One Hundred Percent Reparability of Mitral Prolapse: Results of a Dynamic Nonresectional Technique

Lawrie, Gerald M.; Zoghbi, William A.; Little, Stephen H.; Shah, Dipan J.; Earle, Nan; Earle, Elizabeth A.

doi:10.1016/j.athoracsur.2020.09.090

Cited by 12 publications

(6 citation statements)

References 32 publications

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“…Initially, resection-based techniques were used but largely fell out of favor due to poor outcomes . Over subsequent years, chordal transposition and chordal shortening became more common but were also largely abandoned . Our data reflect that while these older techniques are at times still used, it is with decreasing frequency.…”

Section: Discussionmentioning

confidence: 75%

Trends in the Management of Anterior Mitral Leaflet Regurgitation

Khairallah,

Rahouma,

Gambardella

et al. 2024

JAMA Netw Open

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ImportanceThe overall prevalence of mitral valve replacement (MVR) or MV repair at the time of cardiac surgery in the setting of isolated anterior mitral leaflet degenerative pathologic status in the US population is unknown.ObjectiveTo investigate the prevalence of MVR and MV repair using the Society of Thoracic Surgeons’ Adult Cardiac Surgery Database.Design, Setting, and ParticipantsIn a cross-sectional study, all patients diagnosed with isolated anterior mitral leaflet degenerative regurgitation who underwent either surgical MVR or MV repair between July 1, 2011, and June 30, 2022, were identified. Linear regression analysis was used to assess trends over time.Main Outcomes and MeasuresAssessment of the trends in MV repair and MVR over time.ResultsA total of 16 259 patients (9624 [59.2%] men) were identified, and the median age was 68 (IQR, 58-74) years. A total of 7214 patients (44.4%) had MVR, and 9045 (55.6%) had MV repair. There was a declining trend of MV repair from 58.0% in 2011 to 51.6% in 2022 (P = .05). The MVR group was older (median [IQR] age, 70 [62-77] vs 67 [58-74] years; P &lt; .001) and had more comorbidities. A total of 85.1% of all patients underwent concomitant procedures. In 81.7% of MVR cases, no attempt at MV repair was made. The median (IQR) annual hospital volume was lower with MVR vs MV repair (2.50 [1.50-5.00] vs 4.00 [2.00-7.00]; P &lt; .001). Conventional surgical approaches were most common (91.5%) but with a declining trend (P &lt; .001). Minimally invasive approaches were used in 13.1% (robotic, 4.6%), and with an inclining trend from 5.0% in 2011 to 12.0% in 2022 (P &lt; .001). Annuloplasty was performed in 88.8% of MV repair cases. Its use as a sole mean of MV repair decreased from 48.0% in 2011 to 13.9% in 2022 (P &lt; .001). Repair maneuvers in addition to annuloplasty were neochordae (overall 40.1%, increasing from 22.5% in 2011 to 62.3% in 2022; P &lt; .001), leaflet resection (overall 10.2%, decreasing from 13.1% in 2011 to 7.9% in 2022, P = .002), edge-to-edge MV repair (overall 5.3%, decreasing from 6.9% in 2011 to 4.5% in 2022; P = 0.04), and chordal transfer (overall 2.4%, decreasing from 2.7% in 2011 to 0.7% in 2022; P = .004).Conclusions and RelevanceIn this cross-sectional study, MV repair was the preferred option for degenerative mitral valve disease but was only slightly more commonly performed than MVR for isolated anterior leaflet pathologic status. A large proportion of MVR was performed without an MV repair attempt, suggesting reluctance to repair this pathologic condition.

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Section: Discussionmentioning

confidence: 75%

Trends in the Management of Anterior Mitral Leaflet Regurgitation

Khairallah,

Rahouma,

Gambardella

et al. 2024

JAMA Netw Open

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“…[38][39][40] The respect approach consists of implanting polytetrafluoroethylene (PTFE) neochordae into the prolapsing segments (Figure 2b). Studies on chordal replacement (respect concept) show good long-term results with good survival, [31,35,40] low rates of MR recurrence, [11,[41][42][43] and mitral valve reoperations. [37,44,45] Since the respect approach in principle leaves more valve tissue, larger rings may be selected for annuloplasty.…”

Section: Evidence For Structural Mrmentioning

confidence: 99%

“…Respect 363/358 1.1/0.4 NA 99.6/100 88/89.3 Pfannmueller et al[ 46 ] 10 years 2021 Early mortality, freedom from late cardiac-related deaths freedom from reoperation Resect r.s . Respect 383/662 1.6/0.7 96/97 NA/NA 81/85.6 Lazam et al[ 31 ] 20 years 2017 Early mortality, long-term survival, freedom from recurrent MR, freedom from reoperation, freedom from valve related complications Respect 1709 1.3 95.9 88 46 Lawrie et al[ 99 ] 10 years 2011 Early mortality, freedom from recurrent MR, freedom from reoperation Respect 662 2.6 90.1 93.9 NA Shibata et al[ 41 ] 5 years 2015 Early mortality, long-term survival, freedom from recurrent MR, freedom from reoperation Respect 180 0.5 99.5 91.5 98.3 Axtell et al[ 42 ] 3 years 2020 Early mortality, late cardiac-related deaths freedom from recurrent MR, freedom from reoperation, reverse LV remodeling Respect 101 0 100 100 100 Lawrie et al[ 43 ] 10 years Early mortality, long-term survival, freedom from recurrent MR, freedom from reoperation …”

