Improved owner quality of life following surgical repair of canine myxomatous mitral valve disease
1
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Abstract OBJECTIVE To determine quality-of-life changes in owners of dogs undergoing mitral valve repair for myxomatous mitral valve disease, up to 12 months postoperatively. SAMPLE Owners of 26 dogs undergoing mitral valve repair at a single UK veterinary referral hospital. METHODS Dogs underwent mitral valve repair under cardiopulmonary bypass as previously described. Owner quality of life was assessed by self-completion of a previously validated questionnaire preoperatively and at 1, 3, 6, and 12 months postoperatively. RESULTS There was a statistically significant improvement in quality-of-life scores from preoperatively up to 3 months postoperatively and a statistically significant improvement in individual question scores up to 6 months postoperatively. CLINICAL RELEVANCE Results suggested that owner quality of life is significantly improved following surgical repair of their pet’s myxomatous mitral valve disease, and this improvement continues beyond the immediate postoperative period. These results may be useful when counseling owners of surgical candidates and is another useful outcome measure.Given the increasing age of the US population and the accompanying rise in cardiovascular disease, we expect to see an increasing number of patients affected by degenerative mitral valve disease in a more complex patient population. Therefore, increasing the overall rate of mitral valve repair will become even more important than it is today, and the capability to provide a universally and uniformly accepted quality of repair will have important medical, economic, and societal implications. This article will describe preoperative and intraoperative considerations and the currently practiced mitral valve repair approaches and techniques. The aim of the article is to present our contemporary approach to mitral valve repair in the hope that it can be adopted at other institutions that may have low repair rates. Adoption of simple and reproducible mitral valve repair techniques is of paramount importance if we as a profession are to accomplish overall higher rates of mitral valve repair with optimal outcomes.
Cite
Citations (17)
Central MessageThe history of mitral repair is reviewed and mitral folding plasty variations are described.See Article page 68.To perform an adequate mitral valve repair, a surgeon must not only be experienced but also he or she needs to know all concepts of mitral valve repair techniques. This allows the surgeon to use the perfect technique for each type of mitral valve pathology. Carpentier and colleagues1Carpentier A. Adams D.H. Filsoufi F. Carpentier's Reconstructive Valve Surgery.1st ed. Saunders, Philadelphia2010Google Scholar developed a collection of maneuvers that allows for the achievement of mitral valve repair of most degenerative mitral diseases. Some procedures are simple and are more commonly used, such as quadrangular resection, and others are more complex. Among the initial mitral valve repair techniques, McGoon,2McGoon D.C. Repair of mitral insufficiency due to ruptured chordae tendineae.J Thorac Cardiovasc Surg. 1960; 39: 357-362Abstract Full Text PDF Google Scholar more than 6 decades ago, utilized a folding technique for the prolapsed segment of the posterior mitral valve leaflet (folding plasty) as a method of repair the mitral valve.2McGoon D.C. Repair of mitral insufficiency due to ruptured chordae tendineae.J Thorac Cardiovasc Surg. 1960; 39: 357-362Abstract Full Text PDF Google Scholar The simplicity of the procedure, reversibility of the initial folding plasty, if not perfect, and shortened operative times, made this a popular technique at that time. Since then, resectional techniques, with the introduction of neochordae, have greatly improved surgical repair techniques. For the most part, the McGoon folding plasty is of historical value, although there may be some situations in which it might be useful. Reasons for the difficulty in repair may be due to poor visibility/access using so-called minimally invasive techniques, and should not be a reason to compromise the repair in place of more advanced techniques. Tabata and colleagues3Tabata M. Yanagisawa H. Nonresectional folding repair techniques for posterior leaflet lesions in degenerative mitral regurgitation.J Thorac Cardiovasc Surg Tech. 2021; 10: 68-73Scopus (1) Google Scholar describe in detail a variety of folding plasty techniques that the authors have utilized in the surgical treatment of posterior leaflet prolapse, reporting excellent results. Although this procedure was utilized for many years, long-term follow-up is lacking. Concern remains about bulky posterior leaflet after a folding plasty repair that may change the characteristics of the mitral valve, leading to problems in the long-term.What is the value of this article? It is primarily a review of folding plasty techniques. To that end, it is excellent reading for those interested in the history of mitral repair. For surgeons with experience, in centers with a large volume of mitral surgery, it is likely that this article will not change their practice. However, in difficult cases, it remains an option, especially for surgeons who perform few valve repairs per year in their limited valve practice. The history of mitral repair is reviewed and mitral folding plasty variations are described. The history of mitral repair is reviewed and mitral folding plasty variations are described. See Article page 68. See Article page 68. To perform an adequate mitral valve repair, a surgeon must not only be experienced but also he or she needs to know all concepts of mitral valve repair techniques. This allows the surgeon to use the perfect technique for each type of mitral valve pathology. Carpentier and colleagues1Carpentier A. Adams D.H. Filsoufi F. Carpentier's Reconstructive Valve Surgery.1st ed. Saunders, Philadelphia2010Google Scholar developed a collection of maneuvers that allows for the achievement of mitral valve repair of most degenerative mitral diseases. Some procedures are simple and are more commonly used, such as quadrangular resection, and others are more complex. Among the initial mitral valve repair techniques, McGoon,2McGoon D.C. Repair of mitral insufficiency due to ruptured chordae tendineae.J Thorac Cardiovasc Surg. 1960; 39: 357-362Abstract Full Text PDF Google Scholar more than 6 decades ago, utilized a folding technique for the prolapsed segment of the posterior mitral valve leaflet (folding plasty) as a method of repair the mitral valve.2McGoon D.C. Repair of mitral insufficiency due to ruptured chordae tendineae.J Thorac Cardiovasc Surg. 1960; 39: 357-362Abstract Full Text PDF Google Scholar The simplicity of the procedure, reversibility