Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era (original) (raw)
Related papers
Outcomes of mitral valve repair for bileaflet prolapse
The Journal of thoracic and cardiovascular surgery, 2012
Repair of bileaflet prolapse has been considered to be technically demanding and challenging. To assess the reliability and durability of mitral valve repair for bileaflet prolapse, the present study compared the outcomes of mitral valve repair for bileaflet prolapse with those for posterior prolapse.
2014
OBJECTIVE: Although mitral valve repair is the preferred treatment for degenerative mitral valve disease, valve replacement still remains prevalent, particularly in the setting of anterior leaflet prolapse. We sought to determine the feasibility and mid-term durability of a lesion-based surgical strategy applied systematically in a consecutive and nonexclusionary (all comers) series of patients with degenerative mitral valve disease and either isolated anterior leaflet or bileaflet prolapse. METHODS: From January 2002 to December 2010, 188 consecutive patients [mean age 56 ± 14 years (range 12-86), 31% female, mean left ventricular ejection fraction 55 ± 9%] underwent surgery for degenerative anterior mitral leaflet prolapse [isolated (n = 42, 22%) or bileaflet prolapse (n = 146, 78%)]. Degenerative aetiology was Barlow's disease in 110 (58%) patients and fibroelastic deficiency in 78 (42%). RESULTS: Patients with anterior leaflet prolapse were significantly more symptomatic (New York Heart Association functional Class III-IV) than those with bileaflet prolapse (28.6 vs 9.6%; P = 0.003) at the time of surgery. All patients underwent mitral valve repair and ring annuloplasty. There was 1 immediate valve replacement due to atrioventricular groove bleeding and consequent haematoma in an elderly female patient (99.5% repair rate). Predominant repair techniques were polytetrafluoroethylene neochordoplasty (or loop technique) in 93 (49%) patients, chordal transfer in 86 (46%) and posterior leaflet flip technique in 21 (11%). Median length of stay was 6 (interquartile 5-8) days. In-hospital mortality was 1% (n = 2). Predischarge transthoracic echocardiography showed none to trace mitral regurgitation in 91% of the patients and mild mitral regurgitation in 9%. The Kaplan-Meier estimates for cumulative survival at 1 and 7 years were 98.4 ± 0.9 and 88.7 ± 2.2%, respectively. Freedom from ≥moderate mitral regurgitation was 100% at 1 year, 93.7 ± 2.2% at 4 years and 90.3 ± 3.7% at 7 years. When the interval-censored estimator was used, freedom from ≥moderate mitral regurgitation at 1, 4 and 7 years was 100, 96 and 92%, respectively. CONCLUSION: A lesion-based surgical approach with an intention to repair all degenerative valves with anterior leaflet prolapse was applied to a consecutive series of patients with degenerative mitral valve disease. We were able to achieve a near-100% repair rate. Repair of all degenerative valves may be feasible with good mid-term durability, regardless of valve morphology, patient age or comorbidities.
Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2018
Background: To evaluate the long term results of two simple techniques for correction of posterior or bileaflet prolapse with no incidence of postoperative systolic anterior motion of the anterior mitral leaflet (SAM). Methods: From June 2010 to June 2016, 64 patients underwent mitral valve repair. Edge to edge,(35 patients)(group A) Vs. ('U') technique, (29 patients) (group U). A mean follow-up of 58 ± 13 months in (group A) and 42 ± 16 months in (group U). Results: There were no early or late deaths. Both surgical techniques showed excellent immediate postoperative results regarding reduction of the mitral regurgitation gradeaccepted mean pressure gradients (MPG) through the mitral valve (2.3 ± 0.6). Left ventricular function was maintained, and tricuspid regurgitation grade was reduced overall. During the follow-up period, Significant increase in the MPG was observed in (group A) with no significant change in the degree of mitral regurge. The majority of them with significant increase are due to the rheumatic pathology(9/12). They became symptomatic and came out of the study after a follow up period of 41 ± 13 months and their valves were replaced while those with non rheumatic pathology remained of reasonable gradient. Redo mitral valve replacement was done in only one patient in (group U) due to early endocarditis. Conclusions: Despite the rationale is completely different in both techniques (double orifice, double leaflet(A) versus Uni-leaflet, Uni-orifice(U)), the long-term results are comparable in both. The U technique is mostly better in rheumatic patients but need more follow up on larger scales of this patient group.
Mitral valve replacement with bileaflet preservation: a modified technique
European journal of cardio- …, 2002
We present a modified bileaflet preserving mitral valve replacement technique to eliminate left ventricular outflow tract obstruction and larger size prosthesis implantation. Mitral anterior leaflet was incised from the middle of leaflet to mitral annulus. Pletgetted sutures were firstly ...
Interactive CardioVascular and Thoracic Surgery, 2015
A 74-year old lady was admitted for the presence of a symptomatic severe mitral regurgitation (MR) due to bileaflet prolapse. The patient refused any surgical conventional procedure because of severe arthrosis and osteoporosis documented by previous fractures requiring knee and hip replacements, and was sent directly to us for transapical off-pump mitral valve repair with Neochord implantation (TOP-MINI procedure). The TOP-MINI procedure was performed under general anaesthesia and transoesophageal echocardiographic guidance. Four Neochordae were implanted on the posterior leaflet and two on the anterior leaflet in order to correct a residual anterior prolapse that was not seen at preoperative screening. After 11 months of follow-up, the patient presented with recurrence of symptomatic moderate MR due to rupture of one of two neochordae implanted on the anterior leaflet and new onset of atrial fibrillation. The patient underwent uneventful mitral valve replacement.
European Journal of Cardio-Thoracic Surgery, 2009
Objective: We sought to compare the outcomes of minimally invasive mitral valve (MV) surgery for anterior (anterior mitral leaflet, AML), posterior (posterior mitral leaflet, PML) or bileaflet (BL) MV prolapse. Methods: Between August 1999 and December 2007, 1230 patients who presented with isolated AML (n = 156, 12.7%), isolated PML (n = 672, 54.6%) or BL (n = 402, 32.7%) MV prolapse underwent minimally invasive MV surgery. The preoperative mitral regurgitation (MR) grade was 3.3 AE 0.8, left ventricular ejection fraction (LVEF) was 62 AE 12% and mean age was 58.9 AE 13.0 years; 836 patients (68.0%) were male. Mean follow-up time was 2.7 AE 2.1 years, and the follow-up was 100% complete. Results: Overall, the MV repair rate was 94.0% (1156 patients). Seventy-four patients (6.0%) received MV replacement. MV repair for PML prolapse was accomplished in 651 patients (96.9%), for AML in 142 patients (91%) and for BL in 363 patients (90.3%). Repair techniques consisted predominantly of leaflet resection and/or implantation of neochordae, combined with ring annuloplasty. Concomitant procedures were tricuspid valve surgery (n = 56), atrial fibrillation ablation (n = 286) and closure of an atrial septal defect or patent foramen ovale (PFO) (n = 89). The overall duration of cardiopulmonary bypass was 127 AE 40 min and aortic cross-clamp time was 78 AE 33 min. The mean postoperative hospital stay was 11.6 AE 9.7 days for the overall group. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3 AE 0.5. For the overall group, 5-year survival rate was 87.3% (95% CI: 83.9-90.1) and 5-year freedom from cardiac reoperation rate was 95.6% (95% CI: 94.1-96.7). The log-rank test revealed no significant difference between the three groups regarding long-term survival or freedom from reoperation. Conclusions: Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse. #
Correction of bileaflet mitral valve prolapse via reduction of posterior leaflet height
The Annals of Thoracic Surgery, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.