Valve repair in mitral regurgitation complicated by severe annulus calcification

Ng, Choi-Keung; Punzengruber, Christian; Pachinger, Otmar; Nesser, Joachim; Auer, H; Franke, H; Hartl, P.

doi:10.1016/s0003-4975(00)01347-3

Cited by 41 publications

(27 citation statements)

References 22 publications

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“…In particular, important annular calcification was the most common condition precluding the possibility of a simultaneous annuloplasty. [12][13][14][15][16] In a smaller number of patients, annuloplasty was intentionally avoided because of the presence of only mild annular dilatation/deformation. Although in our institution residual MR >1+ is not accepted after repair, 17 we decided to tolerate this suboptimal result in a minority of patients included in this [12][13][14][15][16] The reason why the EE technique failed in the calcified annulus is 2-fold.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

et al. 2014

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Preoperative, intraoperative, and postoperative data were collected through a hospital database and patients' records. Follow-up data were Background-To assess the long-term results of the edge-to-edge mitral repair performed without annuloplasty in degenerative mitral regurgitation (MR). Methods and Results-From 1993 to 2002, 61 patients with degenerative MR were treated with an isolated edge-to-edge suture without any annuloplasty. Annuloplasty was omitted in 36 patients because of heavy annular calcification and in 25 for limited annular dilatation. A double-orifice repair was performed in 53 patients and a commissural edge-to-edge in 8. Hospital mortality was 1.6%. Follow-up was 100% complete (mean length, 9.2±4.21 years; median, 9.7; longest, 18.1). ResultsThe preoperative data of the final study population are reported in Table 1. At admission, 24 (39%) patients were in New York Heart Association (NYHA) class I or II, whereas 37 (61%) patients were in class III. Fifteen patients (24%) were in atrial fibrillation.Mitral regurgitation degree was determined by means of a combination of color Doppler (color flow jet area and vena contracta width) and pulmonary vein flow analysis and classified as mild (1+/4+), moderate (2+/4+), moderate to severe (3+/4+), and severe (4+/4+). Mitral regurgitation was severe (4+/4+) in 34 patients (34/61; 55.7%) and moderate to severe (3+/4+) in the remaining 27 patients (27/61; 44.2%).Transesophageal echocardiography showed that the mechanism of MR was bileaflet prolapse in 28 patients (46%), anterior leaflet prolapse in 11 patients (18%), and a prolapse of the posterior leaflet in 22 patients (36%). Important annular calcification was found in 36 patients (59%). Surgical ProcedureThe MV was approached through a median sternotomy and a standard left atrial incision in all cases. According to the location of the main regurgitant jet, a double-orifice repair was performed in 53 (86.8%) patients and a commissural EE repair in the remaining 8 (13.1%). The paracommissural repair was posteriorly located in 6 patients and anteriorly located in 2 patients. A 4-0 polypropylene continuous suture without pledgets was used in most cases for leaflet approximation, unless the leaflets were thin. In these cases, a 5-0 suture was preferred.In case of annular calcification, the rationale for adopting the EE technique was to correct leaflet lesions with no annular manipulation. Indeed, the main reason for annuloplasty omission was the presence of significantly/severely calcified annulus which was present in 36 patients (36/61; 59%). In the remaining 25 patients (41%), the EE was intentionally performed without a concomitant annuloplasty because the annulus was judged by the surgeon not to be significantly dilated. By avoiding annuloplasty in those cases, also the risk of inducing postoperative mitral stenosis was minimized. Several associated procedures were performed concomitantly with valve repair, including coronary artery revascularization (9 patients), tricuspid annuloplasty (7 patients), ...

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Section: Discussionmentioning

confidence: 99%

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

et al. 2014

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“…En bloc annular resection is advised instead of using rongeur or ultrasound to debride calcium. 1,2,7 Some surgeons may prefer prosthetic valve fi xation with big pledget sutures following partial debridement. 1 However, this approach is observed to increase both mortality (particularly post-MVR left ventricular rupture rate) and morbidity (prosthetic valve dysfunction, paravalvular regurgitation and embolic incidences).…”

Section: Discussionmentioning

confidence: 99%

“…This is thought to prevent progressive thickening and early degeneration. 6,7 Despite discussions on this matter, the use of fresh autologous pericardium is becoming more popular in cases with surrounding support tissue (for instance, left ventricle and left atrium posterior wall) and endocarditic cases. The use of glutaraldehyde-processed pericardium in the repair of unsupported areas such as fi brous tissue between aortic and mitral annulus is therefore preferred.…”

Section: Discussionmentioning

confidence: 99%

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The Use of Autologous Pericardium for Complicated Mitral Valve Annulus

Güden¹,

Kazimoğlu

Sanisoğlu³

et al. 2004

Asian Cardiovasc Thorac Ann

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The study aims to discuss annular repair using the autologous pericardial patch in cases with severe mitral ring calcification and endocarditis during mitral valve replacement. In the study, annular reconstruction was applied, during mitral valve replacement, to 8 patients who had extensive annular calcification or annular destruction due to endocarditis. After annular resection, a two-centimeter wide autologous pericardial patch was sutured continuously to the left ventricular wall close to the posterior annulus. After the valve sutures with pledgets were placed at the back of the pericardial patch, the other edge of the patch was sutured continuously to the left atrial posterior wall. Suturing was complete after the whole annulus was encircled. Thereafter, an appropriately sized mechanical prosthesis valve was used. One patient died postoperatively due to low cardiac output (early mortality 12.5%). Echocardiographical paravalvular leakage was not detected in any of the cases during follow-up. Annular dehiscence and other annular pathologies were also not detected. This reconstructive approach may positively influence mortality and morbidity in cases with complicated mitral pathologies.

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“…Although quadrangular resection and ring annuloplasty after complete ''en bloc'' decalcification of the posterior MV annulus has been described, 25 this technique remains technically challenging and may be complicated by thromboembolic events and atrioventricular disassociation. 26 In a case shown in this scenario, calcifications intrude deeply into the posterior leaflet, making annular decalcification difficult. On the other hand, the extension of the prolapsing tissue of P2 is limited and can therefore be repaired with a simple triangular resection.…”

Section: Scenario 4: P2 Flail and A2 Prolapse With Posterior Annular mentioning

confidence: 99%

Three-Dimensional Transesophageal Echocardiography in Degenerative Mitral Regurgitation

Faletra

Demertzis

Pedrazzini

et al. 2015

Journal of the American Society of Echocardiography

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Valve repair in mitral regurgitation complicated by severe annulus calcification

Cited by 41 publications

References 22 publications

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

Long-Term Results (≤18 Years) of the Edge-to-Edge Mitral Valve Repair Without Annuloplasty in Degenerative Mitral Regurgitation

The Use of Autologous Pericardium for Complicated Mitral Valve Annulus

Three-Dimensional Transesophageal Echocardiography in Degenerative Mitral Regurgitation

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