Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation?

OBJECTIVES: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the mid-term follow-up period, to evaluate the clinical utility of simultaneous mitral valve repair (MVR). METHODS: From June 2005 to March 2014, 60 patients with VSD and MR underwent surgical treatment. After performing propensity score analysis (1:1) for the entire sample, 46 patients were selected and divided into 2 groups: those with VSD closure and MVR - 23 patients and those with VSD closure without mitral valve intervention - 23 patients. The follow-up period - 32 (28;40) months. RESULTS: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups. Mean cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the 'VSD + MVR' group (cardiopulmonary bypass, P=0.023; aortic cross-clamp, P< 0.001). There was no significant difference in regurgitation area (P=0.30) and MR grade (P= 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, P= 0.28). The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period ( P=0.037). CONCLUSIONS: In infants with VSD combined with MR, simultaneous MVR has no benefits simultaneous MVR provided no advantage over that of isolated VSD closure. We found that the presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.

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Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation?

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx231 ◽

2017 ◽

Vol 26 (1) ◽

pp. 106-111 ◽

Cited By ~ 2

Author(s):

Yuriy Y Kulyabin ◽

Ilya A Soynov ◽

Alexey V Zubritskiy ◽

Alexey V Voitov ◽

Nataliya R Nichay ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Ventricular Septal Defect ◽

Mitral Valve Repair ◽

Septal Defect ◽

Valve Repair

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Mitral Valve Repair for Mitral Regurgitation With Ventricular Septal Defect in Children

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(96)00637-6 ◽

1996 ◽

Vol 62 (6) ◽

pp. 1773-1777 ◽

Cited By ~ 18

Author(s):

Kouichi Hisatomi ◽

Tadashi Isomura ◽

Tohru Sato ◽

Kenichi Kosuga ◽

Kiroku Ohishi ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Ventricular Septal Defect ◽

Mitral Valve Repair ◽

Septal Defect ◽

Valve Repair

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Mitral Valve Repair in Infants with Ventricular Septal Defect Combined with Mitral Regurgitation

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1627956 ◽

2018 ◽

Vol 66 (S 01) ◽

pp. S1-S110

Author(s):

Y. Kulyabin ◽

Y. Gorbatykh ◽

I. Soynov ◽

A. Zubritskiy ◽

A. Bogachev-Prokophiev

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Ventricular Septal Defect ◽

Mitral Valve Repair ◽

Septal Defect ◽

Valve Repair

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The Impact of Aorto-mitral Angle on New Onset Atrial Arrhythmia after Mitral Valve Repair in Patients with Mitral Regurgitation

10.22541/au.161322131.18603327/v1 ◽

2021 ◽

Author(s):

Shunsuke Kagawa ◽

Yukio Abe ◽

Yoshiki Matsumura ◽

Nanaka Nomura ◽

Kenji Shimeno ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Odds Ratio ◽

Atrial Arrhythmia ◽

Valve Repair ◽

Mitral Annuloplasty ◽

New Onset

Background: We hypothesized that the post-operative aorto-mitral angle might relate to the occurrence of post-operative atrial arrhythmia (AA), including atrial fibrillation and atrial tachycardia, after mitral valve repair in patients with mitral regurgitation (MR). The purpose of the present study was to determine the effects of the post-operative aorto-mitral angle on new onset AA after mitral valve repair with mitral annuloplasty for treating MR. Methods: One-hundred seventy-two patients without any history of AA underwent mitral valve repair with mitral annuloplasty in our institution between 2008 and 2017. Patient information, including medical records and echocardiographic data, were retrospectively studied. Results: AA occurred in 15 (8.7%) patients during the follow-up period (median, 35.7 months; range, 0.5-132 months). The patients with AA had a longer cardiopulmonary bypass time and a smaller aorto-mitral angle at post-operative TTE than the others (119 ± 6 degrees vs. 125 ± 10 degrees, P = 0.003). There was no significant difference in the degree of post-operative residual MR or functional MS between the groups. In a multivariate Cox proportional hazards analysis, the longer cardiopulmonary bypass time and the smaller post-operative aorto-mitral angle were independent predictors of the occurrence of AA during the follow-up period (odds ratio per 10 minutes 1.11; 95% CI 1.02-1.22, P = 0.019: odds ratio 0.91; 95% CI 0.85-0.98, P = 0.012). Conclusion: A small aorto-mitral angle at post-operative TTE was a predictor of new onset AA after a mitral valve repair for treating MR.

