Successful Mitral Valve Repair Research Articles

Transthoracic echocardiography in patients undergoing mitral valve repair: comparison of new transthoracic 3D techniques to 2D transoesophageal echocardiography in the localization of mitral valve prolapse

Successful mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is mainly related to surgical expertise and MV anatomy. Although 2D echocardiography, specifically transoesophageal (TOE), provides precise information regarding MV anatomy, recent advancements in matrix technology meant a decisive step forward to the point where segmental MV analysis can be accurately performed from a noninvasive 3D transthoracic (TTE) approach. The aims of this study were: (a) to evaluate the feasibility and time required for real-time 3DTTE in a large consecutive cohort of patients with severe DMR in the assessment of MV anatomy; (b) to compare the accuracy of 3DTTE and 2DTOE versus surgical inspection in the recognition and localization of all components of the MV leaflets; (c) to establish the added diagnostic value of 3D colourDoppler examination to pure 3D morphologic evaluation. 149 consecutive patients with severe DMR underwent complete 3D TTE before surgery and 2D TOE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. 3D TTE was feasible in a relatively short time (8 ± 4min), with good (49%) and optimal (33%) imaging quality in the majority of cases. 3D TTE had significant better overall accuracy compared to 2D TOE (93 and 91%, p < 0.05, respectively). 2D TOE was significantly more specific than 3D TTE in the identification of A3 prolapse (99 vs. 96%). The colourDoppler mode did not improve significantly the accuracy of 3DTTE, albeit it determined a better sensitivity in the detection of A2 prolapse if compared to 2D TOE (95 vs. 85%). 3D TTE with or without colourDoppler is a feasible and useful method in the analysis of MV prolapse; it allows a preoperative and noninvasive description of the pathology as accurate as the 2D TOE.

Reference Values for Physical Stress Echocardiography in Asymptomatic Patients after Mitral Valve Repair.

Clinical decision-making in symptomatic patients after mitral valve (MV) repair remains challenging as echocardiographic reference values are lacking. In native MV disease intervention is recommended for mean transmitral pressure gradient (TPG) >15 mmHg or systolic pulmonary artery pressure (SPAP) >60 mmHg at peak exercise. Insight into standard stress echo parameters after MV repair may therefore aid to clinical decision-making during follow-up. Stress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves. In 25 patients (NYHA I) after MV repair stress echocardiography was performed on a semi-supine bicycle. Doppler flow records and MV related hemodynamics at rest and peak were obtained. Linear regression analysis was performed for mean TPG and SPAP at peak, using predetermined variables and confounders. Mean TPG at rest (3.2 ± 1.4 mmHg) significantly increased at peak (15.0 ± 3.4 mmHg) but was always <25 mmHg. Mean SPAP at rest (21.4 ± 3.8 mmHg) significantly increased at peak (41.8 ± 8.9 mmHg) but was never >57 mmHg. Only the indexed MV ring diameter was inversely correlated to mean TPG at peak in a multivariable model. In contrast to current recommendations in native MV disease, our data indicate that the standard value for mean TPG during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15 mmHg in >50%, but always <25 mmHg. For SPAP, patients never reached the guideline cutoff (60 mmHg). Long-term follow-up data are needed to provide insight in clinical consequences. Baseline stress echocardiography may indicate individual reference values to compare with during follow-up. https://clinicaltrials.gov/ct2/show/NCT02371863?term=chamuleau+AND+Mitral&rank=1.

Associations Between Surgical Ablation and Operative Mortality After Mitral Valve Procedures

Surgical ablation (SA) for atrial fibrillation (AF) concomitant to mitral valve repair/replacement (MVRR) improves longitudinal sinus rhythm. However, the risk of adding SA remains a clinical question. This study examined whether the addition of contemporary SA for AF has an impact on operative outcomes. The study cohort included 88,765 MVRR patients with or without SA, coronary artery bypass grafting (CABG), septal defect, and tricuspid repair in The Society of Thoracic Surgeons Database between 2011 and 2014. Group 1 did not have AF (No-AF) and did not receive SA (No-SA); group 2 had No-AF immediately preoperatively but received SA; group 3 had AF but No-SA; and group 4 had AF with SA. Groups 3 and 4 were stratified into paroxysmal versus nonparoxysmal AF. With the use of logistic regression, with group 1 as reference, risk-adjusted odds ratios (OR) for mortality were compared for SA performance, AF type, and SA technique. Group 3 had higher age, New York Heart Association class, redo operations, and unadjusted mortality than group 4. Relative to group 1, group 3 had an OR for mortality of 1.15 (95% confidence interval: 1.04 to 1.27, p < 0.01). OR increments were similar for paroxysmal and nonparoxysmal AF. In group 4, concomitant SA was independently associated with lower AF-related relative risk (OR 1.08), to a level that was not different from group 1 (p= 0.13). Observed treatment effects were equivalent for paroxysmal and nonparoxysmal AF and across all levels of baseline risk. For patients with AF at the time of mitral operation, the performance of SA seems associated with a lower risk-adjusted operative mortality compared with patients who do not undergo ablation.

