve and an inverted pericardium, indicating that the patch had flipped upward. Although complications of this type following the augmentation of the mitral posterior leaflet are rare, we promptly detected it using TEE, which incorporates three-dimensional imaging.
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Affiliation(s)
- Satoshi Aihara
- Anesthesiology and Critical Care, Kansai Medical University, Osaka, JPN
| | | | | | | | - Koichi Akiyama
- Anesthesiology and Critical Care, Kindai University, Osaka, JPN
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Yoshida S, Matsumoto I, Saito D, Tanaka Y, Takemura H, Oi A. Partial Tracheal Defects Closure using Glutaraldehyde-Treated Autologous Pericardium. Thorac Cardiovasc Surg 2023; 71:490-496. [PMID: 36216333 PMCID: PMC10480013 DOI: 10.1055/s-0042-1757301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The usefulness of autologous pericardium treated with glutaraldehyde (GA) for tracheal defect closure is unknown. This study preliminarily evaluated whether a GA-treated autologous pericardial graft can effectively close tracheal defects in a beagle model. METHODS Defects of 10 mm × 10 mm were created on the trachea of 10 beagles and divided into a GA-treated group (n = 5), with tracheal reconstruction using GA-treated pericardium, and control group (n = 5), using fresh pericardium. Repair sites were evaluated through bronchoscopy and histology. Blood flows on graft were measured using laser Doppler technique on postoperative days (PODs) 0, 4, 7, 14, 28, and 56. Repair sites were histologically evaluated on POD 56. In addition, GA-treated pericardia of three other beagles were histologically evaluated 12 months postoperatively, for long-term follow-up. RESULTS All animals survived; none developed anastomotic insufficiency. The mean suturing time and frequency of additional suture were significantly shorter and lower in the GA-treated group than in the control group (p = 0.002, 0.004). All animals in the control group exhibited graft contraction, whereas the GA-treated group healed with most graft residual and reepithelialization in the bronchoscopic and histological findings (p = 0.01, 0.004). Further, all long-term GA-treated pericardia of three beagles were confirmed as residual grafts with reepithelialization, without contraction, at 12 months postoperatively. Blood flows on graft using laser Doppler technique in the GA-treated group were detected at POD 14 or thereafter. CONCLUSION GA-treated pericardium was easier to handle and provided favorable scaffolding, without graft contraction, compared with the nontreated pericardium at short- and long-term follow-up.
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Affiliation(s)
- Shuhei Yoshida
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Isao Matsumoto
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Daisuke Saito
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Yusuke Tanaka
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan
| | - Akishi Oi
- Department of Molecular and Cellular Pathology, Kanazawa University, Kanazawa, Japan
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Haidari Z, Wendt D, Thielmann M, Jakob H, Ruhparwar A, El-Gabry M. Limited Versus Radical Resection in Mitral Valve Infective Endocarditis Surgery. J Cardiovasc Dev Dis 2023; 10:jcdd10040146. [PMID: 37103026 PMCID: PMC10144351 DOI: 10.3390/jcdd10040146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compare a limited-resection and non-patch technique with the classic radical-resection technique. Methods: Eligible candidates were patients with definitive IE of the native mitral valve undergoing surgery between January 2013 and December 2018. Patients were classified according to the surgical strategy into two groups: limited- versus radical-resection strategy. Propensity score matching was used. Endpoints were repair rate, all-cause mortality (30-day and 2-year), re-endocarditis and reoperation at q-year follow-up. Results: After propensity score matching, 90 patients were included. Follow-up was 100% complete. Mitral valve repair rate was 84% in the limited-resection versus 18% in the radical-resection strategy, p < 0.001. The 30-day and 2-year mortality were 20% versus 13% (p = 0.396) and 33% versus 27% (p = 0.490) in the limited-resection versus radical-resection strategy, respectively. The incidence of re-endocarditis during the 2-year follow-up was 4% in the limited-resection strategy versus 9% in the radical-resection strategy, p = 0.677. Three patients in the limited-resection strategy underwent reoperation of the mitral valve, while there were none in the radical-resection strategy (p = 0.242). Conclusions: Although mortality in patients with IE of the native mitral valve remains high, the limited-resection and non-patch surgical strategy is associated with a significantly higher repair rates with comparable 30-day and mid-term mortality, risk of re-endocarditis and re-operation compared to the radical-resection strategy.
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Affiliation(s)
- Zaki Haidari
- Correspondence: ; Tel.: +49-(0)201-723-84851; Fax: +49-(0)201-723-5451
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Sasaki H, Numata Y, Saito J, Sone Y, Asano M. Posterior Mitral Leaflet (PML) Perforation due to Infective Endocarditis (IE) Complicated with Cerebral Infarction. Cureus 2023; 15:e36491. [PMID: 37090267 PMCID: PMC10118631 DOI: 10.7759/cureus.36491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
A 64-year-old man on dialysis presented to the emergency department with a fever and chills. Transthoracic echocardiography (TTE) showed small vegetation on the posterior mitral leaflet (PML). Antibiotic therapy was initiated. Two weeks later, right hemiparesis occurred. MRI of the head showed occlusion of the left middle cerebral artery, which suggested an embolism derived from the vegetation. The patient was then referred to the department of cardiovascular surgery. Transesophageal echocardiography (TEE) revealed perforation of the PML and severe mitral regurgitation (MR). The patient underwent mitral valve repair. The postoperative course was uneventful, and the patient was discharged after six weeks of antibiotic treatment. A fresh autologous pericardium is the material of choice to repair the valve.
