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Garatti A, Canziani A, Parolari A, Castelvecchio S, Guazzi M, Daprati A, Farah AA, Grimaldi F, Tripepi S, Menicanti L. Long-term results of suture annuloplasty for degenerative mitral valve disease: a propensity-matched analysis. J Cardiovasc Med (Hagerstown) 2017; 19:22-28. [PMID: 29206693 DOI: 10.2459/jcm.0000000000000608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Ring annuloplasty is the gold standard of surgical repair in degenerative mitral valve disease. However, prosthetic annuloplasty has some drawbacks and potential hazards. Suture annuloplasty theoretically is able to preserve annular leaflet dynamics and left ventricular performance, but experience is limited. The aim of the study was to review the early and long-term outcome of the posterior double-suture annuloplasty (DSA) technique for degenerative mitral valve repair. METHODS From January 2002 to December 2008, 400 patients underwent primary mitral valve repair for degenerative disease either with posterior DSA [n = 147 (37%)] or with flexible posterior annuloplasty band [n = 253 (63%)]. Differences in patient characteristics were addressed by propensity-score matching (132 pairs). A composite end-point of mitral valve failure (MVF) was calculated as the incidence of mitral valve regurgitation greater than 2+ or need for mitral valve replacement at follow-up. RESULTS After propensity-score matching, the distribution of preoperative variables among matched pairs was, on average, equal. Isolated annuloplasty and leaflet repair techniques were similarly performed in both groups (P = 0.20). In-hospital mortality was comparable between the two study groups (P = 0.48). Predischarge echocardiography showed excellent results regarding valve hemodynamics (P = 0.71). At a mean follow-up of 11 ± 3 years, all-cause mortality (P = 0.12), need for mitral valve replacement (P = 0.49), and cardiac re-hospitalization rate (P = 0.57) resulted comparable between the two groups. Ten-year survival (75 vs. 71%, P = 0.51) and freedom from MVF (92 vs. 84%, P = 0.39) were similar between posterior annuloplasty band and DSA groups. CONCLUSION Suture annuloplasty demonstrated comparable results with posterior flexible band repair and could be a viable option for mitral valve surgery in selected patients, such as in the minimally invasive approach, in endocarditis, and in developing countries.
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Affiliation(s)
- Andrea Garatti
- aDepartment of Cardiac SurgerybDepartment of Clinical CardiologycHeart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Benetis R, Orda P, Vaškelytė JJ, Ivanauskas V, Ereminienė E, Jakuška P, Jankauskienė L. Non-ischaemic mitral valve suture annuloplasty: late follow-up results. Perfusion 2016; 31:568-75. [DOI: 10.1177/0267659116645398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate late outcomes after posterior mitral valve (MV) annulus double-suture annuloplasty for degenerative (non-ischaemic) MV insufficiency. Design: Between 2005 and 2011, 138 patients underwent MV repair using posterior MV double-suture annuloplasty and an additional 105 patients underwent tricuspid valve repair. The study protocol included operative mortality, reoperation rate and reasons, as well as echocardiographic parameters at pre- and postoperative and follow-up periods (2-9 years). Results: In-hospital mortality was 2/138 (1.45%). Early post operation, no regurgitation was noted in 74/136 (54.4%) patients, Io regurgitation was observed in 55/136 (40.4%), IIo was observed in 6/136 (4.4%) and IIIo was observed in 1/136 (0.7%); during late follow-up (from 2 to 9 years), no regurgitation was observed in 21.6% patients, Io was observed in 58%, IIo was observed in 17% and IIIo was observed in 3.4%. The mean preoperative anterolateral diameter of the MV annulus was 39.02±4.97 mm and, at late follow-up, it was 27.66±3.94 mm (p=0.000); at these same time points, left ventricular end-diastolic diameter (LVEDD) was 55.74±7.29 mm and 49.17±6.01 mm (p=0.000), respectively, and the left ventricular ejection fraction (LVEF) was 53.08±8.93% and 50.92±6.78%, respectively (p=0.007). Conclusions: This study demonstrates suture annuloplasty to be an effective treatment up to 9 years for degenerative mitral valve disease. This technique enables preservation of the posterior mitral valve annulus diameter with stable long-term (up to 9 years) reduction, a competent (no regurgitation/⩽IIo regurgitation) MV in 96.6% of cases and positive left ventricular (LV) remodelling.
