Very long-term results (up to 17 years) with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation

Bonis, Michele De; Lapenna, Elisabetta; Lorusso, Roberto; Buzzati, Nicola; Gelsomino, Sandro; Taramasso, Maurizio; Vizzardi, Enrico; Alfieri, Ottavio

doi:10.1016/j.jtcvs.2012.07.034

Cited by 75 publications

(53 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As far as the EE technique is concerned, in patients with degenerative MR, the long-term results of this procedure are excellent whenever an annuloplasty is concomitantly used. 7,8 However, when annuloplasty is omitted and annular dilatation is not corrected, computational models have predicted higher stresses on the suture and on the leaflets, possibly leading to progressive degeneration of the reconstruction. 9 In the clinical setting, we first reported a higher failure rate at 5 years for the EE technique without ring annuloplasty in 260 patients submitted to the double-orifice repair.…”

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

Self Cite

View full text Add to dashboard Cite

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), ...

show abstract

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…In this series, the degree of acute residual MR was a predictor of follow-up MR >2þ recurrence (p ¼ 0.02), 24% of patients being discharged with 2þ residual MR. Indeed, in the surgical experience, a suboptimal repair with residual prolapse and 2þ MR is a well-known predictor of recurrent severe MR. 15 MitraClip repair is a leaflet procedure and lacks annuloplasty, which is fundamental to achieve optimal and durable results in surgery. We recently published our long-term results with the edge-to-edge technique without annuloplasty in the surgical setting, 16 reporting a disappointing freedom from MR recurrence of 64% at 10 years despite an initial optimal result (MR 1).…”

mentioning

confidence: 99%

Comparison of Outcomes of Percutaneous MitraClip Versus Surgical Repair or Replacement for Degenerative Mitral Regurgitation in Octogenarians

Buzzatti

Maisano

Latib

et al. 2015

The American Journal of Cardiology

Self Cite

View full text Add to dashboard Cite

“…A limitation of this technique is that the cause of the annulus‐dilatation in FMR is not addressed by this technique. OMVR with E‐t‐E repair combined with an annuloplasty ring provides an increased long‐term durability and decreased risk of recurrent MR . Long‐term durability of the technique without an annuloplasty ring has not yet been proven and the number of patients treated this way are limited in comparison with other oMVR techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Long‐term durability of the technique without an annuloplasty ring has not yet been proven and the number of patients treated this way are limited in comparison with other oMVR techniques. The absence of annuloplasty has been identified as an important predictor of reccurence of MR …”

Section: Discussionmentioning

confidence: 99%

(Meta)‐Analysis of Safety and Efficacy Following Edge‐to‐Edge Mitral Valve Repair Using the MitraClip System

Bail

2015

J Interven Cardiology

View full text Add to dashboard Cite

Based on the analysis of the current literature treatment with MCS is associated with good short-term success and low mortality. MCS is safe and effective for patients with limited surgical options. The results are comparable with open mitral valve repair (oMVR) but patients are markedly older and have a higer risk profile than patients who undergo oMVR. Prospective randomized controlled trials are warranted to determine potential AEs, device durability and long-term follow-up.

show abstract

Very long-term results (up to 17 years) with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation

Abstract: The double-orifice repair combined with ring annuloplasty provides very satisfactory long-term results in patients with degenerative mitral regurgitation in the setting of bileaflet and anterior leaflet prolapse.

Cited by 75 publications

References 23 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

Comparison of Outcomes of Percutaneous MitraClip Versus Surgical Repair or Replacement for Degenerative Mitral Regurgitation in Octogenarians

(Meta)‐Analysis of Safety and Efficacy Following Edge‐to‐Edge Mitral Valve Repair Using the MitraClip System

Contact Info

Product

Resources

About