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Affiliation(s)
- Hideki Sasaki
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Yukihide Numata
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Jien Saito
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Yoshiaki Sone
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Miki Asano
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
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Sakon Y, Takahashi Y, Fujii H, Morisaki A, Nishiya K, Yamane K, Kishimoto N, Kawase T, Murakami T, Shibata T. Mitral valve repair with patch augmentation for atrial functional mitral regurgitation complicated with giant left atrium. Gen Thorac Cardiovasc Surg 2023; 71:104-112. [PMID: 35776257 DOI: 10.1007/s11748-022-01833-3] [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: 11/10/2021] [Accepted: 05/16/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to assess the results of posterior leaflet augmentation with an autologous pericardial patch in atrial functional mitral regurgitation. METHODS Data of 16 patients with atrial functional mitral regurgitation who underwent posterior leaflet patch augmentation for mitral valve repair were retrospectively analyzed. This procedure was applied to a short posterior leaflet with a height of < 10 mm in P2. The median age was 72.5 [67.8-78.3] years. Preoperative New York Heart Association functional class was II in 7 (43.8%) and III or IV in 9 (56.2%) patients. Mitral regurgitation was moderate in 2 (12.5%) and severe in 14 (87.5%) patients. RESULTS Operative mortality occurred in 1 (6.2%) patient due to cerebral infarction. One patient required valve replacement because of patch perforation early after operation. Mitral regurgitation was reduced to less than mild in 15 (93.8%) patients and less than trivial in 11 (68.8%) patients (P < 0.01) postoperatively. As for mid-term results, New York Heart Association functional class improved to I or II in 12 (75%) patients (P < 0.01). Two cases of thrombotic complication were observed. Remote recurrent regurgitation occurred in one case due to small patch size. The 3-year free rate of valve-related morbidity and regurgitation recurrence was 65.6% and 87.1%, respectively. The 5-year survival rate was 93.8%. CONCLUSIONS Pericardial patch augmentation in atrial functional mitral regurgitation leads to good survival and mitral regurgitation recurrence-free rates. Steady anticoagulation and the use of larger patches would be necessary to reduce thrombotic complications and recurrent MR.
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Affiliation(s)
- Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan.
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
| | - Kenta Nishiya
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
| | - Kokoro Yamane
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
| | - Noriaki Kishimoto
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
| | - Takumi Kawase
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585, Japan
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Hosoba S, Ito T, Mori M, Kato R, Kobayashi M, Nakai Y, Morishita Y. Midterm results after seamless patch mitral reconstruction. JTCVS Tech 2022; 16:35-42. [PMID: 36510531 PMCID: PMC9737040 DOI: 10.1016/j.xjtc.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Some pathologies, including infective endocarditis or sclerotic changes of the mitral leaflet, make the conventional mitral valve repair challenging. Our previously described technique for reconstruction with a seamless pericardial patch makes the repair feasible in some of such difficult pathologies. However, the extent of mitral leaflet segments that could be safely repaired using this technique remains unknown. We investigated the association between the midterm outcome and the extent of mitral leaflet segments replaced by a pericardial patch. Methods From January 2009 to January 2022, patients who underwent mitral valve repair with the seamless 1-patch reconstruction technique were included. The glutaraldehyde-treated pericardium was trimmed and anchored at the papillary muscle. The edge was sewn to the leaflet and the annulus. Results A total of 49 patients (aged 60 ± 15 years) underwent mitral valve repair with this technique. The totally endoscopic approach was used in 27 patients (55%). No patient's repair was converted to valve replacement. No operative mortality or disabling stroke was observed during the early postoperative period. In the midterm follow-up, redo surgery was required in 9 patients (18%). Freedom from mitral valve reintervention rates at 1, 5, and 10 years were 84%, 82%, and 82% for all patients, respectively. Freedom from reoperation at 5 years was 100%, 92%, and 46% for commissural lesion, 1- to 2-segment involvement, and 3-segment involvement, respectively. There was a significant difference among the 3 groups with regard to mitral valve reoperation rate (P = .002). Conclusions Mitral valve seamless patch reconstruction provides excellent midterm results if applied to commissural lesions or lesions involving up to 2 segments.
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Affiliation(s)
- Soh Hosoba
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
- Address for reprints: Soh Hosoba, MD, PhD, Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita, Nakamura, Nagoya 453-8511, Japan.
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Makoto Mori
- Division of Cardiothoracic Surgery, Yale School of Medicine, New Haven, Conn
| | - Riku Kato
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masaaki Kobayashi
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuji Nakai
- Department of Clinical Engineering, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yoshihiro Morishita
- Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
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A New Detergent for the Effective Decellularization of Bovine and Porcine Pericardia. Biomimetics (Basel) 2022; 7:biomimetics7030104. [PMID: 35997424 PMCID: PMC9397045 DOI: 10.3390/biomimetics7030104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/10/2022] Open
Abstract
Human and animal pericardia are among the most widely exploited materials suitable to repair damaged tissues in the cardiovascular surgery context. Autologous, xenogeneic (chemically treated) and homologous pericardia are largely utilized, but they do exhibit some crucial drawbacks. Any tissue treated with glutaraldehyde is known to be prone to calcification in vivo, lacks regeneration potential, has limited durability, and can result in cytotoxicity. Moreover, autologous tissues have limited availability. Decellularized biological tissues represent a promising alternative: decellularization removes cellular and nuclear components from native tissues and makes them suitable for repopulation by autologous cells upon implantation into the body. The present work aims to assess the effects of a new detergent, i.e., Tergitol, for decellularizing bovine and porcine pericardia. The decellularization procedure successfully removed cells, while preserving the histoarchitecture of the extracellular matrix. No cytotoxic effect was observed. Therefore, decellularized pericardia showed potential to be used as scaffold for cardiovascular tissue regeneration.
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El-Sayed Ahmad A, Salamate S, Giammarino S, Ciobanu V, Bakhtiary F. Transmitral Septal Myectomy and Mitral Valve Surgery via Right Mini-Thoracotomy. Thorac Cardiovasc Surg 2022; 71:171-177. [PMID: 35644132 DOI: 10.1055/s-0042-1744261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Background Transmitral myectomy for symptomatic hypertrophic obstructive cardiomyopathy is possible with existence of substantial mitral valve disease. We present herein our experience of minimally invasive transmitral septal myectomy combined with mitral valve surgery through right anterior mini-thoracotomy in the past 4 years at our institution.
Methods Between March 2017 and October 2020, 14 patients with hypertrophic obstructive cardiomyopathy and mitral valve disease required minimally invasive transmitral septal myectomy combined with mitral valve reconstruction or replacement at our institution. Mean age of patients was 54.2 ± 11.4 and 42.9% (n = 6) were female. Twelve patients (85.1%) were in New York Heart Association class III to IV and 6 patients (42.9%) presented with persistent atrial fibrillation. Clinical data were prospectively entered into our institutional database.
Results Cardiopulmonary bypass time accounted for 140.2 ± 32.6 minutes and the myocardial ischemic time was 78.5 ± 12.4 minutes. Thirty-day mortality and overall mortality were zero. Peak ventricular outflow gradient decreased from 75.2 ± 12.7 to 9.4 ± 2.3 mm Hg (p < 0.0001). Simultaneously, mitral valve reconstruction and replacement were performed in 11 (78.6%) and 3 (21.4%) patients, respectively. No systolic anterior motion was seen in patients with mitral valve repair. No conversion to full sternotomy and/or rethoracotomy was noted. During a mean follow-up period of 24 ± 13 months, no patient required reoperation, no recurrence mitral regurgitation, and left ventricular outflow tract obstruction.
