Late results of mitral valve repair for mitral regurgitation

Okada, Yukikatsu; Nasu, Michihiro; Takahashi, Yutaka; Handa, Nobuhiro; Fujiwara, Hiroshi; Shinkai, M; Shomura, Yu; Wakiyama, Hidetaka; Tsuda, Shouichi

doi:10.1007/bf02719379

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…The patient characteristics are listed in Table 1. The mean age of the patients was significantly younger than those who required mitral valve repair for degenerative MR. 3 As we reported previously, our basic concept has changed from conventional treatment to early surgical intervention for active IE patients. 6 There were 48 (33%) patients who demonstrated stroke by brain computed tomography before surgery.…”

Section: Methodsmentioning

confidence: 92%

“…We introduced standard ring annuloplasty, chordal reconstruction with expanded polytetrafluoroethylene (ePTFE) sutures, and autologous pericardium to increase the coaptation surface area from 1991. 3,4 Repair was used in 1988 for patients with mitral IE with a simple posterior lesion, and a small number of mitral valve repairs for mitral IE was reported in 1995. 5 We retrospectively analyzed our clinical results of mitral valve repair for mitral IE.…”

Section: Introductionmentioning

confidence: 99%

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Mitral valve repair for infective endocarditis: Kobe experience

Okada¹,

Nakai²,

Muro³

et al. 2020

Asian Cardiovasc Thorac Ann

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Objectives We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups ( p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B ( p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

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Section: Methodsmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Mitral valve repair for infective endocarditis: Kobe experience

Okada¹,

Nakai²,

Muro³

et al. 2020

Asian Cardiovasc Thorac Ann

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“…Mitral valvuloplasty preserves the valve device to protect the left ventricular function [2] . Moreover, patients do not need long-term anticoagulant therapy after surgery, and the incidence of postoperative anticoagulation-related complications is lower than that after mitral valve replacement [3] . Therefore, for patients with mitral regurgitation, mitral valvuloplasty is preferred based on valvular lesions [4] .…”

Section: Discussionmentioning

confidence: 99%

Clinical Comparison of Robot-Assisted and Conventional Thoracotomy with Mitral Valvuloplasty

Liang¹,

Yang²

2018

ijSciences

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Objective To compare the clinical therapeutic effects of robot-assisted and conventional thoracotomy with mitral valvuloplasty, and to further clarify the advantages and disadvantages of the Da Vinci robotic surgery system in cardiac surgery. Method A total of 116 patients with mitral valvuloplasty were enrolled from November 2014 to July 2018 in the Affiliated Hospital of Qingdao University, which included 38 cases of the robot-assisted mitral valvuloplasty and 78 cases of conventional thoracotomy with mitral valvuloplasty; the clinical treatment of the two patient groups was compared and analyzed. Result The surgical outcomes of the two groups were satisfactory and there were no deaths in the hospital. The operation time, cardiopulmonary bypass (CPB) time, and ascending aorta occlusion time were longer in the Da Vinci group than in the conventional group (P<0.05). Intensive care unit(ICU) time, tracheal intubation time, postoperative hospital stay, postoperative blood transfusion, postoperative drainage and incidence of postoperative complications were lower in the Da Vinci group than in the conventional group (P<0.05). There was no significant difference in postoperative cardiac ultrasound results between the Da Vinci group and the conventional group. (P>0.05). Conclusion Robotic technique can be safely and effectively be applied in mitral valvuloplasty, and can significantly shorten the ICU time, tracheal intubation time and postoperative hospital stay, also reduce postoperative blood transfusion, postoperative drainage, and incidence of postoperative complications. Robot-assisted surgery is a good choice for minimally invasive surgery, but its operation time, extracorporeal circulation time and ascending aorta occlusion time are longer than conventional surgery, and further improvement is needed.

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“…Chordal preservation appears to represent a significant departure from the trend of worsening results after conventional MVR [15], yet analogous to results associated with mitral reconstruction [16,17] . Nevertheless retention of the posterior leaflet with anterior leaflet resection is the more customary method of MVR this is probably for fear of left ventricular outflow obstruction by papillary muscles and chordae tendineae of the anterior leaflet [18] as is described in some isolated case reports.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve replacement with the preservation of the entire valve apparatus

Alsaddique¹

2007

Rev Bras Cir Cardiovasc

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Substituição da valva mitral com preservação do aparato completo da valvaMitral valve replacement with the preservation of the entire valve apparatus Abstract Objective: The papillary muscles and the chordae tendineae of both mitral leaflets contribute to the preservation of the left ventricular function. Most surgeons, however, routinely excise the anterior mitral leaflet.Methods: In a group of nine patients, six of them underwent mitral valve replacement alone and three underwent both aortic and mitral valve replacements, all the mitral apparatus was preserved. All of these patients had mechanical valves using CarboMedics cardiac prosthesis (CarboMedics, Inc. Austin, Texas).Results: There was no mortality. Postoperative echocardiographic assessment revealed maintained left ventricular function with no interference with the prosthetic leaflet mobility and no left ventricular outflow tract gradient.Conclusion: We believe that in most patients with longstanding mitral valve regurgitation, thinned out papillary muscles and elongated chordae tendineae that are not amenable to repair, valve replacement with the preservation of the entire native valve is possible and should be encouraged. This is especially valuable for those with depressed left ventricular function, who might otherwise suffer from left ventricular dysfunction in the long-term if the entire mitral valve apparatus were to be excised.Descriptors: Mitral valve, surgery. Mitral valve insufficiency, surgery. Heart valve prosthesis implantation, methods. 219ALSADDIQUE, AA -Mitral valve replacement with the preservation of the entire valve apparatus Braz J Cardiovasc Surg 2007; 22(2): 218-223

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Late results of mitral valve repair for mitral regurgitation

Cited by 9 publications

References 21 publications

Mitral valve repair for infective endocarditis: Kobe experience

Mitral valve repair for infective endocarditis: Kobe experience

Clinical Comparison of Robot-Assisted and Conventional Thoracotomy with Mitral Valvuloplasty

Mitral valve replacement with the preservation of the entire valve apparatus

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