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Affiliation(s)
- Rimantas Benetis
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Orda
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Vytenis Ivanauskas
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Ereminienė
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuška
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Loreta Jankauskienė
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Fundarò P, Tartara PM, Villa E, Fratto P, Campisi S, Vitali EO. Mitral Valve Repair: Is There Still a Place for Suture Annuloplasty? Asian Cardiovasc Thorac Ann 2016; 15:351-8. [PMID: 17664215 DOI: 10.1177/021849230701500420] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prosthetic ring annuloplasty is considered the gold standard technique for mitral valve repair, but it has been associated with some drawbacks. Suture annuloplasty is less expensive and may have some physiopathologic advantages. We reviewed the literature to assess clinical results of mitral suture annuloplasty. Thirteen series, each reporting more than 50 patients and published in the last 10 years, were included in the analysis. They comprised 1,648 patients with cumulative follow-up of 5,607 patient-years. Our review suggests that suture annuloplasty is a safe procedure, but a trend toward recurrence of annular dilatation with time was reported. In selected cases, suture annuloplasty is effective, and its mid-term clinical results are encouraging and compare well with those of prosthetic ring repair series. The quality of the results varies according to the particular annuloplasty technique used and to the mitral valve pathology treated. Recent technical modifications have been found to decrease the incidence of repair failure and promise to improve the reproducibility of the procedure. Further investigations are warranted to better assess the long-term results of suture annuloplasty, and to determine whether its theoretical functional advantages translate into a real clinical benefit.
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Affiliation(s)
- Pino Fundarò
- Department of Cardiac Surgery, Ospedale Niguarda Cà Granda, Milan, Italy
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Emrecan B, Onem G, Ozdemir AC, Kılıç ID, Alihanoğlu Yİ. A good surgical option for ischemic mitral regurgitation in co-morbid patients: semicircular reduction annuloplasty. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:141-5. [PMID: 23888173 PMCID: PMC3708053 DOI: 10.3969/j.issn.1671-5411.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/23/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ring annuloplasty is the standard treatment of ischemic mitral regurgitation (MR), however, it has been associated with some drawbacks. It abolishes normal annular dynamics and freezes the posterior leaflet. In the present study, we evaluated Paneth suture annuloplasty in chronic ischemic MR and both early and mid-term outcomes of the technique on a selected population. METHODS The study period was from June 2010 to June 2012. We operated on 21 patients who had the diagnosis of coronary artery disease and MR of grade 3 or 4. The patients had both a coronary artery bypass operation and the mitral semicircular reduction annuloplasty described by Paneth-Burr. The data on the patients were retrospectively collected. Patients were contacted by outpatient clinic controls for mid-term results. RESULTS The male/female ratio was 10/11. The mean age of the patients was 71.0 ± 6.4 years. Preoperative and postoperative left ventricular ejection fraction was statistically similar (P = 0.973). Early postoperative MR grade (mean, 0.57 ± 0.51) was statistically lower than the preoperative MR grades (mean, 3.38 ± 0.50) (P < 0.001). There was no revision for excess bleeding. Two patients had prolonged hospitalization, one for sternal infection and the other for severe chronic obstructive pulmonary disease. No hospital or late postoperative deaths occurred. The mean late postoperative MR grade was 0.66 ± 0.97 degrees. One patient had progression of MR in the later follow-up, which was treated by mitral valve replacement. CONCLUSION Semicircular reduction annuloplasty is an effective, inexpensive and easy surgical annuloplasty technique with low mortality and morbidity in severe symptomatic ischemic MR.