of the initial folding plasty, if not perfect, and shortened operative times, made this a popular technique at that time. Since then, resectional techniques, with the introduction of neochordae, have greatly improved surgical repair techniques. For the most part, the McGoon folding plasty is of historical value, although there may be some situations in which it might be useful. Reasons for the difficulty in repair may be due to poor visibility/access using so-called minimally invasive techniques, and should not be a reason to compromise the repair in place of more advanced techniques. Tabata and colleagues3Tabata M. Yanagisawa H. Nonresectional folding repair techniques for posterior leaflet lesions in degenerative mitral regurgitation.J Thorac Cardiovasc Surg Tech. 2021; 10: 68-73Scopus (1) Google Scholar describe in detail a variety of folding plasty techniques that the authors have utilized in the surgical treatment of posterior leaflet prolapse, reporting excellent results. Although this procedure was utilized for many years, long-term follow-up is lacking. Concern remains about bulky posterior leaflet after a folding plasty repair that may change the characteristics of the mitral valve, leading to problems in the long-term. What is the value of this article? It is primarily a review of folding plasty techniques. To that end, it is excellent reading for those interested in the history of mitral repair. For surgeons with experience, in centers with a large volume of mitral surgery, it is likely that this article will not change their practice. However, in difficult cases, it remains an option, especially for surgeons who perform few valve repairs per year in their limited valve practice. Nonresectional folding repair techniques for posterior leaflet lesions in degenerative mitral regurgitationJTCVS TechniquesVol. 10PreviewSurgical mitral valve repair is a gold standard treatment for severe degenerative mitral regurgitation (MR). Leaflet prolapse, excess leaflet width, excess leaflet height, annular geometry, or a combination of these factors must be corrected during degenerative MR repair. The standard approaches for excess leaflet tissue are resectional repair techniques, such as triangular/quadrangular resection and sliding valvuloplasty, and those for leaflet prolapse are leaflet resection and chordal replacement. Full-Text PDF Open Access
Chordae tendineae
Mitral valve prolapse
Mitral incompetence
Cite
Citations (0)
Mitral valve repair has become the procedure of choice for most diseases of the mitral valve as it preserves both the valvular and subvalvular apparatus. In contrast to mitral valve replacement surgery, patients undergoing mitral valve repair have lower in-hospital mortality and length of stay and improved long-term survival.Several factors have contributed to the evolution of new techniques for mitral valvuloplasty, including changing patient demographics and increased use of intraoperative transesophageal echocardiography (IOE).1-3 Demographically, there are fewer patients with rheumatic disease and more patients with mitral valve disorders that are amenable to repair, such as primary mitral valve degenerative disease or mitral regurgitation (MR} resulting from coronary artery disease. Concurrently, improved diagnostics by physicians skilled in using IOE have increased the potential candidates for mitral valve repair-for example, patients whose mitral valve disease can be diagnosed at the time of coronary artery bypass surgery. Information derived from IOE data can help determine the cause and severity of the mitral valve disease, assess the feasibility of performing a repair, and determine the success of the repair or if further intervention is needed. Medical causes of postoperative MR (systolic anterior motion of the anterior mitral leaflet or the chordae) must be ruled out in advance.4-6
Mitral valvuloplasty
Mitral valve annuloplasty
Mitral valve replacement
Cite
Citations (0)
Cite
Citations (0)
Mitral valve repair has become the procedure of choice for most diseases of the mitral valve as it preserves both the valvular and subvalvular apparatus. In contrast to mitral valve replacement surgery, patients undergoing mitral valve repair have lower in-hospital mortality and length of stay and improved long-term survival.Several factors have contributed to the evolution of new techniques for mitral valvuloplasty, including changing patient demographics and increased use of intraoperative transesophageal echocardiography (IOE).1-3 Demographically, there are fewer patients with rheumatic disease and more patients with mitral valve disorders that are amenable to repair, such as primary mitral valve degenerative disease or mitral regurgitation (MR} resulting from coronary artery disease. Concurrently, improved diagnostics by physicians skilled in using IOE have increased the potential candidates for mitral valve repair-for example, patients whose mitral valve disease can be diagnosed at the time of coronary artery bypass surgery. Information derived from IOE data can help determine the cause and severity of the mitral valve disease, assess the feasibility of performing a repair, and determine the success of the repair or if further intervention is needed. Medical causes of postoperative MR (systolic anterior motion of the anterior mitral leaflet or the chordae) must be ruled out in advance.4-6
Mitral valve replacement
Mitral valve annuloplasty
Mitral valvuloplasty
Cite
Citations (0)
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.
Functional mitral regurgitation
Cite
Citations (0)
Confusion
Cite
Citations (0)
Mitral valve annuloplasty
Single Center
Median sternotomy
Mitral valve replacement
Cite
Citations (184)
Patients with severe mitral valve regurgitation secondary to degenerative disease are known to benefit from mitral valve repair surgery. Novel techniques for achieving mitral valve repair on the beating heart have been developed and are being introduced into clinical practice. The HARPOON Beating Heart Mitral Valve Repair System (MVRS) in recent studies has demonstrated efficacy and safety for the repair of degenerative mitral valve disease on the beating heart. The device uses transoesophageal echocardiographic guidance to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on prolapsed mitral valve leaflets in the beating heart. It requires general anaesthesia and there are specific intensive care and anaesthesia considerations for the safe management of these cases. This article describes the general principles of intensive care and anaesthesia management employed for the initial patients treated with the HARPOON Beating Heart MVRS, the outcomes for these patients, and the potential challenges for the future management of these cases.
Cite
Citations (2)
Mitral valve annuloplasty
Mitral valve replacement
Cite
Citations (0)