A Simplified Technique for Correcting Mitral Valve Regurgitation via Minimally Invasive Approach

Mitral valve regurgitation may require complex repair techniques that are challenging in minimally invasive and may expose patients to prolonged cardiopulmonary bypass and cross-clamp times. Here, we present a stepwise operative approach that may facilitate the repair of the mitral valve in a minimally invasive fashion and may be carried out even when multiple posterior segments are involved. This how-to-do article presents a method that was performed in 148 patients that were referred to our institution for severe organic mitral regurgitation between 2008 and 2016. At mean ± SD follow-up of 45.5 ± 27 months, freedom from recurrent of mitral regurgitation 2+ or greater and reoperation was 95.2%.

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A Simplified Technique for Complex Mitral Valve Regurgitation by a Minimally Invasive Approach

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2018.04.010 ◽

2018 ◽

Vol 106 (3) ◽

pp. 728-734 ◽

Cited By ~ 4

Author(s):

Giuseppe Speziale ◽

Marco Moscarelli ◽

Nicola Di Bari ◽

Raffaele Bonifazi ◽

Massimo Salardino ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Regurgitation ◽

Valve Regurgitation ◽

Minimally Invasive Approach ◽

Invasive Approach

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A Simplified Technique for Correcting Mitral Valve Regurgitation via Minimally Invasive Approach

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451801300315 ◽

2018 ◽

Vol 13 (3) ◽

pp. 236-238

Author(s):

Giuseppe Speziale ◽

Marco Moscarelli

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Regurgitation ◽

Valve Regurgitation ◽

Minimally Invasive Approach ◽

Invasive Approach

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An 86-Year-Old Female with Mitral Regurgitation and Significant Pectus Excavatum

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0039-1700881 ◽

2019 ◽

Vol 08 (01) ◽

pp. e37-e40

Author(s):

Raphael Tasar ◽

Sophie Tkebuchava ◽

Mahmoud Diab ◽

Torsten Doenst

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Pectus Excavatum ◽

Heart Team ◽

Case Description ◽

Valve Repair ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Surgical Access

Abstract Background We report the case of minimally invasive mitral valve repair in an 86-year-old female with symptomatic structural mitral regurgitation and severe pectus excavatum. Case Description The case summarizes four areas of repetitive heart team discussions. First, should an 86-year-old patient still be treated invasively? Second, if so, should treatment be interventional or surgical? Third, if surgical, should we replace or repair at that age and fourth which surgical access is best with respect to her chest deformation? Conclusion We chose to surgically repair the valve using a minimally invasive approach. The patient was extubated 3 hours after surgery and discharged after 7 days.

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Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz114 ◽

2019 ◽

Vol 56 (5) ◽

pp. 968-975 ◽

Cited By ~ 3

Author(s):

Jonas Pausch ◽

Eva Harmel ◽

Christoph Sinning ◽

Hermann Reichenspurner ◽

Evaldas Girdauskas

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Functional Mitral Regurgitation ◽

Invasive Approach ◽

Type Iiib ◽

Duration Of Surgery ◽

Group A ◽

Group B

Abstract OBJECTIVES Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures. METHODS A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups. RESULTS Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041). CONCLUSIONS Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.

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Minimally Invasive Mitral Valve Replacement Using the Valve-in-valve Technique

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181b02871 ◽

2009 ◽

Vol 4 (4) ◽

pp. 221-224 ◽

Cited By ~ 1

Author(s):

Orlando Santana ◽

Francisco A. Tarrazzi ◽

Joseph Lamelas

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Pulmonary Edema ◽

Left Atrium ◽

Bioprosthetic Valve ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Valve In Valve ◽

Bioprosthetic Mitral Valve

A 90-year-old woman with two previous mitral valve replacements, presented with pulmonary edema due to mitral regurgitation from degeneration of her bioprosthetic mitral valve. A minimally invasive approach was used to replace the bioprosthetic mitral valve. During surgery, the bioprosthetic valve was noted to be too adherent to the endocardium of the left atrium, making removal of the prosthesis not only difficult, but also potentially harmful. The new bioprosthetic valve was instead placed using a valve-in-valve approach.

