Mitral Valve Repair with Artificial Chordae for Posterior Leaflet Disease
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Background: Recently, the concept of “Respect rather than resect” has been proposed in an attempt to restore mitral valve function. We investigated the results of mitral valve repair for posterior leaflet disease. Methods: Between April 2008 and July 2017, mitral valve repair was performed in 78 cases at our facility. Among them, 37 cases were analyzed. We divided patients into three groups according to the repair techniques used: artificial chordae technique, which uses the anchoring-technique and measured tube technique (Group A, 23 cases), resection and suture technique (Group R, 10 cases), and artificial chordae together with resection and suture technique (Group AR, 4 cases), and compared their postoperative outcomes. Results: Residual postoperative mitral regurgitation (MR) grade in groups A, R and AR at discharge were 0.3 ± 0.4, 0.8 ± 0.9 and 0.0 ± 0.0 (p = 0.07), respectively. Mitral valve areas (cm2) in groups A, R and AR were 3.2 ± 0.6, 2.9 ± 0.6 and 3.0 ± 0.6 (p = 0.47), respectively. Freedom from severe MR at 5 years postoperatively was seen in 91.7%, 90% and 100% (p = 0.92) in groups A, R and AR, respectively. Conclusions: There was no significant difference in postoperative outcomes, as assessed echocardiographically, between the artificial chordae technique and resection and suture technique. The results of all repair techniques were satisfactory.Keywords:
Functional mitral regurgitation
Functional mitral regurgitation
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Ischemic Cardiomyopathy
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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.
Cardiothoracic surgery
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Functional mitral regurgitation
Chordae tendineae
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Functional mitral regurgitation
Dilated Cardiomyopathy
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Functional mitral regurgitation
Mitral valve annuloplasty
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Mitral valve replacement
Concomitant
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•Primary mitral regurgitation (MR) is commonly due to mitral valve (MV) prolapse.•Off-pump minimally invasive MV repair is an alternative to conventional MV surgery.•This case describes MV repair using the Harpoon TSD-5 device.•The technique facilitates image-guided minimally invasive repair.•Early data suggest the Harpoon procedure is safe and durable and reduces morbidity.
Mitral valve prolapse
Mitral valve regurgitation
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Background Commonly used complete mitral annuloplastic rings include saddle-shaped and semirigid rings, with no clear indication for either type. A semirigid ring may be preferred in patients whose native mitral saddle shape is well maintained. We present our experience of using semirigid rings for mitral valve repair. Methods We routinely measured the annular height-to-commissural width ratio by 3-dimensional transesophageal echocardiography prior to mitral repair. We generally chose a semirigid (Memo 3D) ring in patients whose annular height-to-commissural width ratio was normal (≥ 15%). The same semirigid ring with an additional chordal guiding system (Memo 3D ReChord) was selected for patients with anterior leaflet or bileaflet pathology. Over an 18-month period, 66 patients with severe degenerative ( n = 60) or functional ( n = 6) mitral regurgitation had Memo 3D ( n = 32) or Memo 3D ReChord ( n = 34) rings implanted. Results Postoperative 3-dimensional transesophageal echocardiography was completed in all patients (mean follow-up 7 ± 5 months). The majority of patients had no or mild residual mitral regurgitation; only two had moderate (2+) mitral regurgitation. There was no mortality at 30-days or on midterm follow-up. Conclusions Our series represents the first Asian clinical experience using the Memo 3D ReChord ring. Although the long-term durability of mitral repair with this type of semirigid annuloplastic ring warrants further validation, our current clinical data are encouraging.
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Single Center
Mitral valve replacement
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