Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery

Objective The most common surgical incisions to expose the mitral valve include a paraseptal left atriotomy or a transeptal biatrial approach. Both techniques are normally performed through a full sternotomy and bicaval cannulation. We report our experience with an alternative incision to expose the mitral valve using the left atrial roof (LAR) through a complete sternotomy or a J-shaped upper ministernotomy. Methods Between 2007 and 2011, a total of 512 patients underwent mitral procedures using the LAR approach. A J-shaped ministernotomy was performed in 189 patients, and 61 of these had concomitant aortic valve/root procedures. A standard sternotomy was performed in 323 patients, and 126 of these had concomitant aortic valve/root procedures. The repair rate in patients with mitral regurgitation was 398 of 460 (86.5%). Results In-hospital mortality was 2.3%. An adjunctive pericardial patch to repair the LAR was necessary in 1.9% of patients. A permanent pacemaker was necessary in 3.1% of patients. Four-year survival rate was 91% ± 4.2%. In patients who underwent mitral repair, 4-year freedom from mitral regurgitation greater than 2 was 97.4%. Conclusions The LAR approach is a safe and effective option to perform mitral valve surgery. The limited extension of this incision and the possibility to use a single venous cannula make this approach suitable for minimally invasive isolated mitral valve procedures, whereas the proximity of the LAR to the aortic root makes this approach particularly attractive for combined mitroaortic procedures through a ministernotomy.

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Microinvasive Mitral Valve Surgery: A New Frontier to Tackle Mitral Regurgitation

10.22541/au.163251877.73709582/v1 ◽

2021 ◽

Author(s):

Solomon Seifu ◽

Eduardo de Marchena

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Repair System ◽

Valve Repair ◽

Mitral Repair ◽

New Frontier ◽

Clinical Benefits

Microinvasive, catheter-based mitral valve repair of severe mitral regurgitation utilizes less invasive approaches with less procedural morbidity and mortality. The procedural steps and clinical benefits of the transcatheter transapical mitral valve annuloplasty (AMEND mitral repair implant) and transcatheter transapical chordal repair systems (Neochord DS 1000 device and Harpoon Mitral Valve Repair System) are reviewed in this manuscript.

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Variation of Left Atrial Function in Different Stages of Mitral Regurgitation and Its Association With Guidelines-Based Surgical Indication

The Heart Surgery Forum ◽

10.1532/hsf.3191 ◽

2020 ◽

Vol 23 (6) ◽

pp. E746-E751

Author(s):

Fengming Bai ◽

Lingfei Cun ◽

Bo Li

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Left Atrial ◽

Left Atrial Volume ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Atrial Function ◽

Left Atrial Function ◽

Atrial Volume ◽

Current Guidelines

Purpose: The current guidelines associate indications for surgery in mitral regurgitation (MR) with left ventricle size and function. However, there is not enough emphasis in current guidelines on left atrial function, which is thought to be an important factor predicting adverse outcomes in MR. The aim of this study was to investigate the left atrial function at different stages of mitral regurgitation and its value in predicting the indications of mitral valve surgery. Methods: This was a retrospective study with 163 consecutive chronic primary MR patients who underwent color doppler echocardiography at the Guangxi Zhuang Autonomous Region Second People's Hospital between January 2016 and June 2018. All patients were in sinus rhythm, classified into three groups, according the degree of mitral regurgitation. Comparison was made with 30 control patients. Using Simpson’s methods, we recorded maximal left atrial volume, left atrial volume before active contraction and minimal left atrial volume, from which left atrial expansion index, left atrial passive emptying fraction, left atrial active emptying fraction, and the total left atrial emptying fraction were derived. Results: Left atrial volume was expanded and left atrial emptying fraction was reduced in the mitral regurgitation group. By multivariate analysis, left atrial passive emptying fraction and left atrial active emptying fraction were independent predictors of mitral regurgitation requiring surgery. Using receiver-operating characteristic analysis, left atrial passive emptying fraction <97.4% demonstrated 98% sensitivity and 67% specificity for predicting the presence of surgical indication (area under the curve: 0.91; P < .001). Conclusion: During mitral regurgitation, left atrial volume increases and functions decrease. The left atrial passive emptying fraction can be used as an additional tool to predict the indications of mitral valve surgery.

