Left ventricular performance early after repair for posterior mitral leaflet prolapse: Chordal replacement versus leaflet resection

Imasaka, Ken-ichi; Tayama, Eiki; Tomita, Yukihiro

doi:10.1016/j.jtcvs.2015.06.022

Cited by 26 publications

(33 citation statements)

References 31 publications

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“…3 Recent studies have suggested that LV performance is superior in patients with degenerative MR repaired with ePTFE artificial cordal techniques compared with resection methods. 11 In North America, there is increasing use of ePTFE in mitral valve repair: Between 2011 and 2014, among 20 523 patients undergoing mitral valve repair for degenerative disease, ePTFE cordal replacement was used in 31% (6370). 2 We reasoned that a shafted instrument with a narrow diameter that could reliably anchor ePTFE artificial cords to a prolapsed mitral valve leaflet with the use of transapical access and TEE guidance would enable reliable and durable mitral valve repair through a small nonsternotomy incision on the beating heart.…”

Section: Discussionmentioning

confidence: 99%

Transapical Beating-Heart Mitral Valve Repair With an Expanded Polytetrafluoroethylene Cordal Implantation Device

et al. 2016

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BACKGROUND:Degenerative mitral valve (MV) disease is a common cause of severe mitral regurgitation (MR) and accounts for the majority of MV operations. Conventional MV surgery requires cardiopulmonary bypass, aortic cross-clamping, cardioplegia, and a thoracotomy or sternotomy and, therefore, is associated with significant disability, risks, and unpredictable rates of MV repair. Transesophageal echocardiography-guided beating-heart MV repair with expanded polytetrafluoroethylene cordal insertion has the potential to significantly reduce surgical morbidity. We report the first-in-human clinical experience with a novel preformed expanded polytetrafluoroethylene knot implantation device (Harpoon TSD-5) designed to treat degenerative MR. METHODS:Through a small left thoracotomy, the device was inserted into the heart and guided by transesophageal echocardiography to the ventricular surface of the prolapsed leaflet. Multiple expanded polytetrafluoroethylene cords were anchored in the leaflet and then adjusted to the correct length to restore MV leaflet coaptation and secured at the epicardium. RESULTS:Eleven patients with posterior leaflet prolapse and severe MR, with mean±SD age of 65±13 years and mean ejection fraction of 69±7%, were treated with 100% procedural success. Immediate postprocedural mean MR grade was trace. At 1 month, the mean MR grade was mild with significant decreases in end-diastolic volume (139 to 107 mL; P=0.03) and left atrial volume (118 to 85 mL; P=0.04). CONCLUSIONS:A novel device used for beating-heart image-guided MV repair demonstrates a significant reduction in MR with favorable left ventricular and left atrial reverse remodeling. This approach has the potential to decrease invasiveness and surgical morbidity. Further follow-up is necessary to assess long-term efficacy. CLINICAL TRIAL REGISTRATION: 190M itral valve disease is the most prevalent heart valve disorder and is 3 to 4 times more common than aortic valve disease. Significant mitral regurgitation (MR) affects ≈2% of the total population and 9% of the population >75 years of age.1 MR causes volume overload of the left ventricle (LV), which in turn can progress to ventricular dilation, decreased ejection performance, pulmonary hypertension, congestive heart failure, atrial fibrillation (AF), right ventricular dysfunction, and eventually death. Degenerative MR is the most common indication for mitral valve surgery in North America.2 Introduced clinically in 1986, mitral valve repair with expanded polytetrafluoroethylene (ePTFE) artificial cords has been shown to be equivalent to leaflet resection techniques 3 and is increasingly being used in conventional mitral valve repair operations. 4 Although effective, conventional mitral valve surgery requires cardiopulmonary bypass, aortic crossclamping, cardioplegia, and a thoracotomy or sternotomy. It is therefore associated with significant disability and risks, including stroke, renal failure, widely variable rates of mitral valve repair versus replacement, and death.5 As a result, the...

