Infant Ross-Konno, Endocardial Fibroelastosis Resection and Mitral Valve Repair

Optimal management of critical aortic stenosis (AS) in infants depends on the left ventricle's (LV's) ability to maintain adequate output. Determining feasibility of biventricular repair may be difficult, particularly in those with mitral disease, endocardial fibroelastosis (EFE), multi-level obstruction, and uncertain physiologic capacity. We report a case of a three-month-old with critical AS, severely reduced LV function, EFE, and moderate mitral regurgitation (MR), who underwent a Ross-Konno procedure with concomitant EFE resection and mitral valve repair. Although the technical sequence is challenging, definitive surgery completely relieved multi-level obstruction and MR with markedly improved LV function.

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Visualization and Hemo-Dynamic Evaluation of Edge-to-Edge Mitral Valve Repair Within Reanimated Swine Hearts

Journal of Medical Devices ◽

10.1115/1.3136430 ◽

2009 ◽

Vol 3 (2) ◽

Author(s):

M. G. Bateman ◽

J. L. Quill ◽

J. St. Louis ◽

P. A. Iaizzo

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Imaging Modality ◽

Systolic Pressure ◽

Left Ventricular ◽

Lv Function ◽

Valve Repair ◽

Regurgitant Fraction ◽

Orifice Area ◽

Leaflet Coaptation

This project aims to investigate the performance of edge-to-edge mitral valve repair (MVR) within reanimated swine hearts. Direct imaging and hemodynamic data of the mitral valve during normal cardiac function (Normal), after an induced prolapse (Prolapse), and post surgical repair (E2E) was obtained. Isolated swine hearts (n=6) were reanimated using a clear Krebs–Henseleit buffer. Mitral prolapse, and regurgitation, in the P2 region was induced by cutting chordae tendinae of the posterior leaflet. An edge-to-edge MVR procedure was performed, suturing the prolapsed P2 region to the A2 region of the anterior leaflet. The mitral valve was imaged using endoscopic cameras in the left atrium and ventricle allowing verification of stitch placement and leaflet coaptation. Analysis of the endoscopic images provided measures of annulus area, orifice area, and regurgitant area. Echocardiography, the standard clinical imaging modality, was used to determine the hemodynamic performance of the valve. Additionally, ECG and left chamber pressures were recorded at a sample rate of 5 kHz. Prolapse of the P2 region was consistently created, and edge-to-edge repair of the mitral leaflet showed full leaflet coaptation. The annulus area of the valve was tracked throughout the procedure and did not show significant variation. The orifice area, defined as the area of the annulus that does not contain leaflets, normalized to the corresponding annulus area for Normal, Prolapse and E2E were: 41±13%, 44±14% and 21±13%, p=0.02. The regurgitant area, normalized to the corresponding annulus area, increased from 2±2% for Normal to 8±3% for the Prolapse and then decreased to 1±1% for the E2E group. The regurgitant fraction, normalized against the maximum observed, for Normal, Prolapse and E2E was 10±6%, 57±26% and 13±13%, p<0.01. Over the course of the experiment the left ventricular (LV) systolic pressure and negative dP/dt reduced from 95 to 54 mm Hg and 743 to 402 mm Hg/s, respectively. Our results show that orifice area was significantly smaller after MVR when compared to Normal and Prolapse periods. There was no significant change in regurgitant area and regurgitant fraction from the Normal to repaired valve as compared to a significant increase in regurgitant area and regurgitant fraction during Prolapse. Low gradients were observed for all three groups, with no indications for symptomatic stenosis. The reduction of LV function was caused by global ischemia and the progressive onset of edema. In this acute assessment of edge-to-edge repair of P2 prolapse, repair does not affect annulus area, decreases orifice area, and successfully eliminates regurgitant area with no evidence of mitral stenosis.

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27 Seven-year review of mitral valve repair rates and early outcomes for degenerative mitral disease

10.1136/heartjnl-2018-ics.27 ◽

2018 ◽

Author(s):

L Casey ◽

A Hayes ◽

J McCarthy

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Disease

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Mitral valve repair or bioprosthetic replacement: The conundrum in Indigenous rheumatic mitral disease

Heart Lung and Circulation ◽

10.1016/j.hlc.2014.12.049 ◽

2015 ◽

Vol 24 ◽

pp. e22

Author(s):

G. Crouch ◽

A. Main ◽

G. Rice ◽

R. Baker ◽

J. Bennetts

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Disease

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Reoperation rate for recurrent mitral disease is low after robotically assisted mitral valve repair

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2017.08.126 ◽

2018 ◽

Vol 155 (1) ◽

pp. e13-e16 ◽

Cited By ~ 1

Author(s):

Amit Taggarse ◽

Joseph A. Dearani ◽

Richard C. Daly ◽

Lucman A. Anwer ◽

Wooseok Choi ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Reoperation Rate ◽

Valve Repair ◽

Mitral Disease

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Acute hemodynamic effects of iatrogenic inter-atrial shunts after percutaneous edge-to-edge mitral valve repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.2645 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Koschutnik ◽

G Goliasch ◽

C Nitsche ◽

A.A Kammerlander ◽

C Dona ◽

...