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Combined Mitral and Aortic Valve Surgery: 17 Years’ Experience in a Single Center

Scandinavian Journal of Surgery ◽

10.1177/1457496920987427 ◽

2021 ◽

pp. 145749692098742

Author(s):

A. Husso ◽

T. Riekkinen ◽

A. Rissanen ◽

J. Ollila ◽

A. Valtola

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Regurgitation ◽

Real Life ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Aortic Valve Surgery ◽

Single Center

Background and Aims: It is not uncommon that patients requiring valve surgery have several simultaneous valvular dysfunctions. Combined aortic and mitral valve surgery is the most common form of double-valve surgery. The aim of this study was to analyze and present the outcomes of simultaneous aortic and mitral valve surgery in a single center in a real-life setting. Materials and Methods: The study population consisted of 150 patients operated in the Kuopio University Hospital from 2004 to 2020. All patients undergoing concomitant mitral and aortic valve surgery were included. Four groups were formed based on either the etiology or pathophysiology of the valvular dysfunction. The most common combination was mitral regurgitation with aortic regurgitation ( n = 72, 48%), followed by mitral regurgitation with aortic stenosis ( n = 37, 25%), endocarditis ( n = 29, 19%), and mitral stenosis with aortic regurgitation or stenosis ( n = 12, 8%). Concomitant coronary artery revascularization was performed in 37 (25%) patients and tricuspid valve repair in 26 (17%) patients. Results: Operative mortality was 2% and 30-day mortality was 7%. Overall survival was 86%, 78%, and 61% in 3, 5, and 10 years, respectively. Patients with endocarditis were significantly more morbid, and more often than other patients had to undergo an emergency operation. There were no significant differences between the groups in terms of early and late survival. In the overall cohort, the EuroSCORE II value, increased pulmonary artery pressure, decreased glomerular filtration, and length of the operation displayed a negative correlation with survival. Conclusion: Despite the challenging nature of multivalvular heart disease, surgery is a safe method of treatment with good short- and long-term outcomes.

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Aortic Valve Leaflet Perforation after Mitral Valve Repair

Prague Medical Report ◽

10.14712/23362936.2014.19 ◽

2013 ◽

Vol 114 (3) ◽

pp. 172-176 ◽

Cited By ~ 3

Author(s):

M. Aboelnasr ◽

Vilém Rohn

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Repair ◽

Mitral Repair ◽

Autologous Pericardial Patch ◽

Aortic Leaflet ◽

Coronary Cusp

A 32-year-old patient with symptomatic severe aortic regurge, 6 weeks after mitral valve repair, was admitted for aortic valve surgery. No preoperative clinical data consistent with infective endocarditis could be detected. Preoperative transthoracic echocardiography showed aortic leaflet perforation affecting non coronary cusp. During operation, leaflet perforation was detected and closed completely with autologous pericardial patch. No vegetations or abscess could be seen during operation. Iatrogenic aetiology of leaflet perforation after mitral repair was suspected in  this case. Recognition of this complication will help in  avoiding it during mitral valve surgery and expecting it as a possible complication during intraoperative transesophageal echocardiography.

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TCT-459 Impact of Type of Mitral Regurgitation on Outcomes of Mitral Valve Surgery After Edge-to-Edge Transcatheter Mitral Repair: Results From the CUTTING-EDGE Registry

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2021.09.1312 ◽

2021 ◽

Vol 78 (19) ◽

pp. B189

Author(s):

Syed Zaid ◽

Thomas Modine ◽

Paolo Denti ◽

Vinayak Bapat ◽

Tsuyoshi Kaneko ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Cutting Edge ◽

Mitral Repair

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Correction of moderate secondary mitral regurgitation due to aortic valve disease: immediate results

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2013-4-7-10 ◽

2015 ◽

Vol 17 (2) ◽

pp. 7

Author(s):

V. M. Nazarov ◽

S. I. Zheleznev ◽

I. I. Demin ◽

K. A. Smolyaninov ◽

A. V. Afanasev ◽

...

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Insufficiency ◽

Mitral Valve Surgery ◽

Early Postoperative Period ◽

Valve Surgery ◽

Secondary Mitral Regurgitation ◽

Group B ◽

The Impact

To evaluate the impact of surgical strategy in concomitant mitral valve surgery or isolated aortic valve replacement (AVR) in patients with moderate secondary mitral regurgitation (MR), 1 574 patients underwent AVR over a period from January 2003 to December 2011. 241 patients had secondary MR 2+ and constituted the study population. Patients were stratified into two groups, those without concomitant mitral valve surgery (Group A, n = 113) and with it (Group B, n = 128). It was found out that AVR plastic correction of MI reduces its recurrence during short-term follow-up but increases the intervention time leading to an insignificant rise in lethality. In patients with aortic stenosis the age exceeding 70 years and the presence of atrial fibrillation are found to be the most significant predictors of preservation of residual mitral regurgitation in the early postoperative period, while more indicative for patients with aortic insufficiency is the presence of tricuspid regurgitation grade 2 or higher.

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