Very Long-Term Results (More Than 20 Years) of Valve Repair With Carpentier’s Techniques in Nonrheumatic Mitral Valve Insufficiency

Braunberger, E.; Deloche, A; Berrébi, Alain; Fayssoil, A.; Celestin, J.A; Meimoun, P.; Chatellier, G.; Chauvaud, Sylvain; Fabiani, Jean‐Noël; Carpentier, A

doi:10.1161/01.cir.104.suppl_1.i-8

Cited by 387 publications

(128 citation statements)

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“…A variety of surgical techniques used for the repair of mitral valves have already been described in the relevant literature. 14) At the time of completion of the surgical procedures, mitral competence was evaluated by cold saline bulb syringe injection. In addition, perioperative transesophageal echocardiography was undertaken in all patients for the purposes of the assessment of the effectiveness of valve repair or replacement, subsequent to weaning from cardiopulmonary bypass support.…”

Section: Methodsmentioning

confidence: 99%

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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SUMMARYMitral repair is feasible for patients with degenerative or ischemic heart disease, however, the appropriateness of repair for rheumatic heart disease remains controversial. We compared our outcomes for primary isolated mitral repair versus replacement in an elderly population. From November 1997 to July 2005, mitral repair (group I) was performed in 33 patients while 59 underwent replacement (group II). Survival and risk factors were evaluated by Kaplan-Meier and Cox regression analysis. Mean age at operation for groups I and II was 49.7 ± 13.2 versus 58.1 ± 11.2 (P = 0.002). No statistically significant differences with regards to demographic parameters were observed except for there being fewer percutaneous transvenous mitral commissurotomy procedures and a lower severity of pulmonary hypertension in group I. Patients with a greater Wilkins score and more valvular calcification underwent replacement more often (P < 0.001). In-hospital mortality, ICU/hospital stay, and postoperative congestive heart failure functional class did not differ significantly. Major adverse cardiac events occurred in 13 and 19 patients, respectively (P = 0.50). There were 4 versus 6 late deaths (P = 0.74). Only two from group I underwent subsequent mitral reoperation. Kaplan-Meier overall survival and event-free survival at 5 years for groups I and II were 0.81 ± 0.08 versus 0.81 ± 0.06 (P = 0.90) and 0.52 ± 0.10 versus 0.51 ± 0.10 (P = 0.21), respectively. Old age, renal insufficiency, LVEF < 40%, and a history of stroke were poor predictors of patient survival. Compared with replacement, mitral repair for rheumatic heart disease was associated with a lower surgical mortality, higher repeat-surgery rate, and good survival. Rheumatic mitral valves should be repaired in select patients with appropriate valvular pathology. (Int Heart J 2008; 49: 565-576)

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Section: Methodsmentioning

confidence: 99%

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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“…Recent long-term studies have indicated that the recurrence of significant mitral regurgitation after surgical repair may be much higher than previously believed, particularly in patients with ischemic mitral regurgitation (57-59). Surgery-induced excessive tissue stress and the resulting tissue failure have been viewed as potential etiological factors (57). These repair-induced stress alterations lead to changes in MVIC metabolism and collagen biosynthesis, and are essential in understanding the biomechanical responses at the organ, tissue, and cellular levels.…”

Section: Relation To Cellular Deformation and Strain-induced Tissue Fmentioning

confidence: 99%

On the Presence of Affine Fibril and Fiber Kinematics in the Mitral Valve Anterior Leaflet

Lee

Zhang

Liao

et al. 2015

Biophysical Journal

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In this study, we evaluated the hypothesis that the constituent fibers follow an affine deformation kinematic model for planar collagenous tissues. Results from two experimental datasets were utilized, taken at two scales (nanometer and micrometer), using mitral valve anterior leaflet (MVAL) tissues as the representative tissue. We simulated MVAL collagen fiber network as an ensemble of undulated fibers under a generalized two-dimensional deformation state, by representing the collagen fibrils based on a planar sinusoidally shaped geometric model. The proposed approach accounted for collagen fibril amplitude, crimp period, and rotation with applied macroscopic tissue-level deformation. When compared to the small angle x-ray scattering measurements, the model fit the data well, with an r 2 ¼ 0.976. This important finding suggests that, at the homogenized tissue-level scale of~1 mm, the collagen fiber network in the MVAL deforms according to an affine kinematics model. Moreover, with respect to understanding its function, affine kinematics suggests that the constituent fibers are largely noninteracting and deform in accordance with the bulk tissue. It also suggests that the collagen fibrils are tightly bounded and deform as a single fiber-level unit. This greatly simplifies the modeling efforts at the tissue and organ levels, because affine kinematics allows a straightforward connection between the macroscopic and local fiber strains. It also suggests that the collagen and elastin fiber networks act independently of each other, with the collagen and elastin forming long fiber networks that allow for free rotations. Such freedom of rotation can greatly facilitate the observed high degree of mechanical anisotropy in the MVAL and other heart valves, which is essential to heart valve function. These apparently novel findings support modeling efforts directed toward improving our fundamental understanding of tissue biomechanics in healthy and diseased conditions.

