Predictors of Mitral Valve Repair: Clinical and Surgeon Factors

Bolling, Steven F.; Li, Shuang; O’Brien, Sean M.; Brennan, J. Matthew; Prager, Richard L.; Gammie, James S.

doi:10.1016/j.athoracsur.2010.07.062

Cited by 286 publications

(196 citation statements)

References 29 publications

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“…Patients with a predictably complex repair should undergo surgery in experienced repair centres with high repair rates, low operative mortality and a record of durable results. 127,128 When repair is not feasible, mitral valve replacement with preservation of the subvalvular apparatus is favoured. Additional tricuspid valve repair should be performed as indicated in section 8.2 (see table of recommendations on indications for tricuspid valve surgery).…”

Section: Indications For Interventionmentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

602

925

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Section: Indications For Interventionmentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

602

925

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“…in MV repair 5 and it is possible that almost all degenerative MVs can be repaired safely with a nearly 100% repair rate at a high-volume reference center. 6, 7 Multisurgeon practices have also reported comparable outcomes and demonstrated that recurrent MR after MV repair is associated with late death.…”

mentioning

confidence: 99%

Effect of Recurrent Mitral Regurgitation After Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation

Kim

Lee

Joo

et al. 2018

Circ J

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Background: This study investigated the consequences of recurrent mitral regurgitation (MR) after mitral valve (MV) repair in patients with degenerative MR and risk factors for recurrence. Methods and Results:From January 1990 to December 2015, 792 patients underwent MV repair due to degenerative MR. Recurrent MR was defined as moderate-to-severe MR on follow-up echocardiography. Mean follow-up duration was 8.71±5.58 years. During the follow-up period, MR recurred in 133 (16.8%) patients, and the MR recurrence-free rate at 20 years was 77.5±2.0%. In the recurrence group, the degree of MR decreased in 8 (6.0%) patients and was aggravated in 46 (34.6%) patients. Recurrent MR was associated with increased mortality and adverse left ventricular (LV) remodeling. Independent risk factors for MR recurrence were MV repair performed before 2000, preoperative atrial fibrillation, high LV end-diastolic dimension (LVEDD), prolapse of the isolated anterior leaflet or multiple segments, and absence of ring annuloplasty. Predictors of MR progression were high LVEDD and repair without artificial chordae implantation.Conclusions: Recurrent MR after MV repair in patients with degenerative MR showed a tendency to progress and was associated with increased mortality and adverse LV remodeling. Early referral for MV repair before development of atrial fibrillation and LV enlargement may reduce the risk of MR recurrence. Moreover, artificial chordae implantation and ring annuloplasty may assure the long-term durability of MV repair.

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“…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, there is intense interest in the development of less invasive therapies for the treatment of MR. In this report, we describe the initial clinical experience with the safety and performance of a device designed to implant ePTFE artificial cords and to correct degenerative MR in the beating heart with echocardiographic image guidance.…”

mentioning

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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Predictors of Mitral Valve Repair: Clinical and Surgeon Factors

Cited by 286 publications

References 29 publications

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Effect of Recurrent Mitral Regurgitation After Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation

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

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