Conclusion Transmitral septal myectomy combined with mitral valve surgery through right anterior mini-thoracotomy can be performed safely with excellent surgical outcomes.
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Affiliation(s)
- Ali El-Sayed Ahmad
- Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, Siegburg, Germany
| | - Saad Salamate
- Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, Siegburg, Germany
| | - Sabrina Giammarino
- Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, Siegburg, Germany
| | - Veceslav Ciobanu
- Division of Thoracic and Cardiovascular Surgery, HELIOS Universitätsklinikum Wuppertal, Siegburg, Germany
| | - Farhad Bakhtiary
- Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, Siegburg, Germany
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Handa K, Masai T, Ohata T, Sakamoto T, Kuratani T. Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve. J Cardiothorac Surg 2022; 17:97. [PMID: 35505349 PMCID: PMC9066869 DOI: 10.1186/s13019-022-01851-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/20/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods Five patients (54 (38–60) years of age; 3 men, 2 women) underwent this procedure from January 2011 to April 2022. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 69 (66–75)). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 36 (28–42) days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The median follow-up period was 9.6 (6.0–10.4) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions The short- and long-term outcomes of this procedure might be acceptable. This procedure might be considered as an effective and valuable option, especially in young patients.
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Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan.
| | - Toshihiro Ohata
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
| | - Tomohiko Sakamoto
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kitaku, Osaka, 530-0001, Japan
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Kinoshita R, Arai H, Yashima M, Hachimaru T, Fujiwara T, Tamura K, Tanaka H, Oi K, Mizuno T, Nagaoka E. Mid-term results of mitral valve reconstruction with autologous pericardial patch for active infective endocarditis with extensive leaflet destruction. Gan To Kagaku Ryoho 2022; 70:694-704. [PMID: 35138563 DOI: 10.1007/s11748-022-01776-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/14/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study aimed to evaluate the outcomes of our repair technique using autologous pericardial patches for active infective endocarditis with extensive mitral valve destruction. METHODS From 2009 through 2016, 12 patients with extensive mitral leaflet destruction due to infective endocarditis underwent mitral valve repair with an autologous pericardial patch. Mid-term clinical outcomes and echocardiographic findings of these patients were retrospectively assessed. RESULTS The perioperative mortality rate was 8.3% (1/12). Postoperatively, the mitral regurgitation grade was ≤ 1 + in all patients. During 5.0 ± 3.2 years of follow-up, there was no recurrence of infective endocarditis or death. There were no cases of mitral regurgitation grade > + 1 and pressure gradient > 5 mmHg during follow-up among 6 patients who underwent posterior leaflet reconstruction, whereas elevation of the pressure gradient was observed in patients who underwent reconstruction of two areas of the anterior leaflet and survived up till the follow-up phase among 3 patients who underwent anterior leaflet repair. The mitral regurgitation grade worsened and pressure gradient was elevated during the follow-up phase in the 2 patients who underwent bi-leaflet repair, and reoperation was performed. CONCLUSION Mitral valve reconstruction using autologous pericardial patch is a useful treatment option for extensive mitral valve destruction due to active infective endocarditis. Our clinical data revealed that good mid-term results were obtained for posterior leaflet lesions, while extensive anterior leaflet and bi-leaflet lesion repair did not yield satisfactory results. The indication for surgical repair should be carefully evaluated when an extensive anterior region is involved.
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Affiliation(s)
- Ryoji Kinoshita
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Masafumi Yashima
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tsuyoshi Hachimaru
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Kiyoshi Tamura
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
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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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12
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6547516. [DOI: 10.1093/ejcts/ezac133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
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Baciewicz FA. Commentary: Should we book a seat on the aortic neocuspidization rocket? JTCVS OPEN 2021; 8:203-204. [PMID: 36004078 PMCID: PMC9390572 DOI: 10.1016/j.xjon.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/04/2022]
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Nwafor IA, Eze JC, Nwafor MN. Surgical Treatment of Valvular Heart Disease in Nigeria: A 6-Year Experience. Tex Heart Inst J 2021; 48:475569. [PMID: 34913972 DOI: 10.14503/thij-19-7080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11-80 yr]) underwent surgical treatment of a total of 122 diseased valves, including 72 (59.0%) mitral, 26 (21.3%) aortic, 21 (17.2%) tricuspid, and 3 (2.5%) pulmonary. The most prevalent pathophysiologic cause of disease was rheumatic (87 valves [71.3%]), followed by functional (20 [16.4%]), congenital (8 [6.6%]), degenerative (5 [4.1%]), and endocarditic (2 [1.6%]). All 3 diseased pulmonary valves had annular defects associated with congenital disease. Surgical treatment included mechanical prosthetic replacement of 92 valves (75.4%), surgical repair of 29 (23.8%), and bioprosthetic replacement of 1 (0.8%). We conclude that, in Nigeria, valvular disease is mainly rheumatic, affects mostly younger to middle-aged individuals, and is usually treated with prosthetic replacement.
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Affiliation(s)
- Ikechukwu A Nwafor
- Department of Surgery, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - John C Eze
- Department of Surgery, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Maureen N Nwafor
- Department of Pharmacy, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Enugu, Nigeria
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15
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Yoon SH, Yeo MK, Kim SH, Song IS, Jeon GS, Han SJ. Feasibility of using the homologous parietal peritoneum as a vascular substitute for venous reconstruction during abdominal surgery: An animal model. Surgery 2021; 170:1268-1276. [PMID: 34247840 DOI: 10.1016/j.surg.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The interest in vascular substitutes has recently increased. We evaluated the feasibility of using a homologous parietal peritoneum as a vascular substitute for venous reconstruction during abdominal surgery. METHODS The inferior vena cava was replaced with a homologous parietal peritoneum after cross-linking with glutaraldehyde in 36 rabbits. At 7, 14, and 28 days, the patency rate, outer and inner graft diameters, histology, and immunohistochemistry were evaluated. RESULTS Both the 7- and 14-day groups maintained vascular patency. Vascular patency was maintained in 3 rabbits in the 28-day group. The inner diameters of the anastomotic sites were 6.23 ± 0.18, 5.64 ± 0.16, and 2.34 ± 0.21 mm in the 7-day, 14-day, and 28-day groups, respectively. The midpoint inner diameters of the homologous parietal peritoneum grafts were 624 ± 0.46, 5.74 ± 0.26, and 2.14 ± 0.28 mm in each group, respectively. Endothelial cell proliferation on the homologous parietal peritoneum graft surfaces in all groups was based on the histological findings from the first group. Multiple neovascularizations of the homologous parietal peritoneum graft were found in the 14- and 28-day groups, indicating neo-media formation. Acute inflammation appeared to progress to the entire layer of the homologous parietal peritoneum graft without an intraluminal thrombus, but the graft was patent in the 14-day group. In the 28-day group, 6 rabbits showed near-total occlusion and a thrombus formed in the homologous parietal peritoneum graft at the anastomosis site with severe stricture; however, the rabbits were alive and had collateral vessel formation. CONCLUSION Using homologous parietal peritoneum is feasible for venous reconstruction in abdominal surgery.
