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Tomšič A, Holubec T, Sandoval E, Pham T, Castella M, Klautz RJM, Marsan NA, Pereda D, Palmen M. Mitral valve repair with resection and non-resection techniques in Barlow's disease: A multi-center study. Int J Cardiol 2024:132387. [PMID: 39047796 DOI: 10.1016/j.ijcard.2024.132387] [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: 01/07/2024] [Revised: 05/22/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Various mitral valve (MV) repair techniques are nowadays in use. Non-resection techniques, that rely exclusively on Gore-Tex® neochords and annuloplasty, have been popularized; however, their efficacy in Barlow's disease, characterized by large myxomatous leaflets, is yet unclear. METHODS Consecutive patients undergoing MV repair for Barlow's disease between 2011 and 2019 were selected on the basis of being eligible for resection and non-resection techniques. Study endpoints included overall survival, freedom from MV reintervention and recurrent regurgitation. RESULTS Of 209 patients meeting the inclusion criteria, 135 (65%) underwent MV repair with and 74 (35%) without resection. There was one early reoperation due to residual regurgitation (resection group). Mean clinical follow-up duration was 6.1 (IQR 3.9-8.5) years. At 6 years after surgery, there was no difference in overall survival or freedom from MV reintervention. Mean echocardiographic follow-up (95% complete) duration was 3.5 (IQR 2.3-5.8) years. At 6 years, there was no difference in freedom from recurrent regurgitation rate (86.1%, 95% CI 78.5-93.7% vs. 83.0%, 95% CI 71.6-94.4%, P = 0.20) between the groups. Inverse probability-of-treatment weighting adjusted analysis demonstrated no significant difference between groups (HR 0.535, 95% CI 0.212-1.349, P = 0.20). Uni- and multivariable Cox proportional regression analysis did not demonstrate an effect of valve repair technique on the occurrence of recurrent regurgitation. CONCLUSIONS At mid-term, the clinical and echocardiographic results of valve repair for Barlow's disease were very good and MV reintervention was rarely needed. At this time point, the results of non-resection techniques were comparable to the "gold standard" resection techniques.
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Affiliation(s)
- Anton Tomšič
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Thao Pham
- Department of Cardiovascular Surgery, University Hospital and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Manuel Castella
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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Florissi IS, Acton M, Kolesnik I, Pasrija C, Patel I, Etchill E, Holmes SD, Quinn R, Gammie JS. Non-resectional cordal repair for Barlow mitral valve disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:289-295. [PMID: 38511306 DOI: 10.23736/s0021-9509.24.12899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair. METHODS Patients included in this analysis underwent mitral valve repair from 01/2004-11/2021 by a single surgeon. RESULTS Of 2798 patients undergoing mitral valve operations, 46% (N.=1292) had degenerative pathology and 7% (N.=184) had Barlow disease. Of the 179 Barlow patients, median age at surgery was 62 (51-70) years; 64% were male (115/179). Rates of non-resectional cordal repair and resectional repair were 86% (154/179) and 14% (25/179). Among patients undergoing non-resectional repair, the median number of cordal pairs inserted on the anterior and posterior leaflets was 2 (2-3) and 4 (3-4). Incidence of return to bypass for systolic anterior motion of the mitral valve, perioperative death, stroke, and renal failure was 2% (4/179), 1% (2/179), 0% (0/179), and 0% (0/179). Rates of clinical and echocardiographic follow-up were 93% (165/177) and 89% (157/177). Median time to latest postoperative clinical and echocardiographic follow-up was 2.4 (0.8-6.1) and 2.1 (0.6-4.7) years. Mitral regurgitation grade at latest follow-up or time of repair failure was none/trace, mild, mild to moderate, and severe in 63% (98/157), 26% (41/157), 8% (12/157), and 4% (6/157); five of six patients with severe MR underwent reoperation. Since 2011 97% (139/144) of patients underwent cordal repair without resection. CONCLUSIONS Non-resectional artificial cordal repair is safe and feasible in almost all patients with Barlow valves and is associated with excellent mid-term results.
