Late Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease

David, Tirone E.; Armstrong, Susan; McCrindle, Brian W.; Manlhiot, Cedric

doi:10.1161/circulationaha.112.000699

Cited by 311 publications

(241 citation statements)

References 35 publications

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“…Particularly when a prosthetic ring is used, a concomitant annuloplasty, besides remodeling the annulus and forcing leaflet coaptation, stabilizes the repair over time preventing annular redilatation and reducing the risk of late failure. The benefits of annuloplasty in valve repair have been confirmed by several authors [1][2][3][4] who found that the absence of annuloplasty was one of the most important risk factor for late failure of the repair. As far as the EE technique is concerned, in patients with degenerative MR, the long-term results of this procedure are excellent whenever an annuloplasty is concomitantly used.…”

Section: Discussionmentioning

confidence: 83%

“…Particularly when a prosthetic ring is used, repair durability is enhanced by increased leaflet coaptation and prevention of further dilatation of the mitral annulus. [1][2][3][4] After the introduction of the MitraClip system, however, MR has been treated in many patients by applying a percutaneous ringless edge-to-edge (EE) procedure. Defining the long-term results of the surgical EE repair performed without annuloplasty may help to foresee, at least partially, the possible late results of this percutaneous technique.…”

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confidence: 99%

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Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

et al. 2014

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Preoperative, intraoperative, and postoperative data were collected through a hospital database and patients' records. Follow-up data were Background-To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR). Methods and Results-From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2±4.21 years; median, 9.7; longest, 18.1). ResultsThe preoperative data of the final study population are reported in Table 1. At admission, 24 (39%) patients were in New York Heart Association (NYHA) class I or II, whereas 37 (61%) patients were in class III. Fifteen patients (24%) were in atrial fibrillation.Mitral regurgitation degree was determined by means of a combination of color Doppler (color flow jet area and vena contracta width) and pulmonary vein flow analysis and classified as mild (1+/4+), moderate (2+/4+), moderate to severe (3+/4+), and severe (4+/4+). Mitral regurgitation was severe (4+/4+) in 34 patients (34/61; 55.7%) and moderate to severe (3+/4+) in the remaining 27 patients (27/61; 44.2%).Transesophageal echocardiography showed that the mechanism of MR was bileaflet prolapse in 28 patients (46%), anterior leaflet prolapse in 11 patients (18%), and a prolapse of the posterior leaflet in 22 patients (36%). Important annular calcification was found in 36 patients (59%). Surgical ProcedureThe MV was approached through a median sternotomy and a standard left atrial incision in all cases. According to the location of the main regurgitant jet, a double-orifice repair was performed in 53 (86.8%) patients and a commissural EE repair in the remaining 8 (13.1%). The paracommissural repair was posteriorly located in 6 patients and anteriorly located in 2 patients. A 4-0 polypropylene continuous suture without pledgets was used in most cases for leaflet approximation, unless the leaflets were thin. In these cases, a 5-0 suture was preferred.In case of annular calcification, the rationale for adopting the EE technique was to correct leaflet lesions with no annular manipulation. Indeed, the main reason for annuloplasty omission was the presence of significantly/severely calcified annulus which was present in 36 patients (36/61; 59%). In the remaining 25 patients (41%), the EE was intentionally performed without a concomitant annuloplasty because the annulus was judged by the surgeon not to be significantly dilated. By avoiding annuloplasty in those cases, also the risk of inducing postoperative mitral stenosis was minimized. Several associated procedures were performed concomitantly with valve repair, including coronary artery revascularization (9 patients), tricuspid annuloplasty (7 patients), ...

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Section: Discussionmentioning

confidence: 83%

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confidence: 99%

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

et al. 2014

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“…6, 7 Multisurgeon practices have also reported comparable outcomes and demonstrated that recurrent MR after MV repair is associated with late death. 8 The aims of the present study were to investigate the consequences of recurrent MR after MV repair in patients with degenerative MR and to identify risk factors for recurrence.…”

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confidence: 97%

Effect of Recurrent Mitral Regurgitation After Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation

Kim

Lee

Joo

et al. 2018

Circ J

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Background: This study investigated the consequences of recurrent mitral regurgitation (MR) after mitral valve (MV) repair in patients with degenerative MR and risk factors for recurrence. Methods and Results:From January 1990 to December 2015, 792 patients underwent MV repair due to degenerative MR. Recurrent MR was defined as moderate-to-severe MR on follow-up echocardiography. Mean follow-up duration was 8.71±5.58 years. During the follow-up period, MR recurred in 133 (16.8%) patients, and the MR recurrence-free rate at 20 years was 77.5±2.0%. In the recurrence group, the degree of MR decreased in 8 (6.0%) patients and was aggravated in 46 (34.6%) patients. Recurrent MR was associated with increased mortality and adverse left ventricular (LV) remodeling. Independent risk factors for MR recurrence were MV repair performed before 2000, preoperative atrial fibrillation, high LV end-diastolic dimension (LVEDD), prolapse of the isolated anterior leaflet or multiple segments, and absence of ring annuloplasty. Predictors of MR progression were high LVEDD and repair without artificial chordae implantation.Conclusions: Recurrent MR after MV repair in patients with degenerative MR showed a tendency to progress and was associated with increased mortality and adverse LV remodeling. Early referral for MV repair before development of atrial fibrillation and LV enlargement may reduce the risk of MR recurrence. Moreover, artificial chordae implantation and ring annuloplasty may assure the long-term durability of MV repair.

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“…Hence, comprehensive dynamic physiological description of these poorly understood entities is now possible and may provide crucial pathophysiologic insights, offering stronger basis for recent efforts at mechanistic [12][13][14] and genetic [15][16][17] DMVD characterization. Furthermore, dynamic physiological characterization may provide insights crucial to surgical 18,19 or interventional 20 repair of each DMVD phenotype. Thus, our objective was, in patients in whom DMVD phenotype was defined by direct intraoperative visualization, to evaluate by quantitative 3D-transesophageal-echocardiography (3DTEE) combined with comprehensive quantitative MR and cardiac remodeling characterization, the static and dynamic characteristics of mitral annulus, leaflets, and prolapse in FED and DMD, throughout the cardiac cycle.…”

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confidence: 99%

Dynamic Phenotypes of Degenerative Myxomatous Mitral Valve Disease

Clavel

Mantovani

Malouf

et al. 2015

Circ: Cardiovascular Imaging

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Background-Fibro-elastic deficiency (FED) and diffuse myxomatous degeneration (DMD) are phenotypes of degenerative mitral valve disease defined morphologically. Whether physiological differences in annular and valvular dynamics exist between these phenotypes remains unknown. Methods and Results-We performed triple quantitation of cardiac remodeling and of mitral regurgitation severity and of annular and valvular dimensions by real-time 3-dimensional-transesophageal-echocardiography. Forty-nine patients with degenerative mitral valve disease classified as FED (n=31)

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Late Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease

Cited by 311 publications

References 35 publications

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

Effect of Recurrent Mitral Regurgitation After Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation

Dynamic Phenotypes of Degenerative Myxomatous Mitral Valve Disease

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