Long-term Performance of Fresh Autologous Pericardium for Mitral Valve Leaflet Repair

Quinn, Rachael W.; Wang, Yunlong; Foster, Nathaniel; Pasrija, Chetan; Ghoreishi, Mehrdad; Dawood, Murtaza Y.; Gammie, James S.

doi:10.1016/j.athoracsur.2019.05.045

Cited by 35 publications

(32 citation statements)

References 25 publications

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“…In contrast, however, some reports have indicated that glutaraldehyde treatment might be associated with pericardial calcification [10,11]. Excellent long-term outcomes of mitral valve leaflet repair using fresh autologous pericardium were recently reported (89% per 10 years of freedom from reoperation) [11]. This report demonstrated that glutaraldehyde treatment of the pericardium might be associated with late calcification and mitral valve stenosis due to leaflet thickening and loss of pliability.…”

Section: Discussionmentioning

confidence: 88%

“…Glutaraldehyde treatment may repor-tedly improve the durability of the reconstructed pericardium leaflet, providing a lower rate of calcification, shrinkage, or disruption than fresh autologous pericardium [8,9]. In contrast, however, some reports have indicated that glutaraldehyde treatment might be associated with pericardial calcification [10,11]. Excellent long-term outcomes of mitral valve leaflet repair using fresh autologous pericardium were recently reported (89% per 10 years of freedom from reoperation) [11].…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Handa¹,

Masai²,

Ohata³

et al. 2021

Preprint

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Background and aim: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods: Five patients (50 ± 30 years of age; 3 men, 2 women) underwent this procedure from January 2011 to December 2020. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 70% ± 5%). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results: The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 35 ± 5 days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The mean follow-up period was 7.2 (range, 1.3–9.5) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions: The short- and long-term outcomes of this procedure were satisfactory. This procedure might be considered as an effective and valuable option, especially in young patients.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Handa¹,

Masai²,

Ohata³

et al. 2021

Preprint

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“…Follow-up TTE test showed normal systolic and diastolic cardiac function in all the 10 cases. This may be related to the use of fresh pericardial patches, as it was reported that fresh autologous pericardium showed good biological characteristics, such as free of retraction, thickening, stiffness, fibrosis and calcification [15], thus it possibly does not affect right ventricular function in midterm period. In addition, the twopatch technique not only protects the moderator band, an important anatomical structure of the right ventricle, but also avoids a too large patch to cover the entire inner right ventricular wall and thus limit the diastolic function of the right ventricle.…”

Section: Discussionmentioning

confidence: 99%

Biventricular surgical repair of “Swiss Cheese” ventricular septal defects with two-patch and right ventricle apex excluding technique: preliminary experience and clinical results

Shi

Chen

et al. 2020

Preprint

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Background “Swiss Cheese” ventricular septal defects (VSDs) is a kind of rare and complex congenital heart defects and the surgical management remains controversial and a challenge. We reviewed our preliminary clinical experience on biventricular surgical repair of “Swiss Cheese” VSDs with two-patch and right ventricle apex excluding technique in 10 cases. Methods From May 2014 to December 2019, a series of 10 patients (M/F=3/7) were admitted in our center. 9 cases underwent one-stage surgical repair with two-patch and right ventricle apex excluding technique and 1 case received a second-stage surgical repair with the same technique. Surgical repair was done with cardiopulmonary bypass (CPB) in all cases. 2 fresh autologous pericardium patches were used to close defects of the outflow tract area and the apex trabecular area respectively and as a result, the right ventricular apex was excluded from the right ventricular inflow tract. Results All the operations were successful. Median CPB time and aortic clamping time were 96 min and 68 min respectively. Delayed chest closure were done in 2 cases within 48-72 hours postoperatively. The Median time of mechanical ventilation and ICU stay were 131.3 hours and 8 days respectively. Median length of stay after operation was 11 （9-42）days. There was no mortality and major complication except for 2 cases of ventilator associated pneumonia. There was no death and major complication during the median follow-up time of 3.2 years.. The latest echocardiography results showed the left and right heart function was normal in all the cases. Conclusions Biventricular surgical repair of “Swiss Cheese” VSDs with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants is safe and feasible with favorable early and mid-term results. Long term results need to be evaluated with more cases.

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“…They concluded that an early repair-oriented surgical approach can achieve higher repair rates with good long-term durability of the repair and a very low rate of recurrence of endocarditis. Quinn and colleagues 10 recently reported the long-term performance of fresh autologous pericardium for mitral leaflet repair, including 69% of patients with IE. Fresh autologous pericardium is an excellent material for complex mitral leaflet patch repairs, which can be used with the expectation of durable long-term function.…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned before, this group expanded the use of fresh autologous pericardium for mitral valve repair. 10 Feringa and colleagues 12 reviewed 24 reports that included 1194 patients undergoing mitral valve surgery for IE; the repair rate was 39% and mitral valve repair was associated with better clinical outcomes including mortality, reoperation, recurrent endocarditis, and cerebrovascular events. Byrne and colleagues 13 reported the surgical management of endocarditis, the Society of Thoracic Surgeons Clinical Practice Guideline, in 2011.…”

Section: Discussionmentioning

confidence: 99%

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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Long-term Performance of Fresh Autologous Pericardium for Mitral Valve Leaflet Repair

Cited by 35 publications

References 25 publications

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Biventricular surgical repair of “Swiss Cheese” ventricular septal defects with two-patch and right ventricle apex excluding technique: preliminary experience and clinical results

Mitral valve repair for infective endocarditis: Kobe experience

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