Mid-term results of mitral valve repair using flexible bands versus complete rings in patients with degenerative mitral valve disease: a prospective, randomized study

BackgroundWe aimed to compare the outcomes of mitral valve repair with flexible band (FB) versus complete semirigid ring (SR) in degenerative mitral valve disease patients.MethodsFrom September 2011 to 2014, 171 patients were randomized and underwent successful mitral valve repair using a SR (n = 85) or FB (n = 86). There were no significant between-group differences at baseline.ResultsThere were no early mortalities. The mean follow up was 24.7 months. The 2-year survival was 96.0 ± 2.3% (95% confidence interval [CI], 88.6–98.7%) and 94.3 ± 2.8% (95% CI, 85.5–97.9%) in the SR and FB groups, respectively (p = 0.899). The left ventricle remodeling was similar between the groups. Higher transmitral peak (8.5 [3.9–17] vs. 6 [2.1–18] mmHg, p < 0.001), mean pressure gradients (3.7 [1.3–8] vs. 2.8 [0.6–6.8] mmHg, p = 0.001), and systolic pulmonary artery pressure (34.5 [20–68] vs. 29.5 [8–48] mmHg, p < 0.001) was observed in the SR group. The 2-year freedom from recurrence of significant mitral regurgitation was significantly higher in the FB group than the SR group (p = 0.002). Residual mitral regurgitation was an independent prognostic factor of recurrence of mitral regurgitation. The 3-year freedom from reoperation was significantly higher in the FB group than the SR group (p = 0.044).ConclusionPatients with degenerative mitral valve disease may benefit from valve repair with FBs. Residual mitral regurgitation before discharge is an independent risk factor of late insufficiency recurrence.Trial registrationClinicalTrials.gov NCT03278574, retrospectively registered on 06.09.2017.

Percutaneous repair of severe mitral valve regurgitation secondary to chordae rupture in octogenarians using MitraClip.

The aim of this study was to assess feasibility and clinical effectiveness of the MitraClip device in octogenarians suffering from severe mitral valve regurgitation due to chordae rupture. The MitraClip procedure is a suitable technique in high-risk surgical patients to achieve safe and effective percutaneous repair of mitral valve regurgitation. Octogenarians show cumulative risk and social aspects hindering mitral valve surgery. No data exists regarding the use of the MitraClip device in high-risk octogenarians suffering from mitral valve chordae rupture. Between October 2009 and March 2017 98 high-risk octogenarians (society of thoracic surgeons score [STS]: 9.7% ± 0.8) with mitral valve prolapse and consecutively chordae rupture were treated with the MitraClip after interdisciplinary discussion. Successful mitral valve repair was achieved in 91% of the octogenarians. Repair of the mitral valve caused immediate and significant reduction of dyspnoea (NYHA class: 3.5 ± 0.4 vs 2.0 ± 0.3; P < 0.001), cardiac reverse remodeling (LVESD: 39 ± 0.8 vs 35 ± 0.8; P < 0.01) and amelioration of cardiac biomarkers (NTproBNP (4884 ± 52 ng/L vs 2473 ± 210 ng/L; P < 0.05,). Effects were stable over the 12 months observation period. None of our patients died intraprocedurally. Percutaneous repair of chordae rupture is feasible and safe in high-risk octogenarians. The MitraClip should be considered to repair severe mitral valve regurgitation due to mitral valve chordae rupture in high-risk octogenarians after interdisciplinary discussion even facing a challenging anatomy.

