Replacement of A2 and A3 by Pericardium Due to Endocarditis of the Anterior Leaflet of the Mitral Valve

Araji, Omar; Barquero, José M.; Almendro, Manuel; Gutiérrez, M.aA.; García-Borbolla, Mariano; Velázquez, Carlos; Infantes, Carlos

doi:10.1016/j.athoracsur.2008.05.078

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…Some authors have reported extensive reconstruction of the mitral valve leaflets and chordae using autologous or bovine pericardium with or without chordal reconstruction for such devastating cases. These reports described only the short- or mid-term results; the long-term outcomes remain unclear because the durability of the pericardial leaflet is still controversial [ 2 – 5 ]. Furthermore, these reports included repair for chronic endocarditis, whereas repair for active endocarditis may be more challenging.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Handa

Masai

Ohata

et al. 2022

J Cardiothorac Surg

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Objective Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods Five patients (54 (38–60) years of age; 3 men, 2 women) underwent this procedure from January 2011 to April 2022. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 69 (66–75)). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 36 (28–42) days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The median follow-up period was 9.6 (6.0–10.4) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions The short- and long-term outcomes of this procedure might be acceptable. This procedure might be considered as an effective and valuable option, especially in young patients.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Handa

Masai

Ohata

et al. 2022

J Cardiothorac Surg

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“…Some authors have reported extensive reconstruction of the mitral valve lea ets and chordae using autologous or bovine pericardium with or without chordal reconstruction for such devastating cases. These reports described only the short-or mid-term results; the long-term outcomes remain unclear because the durability of the pericardial lea et is still controversial [2][3][4][5]. Furthermore, these reports included repair for chronic endocarditis, whereas repair for active endocarditis may be more challenging.…”

Section: Discussionmentioning

confidence: 99%

Long-term Outcome of Extensive Mitral Valve Reconstruction With Autologous Pericardium and Artificial Chordae for Treatment of Destructive Active Infective Endocarditis of the Mitral Valve

Handa

Masai

Ohata

et al. 2021

Preprint

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Objective: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods: Five patients (50 ± 30 years of age; 3 men, 2 women) underwent this procedure from January 2011 to December 2020. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 70% ± 5%). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC.Results: The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 35 ± 5 days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The mean follow-up period was 7.2 (range, 1.3–9.5) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions: The short- and long-term outcomes of this procedure were satisfactory. This procedure might be considered as an effective and valuable option, especially in young patients.

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“…In previous studies, if vegetation is localized in one scallop MV repair is generally recommended and performed, however, cases with debridement of more than half of the PML or with destruction of more than one segment of the AML remained controversial [9]. Aggressive surgical techniques for the reconstruction of large leaflet defects using patch reconstruction, the sliding technique, and artificial chordae are available [10][11][12], but concerns have been raised about the durability of complex MV repair, particularly during the active-stage of IE. An aggressive approach to repair may render the recurrence of MR a long-term problem.…”

Section: Discussionmentioning

confidence: 99%

Severity Score for Mitral Valve Repair in Active Infective Endocarditis

Omoto¹

2017

AJCTS

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Objectives: Whether to perform mitral valve (MV) repair is often difficult during infective endocarditis (IE), especially in patients with extensive leaflet destruction. The aim of this study was to develop scoring system to predict feasibility of mitral valve (MV) repair and select appropriate surgical candidates for repair during active IE. Methods:Patients who underwent MV repair for active IE were retrospectively divided into two groups during average follow-up period of 81 months: if MV repair was performed without significant recurrence of MR, MV repair was defined as feasible (n=18), and MV repair was defined as non-feasible (n=7) when MV repair resulted in more than moderate MR postoperatively or required redo surgery. Extensiveness of the valvular destruction was assessed by valvular score (VS), and complexity of valve repair was assessed by technical score (TS). Severity score was defined as the sum of VS and TS. Patients with feasible and non-feasible MV repair were compared in severity score, and association between probability of feasible MV repair and severity score was evaluated.Results: Severity score was lower in feasible MV repair than nonfeasible MV repair (5.4±2.2 points vs. 10.7±1.8, respectively, Mann Whiteney U test: p < 0.001). The receiver operating characteristic curve revealed a cut-off value of 8 points as having the best balance of specificity and sensitivity for predicting feasible MV repair. Probability of feasible MV repair was 100% (14/14) in severity score ≤ 7 points, 67% (4/6) in severity score =8 points, and 0% (0/5) in severity score ≥ 9points. Conclusions:Feasibility of MV repair during active IE was associated not only with extensiveness of leaflet destruction but also with surgical technique which would be taken. Probability of feasible MV repair can be categorized into high, moderate, and low probability according to severity score as ≤ 7 points, 8 points and ≥ 9points.

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Replacement of A2 and A3 by Pericardium Due to Endocarditis of the Anterior Leaflet of the Mitral Valve

Cited by 7 publications

References 5 publications

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Long-term Outcome of Extensive Mitral Valve Reconstruction With Autologous Pericardium and Artificial Chordae for Treatment of Destructive Active Infective Endocarditis of the Mitral Valve

Severity Score for Mitral Valve Repair in Active Infective Endocarditis

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