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Minimally Invasive Mitral Valve Surgery for Mitral Valve Infective Endocarditis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1604206 ◽

2017 ◽

Vol 66 (07) ◽

pp. 525-529 ◽

Cited By ~ 3

Author(s):

Joerg Seeburger ◽

Jens Garbade ◽

Uta Schon ◽

Martin Misfeld ◽

Friedrich Mohr ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Annulus ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Mitral Leaflet ◽

Minimally Invasive Approach ◽

Invasive Approach

Background The feasibility of minimally invasive mitral valve (MV) surgery in infective endocarditis (IE) has not been reported in detail. We assessed the safety, efficacy, and durability of the minimally invasive approach through a right anterolateral minithoracotomy for surgical treatment of MV IE. Methods A review of the Leipzig Heart Center database revealed 92 eligible patients operated on between 2002 and 2013. All patients had undergone minimally invasive surgery for IE. The indication for surgery was isolated IE of the MV in all patients. Baseline and intraoperative data, as well as clinical outcomes and short-term follow-up were analyzed retrospectively. Results The patients' mean age was 60.9 ± 15.3 years, the logistic EuroSCORE II was 19.6 ± 19.1%, and 64.1% (59) were male. MV repair was feasible in 23.9% (22/92) of patients. Repair techniques included annuloplasty ring implantation, anterior mitral leaflet resection, posterior mitral leaflet resection, and implantation of neochordae. MV replacement was performed in 69 patients (75%), a mitral annulus patch in 1 patient, and concomitant tricuspid valve surgery for tricuspid regurgitation in 5 patients. Bacteriological analysis showed staphylococcus infection in 45.5%, streptococcus in 36.4%, enterococcus in 13.6%, and others in 4.5%. The 30-day-mortality rate was 9.8% (9 patients). The 1-year follow-up showed a 1-year survival rate of 77.7 ± 4.4% and freedom from reoperation within 1 year due to reendocarditis of 93.3 ± 2.1%. Conclusions The minimally invasive approach is suitable for the treatment of IE of the MV. It is a good technique in IE in selected patients.

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Transapical Off-Pump Neochord Implantation in Case of Severe Mitral Regurgitation

Acta Chirurgica Latviensis ◽

10.1515/chilat-2017-0007 ◽

2016 ◽

Vol 16 (2) ◽

pp. 28-30

Author(s):

Uldis Strazdins ◽

Gvido Janis Bergs ◽

Martins Kalejs ◽

Indra Vilumsone

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Invasive Procedure ◽

Valve Repair ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Off Pump ◽

Significant Clinical Improvement ◽

Artificial Chordae

SummaryMitral regurgitation is common valvular heart disease and a major cause of congestive heart failure and death. It is most often associated with degenerative changes in mitral valve which leads to valve prolapse. Transapical off-pump mitral valve repair is a new minimally invasive procedure to treat mitral regurgitation. Here we report 64-year old female who suffered from grade III mitral regurgitation due to ruptured chorda and posterior leaflet P2/P3 segment prolapse. During surgery 4 artificial chordae were implanted and postoperative echocardiography results showed minimal residual grade I mitral regurgitation, therefore significant clinical improvement can be achieved with minimally invasive approach.

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Minimally Invasive Transaortic Repair of the Mitral Valve

The Heart Surgery Forum ◽

10.1532/hsf98.20101133 ◽

2011 ◽

Vol 14 (4) ◽

pp. 232 ◽

Cited By ~ 2

Author(s):

Orlando Santana ◽

Joseph Lamelas

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Operative Mortality ◽

The Mean ◽

Transaortic Approach

Objective: We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.Methods: From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.Results: There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.Conclusion: Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.

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Surgical Technique: Papillary Muscle Sling for Functional Mitral Regurgitation during Minimally Invasive Valve Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.2013209 ◽

2013 ◽

Vol 16 (5) ◽

pp. E295-E297 ◽

Cited By ~ 3

Author(s):

Joseph Lamelas ◽

Christos Mihos ◽

Orlando Santana

Keyword(s):

Mitral Regurgitation ◽

Minimally Invasive ◽

Median Sternotomy ◽

Rational Approach ◽

Functional Mitral Regurgitation ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Mitral Annuloplasty ◽

Technical Details ◽

Mitral Apparatus

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.

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