Mechanisms of Recurrent Regurgitation After Valve Repair for Prolapsed Mitral Valve Disease

Shimokawa, Tomoki; Kasegawa, Hitoshi; Katayama, Yuzo; Matsuyama, Shigefumi; Manabe, Susumu; Tabata, Minoru; Fukui, Toshihiro; Takanashi, Shuichiro

doi:10.1016/j.athoracsur.2011.01.015

Cited by 49 publications

(30 citation statements)

References 20 publications

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“…12 Shimokawa et al reported that AL prolapse, preoperative atrial fibrillation and non-use of annuloplasty ring were independent predictors of recurrent MR. 11 The present findings, however, differ from the previous studies. Univariate analysis did not identify age, AL prolapse, left ventricular ejection fraction, preoperative atrial fibrillation and non-use of annuloplasty ring as risk factors for reoperation.…”

Section: Discussioncontrasting

confidence: 99%

“…9 Shimokawa et al reported that valve-related failure occurred at a median of 5.7 years after operation and that the main mechanisms of recurrent regurgitation were leaflet thickening in approximately 50%, leaflet prolapse in 30% and dehiscence in approximately 15%. 11 The present outcomes were similar to these reports. Valve-related failure comprised 60% of reoperations and the causes included new prolapse, leaflet thickening leading to mitral stenosis and endocarditis.…”

Section: Details Of Reoperationsupporting

confidence: 92%

“…7, 8 Not many reports exist on the detailed mechanisms of reoperation after MV repair. 9- 11 David et al reported that anterior leaflet (AL) prolapse was the only independent predictor of reoperation, and anterior and bi-leaflet prolapse, age and ejection fraction <40% were independent predictors of recurrent MR after MV repair. 12 Shimokawa et al reported that AL prolapse, preoperative atrial fibrillation and non-use of annuloplasty ring were independent predictors of recurrent MR. 11 They reported that the main mechanism of recurrent MR was progressive degeneration such as leaflet thickening and prolapse.…”

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confidence: 99%

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Mechanism of and Risk Factors for Reoperation After Mitral Valve Repair for Degenerative Mitral Regurgitation

Murashita

Okada

Fujiwara

et al. 2013

Circ J

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Background:We reviewed our 20-year experience of mitral valve (MV) repair for degenerative mitral regurgitation (MR) and analyzed the mechanisms and risk factors of reoperation. Methods and Results:Six hundred and fifty-four patients who underwent MV repair for degenerative MR between 1991 and 2010 were retrospectively reviewed. The mean follow-up duration was 7.5±4.9 years. Late echocardiography was obtained at a fixed schedule. Standard procedures for MV repair were resection and suture for posterior prolapse, artificial chordal reconstruction for anterior prolapse and a combination of them for prolapse of both. Ring annuloplasty was performed in most cases. We encountered 2 early and 23 late reoperations. Fifteen (60%) were valve-related failure, 9 (36%) were procedure-related failure and 1 was unknown. Valve-related failure was characterized with recurrence of MR due to new prolapse region and progression of mitral stenosis due to leaflet thickening. For them, reoperation was performed at 7.6 years and 14.3 years after the initial operation, respectively. Multivariate analysis identified preoperative left ventricular diastolic diameter and residual regurgitation at discharge as risk factors for reoperation. Conclusions:Valve-related failure occurred late due to slow progression of degenerative disease. Long-term followup after surgery is mandatory. Given that progression and severity of MR were identified as risk factors for reoperation, early surgical intervention is desirable for degenerative MR. (Circ J 2013; 77: 2050 -2055

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Section: Discussioncontrasting

confidence: 99%

Section: Details Of Reoperationsupporting

confidence: 92%

mentioning

confidence: 99%

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Mechanism of and Risk Factors for Reoperation After Mitral Valve Repair for Degenerative Mitral Regurgitation

Murashita

Okada

Fujiwara

et al. 2013

Circ J

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“…7,8,[10][11][12]14,15,20 We found that several factors affected cardiac-and valverelated mortality by multivariable models as listed in Table 3. Asymptomatic patients and patients with minimal symptoms were younger and had fewer cardiac comorbidities than those with more advanced symptoms, but functional class was an independent predictor of cardiac-and valve-related death.…”

Section: Discussionmentioning

confidence: 94%

“…Despite this aggressive approach on the treatment of patients with degenerative MR, there has been limited information regarding echocardiographic evaluation of MV function late after repair. [12][13][14][15] This study examines the clinical outcomes of MV repair for MR due to degenerative diseases in a large cohort of patients who were prospectively followed with clinical evaluations and echocardiographic assessment of MV function during the past 26 years.…”

