Augmenting mitral valve repair evaluation with intraoperative left ventricle pressure measurements

Issa, Hugo; Deng, Mimi; Rahmouni, Kenza; Chan, Vincent

doi:10.1093/icvts/ivac242

Cited by 3 publications

(3 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While valve repair technique is the gold standard in degenerative mitral regurgitation rather than mitral valve replacement, [ 15 ] the Ozaki Procedure which is an aortic repair technique, is likely to become more popular than conventional replacement surgery for aortic valve surgery in the future. Besides, its biggest rival will be transcatheter aortic valve implantation (TAVI).…”

Section: Discussionmentioning

confidence: 99%

Single center two years’ experience of Ozaki procedure: Early follow-up

Ozden,

Ozcelik,

Ozdemir

et al. 2023

Medicine

View full text Add to dashboard Cite

The Ozaki Procedure is an innovative surgical technique aiming of aortic valve neocuspidization using glutaraldehyde-treated autologous pericardium was first developed by Ozaki et al in 2007. With this newly developed technique, valve replacement was achieved without using prosthetic material due to both aortic stenosis and aortic insufficiency. Between December 2020 and December 2022, a total of 59 patients were operated on with the Ozaki Procedure due to aortic valve pathologies in our center. We evaluated the pre- and postoperative as well as the first-month data of a total of 44 patients with isolated the Ozaki Procedure and compared their echocardiographic changes. Patients with isolated aortic valve pathology were included in the study. Fifteen patients who underwent simultaneous coronary artery bypass surgery and Ozaki Procedure were excluded from the analysis. In the first month after the operation, n:2 (%4.5) patients died. When the preoperative and postoperative 1st month echocardiographic data of the remaining patients were compared, it was found that the decrease in mean gradient, max gradient and peak velocity values in the aortic valve was statistically significant. This is due to the fact that reaching neo-valves has very similar hemodynamics to the native aortic valve. Aortic valve neocuspidization by Ozaki Procedure may be a viable alternative to both surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation. Its popularity and application is increasing all over the world. Short and mid-term results are available in the literature. The short and mid-term results are good, and the long-term results are hopeful.

show abstract

Section: Discussionmentioning

confidence: 99%

Single center two years’ experience of Ozaki procedure: Early follow-up

Ozden,

Ozcelik,

Ozdemir

et al. 2023

Medicine

View full text Add to dashboard Cite

show abstract

“…The LV was pressurized through the aortic root to 27 ± 1mm Hg, which is the typical LV pressure level reached during the widely used clinical saline test. 38 The FS was mounted above the MV annulus using the fixture secured to a ring stand (Figure 1E). A 4-mm endoscope (Karl Storz) was inserted into the LV just lateral to the apex for direct visualization of the MV orifice, secured by two purse-string sutures (4-0 prolene, red rubber tourniquet, felt pledgets) (Figure 1E).…”

Section: Methodsmentioning

confidence: 99%

“…Of note, Issa et al report an average LV pressure of 27.6 mm Hg across the MV during intraoperative saline testing for valve competence with a standard deviation of 14.6 mm Hg. 38 Given that the standard deviation is more than 50% of the reported average value, there is a meaningful degree of variability in the reported pressure measurements which may impact our experimental design. However, based on preliminary testing, similar measurement variation and accuracy were observed at different pressurized states (15-65 mm Hg), broadening the FS use to a variety of future applications (eg, transcatheter).…”

Section: Commentmentioning

confidence: 99%

Fiberscope-Based Measurement of Coaptation Height for Intraoperative Assessment of Mitral Valve Repair

