Anterior leaflet augmentation for ischemic mitral regurgitation (original) (raw)
Related papers
Acute and 12-Month Results With Catheter-Based Mitral Valve Leaflet Repair
Journal of the American College of Cardiology, 2012
The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study (HRS) assessed the safety and effectiveness of the MitraClip device (Abbott Vascular, Santa Clara, California) in patients with significant mitral regurgitation (MR) at high risk of surgical mortality rate. Background Patients with severe MR (3 to 4ϩ) at high risk of surgery may benefit from percutaneous mitral leaflet repair, a potentially safer approach to reduce MR. Methods Patients with severe symptomatic MR and an estimated surgical mortality rate of Ն12% were enrolled. A comparator group of patients screened concurrently but not enrolled were identified retrospectively and consented to compare survival in patients treated by standard care. Results Seventy-eight patients underwent the MitraClip procedure. Their mean age was 77 years, Ͼ50% had previous cardiac surgery, and 46 had functional MR and 32 degenerative MR. MitraClip devices were successfully placed in 96% of patients. Protocol-predicted surgical mortality rate in the HRS and concurrent comparator group was 18.2% and 17.4%, respectively, and Society of Thoracic Surgeons calculator estimated mortality rate was 14.2% and 14.9%, respectively. The 30-day procedure-related mortality rate was 7.7% in the HRS and 8.3% in the comparator group (p ϭ NS). The 12-month survival rate was 76% in the HRS and 55% in the concurrent comparator group (p ϭ 0.047). In surviving patients with matched baseline and 12-month data, 78% had an MR grade of Յ2ϩ. Left ventricular enddiastolic volume improved from 172 ml to 140 ml and end-systolic volume improved from 82 ml to 73 ml (both p ϭ 0.001). New York Heart Association functional class improved from III/IV at baseline in 89% to class I/II in 74% (p Ͻ 0.0001). Quality of life was improved (Short Form-36 physical component score increased from 32.1 to 36.1 [p ϭ 0.014] and the mental component score from 45.5 to 48.7 [p ϭ 0.065]) at 12 months. The annual rate of hospitalization for congestive heart failure in surviving patients with matched data decreased from 0.59 to 0.32 (p ϭ 0.034). Conclusions The MitraClip device reduced MR in a majority of patients deemed at high risk of surgery, resulting in improvement in clinical symptoms and significant left ventricular reverse remodeling over 12 months. (Pivotal Study of a
Anterior Leaflet Repair With Patch Augmentation for Mitral Regurgitation
Annals of Thoracic Surgery, 2005
Background. Anterior leaflet repair continues to pose significant operative challenges, particularly in patients with retracted or "short" anterior leaflets, due to rheumatic or radiation induced mitral valve disease. This often results in abandonment of repair in favor of mitral valve replacement, requiring anticoagulation and altering left ventricular (LV) function and geometry. This study examines our experience of anterior leaflet repair with patch augmentation.
Percutaneous "edge-to-edge" leaflet repair in patients with secondary mitral valve regurgitation
Mini-invasive Surgery , 2020
Functional or secondary mitral regurgitation (MR) is a heterogeneous entity afflicting patients with heart failure both with reduced or preserved left ventricular ejection fraction. It results from an imbalance between closing forces and tethering or pushing strengths acting on the valve in the absence of structural alterations of mitral valve (MV) apparatus. According to previous studies, more than 20% of patients with heart failure and reduced left ventricular ejection fraction have severe MR, even though the definition of the severity of the MV disease in this setting remains a debated issue due to the poor reproducibility of quantitative measurements and its dynamic nature, highly dependent on left ventricular loading conditions and performance in relation to optimization of medical treatment. Furthermore, it is still unclear whether MR is a direct contributor to a worse prognosis or merely a marker of severity of the disease affecting the left ventricle. Isolated MV surgery in these patients is burdened by significant operative mortality, high rates of recurrent MR and absence of proven survival benefit. In recent years, percutaneous treatment of functional MR arose as a viable and safe alternative to conventional surgery, proving capable of reducing symptoms and recurrent hospitalization rates for heart failure, and even improving prognosis in selected patients. In this review we will discuss the percutaneous treatment of functional MR through transcatheter "edge-to-edge" leaflet repair performed with the two systems currently available: the MitraClip System and the PASCAL Repair System, from available evidence to technical practice.