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Affiliation(s)
- Isabella S Florissi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Acton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Kolesnik
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ishani Patel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric Etchill
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sari D Holmes
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachael Quinn
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James S Gammie
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA -
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Zhang L, Cui H, Shen H, Li D, Li L, Shen H, Jiang S. Mid-term clinical outcomes of totally endoscopic repair for mitral regurgitation in Barlow's disease. J Cardiothorac Surg 2024; 19:233. [PMID: 38627773 PMCID: PMC11020668 DOI: 10.1186/s13019-024-02705-y] [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: 11/11/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This study aimed to confirm the safety and feasibility of totally endoscopic repair for mitral regurgitation (MR) in Barlow's disease. METHODS From June 2018 to December 2022, 21 consecutive Barlow's disease patients (aged 33 ± 12 years; 57.1% male) underwent totally endoscopic mitral valve (MV) repair with leaflets folding, multiple artificial chordae implantation and ring annuloplasty. The safety and feasibility of this technique was evaluated by its mid-term clinical outcomes. RESULTS There was no operative death or complications. The mean cardiopulmonary bypass (CPB) time was 190 ± 41 (128-267) min, and the aortic cross-clamp time was 145 ± 32 (66-200) min. The average number of artificial chordae implantation was 2.9 ± 0.7 (1-4) pairs. The mean MV coaptation length was 1.4 ± 0.3 (0.8-1.8) cm, and the median transvalvular gradient was 1 [interquartile range (IQR), 1-2] mmHg. During a median follow-up time of 24 (IQR, 10-38) months, all patients showed persistent effective valve function with no significant MR or systolic anterior motion. CONCLUSIONS Totally endoscopic repair was a safe, effective, and reproducible procedure with satisfied mid-term clinical outcomes for MR in Barlow's disease. However, further randomized and long-term follow-up studies were warranted to determine its clinical effects.
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Affiliation(s)
- Lin Zhang
- Department of Cardiovascular Surgery, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Huimin Cui
- Department of Cardiovascular Surgery, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hong Shen
- Department of Cardiovascular Surgery, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Dong Li
- Department of Cardiovascular Surgery, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lianggang Li
- Department of Cardiovascular Surgery, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hua Shen
- Department of Cardiovascular Surgery, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, the First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Gollmann-Tepeköylü C, Nägele F, Höfer D, Holfeld J, Hirsch J, Oezpeker CU, Ruttmann-Ulmer E, Kilo J, Hangler H, Müller L, Grimm M, Bonaros N. A qualitative improvement program for minimally invasive mitral surgery: technical advancements ameliorate outcome and operative times. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:ivad030. [PMID: 36866493 PMCID: PMC9982358 DOI: 10.1093/icvts/ivad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/12/2022] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Minimally invasive mitral valve surgery (MIMVS) has evolved over the last 2 decades. The aim of the study was to identify the impact of era and technical improvements on perioperative outcome after MIMVS. METHODS A tota of 1000 patients (mean age: 60.8 ± 12.7 years, 60.3% male) underwent video-assisted or totally endoscopic MIMVS between 2001 and 2020 in a single institution. Three technical modalities were introduced during the observed period: (i) 3D visualization, (ii) use of premeasured artificial chordae (PTFE loops) and (iii) preoperative CT scans. Comparisons were made before and after the introduction of technical improvements. RESULTS A total of 741 patients underwent isolated mitral valve (MV) procedure, whereas 259 received concomitant procedures. These consisted of tricuspid valve repair (208), left atrium ablation (145) and persistent foramen ovale or atrial septum defect (ASD) closure (172). The aetiology was degenerative in 738 (73.8%) patients and functional in 101 patients (10.1%). A total of 900 patients received MV repair (90%), and 100 patients (10%) underwent MV replacement. Perioperative survival was 99.1%, and periprocedural success 93.5% with a periprocedural safety of 96.3%. Improvement in periprocedural safety attributed to the lower rates of postoperative low output (P = 0.025) and less reoperations for bleeding (P < 0.001). 3D visualization improved cross-clamp (P = 0.001) but not cardiopulmonary bypass times. The use of loops and preoperative CT scan both had no impact on periprocedural success or safety but improved cardiopulmonary bypass and cross-clamp times (both P < 0.001). CONCLUSIONS Increased surgical experience improves safety in MIMVS. Technical improvements are related to increased operative success and decreased operative times in patients undergoing MIMVS.