Section: Clinical Perspective On P 1492mentioning

confidence: 99%

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

et al. 2013

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Background-The pathological spectrum of degenerative diseases of the mitral valve (MV) that causes mitral regurgitation (MR) is broad, and there is limited information on late outcomes of MV repair in various subgroups of patients and pathologies. This study examines this issue. Methods and Results-All 840 patients who had MV repair for MR due to degenerative diseases from 1985 to 2004 were prospectively followed with clinical and echocardiographic evaluations at biennial intervals up to 26 years, median of 10.4 years. Clinical, hemodynamic, and pathological variables were evaluated for their association with outcomes. Age, left ventricular ejection fraction, and functional class were predictors of late cardiac-and valve-related deaths by multivariable analysis. MV repair failed to restore life span to normal in patients with functional class IV. Thirty-eight patients had repeat MV surgery, and the probability of reoperation at 20 years was 5.9%. During the follow-up, recurrent severe MR developed in 37 patients, and moderate MR developed in 61. Age, isolated prolapse of the anterior leaflet, the degree of myxomatous changes in the MV, lack of mitral annuloplasty, and duration of cardiopulmonary bypass were associated with increased risk of recurrent MR. At 20 years, the freedom from recurrent severe MR was 90.7%, and the freedom from moderate or severe MR was 69.2%. Conclusions-MV

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Trends in the Management of Anterior Mitral Leaflet Regurgitation

Khairallah,

Rahouma,

Gambardella

et al. 2024

JAMA Netw Open

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ImportanceThe overall prevalence of mitral valve replacement (MVR) or MV repair at the time of cardiac surgery in the setting of isolated anterior mitral leaflet degenerative pathologic status in the US population is unknown.ObjectiveTo investigate the prevalence of MVR and MV repair using the Society of Thoracic Surgeons’ Adult Cardiac Surgery Database.Design, Setting, and ParticipantsIn a cross-sectional study, all patients diagnosed with isolated anterior mitral leaflet degenerative regurgitation who underwent either surgical MVR or MV repair between July 1, 2011, and June 30, 2022, were identified. Linear regression analysis was used to assess trends over time.Main Outcomes and MeasuresAssessment of the trends in MV repair and MVR over time.ResultsA total of 16 259 patients (9624 [59.2%] men) were identified, and the median age was 68 (IQR, 58-74) years. A total of 7214 patients (44.4%) had MVR, and 9045 (55.6%) had MV repair. There was a declining trend of MV repair from 58.0% in 2011 to 51.6% in 2022 (P = .05). The MVR group was older (median [IQR] age, 70 [62-77] vs 67 [58-74] years; P &lt; .001) and had more comorbidities. A total of 85.1% of all patients underwent concomitant procedures. In 81.7% of MVR cases, no attempt at MV repair was made. The median (IQR) annual hospital volume was lower with MVR vs MV repair (2.50 [1.50-5.00] vs 4.00 [2.00-7.00]; P &lt; .001). Conventional surgical approaches were most common (91.5%) but with a declining trend (P &lt; .001). Minimally invasive approaches were used in 13.1% (robotic, 4.6%), and with an inclining trend from 5.0% in 2011 to 12.0% in 2022 (P &lt; .001). Annuloplasty was performed in 88.8% of MV repair cases. Its use as a sole mean of MV repair decreased from 48.0% in 2011 to 13.9% in 2022 (P &lt; .001). Repair maneuvers in addition to annuloplasty were neochordae (overall 40.1%, increasing from 22.5% in 2011 to 62.3% in 2022; P &lt; .001), leaflet resection (overall 10.2%, decreasing from 13.1% in 2011 to 7.9% in 2022, P = .002), edge-to-edge MV repair (overall 5.3%, decreasing from 6.9% in 2011 to 4.5% in 2022; P = 0.04), and chordal transfer (overall 2.4%, decreasing from 2.7% in 2011 to 0.7% in 2022; P = .004).Conclusions and RelevanceIn this cross-sectional study, MV repair was the preferred option for degenerative mitral valve disease but was only slightly more commonly performed than MVR for isolated anterior leaflet pathologic status. A large proportion of MVR was performed without an MV repair attempt, suggesting reluctance to repair this pathologic condition.

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Mechanisms of Recurrent Regurgitation After Valve Repair for Prolapsed Mitral Valve Disease

Cited by 49 publications

References 20 publications

Mechanism of and Risk Factors for Reoperation After Mitral Valve Repair for Degenerative Mitral Regurgitation

Mechanism of and Risk Factors for Reoperation After Mitral Valve Repair for Degenerative Mitral Regurgitation

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

Trends in the Management of Anterior Mitral Leaflet Regurgitation

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