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Affiliation(s)
- Seung-Hwan Yoon
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min-Kyung Yeo
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seok-Hwan Kim
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
| | - In-Sang Song
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Gwang-Sik Jeon
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun-Jong Han
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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16
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Shibata T, Takahashi Y, Fujii H, Morisaki A, Abe Y. Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism. Gen Thorac Cardiovasc Surg 2021; 69:1041-1049. [PMID: 33970433 PMCID: PMC8203518 DOI: 10.1007/s11748-021-01629-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 10/25/2022]
Abstract
Atrial functional mitral regurgitation is a hot research topic in the field of mitral valve disease. Atrial functional mitral regurgitation is distinctly different from ventricular functional mitral regurgitation. The surgical indications for atrial functional mitral regurgitation have not been well established because of the small amount of evidence gathered to date. Mitral annular plication with an artificial ring is an essential surgical procedure because dilatation of the mitral valve annulus is a main factor underlying this pathology. Most of these cases can be treated by mitral annuloplasty alone. However, additional procedures, such as application of artificial chordae to the anterior leaflet for pseudo-prolapse, and posterior leaflet augmentation with a pericardial patch, are required in advanced cases with a giant left atrium and extremely enlarged mitral annulus. Chronic atrial fibrillation causes enlargement of the right and left atria. This pathology is a bilateral atrioventricular valve disease (dual-valve disease). Therefore, the conventional guidelines of single-valve disease should not be applied. Although atrial functional tricuspid regurgitation is underappreciated, tricuspid annuloplasty should be considered for most patients to prevent future regurgitation. In addition to the mitral and tricuspid valve procedure, integrated surgical management, including plication of the atrium and left appendage closure, is required. This review summarizes the current considerations of surgical treatment for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism.
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Affiliation(s)
- Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-5956, Japan.
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-5956, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-5956, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-5956, Japan
- Department of Cardiology, Osaka City General Hospital, 2-13-22, Miyakojima Hondori, Miyakojima, Osaka, 534-0021, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, 2-13-22, Miyakojima Hondori, Miyakojima, Osaka, 534-0021, Japan
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17
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Abstract
The 2 primary objectives of surgery in mitral valve infective endocarditis (IE) are total removal of the infected tissue and reconstruction of cardiac morphology, including repair or replacement of the affected valve. Single-institution series have suggested the feasibility and effectiveness of mitral valve repair (MVrep) over replacement in mitral IE in terms of in-hospital mortality and long-term event-free survival. This article reviews the history, details of the relevant repair techniques, and clinical results of MVrep for mitral IE.
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Affiliation(s)
- Yukikatsu Okada
- Heart Valve Center, Midori Hospital, 1-16 Edayoshi Nishi-ku, Kobe 651-2133, Japan.
| | - Takeo Nakai
- Heart Valve Center, Midori Hospital, 1-16 Edayoshi Nishi-ku, Kobe 651-2133, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi Chuo-ku, Kobe 650-0047, Japan
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18
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Tabata M, Morimura H, Nakanaga H. Double leaflet technique for mitral regurgitation with the small or tethered posterior leaflet. Ann Thorac Surg 2021; 113:e149-e151. [PMID: 33945814 DOI: 10.1016/j.athoracsur.2021.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/11/2021] [Accepted: 04/19/2021] [Indexed: 11/01/2022]
Abstract
Small leaflets make mitral valve repair procedures challenging. Our double leaflet technique creates a new autologous pericardial leaflet attached to the papillary muscle, annuloplasty ring and neighboring scallops above the small or tethered posterior leaflet. This simple additional technique provides deep coaptation after mitral valve repair for both degenerative and functional mitral regurgitation with the small or tethered posterior leaflet.
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Affiliation(s)
- Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center; Department of Cardiovascular Surgery, Toranomon Hospital.
| | - Hayato Morimura
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
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19
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Mitral Valve Repair in Children Below Age 10 Years: Trouble or Success? Ann Thorac Surg 2020; 110:2082-2087. [DOI: 10.1016/j.athoracsur.2020.02.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/16/2020] [Accepted: 02/24/2020] [Indexed: 11/19/2022]
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20
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Sakurai H, Nonaka T, Sakurai T, Kozakai M, Ohashi N, Nishikawa H. Long-term results of tricuspid reconstruction with pericardium in an infant. Gen Thorac Cardiovasc Surg 2020; 69:542-545. [PMID: 32926389 DOI: 10.1007/s11748-020-01486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
We report the long-term clinical outcome of an 8-month-old infant who underwent tricuspid reconstruction using fresh autologous pericardium for severe tricuspid regurgitation due to defects in the leaflets of the tricuspid valve after ventricular septal defect closure and ablation. Ten years after surgery, the tricuspid function is good with mild regurgitation and mild stenosis. From the age of 8 months to 11 years, the patient's body weight and height increased fourfold and twofold, respectively. Thus, a fresh autologous pericardial patch could be the material of choice for tricuspid leaflet repair in pediatric patients.
