1
|
Xu Q, Bing Z, Lv B, Chen R, Xing Q. Surgical repair of "Swiss Cheese" ventricular septal defects with two-patch and right ventricular apex-exclusion technique: mid-term follow-up results. J Cardiothorac Surg 2024; 19:584. [PMID: 39363294 PMCID: PMC11448195 DOI: 10.1186/s13019-024-03085-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/15/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND "Swiss Cheese" ventricular septal defects represent a serious congenital heart disease with suboptimal clinical outcomes and a lack of consensus regarding its management. This study presents mid-term follow-up results of surgical repairs for "Swiss Cheese" ventricular septal defects, utilizing the two-patch and right ventricle apex-exclusion technique. METHODS A retrospective review was conducted on 13 patients who underwent surgical repair utilizing the two-patch and right ventricle apex-exclusion technique at our institution between May 2014 and October 2021. The procedure involved the closure of defects in the outflow tract ventricular septal and the apex trabecular ventricular septal regions using two patches, with concurrent exclusion of the right ventricular apex from the right ventricular inflow tract. RESULTS Median follow-up was 4.9 ± 2.1 years (range: 2-9 years). All cases were successful without mortality or major complications. Two years post-surgery, cardiac magnetic resonance revealed median values for left ventricular ejection fraction, right ventricular ejection fraction, left ventricular end-diastolic volume and right ventricular end-diastolic volume of 63.9% ± 1.8% (range: 61-67%), 49.2% ± 2.6% (range: 46-55%), 39.15 ± 2.11 ml (range: 36.2-42.7 ml), 44.55 ± 3.33 ml (range: 38.7-48.6 ml), respectively. No thrombosis occurred. The latest echocardiography results confirmed normal cardiac function in all cases. CONCLUSIONS The surgical repair of "Swiss Cheese" ventricular septal defects utilizing the two-patch and right ventricle apex-exclusion technique is a viable approach with favorable mid-term outcomes. More cases and long-term follow-up results are needed to validate the feasibility and safety of this technique.
Collapse
Affiliation(s)
- Qiteng Xu
- Heart Center, Affiliated Women and Children's Hospital, Qingdao University, Qingdao, 266000, China
| | - Zhen Bing
- Heart Center, Affiliated Women and Children's Hospital, Qingdao University, Qingdao, 266000, China
| | - Bei Lv
- Heart Center, Affiliated Women and Children's Hospital, Qingdao University, Qingdao, 266000, China
| | - Rui Chen
- Heart Center, Affiliated Women and Children's Hospital, Qingdao University, Qingdao, 266000, China.
| | - Quansheng Xing
- Heart Center, Affiliated Women and Children's Hospital, Qingdao University, Qingdao, 266000, China.
| |
Collapse
|
2
|
Wierup P, Ramgren JJ, Sjögren J, Phan KT, Zindovic I, Nozohoor S, Christierson L, Hakacova N. Mitral valve repair using leaflet expansion and subpartial annuloplasty in children. JTCVS Tech 2024; 23:74-80. [PMID: 38351986 PMCID: PMC10859564 DOI: 10.1016/j.xjtc.2023.10.020] [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: 07/04/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 02/16/2024] Open
Abstract
Objective Mitral valve reconstruction in the pediatric population is a challenge due to the frequent combination of annular dilatation and leaflet restriction and the need for growth. We present a novel strategy using leaflet expansion and subpartial annuloplasty with polytetrafluoroethylene reinforcement. Methods From January 2014 through May 2021, 11 children aged 5 months to 14 years (median, 24 months) underwent elective mitral valve repair due to severe mitral valve regurgitation. The mitral valve abnormalities included congenital malformations (n = 7), postoperative leakage following commissurotomy (n = 1), and functional mitral valve regurgitation due to dilated cardiomyopathy (n = 3). Surgery consisted of leaflet expansions with autologous, untreated pericardium and subpartial annuloplasty with polytetrafluoroethylene reinforcement. Results All children survived their surgeries with uneventful postoperative courses, except for 1 patient who needed an early reoperation to resolve a functional stenosis due to a spinnaker phenomenon. At discharge, mean gradient was 3.5 ± 3.9 mm Hg, with trivial mitral regurgitation in 9 patients (82%). All patients were alive and asymptomatic during the median follow-up of 3 years (range, 1-7 years). Their echocardiographic data showed a mean transmitral gradient of 4.4 ± 1.7 mm Hg and remained unchanged. Residual mitral valve regurgitation was trivial or mild in 9 patients (82%) and moderate in 2 patients (18%). Conclusions Leaflet expansion with autologous pericardium and subpartial annuloplasty with polytetrafluoroethylene reinforcement for mitral regurgitation in the pediatric population gives stable and satisfactory results both early and at intermediate follow-up, permitting growth of the mitral valve.