Keyword(s):

Blood Flow ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Vascular Function ◽

Left Ventricular ◽

Pulmonary Vasculature ◽

Lv Function ◽

Hemodynamic Effects ◽

Valve Repair ◽

Beneficial Effects

Abstract Background Implantable interatrial shunt devices improve pulmonary vascular function in patients with heart failure by transferring richly oxygenated blood to the right heart. Whether iatrogenic atrial septum defects (iASDs) after percutaneous edge-to-edge mitral valve repair (pMVR) are also associated with beneficial hemodynamic effects has not been investigated. Methods We consecutively enrolled patients with relevant functional (FMR) and degenerative mitral regurgitation (DMR) scheduled for pMVR. Invasive hemodynamic assessments were performed prior to and immediately after the procedure. Results 97 consecutive patients (75.4±9.1 years; 58% female) were prospectively included, 65 (66%) presented with relevant FMR. At baseline when compared to the DMR group, FMR was associated with worse left ventricular (LV) function (LV ejection fraction: 39 vs. 49%; p=0.001), higher NT-proBNP levels (7404 vs. 5214 pg/mL; p=0.023), worse renal function (serum creatinine: 1.7 vs. 1.3 mg/dL; p=0.019), and higher usage of spironolactone (68 vs. 42%; p=0.018) and sacubitril/valsartan (33 vs. 0%; p<0.001). Following pMVR, cardiac output (CO) and systemic blood flow (Qs) increased significantly (CO: 4.6 to 5.5 L/min; p<0.001; Qs: 4.9 to 5.8 L/min; p=0.002), with more pronounced changes in the FMR subgroup (ΔCO: 1.0 vs. 0.6 L/min; Figure 1A; ΔQs: 1.2 vs. 0.1 L/min), when compared to DMR. Pulmonary blood flow (Qp) increased by 26% (4.3 to 5.4 L/min; p=0.008), accompanied by a raise in pulmonary artery (PA) oxygen (O2) saturation from 73 to 77% (p<0.001). Arterial O2 saturation levels remained unchanged (98.3 to 98.7%; p=0.165), confirming no significant changes in systemic oxygenation. These changes were associated with a slight decline in pulmonary vascular resistance (PVR: 250 to 225 dynes*sec/cm5; p=0.369, Figure 1B), and a tendency towards improvement of pulmonary compliance (PAC: 3.6 to 4.0 mL/mmHg; p=0.414). Conclusions Invasively measured CO, Qs, Qp, and mixed-venous PA O2 saturation increased immediately after pMVR, alongside with potentially beneficial effects on pulmonary vasculature with marked improvements in PVR and PAC. These changes were more pronounced in the FMR subgroup. Further studies are required to assess long-term hemodynamic effects and underlying mechanisms of persistent iASDs on pulmonary vascular function. Figure 1. Invasive hemodynamics Funding Acknowledgement Type of funding source: None

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Robot-Assisted Mitral Valve Repair with Posterior Leaflet Extension for Rheumatic Disease

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000335 ◽

2017 ◽

Vol 12 (1) ◽

pp. 60-63

Author(s):

Burak Onan ◽

Unal Aydin ◽

Zeynep Kahraman ◽

Korhan Erkanli ◽

Ihsan Bakir

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Mitral Valve Insufficiency ◽

Posterior Leaflet ◽

Valve Repair ◽

Mitral Repair ◽

Autologous Pericardial Patch ◽

Valve Insufficiency ◽

Robot Assistance ◽

Mitral Disease

Mitral valve repair has been one of the widely used applications of robotic surgery. Patients with rheumatic mitral disease usually present at an early age with thickening, retraction, or fusion of the leaflets and subvalvular apparatus. Robotic mitral repair can be feasible among this group of patients, rather than replacement. Herein, we describe a young woman who presented with rheumatic mitral valve insufficiency. A complex mitral repair with posterior leaflet extension with an autologous pericardial patch was successfully conducted using robot assistance.

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Mitral Valve Repair in Rheumatic Mitral Disease

Cardiac Surgery ◽

10.1007/978-3-030-24174-2_42 ◽

2020 ◽

pp. 389-396

Author(s):

Taweesak Chotivatanapong

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Disease

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Increasing Mitral Valve Repair Rates with Nonresectional Techniques

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182181b4b ◽

2011 ◽

Vol 6 (4) ◽

pp. 209-220 ◽

Cited By ~ 9

Author(s):

J. Scott Rankin ◽

Jeffrey G Gaca ◽

Louis A. Brunsting ◽

Mani A. Daneshmand ◽

Carmelo A. Milano ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Long Term Results ◽

Valve Repair ◽

Multiple Sources ◽

Technical Application ◽

Mitral Repair ◽

Mitral Disease

In every common mitral pathology studied to date, repairing the patient's own diseased valve to adequate function has yielded superior long-term results as compared with prosthetic valve replacement with either tissue or mechanical devices. Thus, increasing rates of mitral repair across all valve pathologies would seem to be a logical clinical goal. Techniques for mitral valve repair have undergone continual evolution over the past 50 years. Recently, emphasis has been placed on preserving leaflet surface area and avoiding tissue resection, by combining the methods of Gore-Tex artificial chordal replacement, autologous pericardial leaflet augmentation, and full ring annuloplasty. Using combinations of these three techniques appropriate to the given valve pathology, acute mitral repair rates now are approximating 98% for all common mitral disease etiologies. Simultaneously, operative mortalities for mitral repair have fallen significantly and now are negligible, whereas long-term outcomes using these methods have been increasingly more stable. As a result of innovations from multiple sources, mitral valve surgery has been converted from a higher risk procedure to one of the safest operations in most centers. This review will detail the technical application of “nonresectional” mitral repair approaches to a broad range of mitral disease pathologies.

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