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“…Up to 2011, we repaired degenerative MVs with leaflet resection; after that, we switched to artificial chordae implantation as a routine technique. The most simple and common MV lesion, the prolapse of the posterior leaflet, can be treated with leaflet resection with excellent short-term and long-term results (19) . However, the correction of anterior, bileaflet prolapse, or even large areas of posterior prolapse is more complex (20,21) .…”

Section: Discussionmentioning

confidence: 99%

Repair of Complex Mitral Valve Pathologies: Is It Worth to Cope With?

Salihi¹,

Kızıltan²,

Korkmaz³

et al. 2018

Kosuyolu Heart Journal

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Introduction: Mitral valve (MV) repair is preferred over replacement for its benefits of preservation of ventricular function, lower operative mortality, superior long-term survival, and avoidance of anticoagulation. In this study, we aimed to review the repair techniques of complex MV pathologies and their outcomes. Patients and Methods:We retrospectively analyzed 56 patients (mean age 41.8 ± 16.5 years; 33 males) who underwent repair of complex MV pathologies. 44 patients had pure mitral regurgitation (MR), and 12 (21.4%) had mixed mitral disease (mitral stenosis (MS) + MR). Preoperative and operative characteristics, postoperative MR severity, operative mortality, and midterm survival were examined for each patient.Results: There was only one early death (30-day mortality: 1.8%) due to postoperative low cardiac output syndrome. The procedures were successful in all patients who underwent MV repair. Transthoracic echocardiography examinations revealed no/trivial MR in 74.6% and mild MR in 21.8% of patients at discharge. Late follow-up was obtained in 55 patients. The mean follow-up period of patients was 47.9 ± 23.1 months. Mortality developed in one (1.8%) patient with Marfan syndrome who had acute aortic dissection three years after MV surgery. During follow-up visits, mitral repair procedures were successful in 49 (90.7%) patients. Four (7.4%) patients presented with moderate MR. Only one (1.9%) patient needed reoperation because of severe MR. Conclusion:This study showed that repair of complex MV pathologies provides excellent surgical outcomes. Repair of complex MV pathologies is safe and highly effective, but operations require considerable surgical experience.Key Words: Mitral valve repair; mitral regurgitation; mitral stenosis Kompleks Mitral Kapak Patolojilerin Onarımı; Uğraşmaya Değer mi? ÖZET Giriş: Ventrikül fonksiyonun korunması, daha az cerrahi mortaliteye sahip olması, üstün uzun dönem survey ve antikoagülan kullanımının önlenmesi gibi üstünlükleri nedeniyle mitral kapak onarımı replasmana daha çok tercih edilmektedir. Bu çalışmanın amacı, kompleks mitral kapak patolojilerin onarım teknikleri ve sonuçları sunmaktır. Hastalar ve Yöntem:Retrospektif olarak kompleks mitral kapak patolojilerin onarımı geçiren 56 hasta incelendi (ortalama yaş 41.8 ± 16.5 yıl; 33 erkek). Kırk dört hastada saf mitral yetmezliği varken, 12 (%21.4) hastada miks mitral kapak hastalığı (mitral darlığı + mitral yetmezliği) vardı. Preoperatif ve operatif özellikleri, postoperatif mitral yetmezliği derecesi, cerrahi mortalite ve orta dönem sonuçları her hasta için araştırıldı. Bulgular:Postoperatif düşük kardiyak debi sendromuna bağlı bir hastada erken mortalite (30 gün mortalite: %1.8) görüldü. Mitral kapak onarımı ameliyatı olan bütün hastalarda mitral onarım prosedürleri başarılı olmuştur. Hastalar taburcu olduğunda yapılan ekokardiyografik değerlendirmede %74.6'sında hiç/eser yetersizlik ve %21.8'inde hafif yetersizlik saptandı. 55 hastada geç dönem takibi yapıldı. Hastalarımızın ortalama takip süresi 47.9 ± 23.1 ...

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Very Long-Term Results (More Than 20 Years) of Valve Repair With Carpentier’s Techniques in Nonrheumatic Mitral Valve Insufficiency

Cited by 387 publications

References 0 publications

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

On the Presence of Affine Fibril and Fiber Kinematics in the Mitral Valve Anterior Leaflet

Repair of Complex Mitral Valve Pathologies: Is It Worth to Cope With?

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