Collapse
Affiliation(s)
- Per Wierup
- Department of Pediatric Heart Surgery, Skane University Hospital, Lund, Sweden
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden
| | | | - Johan Sjögren
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden
| | - Kiet Tran Phan
- Department of Pediatric Heart Surgery, Skane University Hospital, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden
| | - Lea Christierson
- Department of Pediatric Cardiology, Skane University Hospital, Lund, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Nina Hakacova
- Department of Pediatric Cardiology, Skane University Hospital, Lund, Sweden
| |
Collapse
|
3
|
Amir G, Lowenthal A, Bruckheimer E, Dagan T, Schiller O, Shostak E, Frenkel G, Birk E. Three-Patch Reconstruction of Hourglass Supravalvar Pulmonary Artery Stenosis Mid-Term Results. World J Pediatr Congenit Heart Surg 2024; 15:89-93. [PMID: 37853700 DOI: 10.1177/21501351231196485] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND Some patients with pulmonary stenosis present with a complex multilevel disease that involves the valve, the leaflets, and the sinotubular junction (STJ) forming an hourglass appearance. We herein report the mid-term results of our experience with the reconstruction of the supravalvar narrowing using three pericardial patches. MATERIAL AND METHODS Retrospective analysis of patient charts and echocardiography studies of patients who underwent three-patch reconstruction of the pulmonary valve (PV) from 2013 to 2022. After PV transection distal to STJ, vertical incisions into the sinuses were performed, and leaflets were trimmed and thinned. The three sinuses were augmented using three pericardial patches. RESULTS Nineteen patients underwent repair of hourglass supravalvar pulmonary stenosis. Mean weight at surgery was 9.4 kg (median 7.2, range 4.7-35); 16 patients underwent previous catheterization with unsuccessful balloon dilatation of the PV (13 pts.). Preoperative aortic/pulmonary annulus ratio was 1.02 (median 1, range 0.89-1.25). After surgery, gradients across the PV were significantly reduced (94 ± 26 vs 29 ± 9 mm Hg, P = .02). Postoperatively, 14 patients had mild or no pulmonary insufficiency (PI) and five had mild to moderate PI. At a mean follow-up of 71 months (median 78 months, range 8-137), gradients continued to decrease (29 ± 9 vs 15 ± 5 mm Hg, P < .001). CONCLUSION The three-patch technique for the repair of supravalvar pulmonary stenosis is simple, reproducible, and achieves excellent and long-standing relief of the right ventricular outflow tract gradient.
