Recurrence of mitral valve regurgitation after mitral valve repair in degenerative valve disease

WillemFlameng,; PaulHerijgers,; KrisBogaerts,

doi:10.1016/s1062-1458(03)00323-4

Cited by 15 publications

(23 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Particularly when a prosthetic ring is used, a concomitant annuloplasty, besides remodeling the annulus and forcing leaflet coaptation, stabilizes the repair over time preventing annular redilatation and reducing the risk of late failure. The benefits of annuloplasty in valve repair have been confirmed by several authors [1][2][3][4] who found that the absence of annuloplasty was one of the most important risk factor for late failure of the repair. As far as the EE technique is concerned, in patients with degenerative MR, the long-term results of this procedure are excellent whenever an annuloplasty is concomitantly used.…”

Section: Discussionmentioning

confidence: 83%

“…Particularly when a prosthetic ring is used, repair durability is enhanced by increased leaflet coaptation and prevention of further dilatation of the mitral annulus. [1][2][3][4] After the introduction of the MitraClip system, however, MR has been treated in many patients by applying a percutaneous ringless edge-to-edge (EE) procedure. Defining the long-term results of the surgical EE repair performed without annuloplasty may help to foresee, at least partially, the possible late results of this percutaneous technique.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

et al. 2014

View full text Add to dashboard Cite

Preoperative, intraoperative, and postoperative data were collected through a hospital database and patients' records. Follow-up data were Background-To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR). Methods and Results-From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2±4.21 years; median, 9.7; longest, 18.1). ResultsThe preoperative data of the final study population are reported in Table 1. At admission, 24 (39%) patients were in New York Heart Association (NYHA) class I or II, whereas 37 (61%) patients were in class III. Fifteen patients (24%) were in atrial fibrillation.Mitral regurgitation degree was determined by means of a combination of color Doppler (color flow jet area and vena contracta width) and pulmonary vein flow analysis and classified as mild (1+/4+), moderate (2+/4+), moderate to severe (3+/4+), and severe (4+/4+). Mitral regurgitation was severe (4+/4+) in 34 patients (34/61; 55.7%) and moderate to severe (3+/4+) in the remaining 27 patients (27/61; 44.2%).Transesophageal echocardiography showed that the mechanism of MR was bileaflet prolapse in 28 patients (46%), anterior leaflet prolapse in 11 patients (18%), and a prolapse of the posterior leaflet in 22 patients (36%). Important annular calcification was found in 36 patients (59%). Surgical ProcedureThe MV was approached through a median sternotomy and a standard left atrial incision in all cases. According to the location of the main regurgitant jet, a double-orifice repair was performed in 53 (86.8%) patients and a commissural EE repair in the remaining 8 (13.1%). The paracommissural repair was posteriorly located in 6 patients and anteriorly located in 2 patients. A 4-0 polypropylene continuous suture without pledgets was used in most cases for leaflet approximation, unless the leaflets were thin. In these cases, a 5-0 suture was preferred.In case of annular calcification, the rationale for adopting the EE technique was to correct leaflet lesions with no annular manipulation. Indeed, the main reason for annuloplasty omission was the presence of significantly/severely calcified annulus which was present in 36 patients (36/61; 59%). In the remaining 25 patients (41%), the EE was intentionally performed without a concomitant annuloplasty because the annulus was judged by the surgeon not to be significantly dilated. By avoiding annuloplasty in those cases, also the risk of inducing postoperative mitral stenosis was minimized. Several associated procedures were performed concomitantly with valve repair, including coronary artery revascularization (9 patients), tricuspid annuloplasty (7 patients), ...

show abstract

Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In our clinical practice, we perform mitral repair in each individual coronary case presenting with severe (3-4) MR. As an accepted guideline recommendation, general practice should be to correct severe MR during coronary artery bypass graft surgery; however, MR recurrence may occur despite successful revascularization and mitral repair (24). Ischemic MR carries a definite risk for higher mortality in the presence of poor ventricular function (7). This can be associated with ongoing ischemic myocardial dysfunction that leads to progressive annular dilatation and lateral displacement of subvalvular structures.…”

Section: Discussionmentioning

confidence: 99%

“…These procedures are feasible in almost 95% of patients with degenerative MR despite the presence of complex lesions (3). The operative mortality and morbidity for isolated mitral valve repair is low, and early failures are uncommon in experienced hands (4)(5)(6)(7). While the repair for the prolapse of the posterior leaflet with valvular resection is usually possible, correction of anterior or bileaflet prolapse may also be feasible with more complex repair procedures.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Korkmaz