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Affiliation(s)
- Hajime Sakurai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya, 457-8510, Japan.
| | - Toshimichi Nonaka
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya, 457-8510, Japan
| | - Takahisa Sakurai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya, 457-8510, Japan
| | - Motoshi Kozakai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya, 457-8510, Japan
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hiroshi Nishikawa
- Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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21
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Okada Y, Nakai T, Muro T, Ito H, Shomura Y. Mitral valve repair for infective endocarditis: Kobe experience. Asian Cardiovasc Thorac Ann 2020; 28:384-389. [PMID: 32757655 PMCID: PMC7818674 DOI: 10.1177/0218492320947586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives We retrospectively analyzed our experience of mitral valve repair for native
mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery
for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At
the time of surgery, 98 patients had healed (group A) and 49 had active
infective endocarditis (group B). Repair procedures included resection of
all infected tissue and thick restricted post-infection tissue, leaflet and
annulus reconstruction with treated autologous pericardium, chordal
reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty
if necessary. Fifty-two (35%) patients required concomitant procedures. The
study endpoints were overall survival, freedom from reoperation, and freedom
from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years
was 88.5% ± 3.5% with no significant difference between the two groups
(p = 0.052). Early reoperation was required in 4
patients in group B due to persistent infection or procedure failure.
Freedom from reoperation at 5 years was 99% ± 1.0% in group A and
89.6 ± 4.0% in group B (p = 0.024). Event-free survival at
10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%,
p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium,
chordal reconstruction, and ring annuloplasty if required. Long-term results
were acceptable in terms survival, freedom from reoperation, and event-free
survival. Mitral valve repair is recommended for mitral infective
endocarditis in most patients.
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Affiliation(s)
| | - Takeo Nakai
- Heart Valve Center, Midori Hospital, Kobe, Japan
| | - Takashi Muro
- Heart Valve Center, Midori Hospital, Kobe, Japan
| | - Hisato Ito
- Department Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Mie, Japan
| | - Yu Shomura
- Department Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Mie, Japan
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22
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Tjørnild MJ, Sørensen SW, Carlson Hanse L, Skov SN, Røpcke DM, Nielsen SL, Hasenkam JM. Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation. Cardiovasc Eng Technol 2020; 11:405-415. [PMID: 32592143 DOI: 10.1007/s13239-020-00472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the anatomical and functional effects of complete surgical reconstruction of the posterior mitral leaflet and associated chordae tendineae with a patch made of 2-ply small intestinal submucosal extracellular matrix in vitro. METHODS Seven explanted mitral valves with intact subvalvular apparatus from 80-kg pigs were evaluated in a left heart simulator and served as their own controls. After testing the native valve, the mitral posterior leaflet and associated chordae tendineae were excised and reconstructed by using the 2-ply small intestinal submucosa extracellular matrix patch. The characterization of the reconstruction was based on geometric data from digital images, papillary muscle force, annular tethering force and leaflet pressure force. RESULTS The reconstructed valves were fully functional without regurgitation, tearing or rupture during incrementally increased pressure from 0 to 120 mmHg. The leaflet areas were preserved after reconstruction, with a normal configuration of the coaptation line. However, the coaptation midpoint moved posteriorly after reconstruction (A2: 15.8 ± 1.4 vs. 18.9 ± 1.5 mm, p = 0.002, diff = 3.1 mm, 95% CI 1.3 to 4.8 mm). The anterior papillary muscle force increased significantly (3.9 vs. 4.6 N, p = 0.029, diff = 0.7 N, 95% CI 0.1 to 1.4 N at 120mmHg) after reconstruction. The posterior papillary muscle force, leaflet pressure force and annular pressure force did not change significantly. CONCLUSIONS In this in vitro model, mitral valve anatomy and function were comparable between the native mitral valve and our new surgical technique for complete reconstruction of the posterior mitral leaflet and associated chordae tendineae. These promising results warrant further in vivo evaluation.
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Affiliation(s)
- Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Orthopaedic Surgery, Randers Regional Hospital, Randers, Denmark.
| | - Søren W Sørensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Diana M Røpcke
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sten L Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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23
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Cheema FH, Loyalka P, Rajagopal K. Defining the Role of MitraClip Therapy for Mitral Valve Regurgitation. Tex Heart Inst J 2020; 47:130-133. [PMID: 32603451 DOI: 10.14503/thij-19-7082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Faisal H Cheema
- Houston Heart, HCA Houston Healthcare, Houston, Texas 77004.,HCA Research Institute, Nashville, Tennessee 37203.,University of Houston College of Medicine, Houston, Texas 77204
| | - Pranav Loyalka
- Houston Heart, HCA Houston Healthcare, Houston, Texas 77004
| | - Keshava Rajagopal
- Houston Heart, HCA Houston Healthcare, Houston, Texas 77004.,University of Houston College of Medicine, Houston, Texas 77204
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24
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El Gabry M, Haidari Z, Mourad F, Nowak J, Tsagakis K, Thielmann M, Wendt D, Jakob H, Shehada SE. Outcomes of mitral valve repair in acute native mitral valve infective endocarditis. Interact Cardiovasc Thorac Surg 2020; 29:823-829. [PMID: 31369076 DOI: 10.1093/icvts/ivz187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Mitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis. METHODS Between January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events. RESULTS The mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively. CONCLUSIONS Although MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.
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Affiliation(s)
- Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Zaki Haidari
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Fanar Mourad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Janine Nowak
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
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25
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Grebenik EA, Gafarova ER, Istranov LP, Istranova EV, Ma X, Xu J, Guo W, Atala A, Timashev PS. Mammalian Pericardium-Based Bioprosthetic Materials in Xenotransplantation and Tissue Engineering. Biotechnol J 2020; 15:e1900334. [PMID: 32077589 DOI: 10.1002/biot.201900334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/29/2020] [Indexed: 12/13/2022]
Abstract
Bioprosthetic materials based on mammalian pericardium tissue are the gold standard in reconstructive surgery. Their application range covers repair of rectovaginal septum defects, abdominoplastics, urethroplasty, duraplastics, maxillofacial, ophthalmic, thoracic and cardiovascular reconstruction, etc. However, a number of factors contribute to the success of their integration into the host tissue including structural organization, mechanical strength, biocompatibility, immunogenicity, surface chemistry, and biodegradability. In order to improve the material's properties, various strategies are developed, such as decellularization, crosslinking, and detoxification. In this review, the existing issues and long-term achievements in the development of bioprosthetic materials based on the mammalian pericardium tissue, aimed at a wide-spectrum application in reconstructive surgery are analyzed. The basic technical approaches to preparation of biocompatible forms providing continuous functioning, optimization of biomechanical and functional properties, and clinical applicability are described.