Collapse
Affiliation(s)
- Gabriel Amir
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lowenthal
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Elchanan Bruckheimer
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Tamir Dagan
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ofer Schiller
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Eran Shostak
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric and Congenital Cardiac Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Einat Birk
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| |
Collapse
|
4
|
Hu YN, Lee WH, Tsai MT, Wang YC, Shih CJ, Huang YC, Roan JN. The Predictors and Outcomes of Functional Mitral Stenosis following Surgical Mitral Valve Repair: A Retrospective Analysis. J Cardiovasc Dev Dis 2023; 10:470. [PMID: 37998528 PMCID: PMC10672255 DOI: 10.3390/jcdd10110470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
To optimize mitral valve repair outcomes, it is crucial to comprehend the predictors of functional mitral valve stenosis (FMS), to enhance preoperative assessments, and to adapt intraoperative treatment strategies. This study aimed to identify FMS risk factors, contributing valuable insights for refining surgical techniques. Among 228 selected patients, 215 underwent postoperative echocardiography follow-ups, and 36 met the FMS criteria based on a mean trans-mitral pressure gradient of >5 mmHg. Patients with FMS exhibited higher pulmonary systolic arterial pressure and increased late mortality during the follow-up. Univariable logistic regression analysis identified several risk factors for FMS, including end-stage renal disease, anterior leaflet lesion, concomitant aortic valve replacement, smaller ring size, ring type, and neochordae implantation. Conversely, resection alone and resection combined with neochordae implantation had protective effects against FMS. Multivariable logistic regression analysis revealed that smaller ring sizes and patch repair independently predicted FMS. When focusing on degenerative mitral regurgitation, the neochordae implantation without resection in leaflet repair, emerged as an independent predictor of FMS. Surgeons should weigh the substantial impact of surgical procedures on postoperative trans-mitral pressure gradients, emphasizing preoperative evaluation and techniques such as precise ring size assessment and effective leaflet management.
Collapse
Affiliation(s)
- Yu-Ning Hu
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Wen-Huang Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Meng-Ta Tsai
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Yi-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Chao-Jung Shih
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Yu-Ching Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| |
Collapse
|
5
|
Saito T, Kawamura M, Toda K, Miyagawa S. Successful surgical repair of adult anomalous origin of the left main coronary artery from the pulmonary artery syndrome complicated by severe mitral regurgitation: a case report. Eur Heart J Case Rep 2023; 7:ytad340. [PMID: 37547367 PMCID: PMC10398421 DOI: 10.1093/ehjcr/ytad340] [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] [Received: 01/08/2023] [Revised: 02/20/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
Background The number of diagnosed cases of anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) in adults has increased substantially because of modern advances in non-invasive cardiac imaging. Here, we report successful surgical repair in an adult patient with ALCAPA complicated by severe mitral regurgitation (MR) and persistent atrial fibrillation. Case summary ALCAPA syndrome was detected in a 65-year-old Asian woman with persistent atrial fibrillation by coronary computed tomographic angiography. An echocardiogram revealed severe MR caused by annular dilation, atrial enlargement, and posterior mitral leaflet tethering. In addition to ALCAPA repair, mitral valve repair and Cox-Maze IV cryoablation were performed. Mitral valve repair was performed using augmentation with an autologous pericardial patch in the posterior leaflet and ring annuloplasty. Discussion Because the mechanism of MR with ALCAPA in an adult varies by comorbidity, mitral valve repair should be performed according to the valvular and subvalvular morphologies. It is essential to develop strategies that provide adequate myocardial protection during the surgical treatment of ALCAPA considering coronary steal and non-coronary collateral blood flow.
Collapse
Affiliation(s)
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan, 565-0871
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan, 565-0871
| | | |
Collapse
|
6
|
Hanse LC, Tjørnild MJ, Karunanithi Z, Høgfeldt Jedrzejczyk J, Islamagič L, Hummelshøj NE, Enevoldsen M, Lugones G, Høj Lauridsen M, Hjortdal VE, Lugones I. Trileaflet Semilunar Valve Reconstruction: Acute Porcine in Vivo Evaluation. World J Pediatr Congenit Heart Surg 2023; 14:509-515. [PMID: 37039366 DOI: 10.1177/21501351231166662] [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] [Indexed: 04/12/2023]
Abstract
Objective: The surgical treatment of malformed semilunar valves in congenital heart defects is challenging in terms of providing both longevity and the potential to grow with the recipient. We investigated a new surgical technique "Trileaflet Semilunar Valve Reconstruction" in an acute porcine model, a technique with geometrical properties that could remain sufficient and allow for some growth with the child. Methods: An acute 60-kg porcine model was used. With echocardiography, baseline pulmonary valvular geometry and hemodynamics were investigated. On cardiopulmonary bypass, the pulmonary leaflets were explanted, and the Trileaflet Semilunar Valve Reconstruction was performed with customized homograft-treated pericardial neo-leaflets. Off bypass, hemodynamics was reassessed. Results: Twelve animals were investigated. The neo-valves were found sufficient in ten animals and with minimal regurgitation in two animals. The neo-valve had a peak gradient of 3 ± 2 mm Hg with a peak velocity of 0.8 ± 0.2 m/s. The coaptation in the neo-valve had a mean increase of 4 ± 3 mm, P < .001. The neo-valve had a windmill shape in the echocardiographic short-axis view, and the neo-leaflets billowed at the annular plane in the long-axis view. Conclusions: In this acute porcine model, the neo-valve had no clinically significant regurgitation or stenosis. The neo-valve had an increased coaptation, a windmill shape, and leaflets that billowed at the annular plane. These geometric findings may allow for sustained sufficiency as the annular and pulmonary artery dimension increase with the child's growth. Further long-term studies should be performed to evaluate the efficacy and the growth potential.