Onan²,

Demir³

et al. 2011

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

ÖZETAmaç: Mitral kapak tamiri günümüz kalp cerrahisinde mitral yetmezliğin her tipinde ilk seçenek olarak akla gelmelidir. Çalışmamızda ciddi mitral yetersizlik nedeniyle uygulanan mitral kapak tamirlerinin klinik sonuçlarını değerlendirdik. Yöntemler: Bu prospektif kohort çalışmada mitral kapak tamiri planlanan 103 hastamızın (61 erkek, 42 kadın) ortalama yaşı 53.2±14.8 idi. Mitral kapak patolojisi hastaların %86'sında yetmezlik ve %14'ünde karışık tipti. Yüz (%97.1) hastada tamir girişimi başarılı idi. Ek cerrahi girişim 57 (%57) hastada yapıldı, bunların 31'i koroner arter baypas ve 13'ü triküspit kapak tamiri şeklindeydi. Ameliyat sonrası erken (<30 gün) ve geç (>30 gün) dönem komplikasyonlar araştırıldı. Tüm hastalara taburcu olduklarında ve klinik takip sırasında ekokardiyografi yapıldı. Geç hayatta kalım ve tromboembolizm, endokardit, reoperasyon ve rezidüel ciddi mitral yetersizlikten gibi istenmeyen olaylardan bağımsız olma oranları Kaplan-Meier sağkalım analizi ile değerlendirildi. Bulgular: Erken mortalite görülmedi. Hastalar taburcu olduğunda yapılan ekokardiyografik değerlendirmede %89'unda hiç/eser yetersizlik ve %11'inde hafif (+1) yetersizlik saptandı. Geç mortalite 14. ayda renal yetersizlik nedeniyle sadece 1 hastada gözlendi. Hastalarımızın ortalama takip süresi 21.2±10.3 aydı. Takipler sırasında yapılan ekokardiyografik değerlendirmede hastaların %96'sında hiç ya da hafif yetersizlik gözlendi. Orta (+2) ABSTRACTObjective: Mitral valve repair has become the procedure of choice for almost every type of mitral regurgitation (MR) in the current surgical era. We assessed clinical outcomes of mitral valve repair in severe MR. Methods: In this prospective cohort study, 103 patients (61 male, 42 female, mean age 53.2±14.8 years), who were planned to undergo valve repair were included. Mitral valve pathology was regurgitant in 86% and mixed in 14% of patients. The intention to perform mitral repair was successful in 100 (97.1%) of patients. Concomitant procedures were performed in 57 (57%) patients including 31 coronary artery bypass grafting and 13 tricuspid valve repairs. After surgery, early (<30 days) and late (>30 days) complications were recorded. Postoperative echocardiography was performed in all patients at discharge and during clinical follow-up. Late survival and freedom from adverse events including thromboembolism, endocarditis, reoperation, and residual severe MR were estimated by using the Kaplan-Meier survival analysis.Results: There was no early mortality. Echocardiographic assessment of patients at discharge revealed no/trivial regurgitation in 89% and mild (1+) MR in 11% of all patients. Late mortality occurred in only one patient at 14 months because of renal failure. The mean follow-up period of patients was 21.2±10.3 months. Echocardiographic examination during follow-up revealed that mitral insufficiency was none or mild in 96% of patients. Three (3%) patients had moderate (2+) MR and were treated medically. Mitral insufficiency recurrence with severe (3+) regurgitation occurred...

show abstract

“…Werden die unbekannten Todesursachen hälftig den kardio-vaskulären und nicht den kardialen zugeordnet, so steigt das Risiko nach MKR an einer kardio-vaskulären Ursache zu sterben auf knapp 50%. Dieser Wert liegt etwas über demjenigen von 40%, den das Bundesamt für Statistik für die Gesamtbevöl-kerung während der letzten 10 Jahre beobachtet hat [6] [14][15][16][17].…”

Section: Abbildungunclassified

Chirurgie der degenerativen Mitralinsuffizienz auch beim asymptomatischen Patienten?

2007

Schweiz Ärzteztg

View full text Add to dashboard Cite

SummaryIt is well known that the natural course of moderate to severe mitral regurgitation in asymptomatic patients is not entirely benign. The purpose of this study was to investigate whether an operation at an early stage before worsening of functional class and left ventricular function or atrial fibrillation occur might improve long term prognosis.From 1987 to 2006 a consecutive series of 688 patients underwent surgery for degenerative mitral regurgitation and was followed retrospectively for risk factors like age, type of operation (reconstruction vs replacement), thrombo-embolism and bleeding episodes, reoperation for residual or recurrent regurgitation, NYHA class, left ventricular function and cardiac rhythm.Long-term survival was better and complications were fewer if the valve could be repaired rather than replaced. A preoperative lower functional class, better left ventricular function and sinus rhythm were significantly associated with improved survival and lower rates of atrial fibrillation late postoperatively. The analysis, however, is complicated by a slightly older age of patients with these risk factors. Conclusion: Surgery for degenerative, moderate to severe mitral regurgitation should be recommended before symptoms arise, cardiac function deteriorates or atrial fibrillation occurs, particularly if the valve can be repaired.

show abstract

Recurrence of mitral valve regurgitation after mitral valve repair in degenerative valve disease

Cited by 15 publications

References 15 publications

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Chirurgie der degenerativen Mitralinsuffizienz auch beim asymptomatischen Patienten?

Contact Info

Product

Resources

About