Simple versus complex degenerative mitral valve disease

Javadikasgari, Hoda; Mihaljević, Tomislav; Suri, Rakesh M.; Svensson, Lars G.; Navia, José L.; Wang, Robert Z.; Tappuni, Bassman; Lowry, Ashley M.; McCurry, Kenneth R.; Blackstone, Eugene H.; Desai, Milind Y.; Mick, Stephanie; Gillinov, A. Marc

doi:10.1016/j.jtcvs.2018.02.102

Cited by 47 publications

(32 citation statements)

References 30 publications

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“… 6 examined the results of early surgical intervention in 6153 patients with degenerative mitral valve disease before the institution of significant left ventricular dysfunction and found similar operative and long-term survival regardless of valve prolapse complexity. 6 In their study, the authors stated that artificial chordae had become their preferred technique in recent years for repair of anterior leaflet prolapse. The patient population comprised a 30% cohort undergoing a minimally invasive approach (12% with right minithoracotomy and 18% with robotic port access).…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 Recent studies employing early contemporary surgical repair of anterior leaflet and bileaflet prolapse have yielded good results in this complex disease group. 6 , 7 We set out to assess the impact of mitral regurgitation (MR) complexity on early- and mid-term clinical and echocardiographic outcomes after endoscopic repair of degenerative MR.…”

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confidence: 99%

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Endoscopic Mitral Repair for Degenerative Mitral Regurgitation: Effect of Disease Complexity on Short- and Mid-term Outcomes

Hage

Manian

et al. 2020

CJC Open

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Background We set out to compare in a prospective cohort study the mid-term clinical and echocardiographic outcomes of mini-mitral repair for simple (posterior prolapse) vs complex regurgitation (anterior/bileaflet prolapse). Methods A total of 245 consecutive patients underwent mini-mitral repair for severe degenerative mitral regurgitation through a right, endoscopic approach (n = 145 simple, n = 100 complex). The most common repair technique was annuloplasty + artificial chordae (84%, n = 121 for simple vs 88%, n = 88 for complex, P = 0.3). Patients were prospectively followed for a maximal duration of 9 years. Patients’ characteristics were well balanced between groups. Results The 30-day/in-hospital mortality was similar (0%, n = 0 simple vs 1%, n = 1 complex, P = 0.2). Both groups had similar rates of early postoperative complications: myocardial infarction (1.4%, n = 2 vs 0%, n = 0, P = 0.2), neurologic complications (1.4%, n = 2 vs 0%, n = 0, P = 0.2), reoperation for bleeding (0.7%, n = 1 vs 3%, n = 3, P = 0.2), intensive care unit length of stay (1 interquartile range, 1-1 days vs 1 interquartile range, 1-1 days, P = 0.7). Late survival (88% for simple vs 92% for complex, P = 0.4) was similar between groups. Cumulative incidence of late reoperation at 6 years is 0% for both groups (subdistribution hazard ratio = 1, P = 1). There was no difference in recurrent mitral regurgitation greater than 2+ at each year after surgery up to 6 years postoperatively. Conclusion Mitral repair using an endoscopic, minimally invasive approach yields excellent mid-term outcomes regardless of disease complexity.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Endoscopic Mitral Repair for Degenerative Mitral Regurgitation: Effect of Disease Complexity on Short- and Mid-term Outcomes

Hage

Manian

et al. 2020

CJC Open

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“…This study provides information on mid-term clinical and echocardiographic outcomes with detailed mechanisms of recurrent MR focusing on bileaflet MV repair due to degenerative disease. Whereas posterior leaflet prolapse now can be repaired in practically all cases, with very low morbidity and excellent outcomes, many published series have documented decreased repair rates in the setting of anterior and bileaflet lesions [1–6].…”

Section: Discussionmentioning

confidence: 99%

“…Compared with promising long-term outcomes of mitral valve (MV) repair of isolated posterior leaflet lesions, anterior leaflet and bileaflet lesions have been recognized as a risk factor associated with repair failure [1–6]. Better outcomes of MV repair of anterior leaflet lesions have been reported after the emergence of several refined techniques, including neochordoplasty [2, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era

Kaneyuki

Nakajima

Asakura

et al. 2019

J Cardiothorac Surg

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BackgroundGood mid-term durability of mitral valve repair of bileaflet lesions has been reported; however, patients may develop failure during follow-up. This study assessed late outcomes and mechanisms of failure associated with mitral valve repair of bileaflet lesions.MethodsFifty-six patients (mean age 67 ± 12 years) underwent mitral valve repair of bileaflet lesions due to degenerative disease in 2011–2018. Mitral annuloplasty was added to all procedures except for 1 patient with annular calcification. Mitral valve lesions were identified by surgical inspection. Mean clinical and echocardiography follow-up occurred at 2.7 ± 2.1 and 2.5 ± 1.9 years, respectively.ResultsAdditional mitral valve repair techniques involved triangular resection (n = 15 patients), quadrangular resection with sliding plasty (n = 12), neochordoplasty (n = 52), and commissural plication (n = 26). Prolapse of ≥2 anterior and posterior leaflet scallops occurred in 22 (39%) and 30 (54%) patients, respectively. During follow-up, 10 (17.8%) patients developed moderate or severe mitral regurgitation. Whereas prolapse or tethering was observed early after neochordoplasty or quadrangular resection, recurrent regurgitation occurred late after commissural repair. Five-year freedom from recurrent moderate or severe mitral regurgitation rates was 71.1 ± 11.0%.ConclusionsSeventeen percent of patients developed recurrent mitral regurgitation during follow-up. Repair failure in the early phase occurred owing to aggressive resection of the posterior mitral leaflet or maladjustment of the artificial neochordae. Recurrent mitral regurgitation might occur in the late phase even after acceptable commissural repair. A sequential approach may be useful to improve the quality of mitral valve repair in bileaflet lesions.

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“…Anterior leaflet pathology still remains a formidable surgical challenge, however, and is associated with inferior long-term outcomes. 2 Artificial polytetrafluoroethylene chordae have been introduced to aid reconstruction of complex mitral lesions, 3 but proper determination of chordal length and the number of chordae needed requires significant experience and mature judgment. In the current issue of the Journal, Chawla and colleagues 4 present an expanded polytetrafluorethylene multichordal device as a potential tool to facilitate repair of complex mitral lesions.…”

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confidence: 99%

The golden polytetrafluoroethylene parachute

Timek

2019

The Journal of Thoracic and Cardiovascular Surgery

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Simple versus complex degenerative mitral valve disease

Cited by 47 publications

References 30 publications

Endoscopic Mitral Repair for Degenerative Mitral Regurgitation: Effect of Disease Complexity on Short- and Mid-term Outcomes

Endoscopic Mitral Repair for Degenerative Mitral Regurgitation: Effect of Disease Complexity on Short- and Mid-term Outcomes

Recurrent mitral regurgitation after mitral valve repair for bileaflet lesions in the modern era

The golden polytetrafluoroethylene parachute

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