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Section: Discussionmentioning

confidence: 99%

Transapical Beating-Heart Mitral Valve Repair With an Expanded Polytetrafluoroethylene Cordal Implantation Device

et al. 2016

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“…In a previous study [ 23 ], Imasaka and colleagues suggested that chordal replacement might be associated with better postoperative LV function than leaflet resection in the repair of posterior leaflet prolapse. However, in other studies [ 19 – 21 ], the factors of lesion segment and repair technique were not observed to be related to postoperative LV systolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Zhao

Zhou

et al. 2020

J Cardiothorac Surg

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Background This study aims to evaluate the early and mid-term outcomes of mitral valve repair for degenerative mitral regurgitation (MR) in patients with left ventricular systolic dysfunction. Methods From January 2005 to December 2016, the profiles of patients with degenerative MR who underwent mitral valve repair at our institution were analyzed. Left ventricular systolic dysfunction was defined as an ejection fraction < 60% or left ventricular end-systolic dimension > 40 mm. Finally, 322 patients with left ventricular systolic dysfunction were included in this study. The prognosis of left ventricular function during follow-up was evaluated and preoperative factors associated with deteriorated left ventricular systolic function during follow-up were analyzed. Results The in-hospital mortality rate was 1.6%. The rate of eight-year overall survival, freedom from reoperation for mitral valve and freedom from recurrent MR were 96.9, 91.2 and 73.4%, respectively. Intraoperative residual mild MR (hazard ratio 4.82) and an isolated anterior leaflet lesion (hazard ratio 2.48) were independent predictive factors for recurrent MR. During follow-up, 212 patients underwent echocardiography examinations at our institution. Among them, 132 patients had improved left ventricular systolic function, and 80 patients had deteriorated left ventricular systolic. Freedom from recurrent MR was found in 75.9% of the improved left ventricular systolic function group and 56.2% of the deteriorated left ventricular systolic function group (P = 0.047). An age > 50 years (odds ratio 2.40), ejection fraction≤52% (odds ratio 2.79) and left ventricular end-systolic dimension≥45 mm (odds ratio 2.31) were independent risk factors for deteriorated left ventricular systolic function during follow-up. Conclusions Mitral valve repair could be safely performed for degenerative MR in patients with left ventricular systolic dysfunction. Intraoperative residual mild MR and an isolated anterior leaflet lesion were independent predictive factors for recurrent MR. An age > 50 years, ejection fraction≤52% and left ventricular end-systolic dimension≥45 mm were independent risk factors for deteriorated left ventricular systolic function during follow-up.

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“…Bei der Respect-Strategie unter Verwendung von Gore-Tex ® -Loops ist die Häu-figkeit einer Reoperation dagegen unabhängig von der Segelpathologie [9]. Zudem legt eine kürzlich veröffentlichte Studie nahe, dass die Respect-Strategie mit einer Verbesserung der postoperativen linksventrikulären Funktion assoziiert ist [12]. Zur Sicherung des Rekonstruktionsergebnisses wird zusätzlich ein Anuloplastiering eingenäht.…”

Section: » Bei Der Respect-strategie Ist Die Häufigkeit Einer Reoperaunclassified

Moderne Mitralklappenchirurgie

Bothe

Beyersdorf

2016

Internist

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At the beginning of the 20th century, Cutler and Levine performed the first successful surgical treatment of a stenotic mitral valve, which was the only treatable heart valve defect at that time. Mitral valve surgery has evolved significantly since then. The introduction of the heart-lung machine in 1954 not only reduced the surgical risk, but also allowed the treatment of different mitral valve pathologies. Nowadays, mitral valve insufficiency has become the most common underlying pathomechanism of mitral valve disease and can be classified into primary and secondary mitral insufficiency. Primary mitral valve insufficiency is mainly caused by alterations of the valve (leaflets and primary order chords) itself, whereas left ventricular dilatation leading to papillary muscle displacement and leaflet tethering via second order chords is the main underlying pathomechanism for secondary mitral valve regurgitation. Valve reconstruction using the "loop technique" plus annuloplasty is the surgical strategy of choice and normalizes life expectancy in patients with primary mitral regurgitation. In patients with secondary mitral regurgitation, implanting an annuloplasty is not superior to valve replacement and results in high rates of valve re-insufficiency (up to 30 % after 3 months) due to ongoing ventricular dilatation. In order to improve repair results in these patients, we add a novel subvalvular technique (ring-noose-string) to the annuloplasty that aims to prevent ongoing ventricular remodeling and re-insufficiency. In modern mitral surgery, a right lateral thoracotomy is the approach of choice with excellent repair and cosmetic results.

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Left ventricular performance early after repair for posterior mitral leaflet prolapse: Chordal replacement versus leaflet resection

Abstract: Chordal replacement might provide patients undergoing valve repair for posterior mitral leaflet prolapse with better postoperative ventricular performance than leaflet resection. Longer follow-up is required to compare long-term outcomes.

Cited by 26 publications

References 31 publications

Transapical Beating-Heart Mitral Valve Repair With an Expanded Polytetrafluoroethylene Cordal Implantation Device

Transapical Beating-Heart Mitral Valve Repair With an Expanded Polytetrafluoroethylene Cordal Implantation Device

Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Moderne Mitralklappenchirurgie

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