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Affiliation(s)
- Ekaterina A Grebenik
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elvira R Gafarova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Leonid P Istranov
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elena V Istranova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Xiaowei Ma
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Jing Xu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Weisheng Guo
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Peter S Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia.,Institute of Photonic Technologies, Research center "Crystallography and Photonics" RAS, Moscow, 142190, Russia.,N. N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, 119991, Russia
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26
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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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27
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Malhotra A, Majmudar S, Siddiqui S, Pandya H, Shah K, Sharma P, Patel K, Gandhi H. Midterm Results of Mitral Valve Repair With Pericardial Leaflet Augmentation: A Single-Center Experience. Semin Thorac Cardiovasc Surg 2019; 32:433-440. [PMID: 31863832 DOI: 10.1053/j.semtcvs.2019.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/11/2022]
Abstract
In certain pathologies, mitral valve repair is complicated by a paucity of tissue caused by fibrosis or destruction. Utilization of autologous pericardium for leaflet augmentation may be the only option to repair these valves. We present the midterm results of mitral valve leaflet augmentation with glutaraldehyde-fixed autologous pericardium. One hundred thirty consecutive patients undergoing mitral valve repair with glutaraldehyde-fixed pericardial augmentation of leaflets were followed up clinically and by echocardiography at 6-month intervals. Mean age was 24.8 years (range 2-64). The etiology was rheumatic in 75.3%, indeterminate in 8.4%, and other in 16.1%. Out of the rheumatics, 57.1%, 24.4%, and 18.3% had combined mitral stenosis and mitral regurgitation, isolated mitral regurgitation, and mitral stenosis, respectively. About 21.5% had a recent history of rheumatic activity. Eight were operated emergently for intractable heart failure. Majority of the patients required repair of multiple components of the mitral valve apparatus. Leaflet peeling was done in 52.3%. Pericardial patch augmentation of anterior mitral leaflet, posterior mitral leaflet, or both were carried out in 61.5%, 34.6%, and 3.8% patients respectively. Sixty percent got chordal procedures, while 92.3% got annuloplasty. There were no deaths during the mean follow-up period of 28 months. Ninety-three percent of our patients were in New York Heart Association class I and II on follow-up. There were 11 repair failures. Seven patients underwent a reoperation, while 4 patients are being managed conservatively (reoperation rate 5.38%). Augmentation of mitral valve leaflets with autologous pericardium allows many significantly fibrosed and destroyed valves to be reliably repaired with good midterm durability and hemodynamics.
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Affiliation(s)
- Amber Malhotra
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India.
| | - Shaival Majmudar
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Sumbul Siddiqui
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Himani Pandya
- Department of Research, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Komal Shah
- Department of Research, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Pranav Sharma
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Kartik Patel
- Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
| | - Hemang Gandhi
- Department of Cardiac Anesthesia, U. N. Mehta Institute of Cardiology and Research Center, Ahmedabad, Gujarat, India
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Sheng W, Zhao G, Chao Y, Sun F, Jiao Z, Liu P, Zhang H, Yao X, Lu F, Zhan H, Zhou J, Song T, Tao L, Liu C. Aortic Valve Replacement with Bovine Pericardium in Patients with Aortic Valve Regurgitation. Int Heart J 2019; 60:1344-1349. [DOI: 10.1536/ihj.18-695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Weiyong Sheng
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Guochang Zhao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Yangyang Chao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Fuqiang Sun
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Zhouyang Jiao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Penghong Liu
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Hang Zhang
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Xingxing Yao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Fanfan Lu
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Haibo Zhan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Jiawei Zhou
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | - Tao Song
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
| | | | - Chao Liu
- Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University
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29
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Wollmann L, Suss P, Mendonça J, Luzia C, Schittini A, Rosa GWXD, Costa F, Tuon FF. Characterization of Decellularized Human Pericardium for Tissue Engineering and Regenerative Medicine Applications. Arq Bras Cardiol 2019; 113:11-17. [PMID: 31271596 PMCID: PMC6684174 DOI: 10.5935/abc.20190094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/19/2018] [Indexed: 12/29/2022] Open
Abstract
Background Pericardium tissue allograft can be used for surgical repair in several
procedures. One of the tissue engineering strategies is the process of
decellularization. This process decreases immunogenic response, but it may
modify the natural extracellular matrix composition and behavior. Objective The aim of this study was to evaluate the effectiveness of cell removal,
maintenance of extracellular matrix properties and mechanical integrity of
decellularized human pericardium using a low concentration solution of
sodium dodecyl sulfate. Methods Decellularization was performed with sodium dodecyl sulfate and
ethylenediaminetetraacetic acid. Histological analysis, DNA quantification,
evaluation of glycosaminoglycans and collagen were performed. Biomechanical
assay was performed using tensile test to compare the decellularization
effects on tissue properties of tensile strength, elongation and elastic
modulus. P < 0.05 was considered significant. Results There was reduction in visible nuclei present in pericardium tissue after
decellularization, but it retained collagen and elastin bundles similar to
fresh pericardium. The DNA contents of the decellularized pericardium were
significantly reduced to less than 511.23 ± 120.4 ng per mg of dry
weight (p < 0.001). The biomechanical assay showed no significant
difference for fresh or decellularized tissue. Conclusion The decellularization process reduces cell content as well as extracellular
matrix components without changing its biomechanical properties.
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Affiliation(s)
- Luciana Wollmann
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brazil
| | - Paula Suss
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brazil
| | - João Mendonça
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brazil
| | - Cesar Luzia
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brazil
| | | | | | - Francisco Costa
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brazil
| | - Felipe F Tuon
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brazil
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30
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Lenoir M, Desnous B, Raisky O, Vouhé P. Particular surgical aspects of endocarditis due to Kingella kingae with cerebral complication. Interact Cardiovasc Thorac Surg 2019; 26:885-887. [PMID: 29309653 DOI: 10.1093/icvts/ivx411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/02/2017] [Indexed: 11/14/2022] Open
Abstract
We report 2 cases of Kingella kingae endocarditis leading to valvular mitral perforation in previously healthy children. Kingella kingae belongs to the HACEK (Haemophilus aphrophilus, Actiobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and K. kingae) group of organisms known to cause endocarditis.
