Outcomes of mitral valve repair for bileaflet prolapse

Okada, Yukikatsu; Nasu, Michihiro; Koyama, Tadaaki; Shomura, Yu; Yuzaki, Mituru; Murashita, Takashi; Fukunaga, Naoto; Konishi, Yasunobu

doi:10.1016/j.jtcvs.2011.11.014

Cited by 24 publications

(20 citation statements)

References 11 publications

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“…In the present study, residual MR was defined as (1) significant leakage found by a saline injection test during the initial repair procedure that resulted in conversion to prosthetic valve replacement based on the surgeon's decision, (2) MR with MRA ≥1 cm 2 confirmed by postbypass TEE after the initial repair procedure that required a corrective second pump run, or (3) very early (<1 month) recurrence of moderate or greater MR. Previous studies have shown that residual MR not exceeding trivial (MRA ≤2 cm 2 ) is associated with a durable repair result, though our institution uses more‐strict criteria, as follows. Patients with MR exceeding an MRA of 1 cm 2 always undergo a corrective second pump run because complete elimination of MR is considered essential for good repair durability.…”

Section: Methodsmentioning

confidence: 99%

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Sakaguchi

Kagiyama

Toki

et al. 2018

JAHA

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BackgroundCarpentier's techniques for degenerative posterior mitral leaflet prolapse have been established with excellent long‐term results reported. However, residual mitral regurgitation (MR) occasionally occurs even after a straightforward repair, though the involved mechanisms are not fully understood. We sought to identify specific preoperative echocardiographic findings associated with residual MR after a posterior mitral leaflet repair.Methods and ResultsWe retrospectively studied 117 consecutive patients who underwent a primary mitral valve repair for isolated posterior mitral leaflet prolapse including a preoperative 3‐dimensional transesophageal echocardiography examination. Twelve had residual MR after the initial repair, of whom 7 required a corrective second pump run, 4 underwent conversion to mitral valve replacement, and 1 developed moderate MR within 1 month. Their preoperative parameters were compared with those of 105 patients who had an uneventful mitral valve repair. There were no hospital deaths. Multivariate analysis identified preoperative anterior mitral leaflet tethering angle as a significant predictor for residual MR (odds ratio, 6.82; 95% confidence interval, 1.8–33.8; P=0.0049). Receiver operator characteristics curve analysis revealed a cut‐off value of 24.3° (area under the curve, 0.77), indicating that anterior mitral leaflet angle predicts residual MR. In multivariate regression analysis, smaller anteroposterior mitral annular diameter (P<0.001) and lower left ventricular ejection fraction (P=0.002) were significantly associated with higher anterior mitral leaflet angle, whereas left ventricular and left atrial dimension had no significant correlation.ConclusionsAnterior mitral leaflet tethering in cases of posterior mitral leaflet prolapse has an adverse impact on early results following mitral valve repair. The findings of preoperative 3‐dimensional transesophageal echocardiography are important for consideration of a careful surgical strategy.

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Section: Methodsmentioning

confidence: 99%

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Sakaguchi

Kagiyama

Toki

et al. 2018

JAHA

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“…Even at valve centers of excellence, repair rates for anterior degenerative disease have been substantially lower than for posterior disease. 16,20 Increased risk of recurrent MR after isolated anterior 11,21,22 and bileaflet 22 repair has also been reported in more contemporary series, although others have found improved freedom from reoperation and survival after both isolated anterior [23][24][25][26][27] and bileaflet [25][26][27][28][29][30] repair. Despite these apparent improvements in performing anterior leaflet repair, a bias within the specialty potentially persists that anterior repair has worse outcomes because of the increased technical challenges of performing anterior leaflet repair 16,23,[28][29][30][31][32][33] and less familiarity with anterior repair due to the lower incidence of anterior leaflet pathology.…”

Section: Perspectivementioning

confidence: 88%

Anterior versus posterior leaflet mitral valve repair: A propensity-matched analysis

