Mitral Valve Surgery

2019 ◽  
pp. 30-40
Author(s):  
Sohail K. Mahboobi
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Disease Process ◽  
Mitral Annulus ◽  
Developed Countries ◽  
Pathological Process ◽  
Mitral Valve Surgery ◽  
Functional Mitral Regurgitation ◽  
Chordae Tendineae ◽  
Mitral Disease

The mitral valve consists of the mitral annulus, anterior and posterior mitral leaflets, anterolateral and posteromedial papillary muscles attached to mitral leaflets with chordae tendineae, and the left ventricle. Any condition or pathological process involving one or more of these components will affect proper functioning of the valve. A degenerative mitral valve disease process is commonly followed by functional mitral regurgitation. Rheumatic heart disease involving the mitral valve is not common in developed countries but is the most common cause of mitral disease in developing countries. A surgical procedure involving the mitral valve requires a thorough understanding of the physiology of a normally functioning valve as well as the mechanism of pathological processes affecting the valve. Mitral regurgitation is more common than mitral stenosis, and mitral valve repair is a preferable technique over replacement of the valve due to less chance of endocarditis, no thrombolytic therapy requirement, and maintenance of normal physiology of the valve. Anesthesiologists providing care for these patients in the operating room play a pivotal role in successful mitral valve procedures by determining the primary mechanism of the pathology, recommending if the valve is repairable, and evaluating the success of the surgical intervention.

scholarly journals Subannular Repair in Mitral Valve Surgery for Type IIIb Functional Mitral Regurgitation

2018 ◽  
Vol 66 (S 01) ◽  
pp. S1-S110
Author(s):  
E. Harmel ◽  
J. Pausch ◽  
B. Kloth ◽  
C. Sinning ◽  
J. Kubitz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Functional Mitral Regurgitation ◽  
Type Iiib

The Use of Rapid Deployment Valves in Combined Aortic and Mitral Valve Surgery

2017 ◽  
Vol 12 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Markus Schlömicher ◽  
Matthias Bechtel ◽  
Zulfugar Taghiyev ◽  
Yazan Al-Jabery ◽  
Peter Lukas Haldenwang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair ◽  
The Mean ◽  
Mitral Disease ◽  
Rapid Deployment

Objective Patients undergoing multiple valve surgery represent a high-risk group who could potentially benefit from a reduction of cross-clamp and cardiopulmonary bypass times because prolonged bypass and cross-clamp times are considered independent risk factors for increased morbidity and mortality after cardiac surgery. Methods Between July 2013 and November 2014, 16 patients underwent rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system in the setting of concomitant mitral disease. Fifteen patients showed mitral regurgitation, whereas one patient had severe mitral stenosis. Fourteen patients received mitral valve repair and two patients received biological mitral valve replacement. Tricuspid valve repair was performed additionally in two patients. The mean ± SD age was 72.8 ± 8.4 years, and the mean ± SD logistic EuroSCORE II is 8.7% ± 3.4%. Results Within a 30-day perioperative period, no patient was lost (n = 0). The mean ± SD follow-up time was 11 ± 2 months. At 1 year, the overall survival was 81% (n = 13). A mean ± SD transaortic gradient of 10.7 ± 2.3 mm Hg and a mean ± SD effective orifice area of 1.7 ± 0.3 cm2 were measured echocardiographically. No higher-grade paravalvular leak (aortic insufficiency > 1+) occurred. Eight patients (61%) had no residual mitral regurgitation, four patients (30%) showed trivial regurgitation (1/4), and one patient (7.3%) had moderate mitral regurgitation (2/4). No interference of the subannular stent frame with the reconstructed valve or the biological mitral prosthesis was seen. Conclusions Rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system in combined aortic and mitral valve surgery can be performed safely with reproducible results. One-year follow-up data of this small series shows encouraging results potentially justifying the extension of the indication for rapid deployment valves to patients with concomitant mitral disease. Especially elderly patients undergoing multiple valve surgery may benefit from a reduction of cardiopulmonary bypass and myocardial ischemic times.

scholarly journals Effect of Mitral Valve Surgery in Patients With Dilated Cardiomyopathy and Severe Functional Mitral Regurgitation

2018 ◽  
Vol 82 (1) ◽  
pp. 131-140 ◽  
Author(s):  
Hyemoon Chung ◽  
Makoto Amaki ◽  
Seiji Takashio ◽  
Hiroyuki Takahama ◽  
Takahiro Ohara ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Dilated Cardiomyopathy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Functional Mitral Regurgitation

scholarly journals Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism

2021 ◽  
Author(s):  
Toshihiko Shibata ◽  
Yosuke Takahashi ◽  
Hiromichi Fujii ◽  
Akimasa Morisaki ◽  
Yukio Abe
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Chronic Atrial Fibrillation ◽  
Mitral Annulus ◽  
Valve Disease ◽  
Functional Mitral Regurgitation ◽  
Functional Tricuspid Regurgitation ◽  
Giant Left Atrium ◽  
Artificial Chordae ◽  
The Right