Collapse
Affiliation(s)
- Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marcell Juan Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Johannes Høgfeldt Jedrzejczyk
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lejla Islamagič
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Malene Enevoldsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Germán Lugones
- Centro de Ciencias Naturais e Humanas, Universidade Federal do ABC, Santo André, Sao Paulo, Brazil
| | - Mette Høj Lauridsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ignacio Lugones
- Department of Congenital Heart Surgery, Hospital General de Niños "Dr Pedro de Elizalde", Buenos Aires, Argentina
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Garzón-Furné AI, Ferreiro-Marzal A, Rodríguez-Serrano F, Esteban-Molina M, García-Orta R, Moreno-Escobar E, García-Delgado M, Sevilla-Martínez M, Gómez-Luque JM, Ocete-Hita E, Rodríguez-Vázquez del Rey MDM, Nuila-Durán LM, Garrido JM. Reparación valvular en la endocarditis mitral. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Morisaki A, Takahashi Y, Fujii H, Sakon Y, Murakami T, Shibata T. Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation. J Thorac Dis 2022; 14:3831-3841. [PMID: 36389294 PMCID: PMC9641335 DOI: 10.21037/jtd-22-828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/09/2022] [Indexed: 12/28/2023]
Abstract
BACKGROUND Long-standing atrial fibrillation is associated with atrial functional mitral regurgitation (AFMR) with atriogenic tethering. We compared the outcomes of patch augmentation (PA) and valve replacement (VR) for AFMR. METHODS We retrospectively compared the data of 16 patients who underwent PA for AFMR with the data of 15 patients who underwent VR between 2008 and 2021. Patients with a left ventricular ejection fraction (LVEF) of <50% were excluded. We also performed atrial plication and left appendage closure if the patients had no weak atrial wall that led to severe bleeding. RESULTS The median age was 72.5 and 76.0 years in the PA and VR groups, respectively. The PA group had a longer cardiopulmonary bypass time (206 vs. 172 min, P=0.012). Although there were no differences in hospital morbidity and mortality between the PA and VR groups, one patient underwent reoperation for patch perforation in the PA group. The overall 3-year survival rate was 93.8% and 100% in the PA and VR groups, respectively (P=0.878). The 3-year rate of freedom from major adverse cardiac events was 75.0% and 53.6% in the PA and VR groups, respectively (P=0.181). Three and six patients were readmitted for congestive heart failure in the PA and VR groups, respectively. Two patients in the PA group developed severe recurrent regurgitation, including one patient who required reoperation. No patients in the VR group required reoperation. The postoperative left atrial volume index (LAVI) was associated with thromboembolic events (P=0.016). CONCLUSIONS PA may achieve comparable outcomes to those of VR for AFMR. Operative procedures should be chosen based on each patient's background. Atrial reduction could be considered to prevent thromboembolic events.
Collapse
Affiliation(s)
- Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Tatari H, Omrani G, Arabian M, Mozaffari K, Toloueitabar Y, Asadian S, Givtaj N, Gholampour Dehaki M, Jalali A. The fate of the fresh autologous pericardium after right ventricular outflow tract reconstruction. J Cardiovasc Thorac Res 2022; 14:47-52. [PMID: 35620750 PMCID: PMC9106945 DOI: 10.34172/jcvtr.2022.06] [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: 09/10/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction: The autologous pericardium, treated or fresh, is used in reconstructive cardiovascular surgery. We aimed to describe the features of fresh pericardium utilized in right ventricular outflow tract (RVOT) reconstruction, years after the initial surgery.
