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Takagi K, Arinaga K, Takaseya T, Otsuka H, Shojima T, Kono T, Zaima Y, Saku K, Oryoji A, Tayama E. Mitral valve repair using a semi-rigid posterior band: a 10-year Japanese single-center experience of 244 patients. J Thorac Dis 2024; 16:333-343. [PMID: 38410614 PMCID: PMC10894386 DOI: 10.21037/jtd-23-1486] [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: 09/22/2023] [Accepted: 12/08/2023] [Indexed: 02/28/2024]
Abstract
Background Mitral valve repair (MVr) is an established procedure for patients who require surgery for primary mitral regurgitation (PMR). The Colvin-Galloway Future Band (CGFB) is a semi-rigid posterior band expected to improve the clinical outcomes of MVr. However, information on the hemodynamic and functional performance and long-term outcomes of CGFB is limited. We evaluated the quality, durability, and clinical performance after MVr using CGFB for PMR as the cohort study. Methods A total of 244 patients who underwent MVr with CGFB were enrolled. Clinical and echocardiographic assessments were performed (mean follow-up period, 4.0±2.4 years). Results Posterior mitral leaflet resection was the most common MVr procedure. CGFBs measuring 28 mm (35.2%) and 30 mm (36.5%) were used. The incidence of systolic anterior motion (SAM) was 1.6%. A total of 93.4% of the patients had no or trace MR at discharge. Over 90% of patients had no or mild MR at the last follow-up. The mean pressure gradient and mitral valve orifice area one year after MVr ranged between 2.6 and 3.6 mmHg and 2.3 and 3.4 cm2, respectively. At follow-up, 85.4% of the patients were New York Heart Association class I. Three patients underwent repeat mitral valve surgery. Conclusions The CGFB demonstrates satisfactory quality and durability in MVr for PMR. Other advantages include a low occurrence of SAM and acceptable hemodynamic outcomes, particularly in patients requiring a smaller annuloplasty device.
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Affiliation(s)
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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van der Merwe J, Casselman F. Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery-A Review of Current Concepts and Perspectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1470. [PMID: 37629762 PMCID: PMC10456639 DOI: 10.3390/medicina59081470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
The devastating impact of a circumflex coronary artery (CX) injury during mitral valve (MV) surgery is well reported. Despite significant improvements in preoperative risk assessment, intraoperative diagnosis and perioperative treatment strategies of CX injury during MV surgery, recent reports re-emphasize the variability in presentation, the unpredictable mechanisms of injury and the conflicting evidence regarding perioperative management. The progressive transition from conventional sternotomy access to minimally invasive surgical and transcatheter (TC) interventions for MV disease are associated with significant learning curves and require additional single-shaft and robotic console suture manipulation skills with special attentiveness to the potential risk of CX injury. The introduction of hybrid theatres that facilitate single stage surgical and TC interventions also provides new intraoperative diagnostic and therapeutic options without transporting unstable patients for percutaneous coronary intervention (PCI) assessment. By utilizing a MeSH terms-based PubMed search, a total of 89 patients with CX injury that occurred during MV surgery was identified from 49 reports between 1967 and 2022. MV surgery was performed by conventional sternotomy (n = 76, 85.4%), endoscopic (n = 12, 13.4%) and robotic access (n = 1, 1.1%), with 35 injuries (39.3%) resulting in total CX occlusion. Rescue PCI was utilized in 40 patients (44.9%). This manuscript provides a systematic overview of all available historic and contemporary reports on CX injury during MV surgery, outlines recent refinements in CX injury mechanisms, describes current MV surgery associated CX injury prevention and diagnosis and treatment strategies and highlights important MV procedural aspects that may minimize the risk and consequences of CX injury.
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Affiliation(s)
- Johan van der Merwe
- The Keyhole Heart Centre, Netcare Blaauwberg Hospital, Cape Town 7441, South Africa;
| | - Filip Casselman
- Cardiovascular Surgery, Cardiovascular Centre, OLV Clinic, 9300 Aalst, Belgium
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Cheng Y, Li H, Li G, Zhou C, Su W, Dong N, Hu Z. Surgical Results of Mitral Valve Repair for Mitral Regurgitation in Pediatric Patients with Mitral Valve Prolapse. Pediatr Cardiol 2022; 43:1578-1586. [PMID: 35362780 DOI: 10.1007/s00246-022-02885-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022]
Abstract
The rare incidence of mitral regurgitation (MR) caused by mitral valve prolapse in children lacks clinical management experience. In this study, we present our experience in surgical management and the difference between isolated anterior mitral leaflet (AML), posterior mitral leaflet (PML), and bileaflet prolapse in pediatric patients. Between January 2014 and February 2021, 52 pediatric patients, aged 7.04 ± 4.02 years (ranged from 0.17 to 14 years), were diagnosed as moderately severe (11, 21.2%) or severe (41, 78.8%) MR, of which, 34 (65.4%) were owing to AML prolapse, one (1.9%) was PML prolapse, and 17 (32.7%) caused by bileaflet prolapse. All had received mitral valve repair, and were divided into the group of AML prolapse and bileaflet prolapse. Demographic and clinical characteristics of all patients were retrospectively collected and analyzed. The left ventricular diameter in the bileaflet group was significantly larger than the AML group (4.04 ± 0.73 cm vs. 3.45 ± 0.75 cm, P = 0.026). The median follow-up time was 33 months (ranged from 6 to 88 months). The postoperative and follow-up results had no significant difference between two groups. And only 2 patients received reoperation due to posterior annuloplasty ring dehiscence. For pediatric patients, the majority of the patients had isolated AML prolapse instead of PML prolapse. There was no difference in recurrent regurgitation or reoperation between isolated AML and bileaflet prolapse after MV repair, and we suggest more aggressive surgical strategy should be considered in pediatric patients with bileaflet prolapse than AML prolapse.
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Affiliation(s)
- Yang Cheng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277#, Wuhan, 430000, People's Republic of China
| | - He Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Geng Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277#, Wuhan, 430000, People's Republic of China
| | - Cheng Zhou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277#, Wuhan, 430000, People's Republic of China
| | - Wei Su
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277#, Wuhan, 430000, People's Republic of China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277#, Wuhan, 430000, People's Republic of China
| | - Zhiwei Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277#, Wuhan, 430000, People's Republic of China.
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Insuficiencia mitral en la enfermedad de Barlow. La mirada desde la reparación. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kalra K, Grubb KJ. Commentary: Is the ring the lord of all problems and solutions in mitral valve repair? JTCVS Tech 2021; 10:43-44. [PMID: 34984358 PMCID: PMC8691933 DOI: 10.1016/j.xjtc.2021.10.037] [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: 10/13/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kanika Kalra
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga
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