Preoperative Invasive Hemodynamic Determinants of Survival Among Patients Undergoing Aortic or Mitral Valve Surgery

To evaluate the association of preoperative invasive hemodynamic parameters with mortality in valvular heart surgery. Retrospective cohort study. Single tertiary academic medical center. A total of 382 patients who underwent preoperative right and/or left heart catheterization before open aortic valve replacement (AVR), open mitral valve repair/replacement (MVR), or combined AVR and MVR, from July 2009 to December 2014. Retrospective chart review. Common hemodynamic indices derived from direct catheterization measurements were assessed, including pulmonary artery systolic pressure (PASP), pulmonary artery pulse pressure (PPP), mean pulmonary capillary wedge pressure (mPCWP), pulmonary artery pulsatility index, diastolic pressure gradient, left ventricular work index, and right ventricular work index. Bivariable and multivariable associations of these measures with survival were determined using Cox proportional hazards regression. Kaplan-Meier survival curves were generated using the log-rank test. The median age of the cohort was 69 years (interquartile range 60-79 years), and 162 (42.4%) of the patients were female. Elevated PASP (hazard ratio [HR] 1.32 per 10 mmHg, p < 0.0001), elevated PPP (HR 1.48 per 10 mmHg, p < 0.0001), and elevated mPCWP (HR 1.95 per 10 mmHg, p < 0.0001) were all associated with decreased survival, as was decreased diastolic blood pressure (DBP) (p = 0.005). The combination of elevated PPP and decreased DBP was associated with the worst outcomes. PASP, PPP, mPCWP, and DBP were significantly associated with mortality in valvular heart surgery patients. These hemodynamic parameters may be useful in risk stratification of this population subset.

Safety and efficacy of MitraClip™ therapy in patients with severely impaired left ventricular ejection fraction: results from the German transcatheter mitral valve interventions (TRAMI) registry.

The aim of the present study was to assess the safety and efficacy of percutaneous mitral valve repair using the MitraClip™ device in patients with severely reduced systolic left ventricular (LV) function. Among 777 MitraClip™ implantations included in the German mitral valve registry, we identified 256 patients suffering from severely reduced LV function [ejection fraction (EF) <30%] in whom successful percutaneous mitral valve repair was performed. Procedural safety, efficacy, and 1-year outcome was compared with 241 patients with preserved LV function (EF >50%) and 280 patients presenting with an EF 30-50% prior to MitraClip™ therapy. High procedural success rates, low periprocedural complication rates, and low residual mitral regurgitation grades at discharge were achieved throughout all groups. In-hospital mortality was low and comparable in all groups. After 1 year, mortality rates were 24.2% (EF <30%), 17.3% (EF 30-50%), and 18.9% (EF >50%). Major adverse cardiac or cardiovascular event rates were 29.7% (EF <30%), 24.4% (EF 30-50%), and 23.5% (EF >50%). Procedural failure was the main predictor for mortality in EF <30% patients (hazard ratio 10.38; 95% CI 3.71-29.02). Improved clinical symptoms were observed in the majority of patients in all groups. Thus, 69.5% of EF <30% patients improved by one or more New York Heart Association functional class. Compared with patients with preserved LV function, this is a significantly larger proportion (EF >50%: 56.8%; P < 0.05). Moreover, quality of life, being very poor at baseline, improved distinctively in severe heart failure patients. In patients with severely reduced systolic LV function undergoing MitraClip™ therapy, procedural safety, efficacy, and clinical improvement after 1 year are comparable to patients with preserved LV function.

4175Five-year outcome after successful transcatheter mitral valve repair in surgical high-risk patients

4175Five-year outcome after successful transcatheter mitral valve repair in surgical high-risk patients

Repair Strategies Based on Pathological Characteristics of the Rheumatic Mitral Valve in Chinese Patients

