Mid-Term Results Comparing the Use of Artificial Chords Versus Native Chords for Mitral Valve Repair in Children

Background: Our study is aimed at evaluating the mid-term surgical outcomes of mitral valve repair in children using various chordal reconstructive procedures (autologous in situ chords or artificial chords). Methods: A retrospective analysis of 154 patients who underwent mitral valve repair using various chordal reconstructive procedures from 1992 to 2012. Patients were divided into group A and group B based on use of artificial chords and autologous in situ chords, respectively, for the repair. There were 102 (66.2%) patients in group A and 52 (33.8%) patients in group B. The mean age at repair was 11.1 ± 4.5 years. Associated cardiac anomalies were found in 94 (61%) patients. Results: The median follow-up period was 4.2 years (Interquartile range: 2.0-9.9). There were two (1.3%) early deaths and five (3.2%) late deaths. There was no significant difference in survival at 15 years between the two groups (group A: 91.8% vs group B: 95.1%; P = .66). There was no significant difference in the freedom from reoperation at 15 years between group A (79.4%) and group B (97.2%; P = .06). However, there was significant difference in freedom from valve failure between group A (56.5%) and group B (74.1%; P = .03). Carpentier functional class III and postoperative residual mitral regurgitation (2+ MR, ie, mild–moderate MR) were the risk factors for valve failure. Conclusions: Severity of the disease and its progression has profound effect on the valve repair than the technique itself. Both chordal reconstructive procedures can be used to produce satisfactory results in children.

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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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Short Term Outcome of Double Valve Replacement vs. Aortic Valve Replacement with Mitral Valve Repair in Bangladesh: A Comparison

Cardiovascular Journal ◽

10.3329/cardio.v13i2.52970 ◽

2021 ◽

Vol 13 (2) ◽

pp. 164-171

Author(s):

Mohammad Rokonujjaman ◽

Syed Tanvir Ahmad ◽

Shaheedul Islam ◽

Md Ibrahim Khalilullah ◽

ZA Faruquee ◽

...

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mitral Valve Repair ◽

Valve Repair ◽

Short Term ◽

Double Valve Replacement ◽

Group A ◽

Group B

Background: Although all mitral valves are not repairable, most non rheumatic valves and a substantial proportion of rheumatic valves are amenable to repair. Repair preserves the normal valvular tissue, so the left ventricular function is well maintained post-operatively. Combined aortic and mitral valve surgery is associated with increased mortality and morbidity. Several studies have shown the superiority of DVR (Double valve replacement) in this entity to prevent reoperation. Some other data suggested superiority of aortic valve replacement combined with mitral valve repair in double valve disease. No study had been done over Bangladeshi population. Our aim was to compare the short-term outcome of mitral valve repair and aortic valve replacement with double valve replacement. Methods: It was a prospective non-randomized observational study took place in the Department of Cardiac Surgery of National Institute of Cardiovascular Disease. In this study post-operative result of double valve replacement was compared with aortic valve replacement and mitral valve repair. Total 60 patients under went aortic valve replacement with either mitral valve replacement (n=30) marked as group A or (n=30) repair marked as Group B. Results: Aortic cross clamp time and cardiopulmonary bypass time was higher in group B than group A but it was well tolerated without any short-term measurable consequences. Required inotrope support was 49.8±2.3 hours in group B and 87.2±3.5 hours in group A (p<0.05). Duration of ICU stay were 91.1±3.2 hours in group A and 60.3±2.9 hours in group B (p<0.05). Development of postoperative low output syndrome was significantly higher (23.33%) in group A versus 3.33% in group B. Patients of group A suffered more from CHF in the follow up period than the group B. But the result was statistically insignificant. There was an early post-operative fall of ejection fraction in both groups but it was recovered after 3 months. Post-operative thromboembolism was 13.79% in group A and 3.33% in group B. There was no early death in repair group though total three (10%) cases died after DVR. There was no valve failure, re-stenosis or regurgitation in any group in this limited follow up period. Higher dose of warfarin was required in group A to maintain INR. Consequently, post-operative major bleeding occurred in 24.14% patients of group A. On the contrary, no patient of repair group suffered from this catastrophe. Conclusion: This study reveals that the result of mitral valve repair with aortic valve replacement is equally comparable or in some cases superior to that of double valve replacement. Therefore, in feasible cases, mitral valve repair should be attempted who need concomitant aortic valve replacement. Cardiovasc. j. 2021; 13(2): 164-171

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Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

Perfusion ◽

10.1177/0267659120915659 ◽

2020 ◽

Vol 35 (7) ◽

pp. 649-657

Author(s):

Biao-Chuan He ◽

Ying-Jie Ke ◽

Kan Zhou ◽

Ze-Rui Chen ◽

Jue Yang ◽

...