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Affiliation(s)
| | | | - Daniel Höfer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Cenk Ulvi Oezpeker
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Juliane Kilo
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Hangler
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ludwig Müller
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Corresponding author. Department of Cardiac Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Tel: +43-512-504-22501; e-mail: (N. Bonaros)
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Folino G, Salica A, Scaffa R, Irace FG, Weltert LP, Bellisario A, Gerosa G, De Paulis R. Mitral repair of myxomatous valves with simple annuloplasty: a follow-up up to 12 years. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6957089. [PMID: 36548399 DOI: 10.1093/ejcts/ezac580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Diffuse myxomatous mitral valve degeneration (DMD) represents a challenge in the reparative mitral valve surgery. A subgroup of patients with symmetrical DMD can be effectively treated with a simple band-annuloplasty with good early and mid-term results. Here, we evaluate the long-term outcomes in terms of freedom from reoperation, recurrence of moderate or severe mitral regurgitation (MR) and overall survival. METHODS Between April 2006 and December 2020, patients with DMD causing severe MR and the echocardiographic features of symmetrical bileaflet prolapse, central regurgitant jet(s), annular dilation and no chordal ruptures were treated using a simple annuloplasty with a semi-rigid band. These patients were prospectively collected and retrospectively analysed. RESULTS Seventy-five patients were enrolled. The mean clinical follow-up time was 104 [standard deviation (SD): 43] months, and echocardiographic follow-up time was 95 (SD: 43) months. The mean age was 54 (SD: 15) years, and 56% were females. Long-term overall survival was 98.2% [standard error (SE): 1.8], 93.7% (SE: 4.7) and 93.7% (SE: 4.7) at 4, 8 and 12 years, respectively. The freedom from reoperation was 100% at 4 and 8 years and 94.1% (SE: 5.7) at 12 years. The freedom from recurrent moderate or severe MR was 98.3% (SE: 1.7), 98.3% (SE: 1.7) and 92.8% (SE: 5.5) at 4, 8 and 12 years, respectively. CONCLUSIONS Mitral repair with the simple band-annuloplasty for the treatment of MR due to symmetrical DMD seems to be stable and effective in the long term.
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Affiliation(s)
- Giulio Folino
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Andrea Salica
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Raffaele Scaffa
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Francesco Giosuè Irace
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Gino Gerosa
- Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Mitral valve repair for extreme billowing and prolapsing valve. JTCVS OPEN 2022; 10:169-175. [PMID: 36004259 PMCID: PMC9390245 DOI: 10.1016/j.xjon.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
Abstract
Objectives We describe our method and results of mitral valve repair up to 20 years in a defined group of patients with mitral regurgitation caused by an extreme billowing and prolapsing valve. Methods An extreme billowing and prolapsing valve was defined by the presence of excess tissue on both leaflets and prolapse of 2 or more of the 3 segments of each leaflet. Among 1344 consecutive patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2012 at the Sakakibara Heart Institute, 73 patients met our definition of an extreme billowing and prolapsing valve. From these 73 patients, 67 patients who underwent mitral valve repair based on the surgical strategy we developed in July 1996 were enrolled in this study. Our strategy of mitral valve repair for extreme billowing and prolapsing valves consists of (1) volume reduction of the leaflets, (2) physiologic remodeling annuloplasty for long anterior leaflet, and (3) wide usage of artificial chordae. Results Mean age of the patients was 46.6 ± 12.9 years. There were no hospital deaths and 6 late deaths in this series. Kaplan–Meier survival at 10 years was 96.8 ± 2.2%. There were 2 reoperations. Cumulative incidence rate of mitral valve reoperation and moderate or severe mitral regurgitation at 10 years was 1.8 ± 1.8% and 11.2 ± 4.0%. Number of artificial chordal replacement was associated with decreased risk of recurrent moderate mitral regurgitation (hazard ratio, 0.60; P = .03). Conclusions Long-term echo follow-up demonstrates good results of mitral valve repair for extreme billowing and prolapsing valves using our strategy.
