Every day mitral valve reconstruction: What has changed over the last 15 years?

Abstract

Objective Mitral valve reconstruction (MVR) is one of the cardiosurgical procedures which cannot be substituted by any intervention owing to the quality of the quasi-anatomical, physiological repair. However, technique and strategies have changed over the years. We looked at procedural characteristics and outcome in an all-comer, non-selected cohort of patients. Methods 738 out of 1.977 patients were retrospectively analyzed receiving MVR with and without concomitant procedures. The cohort was divided into three periods. P1: 2004–2009 (134 pts.); P2: 2010–2014 (294 pts.), and P3: 2015–2019 (310 pts.). Results Early mortality increased from P1 to P2 and decreased from P2 to P3 (9% P1, 13% P2, 10% P3). All patients received an annuloplasty-ring. In P1 resection measures dominated. In P3 artificial chordae were dominant. Age, BMI, and risk scores correlated with early mortality. Survival rates were 66% (5-years), 55% (10-years), 44% (15-years) in P1, 63% (5-years), 50% (10-years) in P2, and 80% (5-years) in P3. Odds ratio for reduced long-term survival were concomitant venous only bypass surgery (10-years 2,701, p = 0.026). 10-year survival was positively influenced by isolated MVR (0.246, p = 0.001), concomitant isolated arterial bypass (IMA) (0.153, p = 0.051), posterior leaflet measure (0.178, p<0.001), and use of artificial chordae (5-years 0.235, p<0.001). Conclusion Indication for ring implantation remained mandatory while preference changed alongside improved designs. Procedural characteristics changed from mainly resection maneuvers to predominant use of artificial chordae. Long-term results were negatively influenced by co-morbidities and positively influenced by posterior leaflet repair and artificial chordae. MVR underwent a qualitative evolution and remains a valuable cardiosurgical procedure.

Simple and Safe: Inverse Plication of the Posterior Mitral Leaflet in Everyday Mitral Valve Reconstruction with and without Concomitant Procedures

“…In a previous study, we looked at all aspects of mitral valve repair, such as ring annuloplasties (N = 738), Wooler plastic (N = 36), NeoChord implantation (N = 168), resections on AML and PML (N = 125), patch plastic on AML and PML (N = 10), plications on both, AML and PML (N = 124) and cleft closures between 2004 and 2019. This study analyzed the evolution of mitral valve reconstruction procedures over time [ 7 ]. For the purpose of a proper comparison of quadrangular resection with inverse plication, the present study compares the outcome of “inverse plication of PML” with quadrangular resection of the PML only.…”

Longitudinal Outcomes Following Surgical Repair of Primary Mitral Regurgitation

“…Surgical mitral valve repair is the gold standard therapy for treating primary MR [ 1 , 3 , 4 , 5 , 6 , 7 ]. Refinement in techniques, in conjunction with standard annuloplasty, have led to excellent outcomes [ 8 ]. Long-term results are often reported as freedom from reoperation, which may lead to an underestimation of recurrent MR as surgery may be deferred in selected patients [ 8 , 9 , 10 ].…”

“…Refinement in techniques, in conjunction with standard annuloplasty, have led to excellent outcomes [ 8 ]. Long-term results are often reported as freedom from reoperation, which may lead to an underestimation of recurrent MR as surgery may be deferred in selected patients [ 8 , 9 , 10 ]. Few studies and centers have reported long-term outcomes following the repair of degenerative MR. Longitudinal assessment requires a dedicated infrastructure and intentional data collection.…”