Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

Mori, Mika; Yoshimuta, Tsuyoshi; Ohira, Miho; Yagi, Mariko; Sakata, Kenji; Konno, Tetsuo; Kawashiri, Masa‐aki; Tomita, Shigeyuki; Watanabe, Go; Iino, Kenji; Takemura, Hirofumi; Yamagishi, Masakazu; Hayashi, Kenshi

doi:10.1007/s12574-015-0255-3

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…Non-ischaemic included degenerative, functional, rheumatic, infectious and congenital mitral regurgitation. In the mitral cohort, 2 studies included ischaemic patients [ 19 , 28 ] while 12 studies included non-ischaemic patients [ 7 , 8 , 10 , 12 , 13 , 18 , 21–27 ]. The ischaemic group consisted of 179 patients reporting a dehiscence rate of 3.91% while the non-ischaemic group consisted of 4155 patients reporting a dehiscence rate of 1.64%, a significant difference between the 2 groups was found ( P = 0.022).…”

Section: Resultsmentioning

confidence: 99%

Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Rad

Naruka

Vardanyan

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.

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Section: Resultsmentioning

confidence: 99%

Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Rad

Naruka

Vardanyan

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…Three-dimensional TEE is highly effective for observing the mitral complex structure [17]. Since Barlow's disease is characterized by multiple prolapse sites, the repair plan differs from that used for local prolapse, and various mitral valve repair techniques have been proposed [18][19][20][21][22][23]. No previous studies have used TEE to predict the annuloplasty ring size and artificial chordae length during robotic, beating heart surgery for Barlow's disease.…”

Section: Discussionmentioning

confidence: 99%

Transesophageal echocardiography in robot-assisted mitral valve repair for Barlow’s disease: usefulness for predicting artificial ring size and artificial chordae length using the loop technique

et al. 2020

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Background: There is no fully recommended methodology for surgery for Barlow's disease. Various methods have been proposed. The aim of this study was to investigate the effectiveness of transesophageal echocardiography (TEE) measurements for selecting the optimal annuloplasty ring size and determining the length of artificial chordae in patients with Barlow's disease who underwent robot-assisted mitral valvuloplasty (R-MVP). Methods: Ten patients were included. Before R-MVP, the anesthesiologist used TEE to predict the optimal annuloplasty ring size and artificial chordae lengths that would reduce mitral regurgitation. The anesthesiolosist's predict ring size was not presented to the surgeon intraoperatively. Results: In 70% (7/10) of cases, the surgeon performed mitral valve repair in full match with the anesthesiologist's repair plan. Mitral regurgitation was controlled in 85% (6/7) of cases. In three cases, the predict annuloplasty ring size and artificial chordae length were not match between anesthesiologist and surgeon. After the operation, 90% (9/10) of patients had no residual mitral regurgitation. Conclusions: Anesthesiologist's TEE measurements were useful for selecting the optimal annuloplasty ring size and artificial chordae length during R-MVP. TEE can play an important role in robot-assisted, minimally invasive cardiac surgery for mitral regurgitation with extensive and complex prolapse, such as in Barlow's disease.

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“…By contrast, the imaging principle affects 2D TEE judgment of tendon lesions; this can lead to the misidentification of lengthened or ruptured tendons. Only operators with significant experience can accurately determine the location and number of tendon ruptures using 2D TEE (7). Finally, 3D TEE can measure tendon length with greater sensitivity than 2D TEE can: Although the number and location of tendon ruptures can be clearly displayed with 2D TEE, offline reconstruction of the mitral valve structure is still necessary to determine the length of the tendons.…”

Section: Discussionmentioning

confidence: 99%

The Application of Transesophageal Echocardiography in Mitral Valve Repair With Tendon Reconstruction

Zhou

Wang

et al. 2020

Front. Surg.

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Objective: To investigate whether tendon reconstruction during mitral valve repair can be effectively guided by transesophageal echocardiography (TEE), using the mid-esophageal bi-commissure view, bicaval view and the aortic valve–mitral valve transition short-axis view.Methods: A total of 40 patients that underwent mitral valve repair with artificial tendineae were recruited. Before the operation, conventional transthoracic echocardiography was used to determine whether mitral valve repair would be possible. Following intraoperative anesthesia, two-dimensional and three-dimensional TEE reconstructions were used to assess the state of the valve and tendon and to make a repair plan.Results: TEE accurately diagnosed single functional tendon rupture and predicted single artificial tendon implantation in 88% of cases (23/26). TEE accurately diagnosed single functional tendon rupture and predicted the implantation of two artificial tendons in 100% of cases (4/4). TEE accurately diagnosed two or more functional tendon ruptures and predicted the implantation of two artificial tendons in 100% of cases (5/5). The length of the tendon cord predicted by TEE (2.45 ± 0.15 mm) was not significantly different (P > 0.05) from the length of the cord that was actually implanted (2.31 ± 0.11 mm). TEE also accurately predicted the size of the annuloplasty ring in 86% of cases (33/38), with differences of 2 mm or less compared to the size of the ring that was actually implanted.Conclusion: Both the mid-esophageal bi-commissure view, bicaval view and the short-axis view of the aortic valve–mitral valve transition can reduce the difficulty of tendon reconstruction by helping to determine what length of tendon and what size of artificial annulus are required.

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Impact of real-time three-dimensional transesophageal echocardiography on procedural success for mitral valve repair

Cited by 10 publications

References 27 publications

Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Mitral and tricuspid annuloplasty ring dehiscence: a systematic review with pooled analysis

Transesophageal echocardiography in robot-assisted mitral valve repair for Barlow’s disease: usefulness for predicting artificial ring size and artificial chordae length using the loop technique

The Application of Transesophageal Echocardiography in Mitral Valve Repair With Tendon Reconstruction

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