Percutaneous "edge-to-edge" leaflet repair in patient with primary mitral valve regurgitation
Mini-invasive Surgery , 2020
Mitral regurgitation (MR) is the most common left-sided heart valve disease in developed countries with a constantly rising number of patients requiring hospitalization or intervention. Organic MR is defined as a primary structural abnormality of the mitral valve (MV) apparatus which may be caused by a broad set of pathological processes, among which myxomatous degeneration of the leaflets causing MV prolapse is the most common. If left untreated, chronic severe MR leads to serious adverse outcomes, from heart failure to death, but medical therapy is unable to change the natural history of the disease. Surgical correction, by means of valve repair or replacement, is the gold standard for the treatment of symptomatic patients with severe primary MR. However, surgery is not feasible for a large percentage of patients because of old age, reduced left ventricular ejection fraction and the presence of severe comorbidities. Therefore, in recent years, several percutaneous therapeutic alternatives suitable for high or prohibitive surgical risk patients were developed. In this review we discuss the transcatheter treatment of primary MR, from available evidence to technical practice, with a focus on the percutaneous "edge-to-edge" leaflet repair performed with the MitraClip System and the PASCAL Repair System.
World Journal of Cardiovascular Surgery, 2013
Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midterm results of leaflet augmentation in mitral valve repair of rheumatic valves with gluteraldehyde preserved autologous pericardium. Patients and Methods: In our department 48 patients were exposed to mitral valve repair by leaflet augmentation either anterior or posterior beside other technique and all patients supported by flexible annuloplasty ring and followed for five years clinically and by echocardiography. Results: Age of the patients ranging from 12 to 47 years, mean age 25.9 ± 8.9 and there were 12 males (25%) and 36 females (75%) with male to female ratio of 1:3. All patients presented with shortness of breath (100%); with 14 patients were in NYHA class III (29.17%) and 34 patients were in NYHA class IV (70.83%). During follow-up period 5 patients needed reoperation by valve replacement, causes of reoperation were restrictive valve motion in one patient, left atrial thrombus in 1 patient and sever mitral regurgitation in 3 patients. Freedom from reoperation was 87.5%. At 5 years, (92.9%) were in New York Heart Association functional class I, three patients (7.1%) were in class II. Echocardiography at follow-up showed satisfactory mitral valve function. Conclusion: leaflet augmentation is a simple and reproducible method of valve repair for rheumatic MR with good midterm result.
Initial Results of Posterior Leaflet Extension for Severe Type IIIb Ischemic Mitral Regurgitation
Circulation, 2009
Background-Management of severe ischemic mitral regurgitation remains difficult with disappointing early and intermediate-term surgical results of valve repair. Methods and Results-Forty-four patients with severe (4ϩ) Carpentier type IIIb ischemic mitral regurgitation underwent mitral valve repair, with or without surgical revascularization, by posterior leaflet extension with a patch of bovine pericardium and a remodeling annuloplasty. Serial echocardiography was performed preoperatively, intraoperatively, and postoperatively to assess mitral valve competence. The postoperative functional status of patients was assessed. The average Parsonnet score was 38Ϯ13. Thirty-day mortality was 11%, and late mortality was 14%. Mean follow-up was 38 months. The actuarial freedom from moderate or severe recurrent mitral regurgitation was 90% at 2 years, whereas 90% of patients were in New York Heart Association class I at 2 years. Conclusion-Posterior leaflet extension with annuloplasty of the mitral valve for severe type IIIb ischemic regurgitation is a safe, effective method that provides good early and intermediate-term competence of the mitral valve and therefore good functional status.
Preliminary experience using the transcatheter mitral valve leaflet repair procedure
The Israel Medical Association journal: IMAJ
Mitral regurgitation (MR) causes increased morbidity and mortality in heart failure patients and is often associated with augmented surgical risk. To assess the preliminary results oftranscatheter mitral valve leaflet repair (TMLR) in a single academic center. Data were collected prospectively in the cardiology department of Rabin Medical Center in 2012. Ten consecutive patients (age 69.3 +/- 15.9 years, ejection fraction 36.5 +/- 9.4) who were poor surgical candidates with severe functional MR underwent general anesthesia, followed by trans-septal puncture and a TMLR procedure using the MitraClip device. All 10 patients were considered to have severe functional MR prior to TMLR treatment and were all symptomatic; the mean New York Heart Association (NYHA) class was 3.4 +/- 0.5. The MR severity was 4 +/- 0. There were no immediate complications or failures of the procedure. One patient died on day 5 due to massive gastrointestinal bleeding. Immediately following TMLR all 10 patients...