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Levy F, Wautot F, Dommerc C, Iacuzio L, Civaia F, Marcacci C, Eker A. Echocardiographic characteristics of non-resectional ring-only valve repair in mitral valve prolapse. Echocardiography 2022; 39:612-619. [PMID: 35277879 DOI: 10.1111/echo.15339] [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: 09/14/2021] [Revised: 02/06/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Simple mitral valve repair (MVR) using a ring-only approach (ROA) was recently proposed for some complex forms of bileaflet myxomatous mitral valve prolapse (MVP). Nevertheless, few data are available concerning the characteristics of MVP patients that may benefit from this simple repair technique. METHODS Based on 39 consecutive patients (28 men; mean age 57 ± 15) with severe primary Mitral regurgitation (MR) caused by bileaflet MVP referred for MVR, we sought to identify the preoperative echocardiographic parameters associated with successful ROA repair. RESULTS Twenty-three patients (59%) underwent standard resectional MVR (SMVR) while 16 (41%) underwent ROA. Cardiopulmonary bypass and cross clamp times were lower in ROA than in SMVR (74 ± 27 min vs 99 ± 42 min and 49 ± 19 min vs 70 ± 25 min, respectively, p = 0.03 and p = 0.005). ROA patients were more frequently women (50% vs 13%, p = 0.027). Echocardiographic characteristics of successful ROA were mid-late systolic MR, a paradoxical systolic papillary muscle displacement, and paradoxical systolic annulus expansion (PAE). A prolapsing depth <10 mm, the absence of flail leaflet and ruptured chordae, the presence of multiple jets, more often in the central part of the valve were also associated with ROA. Non hemodynamic systolic anterior motion and residual trivial MR tended to be more frequent in ROA than in SMVR. CONCLUSION Simple and fast MVR using a ROA is feasible in 4/10 patients with complex forms of bileaflet MVP. Successful ROA patients were more frequently women, with mid-late systolic central multiple jet, low prolapse depth, absence of chordal rupture or flail leaflet and PAE.
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Affiliation(s)
- Franck Levy
- Monaco Cardiothoracic Center, Monaco, Monaco
| | | | | | | | | | | | - Armand Eker
- Monaco Cardiothoracic Center, Monaco, Monaco
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Nakamae K, Oshitomi T, Takaji K, Uesugi H. Mitral Valve Repair for Barlow’s Disease with Mitral Annular and Subvalvular Calcification: A Case Report. J Chest Surg 2022; 55:177-179. [PMID: 35256546 PMCID: PMC9005943 DOI: 10.5090/jcs.21.113] [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: 09/27/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kosuke Nakamae
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Takashi Oshitomi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kentaro Takaji
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hideyuki Uesugi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Raanani E, Schwammenthal E, Moshkovitz Y, Cohen H, Kogan A, Peled Y, Sternik L, Ram E. Repair with annuloplasty only of balanced bileaflet mitral valve prolapse with severe regurgitation. Eur J Cardiothorac Surg 2021; 61:908-916. [DOI: 10.1093/ejcts/ezab548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/02/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Repair of severe mitral valve and mitral regurgitation (MR) in patients with degenerative bileaflet pathology can be challenging. Initial results with a ring-only repair (ROR) approach have shown promising results, but long-term outcomes in larger series are lacking. We report on outcomes of ROR in severe MR secondary to bileaflet prolapse, including Barlow’s disease.
METHODS
Eighty patients with degenerative multi-segment bileaflet disease underwent ROR for severe MR with a predominantly central regurgitant jet indicating balanced bileaflet prolapse. The main outcome measure of this study was long-term recurrent MR probability. Secondary outcomes were late mortality, reoperation and in-hospital complications.
RESULTS
The mean age was 53 ± 15 years and 54% were males. The mean ejection fraction was 59.2 ± 6.6, 24% and 40% had atrial fibrillation. Barlow’s disease was found in 77% of the patients. Minimally invasive surgery was performed in 15 patients (19%). There were no perioperative mortalities or cerebrovascular events in the entire cohort. Post-repair mild outflow tract obstruction (systolic anterior motion) was observed in 4 patients (5%) after ROR. In a mean follow-up of 60 ± 48 months, there was 1 case of death. At follow-up, there was 1 (1%) reoperation due to recurrent MR, and 4 patients who had recurrent moderate or more MR. The 10-year freedom from recurrent MR was 97%. None had severe MR at the latest follow-up.
CONCLUSIONS
In patients with severe MR and a central regurgitant jet secondary to balanced multi-segment bileaflet mitral valve prolapse, ROR is a simple and efficient approach providing excellent long-term results without a substantial risk of systolic anterior motion.
