scholarly journals Coming undone: a case of annuloplasty ring suture degeneration post mitral valve repair leading to recurrent severe MR

2020 ◽  
Vol 7 (1) ◽  
pp. K7-K10
Author(s):  
Patrick Savage ◽  
Michael Connolly
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Progressive Disease ◽  
List Type ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
2D And 3D ◽  
Learning Points

Summary Mitral valve repair is the gold standard treatment for degenerative mitral valve disease with superior perioperative and long-term morbidity and mortality outcomes vs mitral valve replacement. The 10 year survival freedom from redo valve repair varies from 72 to 90%. Often, failure of valve repair necessitating redo surgery is directly related to disease progression; however, rarely it can be attributed to technical complications such as annuloplasty dehiscence, leaflet suture rupture, incorrect artificial chord length or incorrect annuloplasty position. We report one such case of severe mitral regurgitation secondary to a degenerative annuloplasty ring suture occurring 1 year post valve repair. Learning points: Differentiation of causative pathology involved in recurrent mitral regurgitation following repair has important implications for patient outcomes. In the hands of an experienced practitioner echocardiography – in particular, integrated 2D- and 3D echocardiography – is a powerful tool for differentiating between progressive disease and procedural failure.

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

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.

Abstract 2286: Short- and Long-Term Survival of Mitral Valve Repair Versus Mitral Valve Replacement in Patients with Functional Mitral Regurgitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Mario Senechal ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Term Survival ◽  
Long Term Mortality

Mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR) when compared to mitral valve replacement (MVR). However, there is an important controversy about the type of surgical treatment that should be used in patients with functional MR (FMR). The aim of this study was to compare MVRp (i.e. restrictive annuloplasty) and MVR in patients with FMR. Pre- and operative demographic and clinical data of 392 patients (64% of male, mean age: 65±10 years) with FMR who underwent mitral surgery between 1992 and 2007 were prospectively collected in a computerized database. MVRp was performed in 52% of patients (n=204) and MVR in 48% (n=188). Compared to patients undergoing MVRp, those with MVR were significantly more frequently symptomatic (77% vs. 59%, p=0.0002), had lower left ventricular ejection fraction (LVEF) (40±15%, vs. 46±15%, p=0.0003) and had higher prevalence of pulmonary hypertension (36% vs. 24%, p=0.01) preoperatively. However, there was no significant difference between the 2 groups with regards to age, gender, MR severity, diabetes, obesity, systemic hypertension and atrial fibrillation (p>0.3). Although operative mortality was significantly lower after MVRp compared to MVR (9% vs. 17%, p=0.02), long-term survival was not statistically different between procedures (6 years: 74±4% vs. 72±4%; 12 years: 54±5% vs. 52±7%; p=0.58). After adjusting for other risk factors, the type of procedure (MVRp vs. MVR) did not come out as an independent predictor of either operative (Odds-ratio=1.7, 95% confidence interval [CI]: 0.8 –3.8, p=0.15) or long-term mortality (Hazard-ratio [HR]=1.1, 95%CI: 0.9 –1.4, p=0.29). The independent predictors of long-term mortality were age (HR= 1.04, 95%CI: 1.01–1.07, p=0.003), NYHA class ≥III (HR=1.4, 95%CI: 1.1–2, p=0.02) and LVEF (HR=1.02, 95%CI: 1.01–1.04, p=0.0009). As opposed to what has been reported in patients with organic MR, there is no evidence that MVRp provides any benefit in terms of survival compared to MVR in patients with FMR. These findings suggest that MVRp is not an optimal surgical treatment for FMR and provide an impetus toward the development of new surgical approaches for these patients.

Long-term results of mitral valve repair for nonischaemic mitral regurgitation

1991 ◽  
Vol 12 (suppl B) ◽  
pp. 39-43 ◽  
Author(s):  
P. L. Michel ◽  
B. Iung ◽  
B. Blanchard ◽  
P. Luxereau ◽  
R. Dorent ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Long Term Results ◽  
Valve Repair

Impact of recurrent mitral regurgitation after mitral valve repair for functional mitral regurgitation: long-term analysis of competing outcomes

2019 ◽  
Vol 40 (27) ◽  
pp. 2206-2214 ◽  
Author(s):  
Annelieke H J Petrus ◽  
Olaf M Dekkers ◽  
Laurens F Tops ◽  
Eva Timmer ◽  
Robert J M Klautz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
History Of ◽  
The Impact

Abstract Aims Recurrent mitral regurgitation (MR) has been reported after mitral valve repair for functional MR. However, the impact of recurrent MR on long-term survival remains poorly defined. In the present study, mortality-adjusted recurrent MR rates, the clinical impact of recurrent MR and its determinants were studied in patients after mitral valve repair with revascularization for functional MR in the setting of ischaemic heart disease. Methods and results Long-term clinical and echocardiographic outcome was evaluated in 261 consecutive patients after restrictive mitral annuloplasty and revascularization for moderate to severe functional MR, between 2000 and 2014. The cumulative incidence of recurrent MR ≥ Grade 2, assessed by competing risk analysis, was 9.6 ± 1.8% at 1-year, 20.3 ± 2.5% at 5-year, and 27.6 ± 2.9% at 10-year follow-up. Cumulative survival was 85.8% [95% confidence interval (CI) 81.0–90.0] at 1-year, 67.3% (95% CI 61.1–72.6%) at 5-year, and 46.1% (95% CI 39.4–52.6%) at 10-year follow-up. Age, preoperative New York Heart Association Class III or IV, a history of renal failure, and recurrence of MR expressed as a time-dependent variable [HR 3.28 (1.87–5.75), P < 0.001], were independently associated with an increased mortality risk. Female gender, a history of ST-elevation myocardial infarction, a preoperative QRS duration ≥120 ms, a higher preoperative MR grade, and a higher indexed left ventricular end-systolic volume were independently associated with an increased likelihood of recurrent MR. Conclusion Mitral valve repair for functional ischaemic MR resulted in a low incidence of recurrent MR with favourable clinical outcome up to 10 years after surgery. Presence of recurrent MR at any moment after surgery proved to be independently associated with an increased risk for mortality.

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