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Incidence and clinical relevance of persistent iatrogenic atrial septal defect after percutaneous mitral valve repair

Scientific Reports ◽

10.1038/s41598-021-92255-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mhd Nawar Alachkar ◽

Anas Alnaimi ◽

Sebastain Reith ◽

Ertunc Altiok ◽

Jörg Schröder ◽

...

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Atrial Septal Defect ◽

Mitral Valve Repair ◽

Septal Defect ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair ◽

Significant Difference ◽

Iatrogenic Atrial Septal Defect

AbstractPercutaneous mitral valve repair (PMVR) requires transseptal puncture and results in iatrogenic atrial septal defect (iASD). The impact of persistent iASD was previously investigated. However, data were diverse and inconclusive. 53 patients who underwent MITRACLIP were retrospectively included. Based on the presence of iASD in transesophageal echocardiography (TEE) after 6 months, patients were divided in two groups (iASD group vs. non-iASD group). Impact of iASD on outcome at 6 months and at two years was evaluated. Persistent iASD was detected in 62% of patients. Independent predictors for persistent iASD were female gender and reduced left ventricular ejection fraction. At 6-month follow-up, there was no difference in reduction of NYHA class (ΔNYHA = 1.3 ± 1 in iASD group vs. 0.9 ± 1 in non-iASD group, p = 0.171). There was a significant difference in right ventricular end diastolic diameter (RVEDd) (42 ± 8 mm in iASD-group vs. 39 ± 4 mm in non-iASD group, p = 0.047). However, right ventricular systolic function (TAPSE) (14 ± 7 mm in iASD group vs. 16 ± 8 mm in non-iASD group, p = 0.176) and right ventricular systolic pressure (RVSP) (40 ± 12 mmHg in iASD group vs. 35 ± 10 mmHg in non-iASD group, p = 0.136) were still comparable between both groups. At 2 years follow-up, there was no significant difference regarding rate of rehospitalization (24% vs 15%, p = 0.425) or mortality (12% vs 10%, p = 0.941) between both groups. Incidence of persistent iASD after MITRACLIP is markedly high. Despite the increase in right ventricular diameter in patients with persistent iASD, these patients were not clinically compromised compared to patients without persistent iASD.

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Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

European Heart Journal ◽

10.1093/ehjci/ehaa946.2636 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Benito Gonzalez ◽

X Freixa ◽

C Godino ◽

M Taramasso ◽

R Estevez-Loureiro ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

One Year ◽

The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

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Early and Mid-term Results of Mitral Valve Repair in Patients with Degenerative Mitral Regurgitation

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m133 ◽

2021 ◽

Author(s):

Hasan Erdem ◽

Emre Selçuk

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Survival Rates ◽

Mitral Valve Regurgitation ◽

Valve Repair ◽

Repair Rate ◽

Mitral Repair ◽

Mid Term Results

Objectives: In this study, we present the mid-term results of patients who underwent valve repair due to degenerative mitral valve regurgitation in the first five years of our mitral valve repair program. Patients and Methods: In this retrospective study, all patients who were operated for degenerative mitral regurgitation by a single surgical team between 2013 and 2017 were investigated. We determined early and mid-term cumulative survival rates, repair failure and freedom from reoperation. In addition, as a specific subgroup, the results of patients under 18 years of age after mitral valve repair were investigated Results: Mitral repair was performed in 121 of 153 degenerative mitral regurgitation patients during the study period. The overall repair rate was 79%. Mitral valve repair rate increased significantly over years. The Median follow-up time was 63 (range 10-92) months. Early mortality was 2.5% (n=3 patients). During the follow-up period, moderate-to-severe mitral regurgitation was observed in 14 (11.8%) patients, mitral valve reoperation was required in 7 (5.9%) patients. Valve repair was performed in 4 of 7 patients under the age of 18. There was no pediatric case requiring reoperation during the follow-up period (median 46 months). Conclusion: Mid-term results of mitral valve repair in degenerative mitral valve patients are satisfactory. The success rate of repair increases in line with surgical experience.