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Affiliation(s)
- Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Schwammenthal
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Moshkovitz
- Department of Cardiothoracic Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Hillit Cohen
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kogan
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Peled
- Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel
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Madathil T, BabuVanga S, Jose RL, Gangadharan G, Jayanth A, Varma PK, Perier P. Mitral Annular Disjunction: A Serendipitous Discovery by Intraoperative Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2021; 35:2801-2810. [PMID: 34112564 DOI: 10.1053/j.jvca.2021.04.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Thushara Madathil
- Division of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.
| | - Sudheer BabuVanga
- Division of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Reshmi Liza Jose
- Division of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Gopan Gangadharan
- Division of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Aveek Jayanth
- Division of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Praveen Kerala Varma
- Division of Cardiothoracic and Vascular Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Patrick Perier
- Division of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
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Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease. Clin Res Cardiol 2021; 110:1881-1889. [PMID: 33792775 PMCID: PMC8639536 DOI: 10.1007/s00392-021-01844-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022]
Abstract
Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.
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Lawrie G, Zoghbi W, Little S, Shah D, Earle N, Earle E. One Hundred Percent Reparability of Mitral Prolapse: Results of a Dynamic Nonresectional Technique. Ann Thorac Surg 2021; 112:1921-1928. [PMID: 33497666 DOI: 10.1016/j.athoracsur.2020.09.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/10/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND We studied the results of a dynamic mitral repair technique that preserves normal mitral valve function by avoiding leaflet resection and rigid and semirigid annuloplasty rings. METHODS In previous reports we demonstrated that intraoperative simulation of mitral valve locking and isovolumic systole by rapid left ventricular inflation with pressurized saline accurately simulates mitral annular and leaflet shape and position, and left ventricular outflow tract dimensions. Length of polytetrafluoroethylene neochordae and size of fully flexible adjustable annuloplasty ring can be adjusted in three dimensions for accurate apposition of zones of leaflet coaptation, premarked with dots. We followed 1068 consecutive patients after repairs performed between 2001 and 2018. RESULTS Of the 1068 patients, 674 were men (63.1%). Mean age was 62.25 ± 13 years. Leaflet repaired was anterior in 118 patients (11.05%), posterior in 564 (52.81%), both in 55 (5.15%), and neither in 123 (11.5%). Barlow's disease was present in 208 patients (19.48%). Repair was isolated in 82.5% (881 of 1068). Reparability was 100%. Perioperative mortality overall was 1.59% (17 of 1068): isolated repair, 1.14% (10 of 881); and isolated posterior leaflet, 0.85% (4 of 472). Leaflet systolic anterior motion occurred in 1.7% (18 of 1068), and was significant in 0.4% (4 of 1068). Survival at 10 years by Kaplan-Meier analysis was 74.65%, freedom from reoperation was 96.01%, and freedom from severe mitral regurgitation was 94%. The only predictor of reoperation (Cox analysis) was being male (P = .001). CONCLUSIONS Use of intraoperative simulation of mitral dynamics led to 100% reparability for degenerative valves with minimal systolic anterior motion, despite no leaflet resection. Long-term durability has been good and similar for all leaflets.
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Affiliation(s)
- Gerald Lawrie
- Department of Cardiovascular Surgery, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas.
| | - William Zoghbi
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas
| | - Stephen Little
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas
| | - Dipan Shah
- Department of Cardiology, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas
| | - Nan Earle
- Department of Cardiovascular Surgery, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas
| | - Elizabeth Earle
- Department of Cardiovascular Surgery, Methodist DeBakey Heart Center, Houston Methodist Hospital, Houston, Texas
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Schaff HV, Nguyen A. Contemporary techniques for mitral valve repair-the Mayo Clinic experience. Indian J Thorac Cardiovasc Surg 2020; 36:18-26. [PMID: 33061182 DOI: 10.1007/s12055-019-00801-6] [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: 11/30/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022] Open
Abstract
Mitral valve repair for patients with degenerative or functional mitral valve regurgitation improves symptoms and prognosis, and several techniques have been described. Important principles in operation are simplicity, reproducibility, and durability of repair. At Mayo Clinic, we have operated on more than 6000 patients with degenerative mitral valve disease and valve prolapse, and this review details our approach to mitral valve repair, including robotic and minimally invasive techniques. Most patients with isolated leaflet prolapse can be managed with leaflet plication or triangular resection, and chordal replacement is reserved for repair of anterior leaflet prolapse. Posterior annuloplasty with a standard-sized flexible band is used to reduce annular circumference and improve leaflet coaptation. With these methods, early risk of mortality for mitral valve repair is low in the current era (< 1%), and rate of recurrent valve leakage is 1.5 per 100 patient-years during the first year post-repair and 0.9 per 100 patient-years thereafter. This paper also briefly summarizes important considerations for patients with mitral valve regurgitation and severe calcification, perforations due to endocarditis, and rheumatic heart disease.
