Early outcome of folding mitral valve repair technique without resection for mitral valve prolapse in 60 patients

Tsukui, Hiroyuki; Umehara, Nobuhiro; Saito, Hiroyuki; Saito, Satoshi; Yamazaki, Kenji

doi:10.1016/j.jtcvs.2012.08.063

Cited by 11 publications

(14 citation statements)

References 13 publications

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“…Furthermore, folding technique is also applicable to reduce the redundant leaflets. This technique is similar to that previously reported by Tsukui et al, 16 and although these authors reported good short-term outcomes with this technique, further studies are needed to assess the effects of folding mitral valve repair. We now perform mitral valve repair using mainly the loop technique, and other techniques, as needed (resection and suture, plication, folding) would be added to obtain long-term durability.…”

Section: Discussionsupporting

confidence: 81%

Preservation of Mobility of the Posterior Mitral Leaflet After Mitral Valve Repair With Neochordae Using Loop Technique

Kuwabara

Murata

Okamoto

et al. 2016

Circ J

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Section: Discussionsupporting

confidence: 81%

Preservation of Mobility of the Posterior Mitral Leaflet After Mitral Valve Repair With Neochordae Using Loop Technique

Kuwabara

Murata

Okamoto

et al. 2016

Circ J

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“…[5][6][7][8][9][10][11] The evolution may be due to concerns, such as the stressed cut-through phenomenon of sutures used to approximate the resected leaflet, irreversibility caused by inaccurate leaflet resection resulting in necessary valve replacement, or the timeconsuming complexity of the sliding annuloplasty. The 'respect rather than resect' approach is one of these techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Annular procedures such as annuloplasty sutures or rings are not usually feasible for patients with severe posterior mitral annular calcification. In addition, Woo et al [10] and Tsukui et al [11] routinely applied the similar direction-modified or vertical folding technique and reported favorable mid-term results. With the aid of an annuloplasty ring, the optimal coaptation of the mitral leaflet was achieved by embedding a prolapsing PML into the left ventricle, thereby, resulting in a vertical folding leaflet, and subsequent anatomical morphology equivalent to a triangular resection.…”

Section: Discussionmentioning

confidence: 99%

“…[11] Another risk is the degenerative change of the valve elsewhere due to the difference of the leaflet thickness, resulting in an impairment of function. Initially, we were concerned about the impairment of PML movement coming from the disparity between the freely flexible non-folding portion and restrictive rigid folding bulky portion in the long-term, even with successful intraoperative echocardiographic results (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

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Early results of non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse

Yeon¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada posterior mitral kapak orta segment prolapsusunda rezeksiyonel olmayan, dikey katlı mitral kapak tamirinin erken dönem sonuçları bildirildi. Ça lış ma pla nı: Kasım 2011 -Mart 2016 tarihleri arasında posterior mitral kapak orta segment prolapsusu için rezeksiyonel olmayan, dikey katlı mitral kapak tamiri yapılan ardışık 32 hastanın (18 erkek, 14 kadın; ort. yaş: 61.3±12.5 yıl; dağılım 43-75 yıl) verileri retrospektif olarak incelendi. Bul gu lar: Medyan takip süresi 33 ay (dağılım, 3-48 ay) idi. Hiçbir hastada replasman gerektiren tamir başarısızlığına rastlanmadı. Takip süresince, neredeyse hastaların hiçbirinde (n=31, %96.9) mitral yetmezliğin derecesinde kötüleşme görülmedi. So nuç: Çalışma sonuçlarımız posterior mitral kapak orta segment prolapsusunda rezeksiyonel olmayan, dikey katlı mitral kapak tamirinin cerrahi süresini harcamadan kolaylık, geriye döndürülebilirlik ve tekrar edilebilirlik gibi çeşitli avantajları olduğunu göstermektedir. Özellikle deneyimi az cerrahlar için bu teknik değerli bir alternatif olup, teknik araç olarak akılda bulundurulmalıdır. Results:The median follow-up was 33 months (range, 3 to 48 months). Repair failure requiring replacement did not occur in any patient. During follow-up, nearly none of the patients (n=31, 96.9%) experienced aggravation of the degree of mitral regurgitation. Conclusion:Our study results show that non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse has several advantages such as simplicity, reversibility, and reproducibility without consuming surgical time. In particular, for surgeons with a limited experience, this technique is a valuable alternative and should be considered as a technical armamentarium.

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“…3 Additionally, folding valvuloplasty techniques have recently been revisited and are viewed by some as a preferred method of MVP repair, particularly in the setting of minimally-invasive mitral valve surgery. 4–7 Surgical repair of MVP is effective, durable, and safe: 10-year freedom from reoperation exceeds 90%, and peri-operative mortality approximates 0.5%. 8, 9 However, there are patients who are not candidates for conventional open-heart surgery and cardiopulmonary bypass (CPB).…”

mentioning

confidence: 99%

Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model

Feins¹,

Yamauchi²,

Marx³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objective Recently there has been increased interest in minimally-invasive mitral valve prolapse repair techniques; however, these techniques have limitations. A technique was developed for treating mitral valve prolapse that utilizes a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip’s efficacy was tested in an animal model. Methods Yorkshire pigs (n=7) were placed on cardiopulmonary bypass (CPB), and mitral valve prolapse was created by cutting chordae supporting the P2 segment of the posterior leaflet. Animals were weaned off CPB and mitral regurgitation (MR) was assessed echocardiographically. CPB was reinitiated and the plication clip was applied under direct vision to the P2 segment to eliminate prolapse. Animals were survived for 2 hours. Epicardial echocardiography was obtained pre- and post-prolapse creation and 2 hours post-clip placement to quantify MR grade and vena contracta area. Posterior leaflet mobility and coaptation height were analyzed pre- and post-clip placement. Results There were no cases of clip embolization. Median MR grade increased from “trivial” (0–1.5) to “moderate-severe” post-MR creation (2.5–4+) (P<0.05), and decreased to “mild” post-clip placement (0–3+) (P<0.05). Vena contracta area tended to increase post-chordae cutting and decrease post-clip placement: 0.08±0.10cm2 vs. 0.21±0.15cm2 vs. 0.16±0.16cm2 (P=0.21). The plication clip did not impair leaflet mobility. Coaptation height was restored to baseline: 0.51±0.07cm vs. 0.44±0.18cm (P=1.0). Conclusions The leaflet plication clip can treat mitral valve prolapse in an animal model, restoring coaptation height without impacting leaflet mobility. This approach represents a simple technique that may improve the effectiveness of beating-heart and open-heart, minimally-invasive valve surgery.

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Early outcome of folding mitral valve repair technique without resection for mitral valve prolapse in 60 patients

Abstract: Folding mitral valve repair is an easily fine-tuned technique with a pilot suture, which can be easily removed and repositioned, if unsatisfactory. This reversibility is a significant advantage of this technique. Long-term follow-up is necessary to assess the durability of this technique.

Cited by 11 publications

References 13 publications

Preservation of Mobility of the Posterior Mitral Leaflet After Mitral Valve Repair With Neochordae Using Loop Technique

Preservation of Mobility of the Posterior Mitral Leaflet After Mitral Valve Repair With Neochordae Using Loop Technique

Early results of non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse

Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model

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