Mitral Valve Repair in Degenerative Mitral Regurgitation: State of the Art

Bonis, Michele De; Alfieri, Ottavio; Dalrymple-Hay, Malcolm; Forno, Benedetto Del; Dulguerov, Filip; Dreyfus, Gilles

doi:10.1016/j.pcad.2017.10.006

Cited by 23 publications

(26 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We further studied a prospective cohort that was divided into a 3DP-guided group and a traditional image-guided group. The results showed that the rate of transfer from repair to replacement, along with surgery time, could be reduced with the aid of the 3DP dynamic model and CFD Although more than 95% of primary MR cases can be successfully repaired in expert centers, repair rates vary widely depending on the experience of the center and the surgeons (25). Our 3DP dynamic model and CFD, despite being derived from 3D-TEE and CTA image data, can offer unique information on hemodynamics, surgical outcomes, and possible postoperative complications that are not available from traditional image datasets.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic testing using three-dimensional printing and computational fluid dynamics preoperatively may provide more information in mitral repair than traditional image dataset

et al. 2021

View full text Add to dashboard Cite

Background: Mitral valve repair (MVR) has been considered superior to mitral replacement for degenerative MV disease and even rheumatic diseases. However, the repair rate varies widely depending on the medical center and the surgeons' experience. The aim of our study was to apply three-dimensional printing (3DP) and computational fluid dynamics (CFD) in surgical simulation to provide reference for surgical decision-making, especially for inexperienced surgeons.Methods: Our study included retrospective and prospective cohorts. We first enrolled the retrospective cohort of 35 patients who were prepared to have MVR, aiming at exploring the feasibility of surgical simulation using 3DP and CFD. Three-dimensional transesophageal echocardiography (3D-TEE) and computed tomography angiography (CTA) were performed for all patients, and imaging data were fused to construct a 3D digital model. Next, the model was used to make the 3DP dynamic model and for CFD analysis. Mitral repair was simulated in both the 3DP dynamic model and CFD to predict surgical outcomes (grade of regurgitation and vena contracta width) and possible complications (systolic anterior motion, left ventricular outflow tract obstruction). Second, a prospective cohort of 20 patients was studied with 10 patients placed in a 3DP-guided group and 10 in an image-guided group. Rate of transformation to mitral replacement, surgery time, surgical outcomes, and surgical complications were compared between groups.Results: Of the 35 patients retrospectively enrolled, 14 underwent MVR and 21 were transferred to mitral replacement. Surgical simulation for the 14 MVR patients showed high consistency with in vivo results.The result of surgical simulation for the 21 patients transferred to mitral replacement showed that 7 might have benefited from MVR. In the prospective cohort, the rate of transformation to mitral replacement and surgery time in the 3DP-guided group were significantly lower than those in the image-guided group.Conclusions: 3DP and CFD models based on image data can be used for in vitro surgical simulation. These emerging technologies are now changing traditional models of diagnosis and treatment, and the role of imaging data will no longer be limited to diagnosis but will contribute more to assisting surgeons in choosing treatment strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Hemodynamic testing using three-dimensional printing and computational fluid dynamics preoperatively may provide more information in mitral repair than traditional image dataset

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Til að styrkja lokuopið og auka líkur á að viðgerðin haldi til lengri tíma er saumaður hringur eða band úr gerviefni umhverfis lokuna. 12 Á sérhaefðum sjúkrahúsum erlendis er unnt að gera við lokuleka tengdan hrörnun í yfir 85-90% tilfella. 12 Að öðrum kosti er skipt um lokuna, annaðhvort með lífraenni gerviloku eða ólífraenni úr hertu kolefni.…”

Section: Langtímaárangur Viðgerða Vegna Hrörnunartengds Míturlokuleka á íSlandiunclassified

“…12 Á sérhaefðum sjúkrahúsum erlendis er unnt að gera við lokuleka tengdan hrörnun í yfir 85-90% tilfella. 12 Að öðrum kosti er skipt um lokuna, annaðhvort með lífraenni gerviloku eða ólífraenni úr hertu kolefni. 13 Árangur míturlokuviðgerða vegna hrörnunarleka er mjög góður og í erlendum rannsóknum lifa 98% sjúklinga aðgerðina af og rúmlega 80% eru á lífi 5 árum eftir aðgerð.…”

Section: Langtímaárangur Viðgerða Vegna Hrörnunartengds Míturlokuleka á íSlandiunclassified

“…13 Árangur míturlokuviðgerða vegna hrörnunarleka er mjög góður og í erlendum rannsóknum lifa 98% sjúklinga aðgerðina af og rúmlega 80% eru á lífi 5 árum eftir aðgerð. 12,14 Auk þess er tíðni enduraðgerða mjög lág 5 árum eftir aðgerð, eða 4%. 8,15 Víða erlendis eru míturlokuviðgerðir gerðar í auknum maeli með speglunartaekni (endoscopic mitral valve repair) eða með hjálp aðgerðarþjarka (robotic mitral valve repair) með sambaerilegum árangri og eftir hefðbundna viðgerð.…”