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Affiliation(s)
- Hartzell Vernon Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Anita Nguyen
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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Cui H, Zhang L, Wei S, Li L, Ren T, Wang Y, Jiang S. Early clinical outcomes of thoracoscopic mitral valvuloplasty: a clinical experience of 100 consecutive cases. Cardiovasc Diagn Ther 2020; 10:841-848. [PMID: 32968639 DOI: 10.21037/cdt-20-440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We reported our experience of 100 consecutive cases of thoracoscopic mitral valvuloplasty in the early period. Methods Between September 2017 and December 2019, 100 consecutive cases (aged 49.2±14.7 years; 56% male) of thoracoscopic mitral valvuloplasty had been completed in our institution. The safety and feasibility of this technique was evaluated by its early clinical outcomes. Results Mitral valve (MV) repair was performed by means of Carpentier techniques, including leaflet folding in 5 cases, cleft suture in 10, commissuroplasty in 15 including 2 commissurotomy, edge to edge in 1, artificial chordae implantation in 76 cases with an average of 2.5±1.6 (1 to 4) pairs, and prosthetic annuloplasty in all cases. Intraoperative transoesophageal echocardiography (TEE) revealed no mitral regurgitation (MR) in 95 cases and a mild in 2 cases with all coaptation length more than 5 mm. The rest 3 cases with moderate or more MR were successfully reconstructed during a second pump-run. The average cardiopulmonary bypass (CPB) time was 164.4±51.0 min and aortic clamping time was 119.7±39.1 min, and the latest 10 cases were 140.2±45.3 and 96.3±25.4 min, respectively (P<0.05). There was only one operative death from avulsion of left atrial suture after operation and 2 intraoperative re-exploration through a conversion to sternotomy for bleeding. Severe MR was observed in 2 patients 3 months after operation, and MV replacement (MVR) was performed through median sternotomy. Conclusions Totally thoracoscopic mitral valvuloplasty was technically feasible, safe, effective, and reproducible in clinical practice after crossing the learning curve.
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Affiliation(s)
- Huimin Cui
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Lin Zhang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Shixiong Wei
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Lianggang Li
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Tong Ren
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yao Wang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, China
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Sakaguchi T, Totsugawa T, Hayashida A, Ryomoto M, Sekiya N, Tamura K, Hiraoka A, Yoshitaka H. Stepwise mitral valve repair for Barlow's disease via a minimally invasive approach. J Card Surg 2020; 35:1471-1476. [PMID: 32383283 DOI: 10.1111/jocs.14615] [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: 02/19/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM Mitral regurgitation (MR) in Barlow's disease is complicated because of its mixed pathophysiology, leaflet billowing with or without organic prolapse, and abnormal annular dynamics that cause functional prolapse. Complex repair techniques, including aggressive leaflet resection and implantation of multiple artificial chordae, are conventionally performed; nevertheless, these are technically demanding, especially when performed using a minimally invasive approach. We aimed to standardize the repair technique for Barlow's disease and developed stepwise repair techniques. METHODS Of 292 patients who underwent isolated minimally invasive mitral valve repair for MR, 29 patients (seven females, age 49 ± 10 years) were found to have Barlow's disease. Our repair technique consists of the following three steps: (a) stabilization of the mitral annulus by placing annuloplasty ring sutures; (b) distinction between organic and functional prolapse by a saline injection test; and (c) targeted repair for organic prolapse by leaflet resection or chordal replacement. RESULTS Surgical techniques included leaflet resection in 22 patients, chordal replacement in 19 patients, and ring annuloplasty only in one patient. These procedures were applied to the anterior leaflet in one, posterior leaflet in eight, and both leaflets in 19 patients. The median annuloplasty ring size was 34 mm. The repair success rate was 100%. No patients developed moderate or greater MR during a mean follow-up period of 36 ± 21 months. CONCLUSIONS A stepwise repair strategy facilitates mitral valve repair in patients with Barlow's disease and provides excellent outcomes even via a minimally invasive approach.