Recco,

Kneier,

Earley

et al. 2024

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background Restoring adequate coaptation height is a key principle of mitral valve (MV) repair. This study aimed to evaluate the utility of fiberscope (FS) technology to assess MV coaptation height for intraoperative use. Methods Ex-vivo testing was performed on five adult porcine hearts. The left atrium (LA) was resected, and the left ventricle (LV) was pressurized retrograde to 27 ± 1mm Hg. An endoscope was inserted into the LV apex, centered under the MV orifice. An FS system (Milliscope II camera, LED light source, and 0.7 mm diameter × 15 cm long) 90° semirigid scope with 1.2 mm focal length) was mounted above the MV annulus in a custom alignment and measuring fixture. Three blinded measurements were taken at two locations on each MV, A2 and P2 segment, from the top of coaptation to the leaflet edge identified by the FS. Accurate positioning was verified using the LV endoscope. A control (metal rod of similar thickness) was used for comparison, with coaptation height recorded when the control was seen via the endoscope. Results Coaptation heights were similar for the control and FS methods across all hearts at A2 (11.6 ± 2.6 mm control vs 11.8 ± 2.2 mm FS) and P2 (13.3 ± 2.6 mm control vs 13.4 ± 2.9 mm FS) segments, with similar measurement variability (control SD 0.1-1.0 mm; FS SD 0.1-0.9 mm). One outlier was excluded from analysis (n = 19/20). The maximum absolute difference and percent error between measurement methods were less than 1.1 mm (median [IQR], 0.6 [0.3-0.9] mm) and less than 14% (4.1 [2.2-7.6]%). Conclusions Utilization of a miniaturized FS enabled precise and accurate quantification of MV coaptation. This technique is promising for evaluating post-repair valve competence and coaptation height.

show abstract

Evaluation of Intraoperative Saline Injection Leak Test Without Transesophageal Echocardiography as a Reliable Method During Heart Valve Repair

Heidari,

Akiash,

Moradi

et al. 2024

Jundishapur J Chronic Dis Care

View full text Add to dashboard Cite

Background: Valvular heart diseases (VHD) pose a significant global health challenge, leading to numerous cardiac surgeries. The quality of valve repair is typically assessed using transesophageal echocardiography (TEE) and saline injection tests intraoperatively. However, TEE is not universally available, particularly in resource-limited settings. Objectives: This study aimed to evaluate the effectiveness of saline injection tests as the sole method for assessing cardiac valve repair quality. Methods: This retrospective cohort study included patients who underwent cardiac valve surgery without intraoperative TEE assessment. Preoperative transthoracic echocardiography (TTE) was performed on all patients. A consistent team performed all valve repairs, and the quality of these repairs was assessed intraoperatively using the saline injection test. Postoperative TTE was also conducted to evaluate valve function and compare it with preoperative measurements. Results: The study comprised 16 patients (mean age: 63.8 ± 10.6), predominantly male. Mitral valve (MV) repair was performed on 11 patients, with nine showing improved function (P-value: 0.006). Seven patients underwent tricuspid valve repair (TVr), all of whom exhibited improved function (P-value: 0.01). Four patients received aortic valve repair, with three showing improved function (P-value: 0.10). Additionally, significant improvements were observed in left ventricular end-diastolic diameter (LVEDd), left ventricular end-diastolic volume (LVEDV), inter-ventricular septal diameter, posterior wall thickness (PWT), tricuspid annular plane systolic excursion (TAPSE), right ventricular peak systolic myocardial velocity (RVSm), pulmonary artery pressure, tricuspid regurgitation (TR) gradient, and right atrium area. Conclusions: The saline injection test can be a valuable tool for assessing the quality of mitral and tricuspid valve repairs, particularly when TEE is unavailable. However, its reliability for aortic valve repair remains uncertain.

show abstract

Augmenting mitral valve repair evaluation with intraoperative left ventricle pressure measurements

Cited by 3 publications

References 10 publications

Single center two years’ experience of Ozaki procedure: Early follow-up

Single center two years’ experience of Ozaki procedure: Early follow-up

Fiberscope-Based Measurement of Coaptation Height for Intraoperative Assessment of Mitral Valve Repair

Evaluation of Intraoperative Saline Injection Leak Test Without Transesophageal Echocardiography as a Reliable Method During Heart Valve Repair

Contact Info

Product

Resources

About