Keyword(s):

Tricuspid Valve ◽

Venous Drainage ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Thoracoscopic Approach ◽

Significant Difference ◽

Group A ◽

Group B ◽

Drainage Group

Aim: The aim of this study was to investigate the feasibility, safety, and clinical effect of modified unicaval drainage for thoracoscopic reoperative isolated tricuspid valve repair, compared with conventional bicaval drainage. Methods: A total of 45 consecutive cases of patients who underwent thoracoscopic reoperative isolated tricuspid valve repair on beating-heart were enrolled and divided into two groups according to the different venous drainage (Group A: modified unicaval drainage, Group B: conventional bicaval drainage). A retrospective analysis of perioperative data and clinical outcomes were performed and all the surviving cases were followed up. Re-evaluation of echocardiography and electrocardiogram was performed prior to discharge, and at first month, sixth month, and every year follow-up. Results: The overall postoperative 30-day mortality was 4.5% in Group A and 8.7% in Group B. The postoperative tricuspid valve regurgitation grade of both groups decreased significantly from preoperative regurgitation grade, p < 0.001, without intergroup significant difference, p = 0.815. Follow-up duration ranged from 6 to 38 months, there was one death at 24 months in Group A, and another at 9 months in Group B, respectively. Nobody from both groups experienced reintervention for residual tricuspid regurgitation. No significant difference could be identified about the incidence of postoperative morbidities and follow-up adverse events. Conclusion: Both strategies of caval venous drainage can provide satisfactory exposure for thoracoscopic reoperative isolated tricuspid valve repair and equivalent favorable postoperative outcome. And the modified unicaval drainage group may even preserve the anesthetic time and decrease the risk of iatrogenic jugular injury, achieving a more simplified procedure with better cosmetic outcome.

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Relocation of Papillary Muscles for Ischemic Mitral Valve Regurgitation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000040 ◽

2014 ◽

Vol 9 (1) ◽

pp. 54-59 ◽

Cited By ~ 1

Author(s):

Khalil Fattouch ◽

Sebastiano Castrovinci ◽

Giacomo Murana ◽

Pietro Dioguardi ◽

Francesco Guccione ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Geometric Model ◽

Three Dimensional ◽

Mitral Valve Regurgitation ◽

Papillary Muscles ◽

Valve Repair ◽

Truncated Cone ◽

Significant Difference ◽

The Mean

Objective The assessment of the mitral valve apparatus (MVA) and its modifications during ischemic mitral regurgitation (IMR) is better performed by three-dimensional (3D) transesophageal echocardiography (TEE). The aim of our study was to carry out nonrestrictive mitral annuloplasty in addition to relocation of papillary muscles (PPMs) oriented by preoperative real-time 3D TEE through the mitral valve quantification dedicated software. Methods Since January 2008, a total of 70 patients with severe IMR were examined both before and after mitral valve repair. The mean (SD) coaptation depth and the mean (SD) tenting area were 1.4 (0.4) cm and 3.2 (0.5) cm2, respectively. Intraoperative 3D TEE was performed, followed by a 3D offline reconstruction of the MVA. A schematic MVA model was obtained, and a geometric model as a “truncated cone” was traced according to preoperative data. The expected truncated cone after annuloplasty was retraced. A conventional normal coaptation depth of approximately 6 mm was used to detect the new position of the PPMs tips. Results Perioperative offline reconstruction of the MVA and the respective truncated cone was feasible in all patients. The expected position of the PPMs tips, desirable to reach a normal tenting area with a coaptation depth of 6 mm or more, was obtained in all patients. After surgery, all parameters were calculated, and no statistically significant difference was found compared with the expected data. Conclusions Relocation of PPMs plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results in patients with severe IMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction.

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Mitral valverepair: types of correction, immediateand long-term results

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2008-14-1-91-96 ◽

2008 ◽

Vol 14 (1) ◽

pp. 91-96

Author(s):

N. Shikhverdiev ◽

G. Khubulava ◽

S. Marchenko ◽

M. Askerov

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Surgical Correction ◽

Long Term Results ◽

Valve Repair ◽

Reconstructive Procedures ◽

Valve Pathology

The types of surgical correction of the mitral valve pathology, hospital and long-term results were studied. The mitral valve repair being compared to the mitral valve replacement is procedure of choice as it provides stable results. In the study we demonstrate that the long-term results of reconstructive procedures on the mitral valve have advantages over mitral valve replacement in terms of survival, freedom from reoperation and tromboembolc complications.