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Affiliation(s)
- Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Akihiro Hayashida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Masaaki Ryomoto
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Naosumi Sekiya
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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Moscarelli M, Fattouch K, Gaudino M, Nasso G, Paparella D, Punjabi P, Athanasiou T, Benedetto U, Angelini GD, Santarpino G, Speziale G. Minimal Access Versus Sternotomy for Complex Mitral Valve Repair: A Meta-Analysis. Ann Thorac Surg 2020; 109:737-744. [DOI: 10.1016/j.athoracsur.2019.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/31/2022]
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Chemtob RA, Mick S, Gillinov M, Hodges K, Wierup P. Repair of bileaflet prolapse in Barlow syndrome: The 4-chord technique. J Card Surg 2019; 34:605-609. [PMID: 31102304 DOI: 10.1111/jocs.14078] [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: 03/15/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
Barlow syndrome is a form of degenerative mitral valve (MV) disease found in a subset of patients with bileaflet prolapse. The hallmark of Barlow's disease includes excessive and billowing leaflet tissue caused by myxomatous tissue proliferation, elongated chordae, and pronounced annular dilatation. Surgical repair of patients with Barlow's disease is challenging due to the extent of the leaflet and annular abnormalities. Several techniques have been described to repair Barlow's MV including currently popular "non-resectional" approaches. Repair with neochordae has been associated with excellent results and includes the advantage of preserved leaflet mobility and a large surface of coaptation. We describe a simple approach to the use of neochordae to repair bileaflet prolapse in patients with Barlow syndrome and avoid systolic anterior motion.
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Affiliation(s)
- Raphaelle A Chemtob
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie Mick
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Koda Y, Kawamoto T, Yokawa K, Henmi S, Nakai H, Yamanaka K, Inoue T, Tanaka H, Okita Y. Mid-term outcomes of simultaneous mitral valve repair in patients with miral regurgitation and concomitant annulo-aortic ectasia. Gen Thorac Cardiovasc Surg 2019; 67:1014-1020. [PMID: 31041727 DOI: 10.1007/s11748-019-01129-z] [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: 11/26/2018] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated the mid-term outcomes of simultaneous mitral valve repair in patients with mitral regurgitation (MR) and concomitant annulo-aortic ectasia. METHODS The study included 26 patients with MR and annulo-aortic ectasia [mean age 46.0 ± 19.9 (10-86) years] who underwent simultaneous mitral valve repair between January 2007 and March 2018. Of these 26 patients, 11 (42.3%) were diagnosed with Marfan syndrome and 10 (38.5%) with Barlow's disease. All patients underwent complete ring annuloplasty; a semi-rigid ring was used in 14 (53.8%) and a semi-flexible ring (anterior-flexible) in 12 patients (46.2%). All patients underwent valve-sparing root replacement using the reimplantation technique. RESULTS The overall 3-year survival rate was 95.7 ± 4.3%. The 3-year freedom from > moderate MR rate was 94.7 ± 5.1%, and the 3-year freedom from > moderate aortic regurgitation (AR) rate was 86.7 ± 7.3%. The 3-year freedom from reoperation rate was 100%. The 3-year freedom from > moderate MR rate was 100% in the semi-rigid ring group and 85.7 ± 13.2% in the semi-flexible ring group (log-rank test, p = 0.5371). The 3-year freedom from > moderate AR rate was 100% in the semi-rigid ring group and 72.9 ± 16.5% in the semi-flexible ring group (log-rank test, p = 0.0815). CONCLUSIONS Simultaneous mitral valve repair in patients with MR and concomitant annulo-aortic ectasia showed favorable mid-term outcomes.
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Affiliation(s)
- Yojiro Koda
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Tatsuya Kawamoto
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Koki Yokawa
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Soichiro Henmi
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Hidekazu Nakai
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Katsuhiro Yamanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Takeshi Inoue
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Hiroshi Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, 7-5-2 Tyuoku Kusunokityo, Kobe, Hyogo, 650-0017, Japan.