Methods: This cross-sectional study was performed on 72 patients (65.3% male, mean age =18.68 ± 9.63 y) with a history of RVOT reconstruction with the fresh autologous pericardium who underwent reoperation. During the surgery, a 1 × 1 cm sample was cut from the previous pericardial patch, and hematoxylin and eosin (H & E), Masson’s trichrome, and immunohistochemistry (IHC) staining was conducted. All the stained slides were evaluated,and the descriptive results were explained.
Results: The mean follow-up duration was 13.48 ± 7.38 years. In preoperative evaluations,53 (73.6%) patients exhibited no RVOT dilatation, 17 (23.6%) showed mild RVOT dilatation,and 2 (2.8%) had RVOT aneurysms. The H & E staining revealed no calcification in 80.55%(58/72), mild calcification in 9.72% (7/72), and moderate calcification in 9.72% (7/72) of the total samples. None of the specimens demonstrated a marked calcification. All the samples were positive for CD31, CD34, smooth muscle alpha-actin, and von Willebrand factor in IHC. In Masson’s trichrome staining, on average, 64.74% (±18.61) of the tissue sections contained collagen fibers.
Conclusion: The fresh autologous pericardium, utilized for RVOT reconstruction, showed viability, growth potential, positivity for endothelial cell markers, vascular differentiation,insignificant calcification, and no stenosis at long-term follow-up. We would, therefore, suggest it as a suitable choice for such reconstructive operations. Moreover, its usage during total correction of tetralogy of Fallot could be safe, feasible, and durable.
Collapse
Affiliation(s)
- Hassan Tatari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Omrani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maedeh Arabian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kambiz Mozaffari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Toloueitabar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Asadian
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Givtaj
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Gholampour Dehaki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Jalali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
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
|
15
|
Pande S, Arya A, Agarwal S, Tewari P, Kapoor A, Soni N, Kumar S. Long-term performance of untreated fresh autologous pericardium as a valve substitute in pulmonary position. Ann Card Anaesth 2022; 25:164-170. [PMID: 35417962 PMCID: PMC9244266 DOI: 10.4103/aca.aca_22_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Pulmonary regurgitation is imminent after transannular patch (TAP). We analyze the long-term performance of untreated autologous pericardium (UAP) as valve substitute at pulmonary position in patients requiring TAP. Material and Methods: This cross-sectional study include patients operated between 2007 and 2012 (n = 92). A sample of 19 patients was selected for this study which had a follow-up of more than 3 years. This includes patients with no TAP (n = 4) and with TAP and valve substitute, a monocusp (n = 11) or a tricuspid valve (n = 4) at neopulmonary annulus. Patients underwent echocardiography for assessment of right ventricle function and 18 fluoro-deoxyglucose PET CT scan for measurements of valve substitute at neopulmonary annulus. The target to blood ratio (TBR) of uptake of glucose by monocusp was measured at the cooptation edge of the neopulmonary valve. Results: The median age of the patients is 14 (9 – 37). RV function is preserved (TAPSE 18.9 (10.6 – 22.8)) at a mean follow-up of 4 years (3-9). The measurements of monocusp shows a shrinkage in height of the cusp by 35.5% (70% – 1.0%) and length by 7% (-44% - +104%). There was less shrinkage observed in patients below 15 years of age. The TBR of monocusp was 0.945 (0.17 – 3.35) with a strong correlation between the TBR values of aortic valve leaflet and monocusp leaflet of same patient. Conclusion: The UAP is functional and successful as a valve substitute at neo pulmonary annulus at long-term follow-up. It has resisted calcification and has shown uptake of glucose in physiological limits.
