Leakage test during mitral valve repair

Watanabe, Taiju; Arai, Hirokuni

doi:10.1007/s11748-014-0465-z

Cited by 9 publications

(4 citation statements)

References 32 publications

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“…Other assessment methods, such as assessment of a beating heart by antegrade or retrograde coronary perfusion, have recently been reported. [16][17][18][19][20] These assessment methods showed few differences between assessment of a beating heart and intraoperative transesophageal echocardiography. However, assessment with antegrade coronary perfusion has risks of air embolization and technical difficulty under the fibrillated state and blood filling the operative field.…”

Section: Discussionmentioning

confidence: 99%

Loop technique with ink-dot marking test: An alternative strategy to the ink test

et al. 2020

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Objective: We assessed the long-term outcomes of the loop technique with the ink-dot marking test, an alternative to the ink test for aligning the mitral valve (MV) leaflet height, during MV repair.Methods: We retrospectively reviewed 351 patients who underwent MV repair with the loop technique via median sternotomy or right mini-thoracotomy. The ink-dot marking test involves creation of a dotted line between the rough and clear zones in the anterior leaflet and the center of the posterior leaflet by gentian violet. According to this marking, we adjusted the fixing position of the loops with or without the loop-in-loop technique and additional neochordal repair.Results: This study involved 141 women and 210 men (mean age, 63.7 AE 13.0 years). Forty-one patients required additional adjustment after the ink-dot marking test. No significant differences were found in the need for second arrest between patients who did and did not require additional adjustment after the ink-dot marking test (3 vs 32 patients, P ¼ .782). Predischarge transthoracic echocardiography showed trivial residual MV regurgitation (MR) in 285 patients, mild in 64, and moderate in 2. Ten patients needed reoperations (9 MV replacements and 1 MV rerepair) because of recurrent MR during postoperative follow-up. The 3-, 5-, and 10-year postoperative cumulative incidence of moderate to severe recurrent MR was 3.6%, 6.0%, and 19.8%, respectively. Conclusions:The loop technique with the ink-dot marking test provided good early and long-term results. This test may help to decrease residual MR, especially when using the loop technique. (JTCVS Techniques 2020;3:110-21) Ink-dot marking test with a dotted line on the anterior leaflet and the posterior leaflet.

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Section: Discussionmentioning

confidence: 99%

Loop technique with ink-dot marking test: An alternative strategy to the ink test

et al. 2020

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“…For the mitral valve intervention, the valve was approached through Waterston's groove. The mechanism of mitral valve regurgitation was assessed using a saline test ( 19 , 20 ). Mitral valve repair was preferred whenever possible.…”

Section: Methodsmentioning

confidence: 99%

PlasmaBlade-assisted surgical septal myectomy: technique and our experience

Garg,

Lykins,

Alomari

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe pulsed-electron avalanche knife (PEAK) PlasmaBlade provides an atraumatic, scalpel-like cutting precision and electrocautery-like hemostasis. PlasmaBlade operates near body temperature, and its long, thin, and malleable tip can overcome the limitations of a surgical knife. In this study, we aimed to evaluate our clinical experience and histopathological outcomes of septal myectomy using PlasmaBlade.MethodsElectronic medical records were reviewed for preoperative, operative, and follow-up data of the patients who underwent septal myectomy using PEAK PlasmaBlade at our institute between January 2019 and December 2022. Histopathology of the myectomy specimens was reviewed for the depth of muscle necrosis and compared with the left atrial appendage (LAA) specimen.ResultsTwenty-nine patients underwent septal myectomy using the PEAK PlasmaBlade. No mortality was reported. The mean age was 60.6 ± 12.5 years, and 58.6% of patients were male. Peak left ventricular outflow tract (LVOT) gradients were 40.5 ± 34.9 mmHg at rest and 56.5 ± 34.9 mmHg after provocation. Concomitant procedures performed were LAA ligation in 20 (69.0%), aortic valve replacement in 5 (17.2%), and coronary artery bypass grafting in 3 (10.3%) patients. Postoperative complications were complete heart block in one (3.4%) and ventricular septal defect in two (6.9%) patients. Both the ventricular septal defects were identified intraoperatively and repaired. Histopathology of myectomy specimens demonstrated cautery artifact limited to <50 µm depth compared to >1,000 µm with conventional electrocautery. At a mean follow-up of 8.4 ± 10.3 months, the mean LVOT gradient was 4.4 ± 5.8 mmHg at rest and 9.5 ± 3.3 mmHg after provocation. All patients were alive and in New York Heart Association class I/II. No patient developed complications or required reintervention or reoperation.ConclusionAdequate septal myectomy can be precisely and safely performed using the PEAK PlasmaBlade with minimal collateral damage.

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“…The mitral apparatus can be tested by pressurizing the left ventricle via a left ventricular vent, intentional creation of aortic insufficiency, or direct infusion of saline with a bulb syringe. 14,15 Mitral coaptation surface can be assessed by staining the closure line with a surgical marker as described by Anyanwu and Adams. 16 These provocative tests performed by surgeons are critical in that, unlike TEE, a significant positive result does not require reapplication of an aortic cross-clamp or reinitiation of cardiopulmonary bypass.…”

mentioning

confidence: 99%

“…16 These provocative tests performed by surgeons are critical in that, unlike TEE, a significant positive result does not require reapplication of an aortic cross-clamp or reinitiation of cardiopulmonary bypass. 15 However, because of the annular conformational differences in the arrested and beating heart, discrepancies between direct surgical and intraoperative TEE assessment of valve competency can occur. 17 Surgical resistance to relinquish the immense responsibility of testing valve integrity over to another provider is understandable, particularly considering that in one survey, only 63% of cardiac anesthesiologists had passed the National Board of Echocardiography advanced examination.…”

mentioning

confidence: 99%