Seamless reconstruction of mitral leaflet and chordae with one piece of pericardium

Ito, Toshiaki; Maekawa, Atsuo; Aoki, Masakazu; Hoshino, Satoshi; Hayashi, Y.; Sawaki, Shunji; Yanagisawa, Junji; Tokoro, Masayoshi

doi:10.1093/ejcts/ezu140

Cited by 8 publications

(10 citation statements)

References 9 publications

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“…The anterior leaflet was included with the repaired leaflet in three patients in whom large autologous pericardium and several artificial chordae were placed. Mitral regurgitation recurred in one of our five patients and similarly in one of six patients with active endocarditis in the study by Ito et al [ 6 ] and Miura et al [ 7 ] for the same reason (detachment of the pericardial suture line).…”

Section: Discussionsupporting

confidence: 73%

“…Therefore, in this study, we aimed to clarify the long-term results of extensive mitral valve leaflet reconstruction with autologous pericardium focusing only on active infective endocarditis. Ito et al [ 6 ] described 25 patients who underwent seamless reconstruction of the mitral leaflet and chordae with one piece of pericardium and demonstrated good short- and mid-term outcomes. In their observational study, only 6 of 25 patients had active endocarditis.…”

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

Handa

Masai

Ohata

et al. 2022

J Cardiothorac Surg

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Objective 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 (54 (38–60) years of age; 3 men, 2 women) underwent this procedure from January 2011 to April 2022. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 69 (66–75)). 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 36 (28–42) days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The median follow-up period was 9.6 (6.0–10.4) 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 might be acceptable. This procedure might be considered as an effective and valuable option, especially in young patients.

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Section: Discussionsupporting

confidence: 73%

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

Handa

Masai

Ohata

et al. 2022

J Cardiothorac Surg

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“…The anterior leaflet was included with the repaired leaflet in three patients in whom large autologous pericardium and several artificial chordae were placed. In the present study, echocardiographic follow-up was performed at a mean of 80 months (range, 7-111 months) postoperatively, whereas it was performed at a mean of 9.7 months in the study by Ito et al [6]. Mitral regurgitation recurred in one of our five patients and similarly in one of six patients with active endocarditis in the study by Ito et al [6] for the same reason (detachment of the pericardial suture line).…”

Section: Discussionmentioning

confidence: 65%

“…Therefore, in this study, we aimed to clarify the long-term results of extensive mitral valve leaflet reconstruction with autologous pericardium focusing only on active infective endocarditis. Ito et al [6] described 25 patients who underwent seamless reconstruction of the mitral leaflet and chordae with one piece of pericardium and demonstrated good shortand mid-term outcomes. In their observational study, only 6 of 25 patients had active endocarditis.…”

Section: Discussionmentioning

confidence: 99%

“…A conclusion has not yet been reached about the durability of the pericardium and how to manage the pericardium to obtain a good long-term result; however, minimum use of the pericardium should be desired. We believe that the chordae should be reconstructed not by using pericardium as described by Ito et al [6] but by using artificial chordae (polytetrafluoroethylene sutures) to decrease the use of pericardium as much as possible. Furthermore, implantation of artificial chordae is a widespread and familiar technique for many cardiac surgeons.…”

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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Anatomy, Histology, Applied Anatomy, and Physiology of the Human Pericardium

Chowdhury,

Sankhyan

2023

Surgical Treatment of Chronic Constrictive Pericarditis

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Seamless reconstruction of mitral leaflet and chordae with one piece of pericardium

Abstract: Seamless reconstruction of leaflets and chordae with pericardium seemed promising to repair extensively destructed mitral valve.

Cited by 8 publications

References 9 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

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

Anatomy, Histology, Applied Anatomy, and Physiology of the Human Pericardium

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