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Affiliation(s)
- Marien Lenoir
- Department of Pediatric Cardiac Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Beatrice Desnous
- Department of Pediatric Neurology, Robert Debrés Hospital, Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Pascal Vouhé
- Department of Pediatric Cardiac Surgery, Necker Enfants Malades Hospital, Paris, France
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31
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Fukunaga N, Rao V. A Concern About 2-Minute Glutaraldehyde-Treated Autologous Pericardium for Mitral Valve Repair. Circ J 2019; 83:946. [PMID: 30745491 DOI: 10.1253/circj.cj-18-1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoto Fukunaga
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto
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32
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Nakanishi K, Kawasaki S, Amano A. Posterior leaflet augmentation using a left atrial wall patch for severe left atrioventricular valve regurgitation after repair of an atrioventricular defect. J Card Surg 2019; 34:35-36. [PMID: 30625245 DOI: 10.1111/jocs.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Keisuke Nakanishi
- Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan
| | - Shiori Kawasaki
- Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University, School of Medicine, Tokyo, Japan
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33
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Reinventing the Saphenous Vein: Reconstructing the Anterior Mitral Leaflet With a Saphenous Vein. Ann Thorac Surg 2018; 107:e287-e289. [PMID: 30513313 DOI: 10.1016/j.athoracsur.2018.10.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/02/2018] [Accepted: 10/21/2018] [Indexed: 11/22/2022]
Abstract
Mitral valve repair can sometimes require leaflet augmentation or a patch repair of a defect in the leaflet. No ideal patch material is currently available that can grow and adapt to the mitral leaflet. This report describes a new technique using autologous saphenous vein as patch material. The saphenous vein is untreated, living tissue and remains flexible as a patch or leaflet augmentation for up to 3 years on echocardiography.
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34
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Tjørnild MJ, Skov SN, Poulsen KB, Sharghbin M, Benhassen LL, Carlson Hanse L, Waziri F, Røpcke DM, Nielsen SL, Hasenkam JM. Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study†. Eur J Cardiothorac Surg 2018; 54:832-840. [DOI: 10.1093/ejcts/ezy152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Karen B Poulsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mona Sharghbin
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Leila L Benhassen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Farhad Waziri
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Diana M Røpcke
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sten L Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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35
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Sakaguchi T, Totsugawa T, Tamura K, Hiraoka A, Chikazawa G, Yoshitaka H. Minimally invasive trans-mitral septal myectomy for diffuse-type hypertrophic obstructive cardiomyopathy. Gen Thorac Cardiovasc Surg 2018; 66:321-326. [DOI: 10.1007/s11748-018-0908-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/09/2018] [Indexed: 11/25/2022]
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36
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Hosono M, Kuwauchi S, Taniguchi N, Kawazoe K. Posterior leaflet reconstruction using autologous pericardium in mitral repair. Gen Thorac Cardiovasc Surg 2017; 66:432-434. [PMID: 29067555 DOI: 10.1007/s11748-017-0851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/19/2017] [Indexed: 11/26/2022]
Abstract
A 75-year-old woman experienced recurrent mitral regurgitation caused mainly by a shrunken and tethered posterior mitral leaflet with a dilated left ventricle. Posterior leaflet motion was severely restricted. We successfully resolved the tethering and restored valve coaptation and competence using posterior leaflet reconstruction, which is a modified method of posterior leaflet augmentation using autologous pericardium. This technique can recover the posterior leaflet function by improving tissue volume and tethering.
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Affiliation(s)
- Mitsuharu Hosono
- Department of Cardiac Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi City, Osaka, 570-8570, Japan.
| | - Shintaro Kuwauchi
- Department of Cardiac Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi City, Osaka, 570-8570, Japan
| | - Naoki Taniguchi
- Department of Cardiac Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi City, Osaka, 570-8570, Japan
| | - Kohei Kawazoe
- Department of Cardiac Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi City, Osaka, 570-8570, Japan
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37
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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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38
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Nishida H, Nakatsuka D, Kawano Y, Hiraiwa N, Takanashi S, Tabata M. Outcomes of Totally Endoscopic Atrial Septal Defect Closure Using a Glutaraldehyde-Treated Autologous Pericardial Patch. Circ J 2017; 81:689-693. [PMID: 28179595 DOI: 10.1253/circj.cj-16-0888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated the outcomes of totally endoscopic minimally invasive surgery for atrial septal defect (ASD) using a glutaraldehyde-treated autologous pericardial patch in the transcatheter interventional era.Methods and Results:We retrospectively reviewed 37 consecutive patients who underwent totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch between June 2011 and April 2015. All patients had been deferred from catheter-based intervention for clinical or anatomical reasons. We analyzed operative outcomes and postoperative echocardiographic data. The mean age was 45.7±16.5 years, and 25 patients (67.6%) were women. The mean ratio of pulmonary to systemic flow was 2.4±0.7. Six patients (16.2%) underwent concomitant tricuspid valve repair, and 3 patients (8.1%) underwent concomitant atrial fibrillation surgery. There were no operative deaths, and the median length of hospital stay was 5 days. Postoperative echocardiography revealed trivial residual shunt in 1 patient. During the follow-up period, there were no re-interventions for ASD or readmission for heart failure. Follow-up echocardiography revealed no recurrent shunt or calcification of the autologous pericardial patch. CONCLUSIONS Totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch demonstrated excellent outcomes. It is a useful option for patients with unfavorable anatomy or other reasons excluding transcatheter intervention.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Daisuke Nakatsuka
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Yuji Kawano
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Nobuhiko Hiraiwa
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Sakakibara Heart Institute.,Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
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39
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Fukunaga N, Koyama T. Concerns about tricuspid leaflet augmentation for severe tricuspid regurgitation. Eur J Cardiothorac Surg 2017; 51:607. [PMID: 27694250 DOI: 10.1093/ejcts/ezw329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery and Pathology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery and Pathology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan
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40
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Fukunaga N, Koyama T. Pay Attention to Mitral Valve Repair With Autologous Pericardial Leaflet Augmentation. Ann Thorac Surg 2017; 103:689. [PMID: 28109359 DOI: 10.1016/j.athoracsur.2016.06.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
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41
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Mvondo CM, Pugliese M, Giamberti A, Chelo D, Kuate LM, Boombhi J, Dailor EM. Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option. Pan Afr Med J 2016; 24:307. [PMID: 28154662 PMCID: PMC5267788 DOI: 10.11604/pamj.2016.24.307.7504] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 05/12/2016] [Indexed: 11/11/2022] Open
Abstract
Rheumatic valve disease, a consequence of acute rheumatic fever, remains endemic in developing countries in the sub-Saharan region where it is the leading cause of heart failure and cardiovascular death, involving predominantly a young population. The involvement of the mitral valve is pathognomonic and mitral surgery has become the lone therapeutic option for the majority of these patients. However, controversies exist on the choice between valve repair or prosthetic valve replacement. Although the advantages of mitral valve repair over prosthetic valve replacement in degenerative mitral disease are well established, this has not been the case for rheumatic lesions, where the use of prosthetic valves, specifically mechanical devices, even in poorly compliant populations remains very common. These patients deserve more accurate evaluation in the choice of the surgical strategy which strongly impacts the post-operative outcomes. This report discusses the factors supporting mitral repair surgery in rheumatic disease, according to the patients' characteristics and the effectiveness of the current repair techniques compared to prosthetic valve replacement in developing countries.