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Affiliation(s)
- Bilgin Emrecan
- Department of Cardiac and Vascular Surgery, Pamukkale University, Kınıklı, Denizli 20070, Turkey
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Mizuno T, Mizukoshi T, Uechi M. Long-term outcome in dogs undergoing mitral valve repair with suture annuloplasty and chordae tendinae replacement. J Small Anim Pract 2012; 54:104-7. [PMID: 23146131 DOI: 10.1111/j.1748-5827.2012.01305.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mitral valve repair under cardiopulmonary bypass was performed in three dogs with clinical signs associated with mitral regurgitation that were not controlled by medication. Mitral valve repair comprised circumferential annuloplasty and chordal replacement with expanded polytetrafluoroethylene. One dog died 2 years after surgery because of severe mitral regurgitation resulting from partial circumferential suture detachment. The others survived for over 5 years, but mild mitral valve stenosis persisted in one. The replaced chordae did not rupture in any dog. Mitral valve repair appears to be an effective treatment for mitral regurgitation in dogs. Chordal replacement with expanded polytetrafluoroethylene is a feasible technique, demonstrating long-term durability in dogs. However, mitral annuloplasty techniques need improvement.
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Affiliation(s)
- T Mizuno
- Veterinary Cardiovascular Medicine and Surgery, Laboratory of Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Science, Nihon University, 1866 Fujisawa, Kanagawa, 252-0880, Japan
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Uechi M. Mitral valve repair in dogs. J Vet Cardiol 2012; 14:185-92. [PMID: 22366571 DOI: 10.1016/j.jvc.2012.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 12/01/2011] [Accepted: 01/12/2012] [Indexed: 11/17/2022]
Abstract
Prognosis for dogs with severe mitral regurgitation is poor with medical therapy alone. Open surgical mitral valve repair consisting of circumferential mitral annuloplasty and artificial chordal replacement confers durability and improved long-term clinical outcome without a need for long-term antithrombotic therapies. This approach has been successfully used in canine patients, including small-breed dogs. Methods for mitral valve repair applicable to small dogs are described.
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Affiliation(s)
- Masami Uechi
- Veterinary Cardiovascular Medicine and Surgery, Laboratory of Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan.
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Al Zeer S, Dalbeni A, Pozzani L, Lechi A, Delva P. Severe haemolytic anaemia after valvuloplasty and annuloplasty. BMJ Case Rep 2010; 2010:2010/nov09_1/bcr0920081022. [PMID: 22789556 DOI: 10.1136/bcr.09.2008.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemolytic anaemia is a well-recognised but rare complication of heart-valve prostheses. The authors report a case of an 80-year-old woman with severe haemolytic anaemia previously treated with valvuloplasty and annuloplasty without rings. To our knowledge, no cases of haemolysis have been described with this type of surgery.
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Affiliation(s)
- S Al Zeer
- Department of Biomedical and Surgical Science, Section of Internal Medicine, University of Verona, Verona, Italy.
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Szentkirályi I, Péterffy A, Galajda Z. Importance of stabilization of the mitral annulus in mitral valve repair. J Thorac Cardiovasc Surg 2008; 136:1102-3; author reply 1103. [PMID: 18954668 DOI: 10.1016/j.jtcvs.2008.05.026] [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: 04/17/2008] [Accepted: 05/01/2008] [Indexed: 11/25/2022]
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Affiliation(s)
- Ted Feldman
- Evanston Hospital, Cardiology Division, Walgreen Bldg 3rd Floor, 2650 Ridge Ave, Evanston, IL 60201, USA.
