Mitral valve repair using edge-to-edge technique in various situations: real-world experiences

AbstractOBJECTIVESEdge-to-edge (E2E) mitral valve repair (MVP) is a versatile technique used in various situations for mitral regurgitation (MR). This technique has been regaining attention, given the increasing use of the MitraClip procedure. This real-world study evaluates the durability of the E2E technique in different settings.METHODSFrom January 2002 to May 2015, a total of 303 patients with at least moderate MR who underwent E2E MVP were identified. Patients undergoing isolated MVP (n = 133) and concomitant coronary artery bypass grafting or other valvular procedures (N = 170) were included. Cox proportional hazards modelling was used to evaluate the risk factors for cumulative survival, or MV event (i.e. MV reintervention or MR recurrence) while event-free survival—defined as time to composite outcome of either death or MV event—was determined using competing risk Kaplan–Meier analysis. Median follow-up duration was 6.9 (interquartile range 5.8) years.RESULTSThe most common MR aetiology was myxomatous (34%), followed by Barlow’s disease (27.7%), and ischaemic (21.5%). E2E MVP was performed for the following indications: persistent MR (51.5%), systolic anterior motion prophylaxis (22.1%), transaortic approach (17.5%) and systolic anterior motion treatment post-MVP (8.9%). Concomitant ring annuloplasty was performed in 224 patients (73.9%). Operative mortality was 3.6% and MV event rate was 18.5%. Significant predictors of decreased survival included age, renal insufficiency, peripheral vascular disease and ischaemic MR aetiology (all P < 0.050). No ring annuloplasty (HR 2.79; P < 0.001) was the only significant predictor of MV events. Estimated event-free survival for the overall cohort was 8.5 years, and shortest for functional (non-ischaemic; 6.6 years) and ischaemic aetiology (5.5 years).CONCLUSIONSE2E repair is a versatile MVP technique, which can be used in prevention and treatment of systolic anterior motion, transaortic approach or with concomitant techniques, with reasonable outcomes. Ischaemic aetiology and absence of ring annuloplasty were associated with worse cumulative survival and MV event rates, respectively, which raises some concern in light of the expanding indication for MitraClip system.

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Mitral valve repair for infective endocarditis: Kobe experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320947586 ◽

2020 ◽

Vol 28 (7) ◽

pp. 384-389

Author(s):

Yukikatsu Okada ◽

Takeo Nakai ◽

Takashi Muro ◽

Hisato Ito ◽

Yu Shomura

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival ◽

Autologous Pericardium ◽

Ring Annuloplasty ◽

Group A ◽

Group B

Objectives We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups ( p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B ( p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

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Acute response of right ventricular function following transcatheter mitral valve repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.1969 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Sugiura ◽

M.W Weber ◽

N.T Tabata ◽

S.Z Zimmer ◽

U.B Becher ◽

...

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Mitral Valve Repair ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival ◽

Transcatheter Mitral Valve Repair ◽

Increased Risk

Abstract Background Little is known about early right ventricular (RV) response to transcatheter mitral valve repair (TMVR) and its association with clinical outcomes. We assessed the early effect of TMVR on the RV function (RVF) and sought to investigated the prognostic impact of post-procedural RV dysfunction. Methods From January 2011 through April 2019, consecutive patients who underwent MitraClip for severe mitral regurgitation were analyzed. We excluded patients in which the evaluation of RVF were un available. RV dysfunction was defined by an RV fractional area change (RVFAC) <35% or tricuspid annular planar systolic excursion (TAPSE) <16 mm. A Cox proportional regression analysis was conducted to investigate the association of post-procedural RV dysfunction with adverse outcomes (all-cause mortality and rehospitalization due to heart failure [HF]). Results A total of 403 patients were analyzed.Overall, the mean age was 78 years old and 59% of patients were male. The median left-ventricular ejection fraction (LVEF) was 46.1% [IQR 33.1–59.4], RVFAC was 41.9% [IQR 32.9–49.5], and TAPSE was 17 mm [IQR 14–22]. While 68 patients showed an acute improvement of RVF (35% of patients with baseline RV dysfunction), 51 patients (25% of patients with baseline normal RVF) showed an acute worsening of RVF. In patients with baseline normal RVF, atrial fibrillation (OR 4.57, 95% CI 1.56–13.40, p=0.006, HF duration >18 months (OR 2.95, 95% CI 1.32–6.60, p=0.009), LVEF <50% (OR 3.09, 95% CI 1.32–7.25, p=0.009), and tricuspid regurgitation≥3+ (OR 5.62, 2.28–13.90, p<0.001)were associated with an increased risk of acute worsening of RVF. By contrast, in patients with baseline RV dysfunction, HF duration >18 months (OR 0.43, 95% CI 0.22–0.85, p=0.01) and larger RV volume (OR 0.98, 95% CI 0.97–0.99, p<0.001) were associated with less probability of acute RVF improvement. The event-free survival was significantly different according to the subgroup of variation of RVF (p=0.003). Furthermore, post-procedural RV dysfunction was associated with an increased risk of outcomes (adjusted-HR 2.38, 95% CI 1.28–4.43, p=0.006). Conclusion Both acute improvement and worsening of RVF can be observed after TMVR. Post-procedural RV dysfunction is an independent predictor of adverse outcomes. Event-free survival curve Funding Acknowledgement Type of funding source: None

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Mitral valve repair provides improved event-free survival in infective endocarditis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-862033 ◽

2005 ◽

Vol 53 (S 01) ◽

Author(s):

E Ruttmann ◽

G Pölzl ◽

C Legit ◽

O Chevtchik ◽

S Müller ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival

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Faculty Opinions recommendation of First in human transcatheter COMBO mitral valve repair with direct ring annuloplasty and neochord leaflet implantation to treat degenerative mitral regurgitation: feasibility of the simultaneous toolbox concept guided by 3D echo and computed tomography fusion imaging.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732058428.793564325 ◽

2019 ◽

Author(s):

Wendy Tsang

Keyword(s):

Computed Tomography ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Fusion Imaging ◽

Valve Repair ◽

Ring Annuloplasty ◽

3D Echo

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Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519841292 ◽

2019 ◽

Vol 14 (3) ◽

pp. 281-285 ◽

Cited By ~ 1

Author(s):

Burak Onan ◽

Ersin Kadirogullari ◽

Zeynep Kahraman ◽

Onur Sen

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Da Vinci Surgical System ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Valve Repair ◽

Septal Myectomy ◽

Mitral Repair

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

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