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Comparison of Anterior Mitral Leaflet Repair Techniques with and without the Use of Chordal Replacement in Patients with Degenerative Mitral Valve Insufficiency

The Heart Surgery Forum ◽

10.1532/hsf.2317 ◽

2019 ◽

Vol 22 (3) ◽

pp. E234-E240

Author(s):

Ersin Kadiroğulları ◽

Ömer Faruk Çiçek ◽

Serkan Mola ◽

Emre Yaşar ◽

İbrahim Erkengel ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Insufficiency ◽

Anterior Leaflet ◽

Valve Repair ◽

Valve Insufficiency ◽

Group A ◽

Group B ◽

Chordal Replacement ◽

Repair Techniques

Background: The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency. Methods: This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed. Results: No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency. Conclusion: Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.

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Application Value of Musculoskeletal Ultrasound in DAA-THA with Conjoined Tendon Repair

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i6.2711 ◽

2021 ◽

Vol 5 (6) ◽

pp. 61-66

Author(s):

Guanbao Li ◽

Pinquan Li ◽

Wei Zhou ◽

Qiuan Chen ◽

Peng Ma ◽

...

Keyword(s):

Tendon Repair ◽

Direct Anterior Approach ◽

Joint Capsule ◽

Musculoskeletal Ultrasound ◽

Significant Difference ◽

Group A ◽

Harris Score ◽

Group B ◽

Conjoined Tendon

Objective: To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty (DAA-THA), and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair. Methods: A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected; the patients were divided into two groups, an observation group, group A (n = 30), and a control group, group B (n = 30), according to different intraoperative methods. There was no significant difference in gender, age, and diagnosis between the two groups. Direct anterior approach was used for both the groups. For group A, the joint capsule and conjoined tendon (superior gemellus, obturator internus, and inferior gemellus) were repaired in situ, whereas for group B, only the joint capsule was repaired in situ, while the conjoined tendon was not repaired. The healing of the tendon was observed. Results: (1) in terms of diagnosis, after conjoined tendon repair, 26 cases in group A showed good tendon continuity, good tension, and a small amount of effusion echo around, three cases showed partial interruption of tendon echo, low echo, or no echo inside with insufficient structural clarity, and a case showed complete interruption; in group B, all 30 cases had continuous interruption, poor tension, tendon retraction, and thickening; the healing rate of group A’s conjoined tendon repair was 96.67%; (2) in terms of prognostic assessment, one month after the surgery, the Harris score of group A was significantly higher than that of group B (P < 0.05); however, there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery (P > 0.05); the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B (P < 0.05). Conclusion: Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA; it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension, enhance its muscle strength, significantly improve early joint stability and joint function, as well as facilitate the rapid recovery of patients.

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Transcatheter Mitral Edge-to-Edge Repair in Patients with Primary or Secondary Mitral Regurgitation

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.175 ◽

2021 ◽

Vol 1 (10) ◽

Author(s):

Kwakye Peprah ◽

Holly Gunn ◽

Melissa Walter

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Pacemaker Implantation ◽

Vascular Complications ◽

Kidney Injury ◽

Clinical Effectiveness ◽

Valve Repair ◽

Significant Difference ◽

Secondary Mitral Regurgitation

Four systematic reviews (SRs) and 6 retrospective cohort studies provided evidence for the clinical effectiveness of transcatheter mitral valve repair (TMVR) versus open heart conventional surgical mitral valve repair or replacement (SMVR) in patients with primary or secondary mitral regurgitation (MR). No relevant evidence regarding the cost-effectiveness of TMVR versus SMVR in patients with primary or secondary MR was identified; therefore, no summary can be provided. There was evidence indicating a statistically significant difference in favour of TMVR over SMVR regarding the odds of post-procedure bleeding, need for permanent pacemaker implantation, 30-day readmission, and a shorter duration of hospitalization. There was evidence suggesting a statistically significant difference in favour of SMVR over TMVR regarding the odds of recurrent MR, the need for reoperation, and mortality rate (i.e., during hospitalization, at 1 year, and > 3 years). Also, compared with TMVR, the likelihood of residual MR grade > 2 or freedom from MR grade ≥ 2 or ≥ 3 at 4 years was statistically significantly lower or higher, respectively, with SMVR. Evidence regarding the comparative clinical effectiveness of TMVR versus SMVR concerning stroke, acute kidney injury (AKI), cardiogenic shock, and death during hospitalization was conflicting and inconclusive. There was no evidence of a significant difference between the 2 interventions regarding overall mortality or mortality at 5 years, overall survival, freedom from cardiac death at 4 years, cardiac arrest, acute myocardial infarction (MI), and respiratory or vascular complications. A major limitation of the evidence was that it derives from studies of low or unknown quality and risk of bias, Furthermore, all the findings are confounded by differences in patient selection, which reflect the approved indications for the interventions but prevent a direct comparison between the TMVR and SMVR groups.