Collapse
|
16
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6564254. [DOI: 10.1093/ejcts/ezac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/12/2022] Open
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Ruttmann E, Abfalterer H, Wagner J, Grimm M, Müller L, Bates K, Ulmer H, Bonaros N. Endocarditis-related stroke is not a contraindication for early cardiac surgery: an investigation among 440 patients with left-sided endocarditis. Eur J Cardiothorac Surg 2021; 58:1161-1167. [PMID: 33057727 DOI: 10.1093/ejcts/ezaa239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES A treatment dilemma arises when surgery is indicated in patients with infective endocarditis (IE) complicated by stroke. Neurologists recommend surgery to be postponed for at least 1 month. This study aims to investigate the neurological complication rate and neurological recovery potential in patients with IE-related stroke. METHODS A total of 440 consecutive patients with left-sided IE undergoing surgery were investigated. During follow-up, neurological recovery was assessed using the modified Rankin scale and the Barthel index. Mortality was assessed with regression models adjusting for age. RESULTS The median follow-up time was 9.0 years. Patients with previous strokes were more likely to suffer from mitral valve endocarditis (29.5% vs 47.4%, P < 0.001). Symptomatic stroke was found in 135 (30.7%) patients; of them, 42 patients presented with complicated stroke (additional meningitis, haemorrhagic stroke or intracranial abscess). Driven by symptomatic stroke, the age-adjusted hospital mortality risk was 1.4-fold [95% confidence interval (CI) 0.74-2.57; P = 0.31] higher and the long-term mortality risk was 1.4-fold higher (95% CI 1.003-2.001; P = 0.048). Hospital mortality was higher in patients with complicated stroke (21.4% vs 9.7%; P = 0.06) only; however, mortality rates were similar comparing uncomplicated stroke versus no stroke. Among patients with complicated ischaemic strokes, the observed risk for intraoperative cerebral haemorrhage was 2.3% only and the increased hospital mortality was not driven by cerebral complications. In the long-term follow-up, full neurological recovery was observed in 84 out of 118 survivors (71.2%), and partial recovery was observed in 32 (27.1%) patients. Neurological recovery was lower in patients with complete middle cerebral artery stroke compared to other localization (52.9% vs 77.6%; P = 0.003). CONCLUSIONS Contrary to current clinical practice and neurological recommendations, early surgery in IE is safe and neurological recovery is excellent among patients with IE-related stroke. CLINICAL REGISTRATION NUMBER LOCAL IRB UN4232 382/3.1 (retrospective study).
Collapse
Affiliation(s)
- Elfriede Ruttmann
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Hannes Abfalterer
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Julian Wagner
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Ludwig Müller
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Katie Bates
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
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.
Collapse
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
| | | |
Collapse
|
22
|
Wu Q, Shi L, Chen R, Xing Q. Biventricular surgical repair of "Swiss Cheese" ventricular septal defects with two-patch and right ventricle apex excluding technique: preliminary experience and clinical results. J Cardiothorac Surg 2021; 16:33. [PMID: 33743761 PMCID: PMC7981800 DOI: 10.1186/s13019-021-01399-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background “Swiss Cheese” ventricular septal defects (VSDs) is a kind of rare and complex congenital heart defects and the surgical management remains controversial and a challenge. We reviewed our preliminary clinical experience on biventricular surgical repair of “Swiss Cheese” VSDs with two-patch and right ventricle apex excluding technique in 10 cases. Methods From May 2014 to December 2019, a series of 10 patients (M/F = 3/7) were admitted in our center. Nine cases underwent one-stage surgical repair with two-patch and right ventricle apex excluding technique and 1 case received two-stage surgical repair with the same technique. Surgical repair was done with cardiopulmonary bypass (CPB) in all cases. Two fresh autologous pericardium patches were used to close defects of the outflow tract area and the apex trabecular area respectively and as a result, the right ventricular apex was excluded from the right ventricular inflow tract. Results All operations were successful. Median CPB time and aortic clamping time were 96 min and 68 min respectively. Delayed chest closure was performed in 2 cases within 48–72 h postoperatively. The Median time of mechanical ventilation and ICU stay were 131.3 h and 8 days respectively. Median length of hospital stay after operation was 11 (9–42) days. There was no mortality and major complication except for 2 cases of ventilator associated pneumonia. There was no death and major complication during a median follow-up time of 3.2 years.. The latest echocardiography results showed the left and right heart function was normal in all the cases. Conclusions Biventricular surgical repair of “Swiss Cheese” VSDs with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants is safe and feasible with favorable early and mid-term results. Long term results need to be evaluated with more cases.