Mitral valve repair in ischemic mitral regurgitation
Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, 2005
Ischemic mitral regurgitation (IMR) is a common complication after acute myocardial infarction due to annulus dilatation and papillary muscles displacement. In our opinion 3/4 and 4/4 IMR have always to be indicated for MV surgery. In presence of low EF and dilated LV, moderate (2/4) IMR has to be corrected. The end-systolic distance between the coaptation point of mitral leaflets and the plane of mitral valve annulus is the key point to decide repair (≦10 mm) or replacement (≫10 mm). MV annuloplasty has always been addressed to the posterior annulus, whose size can be easily reduced. A specially designed 40 mm long ring has been used to achieve a posterior overreductive annuloplasty. For MV repair thirty-day mortality was 2.4%. Five-year survival and the possibility of being alive and in NYHA class I-II were 75.6±4.7 and 59.8±5.4, respectively. After a mean of 38±35 months, the NYHA class decreases from 3.2±0.5 to 2.1±0.6 (P≪0.001). Most patients (77.4%) have an improvement of its ...
The Journal of Thoracic and Cardiovascular Surgery, 2012
Objective: Recurrence rates as high as 30% have been observed 6 months after treatment of chronic ischemic mitral regurgitation (CIMR) with isolated annuloplasty. We postulated that the high early recurrence rates resulted from the presence of untreated pseudoprolapse of the anterior leaflet. Methods: We conducted a retrospective study of all mitral valve repairs for CIMR performed by a single surgeon (S.W.H.) from 1995 to 2011. After annuloplasty, Gore-Tex neochordae were added if the high-pressure saline test indicated the presence of pseudoprolapse of the anterior leaflet. Results: A total of 47 patients underwent mitral valve repair for CIMR. Of the 47 patients, 24 (51%) were found to have pseudoprolapse requiring the addition of neochordae. For all patients, the average age was 65.1 years, and 65.2% were men. Fourteen (30%) had had a preoperative intra-aortic balloon pump placed by cardiologists. Fourteen (30%) had severe pulmonary hypertension. Concomitant coronary artery bypass grafting was performed in 40 patients, with an average of 2.2 grafts; 7 had previously undergone coronary artery bypass grafting. Mitral Carpentier-Edwards physio annuloplasty rings were used in all patients with a mean size of 29 mm. One patient died postoperatively. Follow-up data were available for all 47 patients at an average of 4.9 years. The 5-year survival rate was 82.5%. The mean pre-and postoperative New York Heart Association class, ejection fraction, and mitral regurgitation grade were 3 and 1.52 (P<.0001), 34% and 41% (P ¼ .0006), and 3.51 and 1.08 (P <.0001), respectively. Two patients developed greater than moderate mitral regurgitation. Conclusions: Effective repair of CIMR should include surgical techniques to correct pseudoprolapse of the anterior leaflet, when present. The selective addition of Gore-Tex neochordae to an undersized annuloplasty nearly eliminates recurrent regurgitation after mitral valve repair for CIMR.
Mitral valve repair for ischemic mitral regurgitation: review of current techniques
The aims of this study were to review the principles underlying use of the Carpentier-McCarthy-Adams IMR ETlogix ® asymmetric annuloplasty ring for the treatment of chronic ischemic mitral regurgitation and to report medium-term clinical outcomes observed at our center. The in-hospital mortality rate was 2.8%. Echocardiography at hospital discharge confirmed the absence of mitral regurgitation in 88.8% of patients. Patients underwent clinical and echocardiographic followup (median duration, 23 months; range, 12-44 months). Late follow-up echocardiography demonstrated the recurrence of moderate mitral regurgitation in 5.7% of patients and of moderate-to-severe mitral regurgitation in 2.9%. The rate of survival free from recurrence of ≥grade-2 mitral regurgitation was 95.2% at 15 months and 88.9% at 25 months. Mitral valve repair using the asymmetric Carpentier-McCarthy-Adams IMR ETlogix ® ring in patients with chronic ischemic mitral regurgitation enabled regurgitation to be effectively corrected by producing asymmetric changes in the morphology of the mitral ring. Medium-term outcomes, with regard to the degree of mitral valve competence, were excellent.