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Residual mitral regurgitation impact on outcomes after mitraclip therapy: five-year follow-up from the GRASP registry

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.220 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

AM Caggegi ◽

P Capranzano ◽

S Scandura ◽

S Mangiafico ◽

G Castania ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Primary Endpoint ◽

Left Ventricular ◽

Valve Repair ◽

Surgical Risk ◽

High Surgical Risk ◽

Mitraclip Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background – Although percutaneous mitral valve repair is an attractive alternative treatment option for patients with severe mitral regurgitation (MR) at high surgical risk, residual MR is commonly observed after the procedure and little is known about its impact on outcomes after MitraClip therapy, expecially in patients with severe left ventricular (LV) impairment. Purpose – The aim of this prospective, observational study was to evaluate the impact of residual MR (MR ≤1+ vs. MR >1+) on long-term outcomes of mitral valve repair with the MitraClip System in high surgical risk patients presenting with moderate-to-severe or severe MR and with severe reduction of LV ejection fraction (EF). Methods – Patients enrolled in the prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) with functional MR and EF ≤30% who were eligible at almost five-year follow-up were included in the present analysis. The primary endpoint was death at 5-year follow-up. Also echocardiographic parameters at baseline and 5-year follow-up and rehospitalization rates were assessed. Results – A total of 139 patients were included: 92 (66.2%) with post-procedural residual MR ≤1+ and 47 (33.8%) with residual MR > 1+ (41 patients with residual MR 2+, 5 with residual MR 3+, 1 with residual MR 4+). Comparable clinical and echocardiographic baseline characteristics were observed between the two groups except for NYHA functional class IV and implanted pace-maker (more frequent in patients with residual MR >1+) and previous myocardial infarction (more frequent in patients with residual MR ≤1+). At 5-year follow-up, no significant differences were reported in the primary endpoint (49.6% in patients with residual MR ≤ 1+ vs. 65.3% in patients with residual MR > 1+, p 0.203) and in cardiac death (37.8% in patients with residual MR ≤ 1+ vs. 42.6% in patients with residual MR > 1+, p 0.921). Cox regression analysis identified residual MR > 1+ as an independent predictor of re-hospitalization (HR 0.51, 95% CI 0.28-0.92, p =0.026). At 5-year follow-up, a significant reduction in left ventricular end-systolic volume was observed in patients with residual MR ≤ 1+. Conclusions – At 5-year follow no significant differences in survival emerged in patients with severe LV dysfunction undergoing MitraClip therapy regardless residual MR. Nevertheless residual MR > 1+ emerged as an indipendent predictor of re-hospitalization.

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Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-1035-3 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Daisuke Kaneyuki ◽

Hiroyuki Nakajima ◽

Toshihisa Asakura ◽

Akihiro Yoshitake ◽

Chiho Tokunaga ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Late Phase ◽

Severe Mitral Regurgitation ◽

Valve Repair ◽

Sequential Approach ◽

Posterior Mitral Leaflet ◽

Quadrangular Resection

Abstract Background Good mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions. Methods Fifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011–2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively. Results Additional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%. Conclusions Seventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.

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Idiopathic Acute Mitral Regurgitation Due to Chordal Rupture in Infants: Surgical Management and Results

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118809076 ◽

2019 ◽

Vol 10 (1) ◽

pp. 37-41

Author(s):

Kosuke Yoshizawa ◽

Keiichi Fujiwara ◽

Nobuhisa Ohno ◽

Kentaro Watanabe ◽

Hisanori Sakazaki

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Surgical Intervention ◽

Valve Repair ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Acute Mitral Regurgitation ◽

Artificial Chordae

Objective: Emergency surgical treatment is required for idiopathic acute mitral regurgitation due to chordae rupture in infants. Nevertheless, mitral valve repair for such a patient population still remains challenging. We report our experience with mitral valve repair for idiopathic acute mitral regurgitation due to chordae rupture in infants. Methods: From 2005 to 2017, six infants (four boys) were diagnosed with acute mitral regurgitation due to chordae rupture and underwent mitral valve repair. The median age, mean body weight, and median follow-up period were 5.5 months (range: 4-9 months), 6.8 kg (range: 5.5-8.0 kg), and 6.4 years (range: 6 months to 10 years), respectively. Results: In all cases, surgical intervention was performed within 24 hours of admission. Artificial chordae reconstruction and paracommissural edge-to-edge repair were utilized in three and four cases, respectively, while Kay’s annuloplasty was performed in all cases. Mean cardiopulmonary bypass time and aortic cross-clamp time were 117 minutes (range: 70-143 minutes) and 73 minutes (range: 35-108 minutes), respectively. No early or late deaths and reoperations had occurred during the follow-up period. Moreover, postoperative mitral regurgitation was significantly reduced, while no chronologic progression of mitral regurgitation was observed. Conclusions: The combination of various techniques, such as artificial chordae reconstruction, paracomissural edge-to-edge repair, and Kay’s annuloplasty, can be a promising surgical option for idiopathic acute mitral regurgitation due to chordae rupture in infants.

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