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Affiliation(s)
| | - Marta Pugliese
- Divison of Cardiac Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - David Chelo
- Department of Pediatrics, Chantal Biya Foundation, Yaoundé, Cameroon
| | | | - Jerome Boombhi
- Department of Cardiology, Yaoundé General Hospital, Yaoundé Cameroon
| | - Ellen Marie Dailor
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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42
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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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43
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Tanaka K, Sakaguchi T, Ota K, Takano H. Surgical repair of isolated anterior mitral leaflet cleft via right minithoracotomy. J Cardiol Cases 2016; 13:196-198. [PMID: 30546645 DOI: 10.1016/j.jccase.2016.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022] Open
Abstract
Isolated anterior mitral leaflet cleft (AMLC) is rare. Several surgical procedures have been described; however, there are few reports which described mitral repair using minimally invasive cardiac surgery for AMLC. We describe successful repair for isolated AMLC via right minithoracotomy. A 29-year-old woman with moderate mitral regurgitation (MR) diagnosed by echocardiogram several years previously presented with dyspnea on exertion. Transthoracic echocardiography revealed severe MR due to an AMLC in the central portion of A2. An autologous pericardial patch augmentation combined with artificial chorda reconstruction under right minithoracotomy approach was performed. It enabled to gain adequate leaflet coaptation area, and MR was effectively controlled by these procedures. <Learning objective: The aim of this case report is to describe a successful operation for congenital mitral valve insufficiency under minimally invasive cardiac surgery. We managed some surgical techniques because of different anatomy unlike other adult valvular disease. There are few reports of surgical repair for isolated anterior mitral leaflet cleft.>.
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Affiliation(s)
- Koyu Tanaka
- Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kazunori Ota
- Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Hiroshi Takano
- Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
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44
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Kanemitsu H, Nakamura K, Fukunaga N, Koyama T. Long-Term Outcomes of Mitral Valve Repair for Active Endocarditis. Circ J 2016; 80:1148-52. [DOI: 10.1253/circj.cj-15-1062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Kanemitsu
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Ken Nakamura
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
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45
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Aguiari P, Fiorese M, Iop L, Gerosa G, Bagno A. Mechanical testing of pericardium for manufacturing prosthetic heart valves. Interact Cardiovasc Thorac Surg 2015; 22:72-84. [DOI: 10.1093/icvts/ivv282] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/03/2015] [Indexed: 01/15/2023] Open
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Fukunaga N, Matsuo T, Saji Y, Imai Y, Koyama T. Mitral Valve Stenosis Progression Due to Severe Calcification on Glutaraldehyde-Treated Autologous Pericardium: Word of Caution for an Attractive Repair Technique. Ann Thorac Surg 2015; 99:2203-5. [PMID: 26046878 DOI: 10.1016/j.athoracsur.2014.07.087] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/24/2014] [Accepted: 07/30/2014] [Indexed: 11/19/2022]
Abstract
A 42-year-old woman presented with a 6-month history of palpitations and progressive dyspnea on exertion. She had undergone aortic and mitral valve repair using glutaraldehyde-treated autologous pericardium for active infective endocarditis 5 years prior. Transthoracic echocardiography showed mitral valve stenosis with limited movement of the anterior leaflet. At redo surgery, severe calcification of the glutaraldehyde-treated pericardial patch on the anterior mitral leaflet was observed. Double valve replacement was performed with pulmonary vein isolation. Pathologic examination showed calcification of the glutaraldehyde-treated autologous pericardium. The patient was discharged on postoperative day 11 with oral anticoagulant therapy.
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Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Takehiko Matsuo
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshiaki Saji
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Ito T, Maekawa A, Aoki M, Hoshino S, Hayashi Y, Sawaki S, Yanagisawa J, Tokoro M. Seamless reconstruction of mitral leaflet and chordae with one piece of pericardium. Eur J Cardiothorac Surg 2014; 45:e227-32. [DOI: 10.1093/ejcts/ezu140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Outcome of surgical management for active mitral native valve infective endocarditis: a collective review of 57 patients. Gen Thorac Cardiovasc Surg 2014; 62:488-98. [DOI: 10.1007/s11748-014-0377-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 01/17/2014] [Indexed: 12/27/2022]
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Miura T, Nakaji S, Ariyoshi T, Tsuneto A, Hashizume K, Eishi K. Mitral leaflet restoration using a billowing leaflet in active infective endocarditis. Ann Thorac Surg 2014; 97:e47-8. [PMID: 24484843 DOI: 10.1016/j.athoracsur.2013.09.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/15/2013] [Accepted: 09/23/2013] [Indexed: 10/25/2022]
Abstract
A key to the success of mitral valve repair in patients with infective endocarditis is the technique used for reconstruction of the missing leaflet. We report the case of a 47-year-old man with active mitral infective endocarditis. After dissection of the infected segments of P3 and the posteromedial commissure, the defect was reconstructed using tissue from a billowing A2 medial and A3 segment. Chordal transfer with an anterior chord was performed to correct the A3 mild prolapse. Follow-up echocardiography showed recovery of mitral valve morphology and function without regurgitation.
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Affiliation(s)
- Takashi Miura
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan.
| | - Shun Nakaji
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Tsuneo Ariyoshi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Akira Tsuneto
- Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Koji Hashizume
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan
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50
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Punjabi PP. Invited commentary. Ann Thorac Surg 2013; 95:2006. [PMID: 23706424 DOI: 10.1016/j.athoracsur.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 03/27/2013] [Accepted: 04/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Prakash P Punjabi
- National Heart and Lung Institute, Imperial College, Department of Cardiothoracic Surgery, Hammersmith Hospital, London, United Kingdom.
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