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Nagy ZL, Peterffy A. Suture annuloplasty for mitral valve repair. J Thorac Cardiovasc Surg 2007; 133:850; author reply 850-1. [PMID: 17320619 DOI: 10.1016/j.jtcvs.2006.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 08/08/2006] [Indexed: 10/23/2022]
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Péterffy A. [Surgery of the mitral valve--in the work of József Kudász]. Orv Hetil 2007; 148:5-9. [PMID: 17344111 DOI: 10.1556/oh.2007.27953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The author described his results of surgical treatment of mitral valve disease. Of 57 patients, the isolated mitral procedure was performed in 72%, and the combined (valve and coronary) in 28% of the cases. In 75% of the patients valve repair, and in 25% valve replacement were performed. There were 2 cases (3.5%) of early mortality after combined surgery where patients had also ischaemic heart disease. All the replaced valve prostheses and 84% of repaired mitral valve had a normal function. The mitral regurgitation was moderate in 14%, of cases and mild in 2% of cases at the follow up, but no reoperation was needed. After the surgery 85% of patients had sinus rhythm, 13% had atrial arrhythmia and in 2% the pacemaker was needed. Attempt of valve repair had to be made in all patients with mitral valve disease which can be performed in almost every case of degenerative valve prolapse and the rupture of chordae tendineae.
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Affiliation(s)
- Arpád Péterffy
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar Kardiológiai Intézet, Szívsebészeti Központ Debrecen Debrecen Móricz Zs. krt. 22. 4032.
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Aybek T, Risteski P, Miskovic A, Simon A, Dogan S, Abdel-Rahman U, Moritz A. Seven years’ experience with suture annuloplasty for mitral valve repair. J Thorac Cardiovasc Surg 2006; 131:99-106. [PMID: 16399300 DOI: 10.1016/j.jtcvs.2005.07.060] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 07/20/2005] [Accepted: 07/21/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Our early experience with the mural annulus shortening suture procedure for mitral valve repair showed superior hemodynamic performance over ring annuloplasty. The aim of this study was to assess the durability of the mural annulus shortening suture procedure and evaluate our 7-year experience regarding valve function, hemodynamic performance, and clinical outcome. METHODS Between 1996 and 2003, 222 elective consecutive patients (58.1% males; age, 59 +/- 14 years) underwent simple or complex mitral valve repair. Minimal invasive reconstruction was performed in 150 patients. For correction of annular dilatation, we used double-running 2-0 polytetrafluoroethylene sutures to reinforce the posterior circumference of the annulus. Patients were investigated prospectively by means of transthoracic echocardiography before discharge and 1 and 5 years after the operation. The mean follow up was 32 +/- 21 months (range 1-77 months). RESULTS The operative mortality was 3.1%. Hemodynamic performance at 1 and 5 years showed low mean transvalvular gradients (2.1 +/- 0.9 and 2.0 +/- 0.8 mm Hg, respectively) and a calculated mitral valve orifice area of 3.3 +/- 0.9 cm2 and 3.1 +/- 0.6 cm2, respectively, with progressive annular dilatation from 31.2 +/- 3 mm to 33.9 +/- 4 mm at 1 year and 35.7 +/- 4 mm at 5 years (P < .01). Clinical status improved from New York Heart Association class 3.0 +/- 0.4 to 0.6 +/- 0.8 at 1 year and 0.8 +/- 0.8 at 5 years. Freedom form nontrivial residual mitral regurgitation was 82.3%, freedom from reoperation was 95.1% and actuarial survival was 87.2%, all at 77 months. CONCLUSIONS The midterm results show satisfactory hemodynamic performance and clinical improvement. Valve competence and reoperation rates are comparable with those of other reports. Durability of the mural annulus shortening suture procedure for mitral valve repair is questioned because progressive annular redilatation occurs.
