Midterm Results of Mitral Valve Repair With Pericardial Leaflet Augmentation: A Single-Center Experience

Malhotra, Amber; Majmudar, Shaival; Siddiqui, Sumbul; Pandya, Himani; Shah, Komal; Sharma, Pranav; Patel, Kartik; Gandhi, Hemang

doi:10.1053/j.semtcvs.2019.10.019

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…There have been several studies reporting mid-term outcomes. The largest study, by Malhotra et al , reported that there was only a 5.4% reoperation rate among the 80 patients who underwent surgery with this technique, but the mean follow-up was limited to only 2 years [ 11 ]. Acar et al reported that only 1 patient required reoperation out of 62 patients (reoperation rate: 2.5%) during 3.2 years of follow-up [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…We reported herein our series of anterior leaflet augmentation, while others apply this technique to the posterior leaflet as well [ 11 , 24 , 26–28 ]. Chauvaud et al adapted pericardial patch augmentation mainly in the posterior leaflet (75%) and reported acceptable outcomes of freedom from reoperation at 10 years of 70% [ 24 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Early and late results of mitral valve repair with anterior leaflet patch augmentation

Kehara

Minakata

McCarthy

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives To determine the long-term results of mitral valve (MV) repair with anterior leaflet patch augmentation. Patients and Methods Between 2012 and 2015, 45 patients underwent MV repair using the anterior leaflet patch augmentation technique at our institution. The mean age of the patients was 65.9 ± 13.0 years (16 males). We reviewed the MV pathology and the surgical techniques used, and assessed the early and late results. Results In terms of MV pathology, 43 patients (95.6%) had pure mitral regurgitation (MR), and 2 patients (4.4%) had mixed mitral stenosis (MS) and MR. Rheumatic changes were seen in 18 patients (40.0%). Postoperative echocardiography showed that 95.6% of patients had none to mild MR. During a median follow-up period of 5.5 years (range 0.1 ∼ 8.3 years), there were 8 late deaths. Nine patients (20%) required reoperation. The mean interval between the initial operation and redo operation was 3.7 ± 3.1 years (range: 0.4 ∼ 7.8 years). The causes of reoperation included patch dehiscence (n = 4), progression of MS (n = 2), band dehiscence (n = 1), patch enlargement (n = 1), and unknown (n = 1). Eight patients underwent MV replacement and 1 underwent repeat MV repair. The freedom from reoperation at 3 and 5 years was 85.7 ± 6.7% and 81.2 ± 7.7%, respectively. Conclusions Anterior leaflet patch augmentation can provide excellent early results in the majority of the patients even in the presence of rheumatic pathology, however, we observed late reoperation in 20% of patients. Thus, this technique should be used with caution and careful follow-up with serial echocardiography is essential.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early and late results of mitral valve repair with anterior leaflet patch augmentation

Kehara

Minakata

McCarthy

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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“…Long-standing atrial fibrillation is associated with significant functional MR and TR, which is in turn associated with a very poor prognosis despite preserved LVEF (8) (10,11). Additionally, Rahmani et al revealed that posterior leaflet PA significantly reduces the forces on the chordae tendinae from the posterior papillary muscle with good hemodynamics in vitro using a functional ischemic MR valve simulation (12).…”

Section: Discussionmentioning

confidence: 99%

“…PA repair provides good mitral valve leaflet coaptation, which leads to good control of MR. Recent studies have shown good early outcomes with low rates of recurrent MR and reoperation after PA for ischemic MR or rheumatic disease by deep leaflet coaptation ( 10 , 11 ). Additionally, Rahmani et al revealed that posterior leaflet PA significantly reduces the forces on the chordae tendinae from the posterior papillary muscle with good hemodynamics in vitro using a functional ischemic MR valve simulation ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation

Morisaki¹,

Fujii²,

Sakon³

et al. 2022

J Thorac Dis

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Background: Long-standing atrial fibrillation is associated with atrial functional mitral regurgitation (AFMR) with atriogenic tethering. We compared the outcomes of patch augmentation (PA) and valve replacement (VR) for AFMR. Methods:We retrospectively compared the data of 16 patients who underwent PA for AFMR with the data of 15 patients who underwent VR between 2008 and 2021. Patients with a left ventricular ejection fraction (LVEF) of <50% were excluded. We also performed atrial plication and left appendage closure if the patients had no weak atrial wall that led to severe bleeding. Results:The median age was 72.5 and 76.0 years in the PA and VR groups, respectively. The PA group had a longer cardiopulmonary bypass time (206 vs. 172 min, P=0.012). Although there were no differences in hospital morbidity and mortality between the PA and VR groups, one patient underwent reoperation for patch perforation in the PA group. The overall 3-year survival rate was 93.8% and 100% in the PA and VR groups, respectively (P=0.878). The 3-year rate of freedom from major adverse cardiac events was 75.0% and 53.6% in the PA and VR groups, respectively (P=0.181). Three and six patients were readmitted for congestive heart failure in the PA and VR groups, respectively. Two patients in the PA group developed severe recurrent regurgitation, including one patient who required reoperation. No patients in the VR group required reoperation. The postoperative left atrial volume index (LAVI) was associated with thromboembolic events (P=0.016).Conclusions: PA may achieve comparable outcomes to those of VR for AFMR. Operative procedures should be chosen based on each patient's background. Atrial reduction could be considered to prevent thromboembolic events.

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“…On 15 January 2013, the patient in case 2 underwent aortic valve replacement with a 25-mm bioprosthesis, mitral valve repair (plasty) (MVP) with anterior commissurotomy, anterior mitral leaflet thinning by peeling of the thickened intima [ 10 ], MAP with a 28-mm ring, TAP with a 30-mm band, the biatrial maze procedure, and RA plication. Cardiopulmonary bypass was established by ascending aortic cannulation and both SVC and IVC cannulation.…”

Section: Case Presentationmentioning

confidence: 99%

Coronary sinus atrial septal defects in adults over the past 20 years at new Tokyo hospital: case series

Sugimori

Nakatani

Ikegaya

et al. 2021

J Cardiothorac Surg

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Background An isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed. Case presentation The patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. Conclusions CS ASD (Kirklin and Barratt–Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.

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Midterm Results of Mitral Valve Repair With Pericardial Leaflet Augmentation: A Single-Center Experience

Cited by 6 publications

References 19 publications

Early and late results of mitral valve repair with anterior leaflet patch augmentation

Early and late results of mitral valve repair with anterior leaflet patch augmentation

Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation

Coronary sinus atrial septal defects in adults over the past 20 years at new Tokyo hospital: case series

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