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Yano M, Nishimura M, Yokota A, Mori K. Mitral valve repair in Barlow's disease by chordal reconstruction using the adjustable slip-knot technique. Gen Thorac Cardiovasc Surg 2018; 68:63-66. [PMID: 30182356 DOI: 10.1007/s11748-018-1004-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/30/2018] [Indexed: 11/25/2022]
Abstract
The adjustable slip-knot technique-a procedure for facilitating repair of the mitral valve prolapse-was first performed and reported by us in 2015. This technique comprises six steps: anchor institution in the papillary muscle, flexible band positioning, saline injection to confirm the prolapsing site, neochorda setting between the anchor and leaflet, fine adjustment of the neochordal length, and knot-fixing to confirm repair. Here, we have described the first case of successful mitral valve repair using the adjustable slip-knot technique in a 51-year-old man with Barlow's disease.
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Affiliation(s)
- Mitsuhiro Yano
- Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Shinbeppu 738-1, Miyazaki, Japan.
| | - Masanori Nishimura
- Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Shinbeppu 738-1, Miyazaki, Japan
| | - Atsuko Yokota
- Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Shinbeppu 738-1, Miyazaki, Japan
| | - Kosuke Mori
- Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Shinbeppu 738-1, Miyazaki, Japan
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20
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Tomšic A, Hiemstra YL, Bissessar DD, van Brakel TJ, Versteegh MIM, Ajmone Marsan N, Klautz RJM, Palmen M. Mitral valve repair in Barlow's disease with bileaflet prolapse: the effect of annular stabilization on functional mitral valve leaflet prolapse. Interact Cardiovasc Thorac Surg 2018; 26:559-565. [PMID: 29186494 DOI: 10.1093/icvts/ivx366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/13/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Barlow's disease is the most severe form of degenerative mitral valve disease, commonly characterized by bileaflet prolapse. Abnormal mitral annular dynamics is typically present and results in functional prolapse of the mitral leaflets that may be addressed with annular stabilization alone. METHODS Between January 2001 and December 2015, 128 patients with Barlow's disease and bileaflet prolapse underwent valve repair. This included anterior mitral valve leaflet (AMVL) repair in 70 patients, whereas 58 patients were identified as having functional prolapse and underwent no specific AMVL repair. During the course of the study, the proportion of patients undergoing specific AMVL repair decreased (77% in the first and 33% in the second 64 patients). Semirigid ring annuloplasty was performed in all cases. The median clinical and echocardiographic follow-up duration was 6.5 years [interquartile range (IQR) 2.9-10.5 years; 93.9% complete] and 4.7 years (IQR 2.2-10.2 years; 94.4% complete), respectively. RESULTS Early mortality was 1.6%. Postoperative echocardiogram demonstrated no residual mitral regurgitation in all but 1 patient (AMVL repair group). There was no significant difference in the overall survival rate at 6 years after operation between both groups. At 6 years, the freedom from recurrent ≥Grade 2+ mitral regurgitation rate was 90.7% (IQR 82.9-98.5%) and 89.1% (IQR 75.8-100%) for patients with and patients with no AMVL repair, respectively (P = 0.43). Three patients required late mitral valve reintervention, all from the AMVL repair group. CONCLUSIONS Annular stabilization can effectively resolve the functional prolapse of the AMVL. Careful discrimination between functional and true AMVL prolapse allows for a technically less challenging operation that provides excellent repair durability.
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Affiliation(s)
- Anton Tomšic
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Daniella D Bissessar
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Michel I M Versteegh
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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Sternik L. Transcatheter mitral regurgitation treatment: Let's learn from surgeons. J Thorac Cardiovasc Surg 2016; 152:328-9. [PMID: 27234019 DOI: 10.1016/j.jtcvs.2016.05.010] [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: 05/01/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Tel-Hashomer, Israel.
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Raanani E. Can the art of mitral valve repair become completely standardized? J Thorac Cardiovasc Surg 2016; 151:1671-2. [PMID: 26971381 DOI: 10.1016/j.jtcvs.2016.02.006] [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: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Ehud Raanani
- Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer, Israel.
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23
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Lawrie GM. Barlow disease: Simple and complex. J Thorac Cardiovasc Surg 2015; 150:1078-81. [DOI: 10.1016/j.jtcvs.2015.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 11/26/2022]
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