AbstractAtrial functional mitral regurgitation is a hot research topic in the field of mitral valve disease. Atrial functional mitral regurgitation is distinctly different from ventricular functional mitral regurgitation. The surgical indications for atrial functional mitral regurgitation have not been well established because of the small amount of evidence gathered to date. Mitral annular plication with an artificial ring is an essential surgical procedure because dilatation of the mitral valve annulus is a main factor underlying this pathology. Most of these cases can be treated by mitral annuloplasty alone. However, additional procedures, such as application of artificial chordae to the anterior leaflet for pseudo-prolapse, and posterior leaflet augmentation with a pericardial patch, are required in advanced cases with a giant left atrium and extremely enlarged mitral annulus. Chronic atrial fibrillation causes enlargement of the right and left atria. This pathology is a bilateral atrioventricular valve disease (dual-valve disease). Therefore, the conventional guidelines of single-valve disease should not be applied. Although atrial functional tricuspid regurgitation is underappreciated, tricuspid annuloplasty should be considered for most patients to prevent future regurgitation. In addition to the mitral and tricuspid valve procedure, integrated surgical management, including plication of the atrium and left appendage closure, is required. This review summarizes the current considerations of surgical treatment for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism.

P6491Predictive effect of mitral annular size on persistent mitral valve dysfunction after transcatheter edge-to-edge mitral valve repair for functional mitral regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kitamura ◽  
T Schmidt ◽  
D Schewel ◽  
H Alessandrini ◽  
K.-H Kuck ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
The Other ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Predictive Effect

Abstract Background In patients with functional mitral regurgitation (FMR), deformation of the mitral valve (MV) apparatus leads to deteriorating coaptation of both leaflets. The MV geometry is essential to predict procedural success of using the MitraClip™ for FMR patients. Persistent such mitral regurgitation (MR) and post-procedural mitral stenosis (MS) are parameters for an increasing mortality rate after MitraClip implantation. The anterior-to-posterior mitral annulus diameter (MAD) is simple to evaluate with a high reproducibility rate. However, the predictive effect has not been determined to date. Purpose We evaluated the predictive effect of baseline anterior-to-posterior MAD on persistent MV dysfunctions after MitraClip™ implantation. Methods We investigated the prevalence of procedural failure (MR at discharge > grade 2+) and post-procedural MS (mean transmitral gradient (mTMG) at discharge ≥6 mmHg) in a patient cohort with FMR (n=190), who underwent MitraClip™ implantation. We measured the MV apparatus geometry on mid-systole using transoesophageal echocardiography before the index procedure. The MAD was stratified by interquartile ranges (IQR) in the comparison. (≤34 mm, 35 to 37 mm, 38 to 40 mm, and ≥41 mm, respectively) Results The mean age was 75±9 years, and 63 patients (33%) were female. The mean left ventricular ejection fraction was 34±14%. Moderate-to-severe (3+) or severe MR (4+) were documented in all patients before the procedure. Transthoracic echocardiography at discharge revealed residual MR (>2+) in 10 patients (5%) and post-procedural MS in 13 patients (7%), in which one patient presented with both residual MR and MS. After stratification by the IQRs of MAD, there were significant differences in body weight (p<0.001), height (p<0.001), and body surface area (p<0.001), but no significant differences in the other baseline characteristics. Notably, significant differences in the prevalence of procedural failure (p=0.004) and post-procedural MS (p=0.022) were observed among the groups. (Figure) Specifically, in the cohort with the 4th IQR (MAD ≥41 mm, n=44), procedural failure was observed in 7 patients (16%), although the prevalence was only 2% in the other IQR groups. Moreover, the cohorts with the 1st and 2nd IQR presented with higher prevalence of post-procedural MS (6 of 46 patients (13%) in the 1st IQR group, and 6 of 51 (12%) in the 2nd IQR group) than those with the 3rd and 4th IQRs. (1 of 49 patients (2%) in the 3rd IQR, and none of 44 patients in the 4th IQR) Figure 1 Conclusion In this analysis we showed that the mitral annulus size affected MV dysfunction after MitraClip™. Anterior-to-posterior MAD was useful to predict the procedural result. For FMR candidates with dilated mitral annulus larger than 40 mm, new-generation MitraClip-XTR™ system or other therapeutic concept such as annuloplasty may be reasonable to obtain satisfactory MV function.

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