Section: Introductionmentioning

confidence: 99%

Surgical mitral valve repair technique considerations based on the available evidence

Can¹,

Kirov²,

Caldonazo³

et al. 2022

Turk Gogus Kalp Dama

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Mitral valve regurgitation is the second most common valve disease in the western world. Surgery is currently the best tool for generating a long-lasting elimination of mitral valve regurgitation. However, the mitral valve apparatus is a complex anatomical and functional structure, and repair results and durability show substantial heterogeneity. This is not only due to differences in the underlying mitral valve regurgitation pathophysiology but also due to differences in repair techniques. Repair philosophies differ substantially from one surgeon to the other, and consensus for the technically best repair strategy has not been reached yet. We had previously addressed this topic by suggesting that ring sizing is "voodoo". We now review the available evidence regarding the various repair techniques described for structural and functional mitral valve regurgitation. Herein, we illustrate that for structural mitral valve regurgitation, resuspension of prolapsing valve segments or torn chordae with polytetrafluoroethylene sutures and annuloplasty can generate the most durable results paired with the best achievable hemodynamics. For functional mitral valve regurgitation, the evidence suggests that annuloplasty alone is insufficient in most cases to generate durable results, and additional subvalvular strategies are associated with improved durability and possibly improved clinical outcomes. This review addresses current strategies but also implausibilities in mitral valve repair and informs the mitral valve surgeon about the current evidence. We believe that this information may help improve outcomes in mitral valve repair as the heterogeneity of mitral valve regurgitation pathophysiology does not allow a one-size-fits-all concept.

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“…Mitral valve (MV) repair serves as the treatment-of-choice for degenerative mitral regurgitation (MR) due to superior outcomes. [1][2][3][4][5] Repair techniques for the posterior mitral leaflet (PML) prolapse are straightforward and easily reproducible, with proven safety and longterm durability. 6,7 On the other hand, anterior mitral leaflet (AML) prolapse repair is technically more demanding with inferior long-term results, and by itself represents an independent risk factor for repair failure.…”

Section: Introductionmentioning

confidence: 99%

“…Mitral valve (MV) repair serves as the treatment‐of‐choice for degenerative mitral regurgitation (MR) due to superior outcomes 1–5 . Repair techniques for the posterior mitral leaflet (PML) prolapse are straightforward and easily reproducible, with proven safety and long‐term durability 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Clinical and echocardiographic predictors of the anterior mitral leaflet repair failure

Stojanović

Okiljević

Radojičić

et al. 2022

Journal of Cardiac Surgery

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Background Anterior mitral leaflet prolapse repair is a highly effective procedure, but despite excellent operative results still has an inferior long‐term durability when compared to posterior leaflet repair. Methods We analysed mitral repair durability in 74 consecutive patients operated for anterior leaflet prolapse between 2010 and 2021. Their pre‐ and postoperative clinical, echocardiographic data and repair durability as well, were compared with 74 randomly assigned posterior leaflet prolapse patients who underwent valve repair during the same period. Results While groups were of similar age, patients with anterior leaflet prolapse had an inferior preoperative status in terms of functional reserve, atrial fibrillation, operative risk, ejection fraction and had more dilated left heart chambers as well. 1, 5, and 10‐year freedom from repair failure was 87.1 ± 4.6%, 79.8 ± 6.5% and 50.7 ± 12.5% in the anterior, and 98.5 ± 1.5% respectively in the posterior leaflet group. Atrial fibrilation (hazard ratio [HR] 5.365; 95%; confidence interval [CI] 1.093–26.324 p = .038) and left ventricle end‐systolic diameter (HR 1.160 95%; CI 1.037–1.299 p = .010) independently predicted anterior leaflet repair failure. Receiver Operating Curve analysis established left ventricle end‐systolic diameter ≤42 mm as a cut‐off value associated with improved anterior leaflet repair durability. Accordingly, 10‐year repair durability in a subset of patients, with preserved left ventricle end‐systolic diameter (≤42 mm) was 86.4 ± 7.8%. Conclusion Better long‐term repair durability in patients with anterior mitral leaflet prolapse and preserved sinus rhytm and left‐ventricle diameters justifies early reconstructive approach.

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One Hundred Percent Reparability of Mitral Prolapse: Results of a Dynamic Nonresectional Technique

Cited by 12 publications

References 32 publications

Trends in the Management of Anterior Mitral Leaflet Regurgitation

Trends in the Management of Anterior Mitral Leaflet Regurgitation

Surgical mitral valve repair technique considerations based on the available evidence

Clinical and echocardiographic predictors of the anterior mitral leaflet repair failure

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