Brescia

Watt

Rosenbloom

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Mitral valve repair is superior to replacement for degenerative disease, but long-term outcomes of anterior versus posterior leaflet repair remain poorly defined. We propensity matched anterior and posterior repairs to compare longterm outcomes.Methods: Patients undergoing first-time degenerative mitral repair between 1992 and 2018 were identified. Primary outcome was overall survival. Secondary outcomes were postprocedural residual mitral regurgitation and reoperation. From 1025 patients, 1:1 propensity score matching was performed, yielding 309 anterior (isolated anterior ¼ 85, bileaflet ¼ 224) and 309 isolated posterior repairs.Results: Age was 58 AE 15 years, ejection fraction was 57% AE 10%, and matched groups were well balanced. Anterior repairs had longer bypass (122 AE 53 vs 109 AE 43 minutes, P ¼ .001) and crossclamp (94 AE 44 vs 85 AE 62 minutes, P ¼ .033) times. Mean residual mitral regurgitation grade was 0.44 (95% confidence interval, 0.24-0.65) for anterior repair and 0.30 (95% confidence interval, 0.13-0.47) for posterior repair (P ¼ .31). Overall, 92% (569/618) of matched patients had no residual mitral regurgitation, with no differences in mitral regurgitation grade between groups (P ¼ .77). Survival did not differ between anterior (10 years: 72% AE 7%; 15 years: 63% AE 7%) and posterior (10 years: 74% AE 7%; 15 years: 60% AE 8%) groups (log-rank P ¼ .93). Linearized incidence of reoperation was 0.62% per patient-year, including 0.74% for anterior and 0.48% for posterior repairs. Cumulative incidence of reoperation at 15 years was 7.5% after anterior repair and 4.9% after posterior repair (Gray's test P ¼ .26). Conclusions:No long-term survival or reoperation difference was found between posterior and anterior repair. On the basis of these findings, surgeons at centers of excellence should aim for repair of both anterior and posterior leaflet pathology with the same decision-making threshold over valve replacement for degenerative mitral disease.

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“…We reported favorable outcomes of mitral valve repair for bileaflet prolapse. 22) This surgical strategy is also applied to elderly patients. In this study, as Detaint, et al reported, 19) elderly patients had higher operative risks than younger patients because elderly patients had a higher NYHA class and higher incidence of persistent atrial fibrillation, pulmonary hypertension, and progression of tricuspid regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Mitral Valve Repair for Degenerative Mitral Regurgitation in the Elderly

Murashita

Okada

Kanemitsu

et al. 2014

ATCS

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Purpose: The number of elderly patients who require surgical treatment for mitral regurgitation (MR) is increasing. However, the feasibility and efficacy of mitral valve repair in elderly patients are unclear. Methods: We retrospectively reviewed 55 patients, aged ≥75 years, who underwent mitral valve repair for degenerative MR between 1991 and 2011. All patients were followed up for 4.7 ± 3.4 years. Results: The patients aged ≥75 years were more symptomatic and had a higher incidence of persistent atrial fibrillation and pulmonary hypertension than those aged <75 years. Thirty-day and in-hospital mortality was 1.8% and 7.3%, respectively, and the 5-year survival rate was 81.6% ± 5.8%. The leading cause of late death was stroke, which primarily occurred in patients with postoperative atrial fibrillation. Except for a single failure of repair due to technical reasons, there was no recurrence of severe MR or reoperation on the mitral valve. In the late follow-up period, the mean left ventricular diastolic diameter significantly decreased and the mean left ventricular ejection fraction was approximately 60%. Most patients had mild symptoms at follow-up. Conclusion: Mitral valve repair can provide satisfactory early as well as long-term outcomes and can preserve left ventricular function even in the elderly.

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Outcomes of mitral valve repair for bileaflet prolapse

Abstract: The reproducibility and reliability of mitral valve repair for bileaflet prolapse compares favorably with that of posterior leaflet prolapse. Early surgery might be recommended for patients with severe mitral regurgitation owing to bileaflet prolapse.

Cited by 24 publications

References 11 publications

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Residual Mitral Regurgitation After Repair for Posterior Leaflet Prolapse—Importance of Preoperative Anterior Leaflet Tethering

Anterior versus posterior leaflet mitral valve repair: A propensity-matched analysis

Feasibility and Efficacy of Mitral Valve Repair for Degenerative Mitral Regurgitation in the Elderly

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