Clinical and echocardiographic outcomes after repair of mitral valve bileaflet prolapse due to myxomatous disease

Chan, Vincent; Ruel, Marc; Chaudry, S.; Lambert, Stéphane; Mesana, Thierry G.

doi:10.1016/j.jtcvs.2012.01.046

Cited by 22 publications

(13 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study involves surgeons and centres familiar with mitral valve reconstruction, thereby minimising the risk to the patient. 6 Also, randomisation will be performed only after the operating surgeon has deemed that successful valve repair can be performed using either leaflet resection or leaflet preservation techniques. In this study, patients will be subjected to several postoperative echocardiographic assessments, which goes beyond the structure of follow-up typically performed at most operating centres.…”

Section: Ethics and Disseminationmentioning

confidence: 99%

“… 4–13 The mitral valve is generally repaired with two techniques involving either leaflet resection or leaflet preservation using artificial neochordae ( figure 1 ). 8–13 Importantly, the decision to employ either surgical strategy is largely based on surgeon preference, 14 and data describing outcomes following mitral repair using either strategy have focused primarily on the development of recurrent MR. 6–13 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Randomised trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis (The CAMRA CardioLink-2 Trial)

Chan¹,

Chu

Leong‐Poi³

et al. 2017

BMJ Open

Self Cite

View full text Add to dashboard Cite

BackgroundThe gold-standard treatment of severe mitral regurgitation (MR) due to degenerative disease is valve repair, which is surgically performed with either a leaflet resection or leaflet preservation approach. Recent data suggest that functional mitral stenosis (MS) may occur following valve repair using a leaflet resection strategy, which adversely affects patient prognosis. A randomised comparison of these two approaches to mitral repair on functional MS has not been conducted.Methods and analysisThis is a prospective, multicentre randomised controlled trial designed to test the hypothesis that leaflet preservation leads to better preservation of mitral valve geometry, and therefore, will be superior to leaflet resection for the primary outcome of functional MS as assessed by 12-month mean mitral valve gradient at peak exercise. Eighty-eight patients with posterior leaflet prolapse will be randomised intraoperatively once deemed by the operating surgeon to feasibly undergo mitral repair using either a leaflet resection or leaflet preservation approach. Secondary end points include comparison of repair strategies with regard to mitral valve orifice area, leaflet coaptation height, 6 min walk test and a composite major adverse event end point consisting of recurrent MR ≥2+, death or hospital readmission for congestive heart failure within 12 months of surgery.Ethics and disseminationInstitutional ethics approval has been obtained from all enrolling sites. Overall, there remains clinical equipoise regarding the mitral valve repair strategy that is associated with the least likelihood of functional MS. This trial hopes to introduce high-quality evidence to help surgical decision making in this context.Trial registration numberNCT02552771.

show abstract

Section: Ethics and Disseminationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Randomised trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis (The CAMRA CardioLink-2 Trial)

Chan¹,

Chu

Leong‐Poi³

et al. 2017

BMJ Open

Self Cite

View full text Add to dashboard Cite

show abstract

“…1 Although various techniques for mitral valve repair have been well described, 2,3 valve repair in this population typically involves leaflet resection, annulus plication, and annuloplasty. 4,5 These surgical maneuvers may theoretically result in some degree of narrowing of the mitral valve orifice.…”

mentioning

confidence: 99%

Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: Potential affect on surgical strategy

Mesana

Lam

Chan

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, some patients still develop recurrent mitral regurgitation (MR) after successful MV repair during the long-term follow-up period. A few studies have focused on late outcomes and mechanisms of failure associated with MV repair of bileaflet lesions requiring multiple reconstructive techniques [13, 14]. The objective of this study was to elucidate the mid-term outcomes and mechanisms of recurrent MR after MV repair of bileaflet lesions.…”

Section: Introductionmentioning

confidence: 99%

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

Kaneyuki

Nakajima

Asakura

et al. 2019

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundGood 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.MethodsFifty-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.ResultsAdditional 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%.ConclusionsSeventeen 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.

show abstract

Clinical and echocardiographic outcomes after repair of mitral valve bileaflet prolapse due to myxomatous disease

Abstract: MV repair of bileaflet prolapse due to myxomatous disease is safe and durable. Successful repair often requires a combination of surgical repair techniques.

Cited by 22 publications

References 10 publications

Randomised trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis (The CAMRA CardioLink-2 Trial)

Randomised trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis (The CAMRA CardioLink-2 Trial)

Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: Potential affect on surgical strategy

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

Contact Info

Product

Resources

About