Collapse
Affiliation(s)
- Qin Wu
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, 266034, Qingdao, People's Republic of China
| | - Lei Shi
- Pediatric Echocardiography Lab, Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, 266034, Qingdao, People's Republic of China
| | - Rui Chen
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, 266034, Qingdao, People's Republic of China
| | - Quansheng Xing
- Heart Center, Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, 266034, Qingdao, People's Republic of China.
| |
Collapse
|
23
|
Nappi F, Acar C. The Use of Anterior Mitral Leaflet Augmentation With Autologous Pericardium: Why Not? Ann Thorac Surg 2020; 112:688-689. [PMID: 33347852 DOI: 10.1016/j.athoracsur.2020.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de, Saint-Denis (CCN), 36 Rue des Moulins Gémeaux, 93200 Saint-Denis, France.
| | - Christophe Acar
- Department of Cardiovascular Surgery, Hopital de la Salpetriere, Paris, France
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Benedetto U, Gergely S, Dimagli A, Sinha S. AVNeo (Ozaki) and transaortic mitral valve repair using autologous pericardium only for aortomitral endocarditis. JTCVS Tech 2020; 3:101-103. [PMID: 34317833 PMCID: PMC8302910 DOI: 10.1016/j.xjtc.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/16/2020] [Accepted: 05/08/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Szabolcs Gergely
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
27
|
Hirji SA, Kaneko T. Commentary: Patch repair for aortomitral endocarditis: Playing the short game or the long game? JTCVS Tech 2020; 3:104-105. [PMID: 34317834 PMCID: PMC8302911 DOI: 10.1016/j.xjtc.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| |
Collapse
|
28
|
Fang C, Pan H, Li Z, Ma L, Han W. Autologous pericardium used for reconstruction of left innominate vein in patient with mediastinal venous aneurysm:a case report. BMC Surg 2020; 20:88. [PMID: 32370775 PMCID: PMC7201798 DOI: 10.1186/s12893-020-00749-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/16/2020] [Indexed: 01/04/2023] Open
Abstract
Background Mediastinal venous aneurysm is a very rare disease and can be easily misdiagnosed. Patients are often asymptomatic while venous aneurysm of large size with adjacent structures oppressed can lead to discomfort. The surgical treatment for aneurysm of large vessels is often complex and challenging. Case presentation We reported a 52-year-old man with mediastinal mass who received operation on July 2019 in our hospital. Left innominate vein aneurysm was diagnosed during operation with superior vena cava involved. The aneurysm was resected and pericardium was taken to repair part wall of superior vena cava and reconstruct left innominate vein. The patient’s postoperative course was uneventful. Conclusions Venous aneurysm should be considered when mediastinal mass has no clear boundary with large veins or even seems to connect with them. Magnetic resonance imaging, computed tomographic angiography and invasive venography can be performed to further evaluate the mass once diagnosis of venous aneurysm was suspected. Using pericardium to repair large veins is a good choice which is safe and costless.
Collapse
Affiliation(s)
- Cheng Fang
- Department of Lung transplantation, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Hui Pan
- Department of Lung transplantation, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Zhoubin Li
- Department of Lung transplantation, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Liang Ma
- Department of Cardiothoracic surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China.
| | - Weili Han
- Department of Lung transplantation, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, 310003, China.
| |
Collapse
|
29
|
Gleason TG. Structural Isomerism of the Aortic Valve: Bicuspidization Redux. Ann Thorac Surg 2019; 110:1-4. [PMID: 31866481 DOI: 10.1016/j.athoracsur.2019.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| |
Collapse
|
30
|
Costa ACBA. Invited Commentary. Ann Thorac Surg 2019; 109:41-42. [PMID: 31306627 DOI: 10.1016/j.athoracsur.2019.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ana Claudia B A Costa
- Department of Cardiovascular Surgery, Mount Sinai Hospital, 1 Gustave L. Levy Pl, New York, NY 10029.
| |
Collapse
|