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Affiliation(s)
- Tayfun Aybek
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
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Nigro JJ, Schwartz DS, Bart RD, Bart CW, Lopez BM, Cunningham MJ, Barr ML, Bremner RM, Haddy SM, Wells WJ, Starnes VA. Neochordal repair of the posterior mitral leaflet. J Thorac Cardiovasc Surg 2004; 127:440-7. [PMID: 14762353 DOI: 10.1016/j.jtcvs.2003.09.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myxomatous mitral valve insufficiency is traditionally repaired by posterior leaflet quadrangular resection and reconstruction. A simplified repair technique without leaflet resection is described, and our initial experience is reviewed. METHODS Thirty-nine consecutive patients with significant mitral regurgitation underwent repair since January 2000 by placement of expanded polytetrafluoroethylene sutures between the leading (coapting) edge of the posterior leaflet and the corresponding papillary muscle. An annuloplasty ring was placed, and no leaflet tissue was resected. Patient medical records were obtained and retrospectively reviewed. RESULTS Twenty-five men and 14 women (median age, 61 years; range, 40-88 years) had their mitral valve repaired by a variety of surgical approaches, including robotic (18 patients), right thoracotomy (6 patients), and sternal (15 patients). Three patients have required valve replacement: 1 at the initial operation, 1 because of dehiscence of the annuloplasty ring, and 1 after subsequent rupture of a previously normal native chorda. At follow-up (median, 12 months), 92% (33/36) of the remaining patients had an intact mitral repair with no to mild regurgitation, 8.3% (3/36) of patients had moderate regurgitation, and 92% of all patients (36/39) were in New York Heart Association class I. There were no deaths. CONCLUSIONS Myxomatous mitral regurgitation due to posterior leaflet insufficiency can be repaired without leaflet resection by placement of neochordae. This repair technique is effective and is readily accomplished by traditional and minimally invasive surgical approaches.
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Affiliation(s)
- John J Nigro
- Department of Cardiothoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
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Kollár A, Kékesi V, Soós P, Juhász-Nagy A. Left ventricular external subannular plication: an indirect off-pump mitral annuloplasty method in a canine model. J Thorac Cardiovasc Surg 2003; 126:977-82. [PMID: 14566235 DOI: 10.1016/s0022-5223(03)00588-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mitral annular dilatation in cardiomyopathy is due to left ventricular chamber enlargement. We hypothesized that the size of the mitral annulus could be "indirectly" reduced if the plicating sutures were placed externally into subannular myocardium. METHODS In healthy mongrel dogs, an off-pump technique to create external subannular plication was designed and implemented. The sutures were placed directly into the myocardium below the atrioventricular groove. In 14 dogs, the sutures were tightened with tourniquets, and after a 30-minute observation period the hearts were arrested. Subsequently the mitral annular size was measured with the tourniquets still tight and then released. In 6 dogs, circumflex coronary blood flow, coronary blood flow reserve, and left ventricular systolic function were also measured during experiments. RESULTS Subannular plication had no significant effect on the animals' hemodynamic stability, and it did not generate any arrhythmias. Suture tightening effectively reduced postmortem mitral annular diameter and circumference by 17% (30.8 +/- 0.4 mm and 96.8 +/- 1.1 mm vs 25.6 +/- 0.4 mm and 80.4 +/- 1.1 mm, respectively, P <.001) and mitral annular area by 31% (747 +/- 17 mm(2) vs 517 +/- 14 mm(2), P <.001). Circumflex coronary blood flow (39.0 +/- 7.9 mL/min vs 37.2 +/- 7.2 mL/min, P not significant) and left ventricular systolic function (dP/dt(max) 1705 +/- 237 mm Hg/s vs 1928 +/- 330 mm Hg/s, P not significant) remained unchanged (n = 6). CONCLUSION In healthy hearts, subannular ventricular plication resulted in a significant indirect mitral annular size reduction without compromising circumflex coronary blood flow or left ventricular systolic performance.
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Affiliation(s)
- András Kollár
- Cardiovascular Research Lab, Semmelweis University, Varosmajor 68, Budapest, 1122 Hungary.
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Affiliation(s)
- Debra Lynn-McHale Wiegand
- Debra Lynn-McHale Wiegand is a staff nurse in the surgical cardiac care unit at Thomas Jefferson University Hospital and a predoctoral fellow at the University of Pennsylvania in Philadelphia, Penn
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