Section: Langtímaárangur Viðgerða Vegna Hrörnunartengds Míturlokuleka á íSlandiunclassified

See 1 more Smart Citation

Long term outcome of valve repair for degenerative mitral valve disease in Iceland

Steinthorsson

Johnsen

Sigurðsson

et al. 2021

LBL

View full text Add to dashboard Cite

OBJECTIVES: Degenerative mitral valve disease is the most common indication for mitral valve repair in the Western world. The aim of this study was to study the long term outcome of mitral valve repair for degenerative mitral valve regurgitation in Iceland. MATERIAL AND METHODS: A retrospective study of 101 consecutive mitral valve repair patients (average age 57.7 years, 80.2% male) operated in Iceland 2004-2018 for degenerative mitral valve regurgitation. Long term survival and MACCE (major adverse cardiac and cerebrovascular event) free survival was estimated using the Kaplan-Meier method and compared to age and gender matched reference population. Median follow-up time was 83 months. RESULTS: On average there were 6,7 (range 1-14) mitral valve repairs performed annually with 99% of the patients receiving ring annuloplasty. A total of 82 (82,2%) underwent resection of the posterior leaflet and 64.4% recieved Gore-Tex®-chordae. Major early complications occured in 28.7% of cases, most commonly perioperative myocardial infarction (11.9%) and reoperation for bleeding (8.9%). Mortality within 30 days was 2%, the median duration of intensive care unit stay was one day and the median hospital length of stay was 8 days. One patient needed reoperation later for recurrent mitral regurgitation. Five and ten year MACCE-free survival was 91.1% (95%-CI: 85.3-97.2) and 81.0 (95%-CI: 71.6-91.6), respectively. Five year survival was 93.5% (95-CI: 88.6-98.7) and 10 year survival 85.3% (95%-CI: 76.6-94.9), which was not different from an age and gender matched reference population (p=0.135, log-rank test). CONCLUSION: Outcomes of mitral valve repair due to degenerative mitral regurgitation is good in Iceland and results are comparable to larger institutions overseas. Long term prognosis is generally good although early postoperative complications often occur

show abstract

“…However, some elderly or high-risk surgical patients cannot tolerate surgical thoracotomy, which reduces the opportunities of these patients to receive effective treatments. [2] In the era of growing percutaneous treatments for valvular heart disease, the transapical NeoChord repair procedure was emerged to offer an alternative option to conventional surgeries for the treatment of high-risk surgical patients. [3] The procedure of NeoChord system could be performed on a beating heart under direct transoesophageal echocardiography (TEE) guidance and allows restoration of normal leaflet motion.…”

Section: Introductionmentioning

confidence: 99%

The first four cases of successful NeoChord procedure in mainland China

Wang¹,

Pu²,

Kong³

et al. 2019

World Journal of Emergency Medicine

View full text Add to dashboard Cite

BACKGROUND: Transapical off-pump NeoChord procedure is a novel minimally invasive surgical repair of degenerative mitral regurgitation (MR). Here, we report the first four cases of NeoChord procedure in patients with mitral valve prolapse in mainland China. METHODS: Four patients, aged 86, 84, 80 and 60 years, with severe MR due to posterior middle scallop prolapse (P2), underwent transapical off-pump artifi cial chordae implantation on April 9 and 10, 2019. The procedure was performed by left mini-thoracotomy under general anaesthesia and guided by 2D and 3D dimensional transoesophageal echocardiography (TEE). RESULTS: Mitral valve repair via NeoChord procedure was successfully performed with implantation of 3 artifi cial chordae in the fi rst patient and 3, 2, and 3 artifi cial chordae in the following patients, respectively. Intraoperative TEE and pre-discharge transthoracic echocardiography (TTE) showed only mild to moderate MR of these four patients and no postoperative complications were noted. There were no changes of TTE fi nding between one-month follow-up and pre-discharge. CONCLUSION: The successful NeoChord procedures in four Chinese indicate that the valve repair using the NeoChord system for Chinese population is feasible.

show abstract

Mitral Valve Repair in Degenerative Mitral Regurgitation: State of the Art

Cited by 23 publications

References 33 publications

Hemodynamic testing using three-dimensional printing and computational fluid dynamics preoperatively may provide more information in mitral repair than traditional image dataset

Hemodynamic testing using three-dimensional printing and computational fluid dynamics preoperatively may provide more information in mitral repair than traditional image dataset

Long term outcome of valve repair for degenerative mitral valve disease in Iceland

The first four cases of successful NeoChord procedure in mainland China

Contact Info

Product

Resources

About