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Long-term outcomes of rheumatic mitral valve repair: Is it worthwhile to do it?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320970769 ◽

2020 ◽

pp. 021849232097076

Author(s):

Somchai Waikittipong

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Young Patients ◽

Class Iii ◽

Valve Repair ◽

Long Term Outcomes ◽

Actuarial Survival

Aim This retrospective study was undertaken to evaluate the long-term outcomes of mitral valve repair in rheumatic patients. Methods From 2003 to 2019, 151 patients (mean age 26.5 ± 14.9 years; 68.9% female) underwent mitral valve repair. Fifty-three (35.1%) had atrial fibrillation, and 79 (52.3%) were in New York Heart Association class III/IV. Pure mitral regurgitation was present in 109 (72.2%) patients, pure stenosis in 9 (6%), and mixed regurgitation and stenosis in 33. Results Three (2%) patients died postoperatively and 4 (2.6%) were lost during follow-up. Mean follow-up was 90.5 ± 55.6 months. There were 22 (14.8%) late deaths. Actuarial survival at 5, 10, and 15 years was 90.7% ± 2.5%, 83.5% ± 3.6%, and 76.5 ± 6.1%, respectively. Twelve (8.5%) patients underwent reoperation. Freedom from reoperation at 5, 10, and 15 years was 96.1% ± 1.7%, 89.8% ± 3.2%, and 82.3% ± 6.1%, respectively. Forty-two (29.2%) patients developed recurrent mitral regurgitation. Freedom from recurrence of mitral regurgitation at 5, 10, and 15 years was 70.9% ± 4.3%, 56% ± 5.9%, and 53.3% ± 6.4%, respectively. Eighty-one (56.6%) patients were and free from all events during follow-up. Freedom from all events at 5, 10, and 15 years was 64.8% ± 4.1%, 48.6% ± 5.3%, and 43.7% ± 5.8%, respectively. Conclusions Although rheumatic mitral valve repair is associated with late recurrence of mitral regurgitation, it has benefits in selected patients, especially children and young patients who want to avoid the lifelong risks of anticoagulation. Long-term follow-up is essential in these patients.

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Percutaneous edge-to-edge mitral repair in the presence of mitral annulus calcification

European Heart Journal ◽

10.1093/eurheartj/ehab724.2211 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Fernandez Peregrina ◽

I P Pascual ◽

X F Freixa ◽

G T C Tirado-Conte ◽

R R E Rodriguez-Estevez ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Cardiovascular Mortality ◽

Mitral Annulus ◽

Functional Class ◽

High Morbidity ◽

Valve Repair ◽

One Year ◽

Mitraclip System

Abstract Background Mitral annular calcification (MAC) is commonly found in patients affected with mitral regurgitation (MR) and it's associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge mitral valve repair with the MitraClip system has been stablished as a valid alternative to surgery in high risk patients with severe MR. However, its efficacy in patients affected with MAC remains uncertain as this population has been excluded from trials. Objectives To analyze the safety, efficacy and mid-term durability of the treatment of MR with the MitraClip system in patients affected with moderate or severe MAC. Methods Data was obtained from a multicenter spanish registry that prospectively included consecutive patients with MR grade ≥3 undergoing transcatheter mitral valve repair with the MitraClip system. Sixty-one patients with moderate or severe MAC were included in the “MAC” group and 791 with no-or-mild MAC were allocated in the “NoMAC” group. Results Procedural success was similar in both groups (91.8% vs 95.06%, p=0.268, in MAC and NoMAC respectively) with a very low rate of complications beside a higher residual mean gradient in the MAC group (3.0 vs 3.6mmHg, p=0.001). At one-year follow-up, 79.5% of NoMAC and 90.6% of MAC patients had MR grade ≤2 (p=0.129). Only 9 patients (1,14%), all in NoMAC group, required reintervention during follow up. Eighty percent of patients in both groups remained in NYHA functional class ≤II and a significant reduction in readmissions for heart failure was also observed (65% vs 78% respectively, p=0.145). One-year mortality was slightly higher in MAC patients (19.67% vs 11.25%, p=0.050) with no difference in cardiovascular mortality (15.25% vs 9.21%, p=0.129). Conclusions Transcatheter edge-to-edge repair with the MitraClip system in selected patients with moderate or severe MAC is safe and feasible with a mid-term durability similar to those without MAC. These patients also benefit clinically from this treatment with a sustained mid-term subjective clinical improvement and no increase in cardiovascular mortality as compared to NoMAC patients. FUNDunding Acknowledgement Type of funding sources: None.

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