Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement

Sharma, Abhishek; Agrawal, Sahil; Goel, Sunny; Borer, Jeffrey S.

doi:10.1007/s11886-017-0813-6

Cited by 10 publications

(7 citation statements)

References 71 publications

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“…FMR is often treated with an annuloplasty ring that is one or two sizes smaller than the actual MA to ensure sufficient leaflet coaptation [ 23 ]. For this patient, using the actual size determined by the MA dimensions (Classic ring size 38), the simulation demonstrated improved leaflet coaptation but with a residual lateral regurgitant orifice.…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis of annuloplasty and papillary muscle relocation on a patient-specific mitral regurgitation model

et al. 2018

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ObjectivesFunctional mitral regurgitation (FMR) is a significant complication of left ventricle (LV) dysfunction associated with poor prognosis and commonly treated by undersized ring annuloplasty. This study aimed to quantitatively simulate the treatment outcomes and mitral valve (MV) biomechanics following ring annulopalsty and papillary muscle relocation (PMR) procedures for a FMR patient.MethodsWe utilized a validated finite element model of the left heart for a patient with severe FMR and LV dilation from our previous study and simulated virtual ring annuloplasty procedures with various sizes of Edwards Classic and GeoForm annuloplasty rings. The model included detailed geometries of the left ventricle, mitral valve, and chordae tendineae, and incorporated age- and gender- matched nonlinear, anisotropic hyperelastic tissue material properties, and simulated chordal tethering at diastole due to LV dilation.ResultsRing annuloplasty with either the Classic or GeoForm ring improved leaflet coaptation and increased the total leaflet closing force while increased posterior mitral leaflet (PML) stresses and strains. Classic rings resulted in larger coaptation forces and areas compared to GeoForm rings. The PMR procedure further improved the leaflet coaptation, decreased the PML stress and strain for both ring shapes and all sizes in this patient model.ConclusionsThis study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into annuloplasty repair techniques for the treatment of FMR patients and could potentially serve as a tool to assist in pre-operative planning for MV repair surgical or interventional procedures.

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Section: Discussionmentioning

confidence: 99%

Finite element analysis of annuloplasty and papillary muscle relocation on a patient-specific mitral regurgitation model

et al. 2018

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“…changed the relocation direction towards the anterior annulus 32,33) and 35,36) . The randomized CSTN trial found that mid-term survival and LV reverse remodeling did not significantly differ between restrictive annuloplasty repair and chordal-sparing valve replacement in patients with severely ischemic MR, but the incidence of recurrent MR and heart failure complications was greater after repair 37) .…”

Section: Moderate Mitral Regurgitation At Coronary Artery Bypass mentioning

confidence: 99%

Ischemic Mitral Regurgitation

Takemura

2019

Journal of Coronary Artery Disease

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“…However, catheter based bailout options in this patient‐cohort require sophisticated imaging diagnostics and high level operator experience and moreover these modalities are not yet clearly defined and standardized. Besides, best surgical approach for functional MR, in particular ischemic MR, remains controversial and is in general associated with both significant mortality and questionable long‐term durability and benefit 14,15 . Even with optimal MC and cardiac electronic devices therapy, results are not always as expected, and thus surgery becomes inevitable despite highest risk constellation.…”

Section: Introductionmentioning

confidence: 99%

“…Besides, best surgical approach for functional MR, in particular ischemic MR, remains controversial and is in general associated with both significant mortality and questionable long-term durability and benefit. 14,15 Even with optimal MC and cardiac electronic devices therapy, results are not always as expected, and thus surgery becomes inevitable despite highest risk constellation. This, therefore, calls for further exploration and refinement of existing predictors of device failure and patient selection criteria for the MC therapy.…”

Section: Introductionmentioning

confidence: 99%

Surgical revision after percutaneous mitral valve repair by edge‐to‐edge device in high‐risk patients

et al. 2020

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Background: Patients scheduled for surgery after unsuccessful MitraClip® intervention present increasingly with multiple comorbidities, and they are often referred to the heart team to suggest the most appropriate intervention. The publication of successful results of initial patient cohorts treated with the MitraClip device has resulted in recruitment of more seriously ill patients, who otherwise would have been denied catheter-based/surgical treatment. There has been increasingly reports on conventional surgery after failed mitral valve repair with the MitraClip device. However, data on such procedures remain scarce and mostly focused on individual case studies. The inevitable increase in use of MitraClip, however, will raise the number of patients in need of surgery post MitraClip, making it imperative for surgeons to understand challenges and outcome data related with surgery in this patient cohort. We present our long-term institutional experience with surgery after MitraClip intervention in highest risk patients. Methods: Eighteen patients underwent surgery of the mitral valve at our Institution between January 2015 and June 2020. These patients developed recurrent mitral regurgitation grade more than 2°at various intervals after MitraClip. Mitral valve repair was performed where possible and gross examination Valve/MitraClip were intra-operatively documented. Implanted MitraClip devices were analyzed histopathologically to evaluate the healing process and rule out inflammation. Regular patient follow-up was performed. Results: Mean patient age was 74 (±9 years) and MitraClip implantation was performed at various tertiary institutions. Sixteen out of eighteen (16/18) patients received mitral valve replacement, whereas the remaining two patients received mitral valve repair and extracorporal membrane oxygenation, respectively. Four patients died of sepsis and intractable multi organ failure in-hospital. The remaining patients were discharged alive out of hospital to different rehabilitation centers. Follow-up was complete in all patients.

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Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement

Cited by 10 publications

References 71 publications

Finite element analysis of annuloplasty and papillary muscle relocation on a patient-specific mitral regurgitation model

Finite element analysis of annuloplasty and papillary muscle relocation on a patient-specific mitral regurgitation model

Ischemic Mitral Regurgitation

Surgical revision after percutaneous mitral valve repair by edge‐to‐edge device in high‐risk patients

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