We aimed to clarify the pathological characteristics of rheumatic mitral valve disease in Chinese individuals, as well as to determine the appropriate rheumatic mitral valve repair strategy according to such characteristics. We obtained detailed statistics regarding the pathological characteristics of patients who underwent mitral valve repair or replacement for rheumatic disease during the past year at our centre. The outcomes of different repair techniques were compared. Multivariate logistic regression analyses were used to identify predictive factors for successful rheumatic mitral valve repair. Between August 2015 and August 2016, 163 patients underwent rheumatic mitral valve repair (77 cases) or replacement (61 cases) at our centre. Although the prevalence of pathological lesions was typically high, the prevalence of severe lesions was low in the leaflets and high in the commissure and subvalvular apparatus (more than one-third of all lesions in these areas). Commissurotomy (97.40%) and leaflet thinning (84.42%) were performed most frequently. On multivariate logistic regression analysis, pathological score >17.5 (odds ratio [OR] for success, 0.049; p<0.0001) and mixed lesion preoperatively (OR for success, 0.186; p=0.011) predicted repair failure, whereas severe regurgitation preoperatively (OR=4.897; p=0.026) predicted successful rheumatic mitral valve repair. Lesions of the commissure and subvalvular apparatus are the main pathological features in Chinese patients with rheumatic mitral valve disease. The commissure processing technique is beneficial in most such patients.

137 Assessment of pre-operative transoesophageal echocardiography guideline predictors of mitral valve repair success with current surgical practice

IntroductionMitral regurgitation (MR) is the second most common valvular heart disorder and severe MR brings with it a poorer prognosis. Successful mitral valve (MV) repair for prolapse has similar patient...

A simple preoperative score including the surgeon's experience to predict the probability of a successful mitral valve repair.

According to recent guidelines, mitral valve (MV) repair is preferable to replacement. However, replacement is sometimes inevitable. Aims of the study were to identify variables that predict the risk of an unsuccessful MV repair and to evaluate a score that could help in planning MV surgical procedures. Clinical data of all consecutive adult mitral valve surgical procedures, performed during a 50-month period, were extracted from our clinical registry, and combined with echocardiographic variables. The variables identified by a univariable analysis, together with factors known from the literature as indicating a possible risk of an unsuccessful MV repair, were compiled in a multivariable logistic regression analysis. The surgeon's experience was also taken into account. Of 545MV procedures, 162 (29.7%) were MV replacements. Seven variables were identified as independent predictors of MV replacement (odd ratio; 95% CI): endocarditis (7.8; 3.7-16.5), absence of annular dilatation (3.6; 2.2-5.9), leaflet calcification (6.1; 3.0-12.7), annular calcification (3.7; 1.9-7.3), mitral stenosis (29.6; 9.3-93.8), mitral sclerosis (3.0; 1.7-5.3), surgeon's limited experience (3.9; 1.4-11.0). The ability of this model to discriminate between repair and replacement was calculated, and an area under the ROC curve of 0.87 was shown. A score was calculated for each patient and distributed into four risk categories: low risk (0-6), moderate risk (7-10), high risk (11-16) and very high risk (>16) of MV replacement with, respectively, 10.2 vs 10.0%, 40.5% vs 38.9%, 66.7 vs 70.4% and 93.2 vs 93.2% observed vs predicted probability of MV replacement. Preoperative assessment of seven variables can accurately predict the risk of an unsuccessful MV repair.

Maneuvers for technical success with transcatheter mitral valve repair

Mitral valve regurgitation (MR) is common, with a prevalence that exceeds 9% for those patients >75 years of age. For symptomatic patients with prohibitive surgical risk, transcatheter mitral valve repair with the MitraClip® system (Abbott Vascular, Menlo Park, CA) is available for clinical use and is effective in reducing MR in select patients. For optimal clinical success, the procedure requires mastery of complex catheterization skills with application of an in-depth understanding of the mitral valve anatomy. We herein describe elementary and advanced maneuvers for successful transcatheter mitral valve repair with MitraClip® . © 2017 Wiley Periodicals, Inc.

Effects of Decreased Annular Height and Annular Saddle-Shaped Non-Planarity in Degenerative Severe Mitral Regurgitation with Normal Left Ventricular Ejection Fraction: Real-Time 3D Transesophageal Echocardiography.

BackgroundThe extent of mitral annular (MA) remodeling and dysfunction is correlated with the severity of mitral regurgitation (MR) as well as left atrial (LA) and left ventricular (LV) dilation. MA dysfunction may be a useful prognostic factor for operative timing and MR recurrence after successful mitral valve (MV) repair. The aim of this study was to evaluate additive prognostic factors of MA non-planarity using real-time 3D transesophageal echocardiography (RT3D-TEE) analysis in patients with chronic severe MR and preserved LV systolic function.MethodsForty-seven patients with chronic severe MR and preserved LV systolic function scheduled for MV repair were prospectively enrolled. Echocardiographic studies were performed before surgery and postoperatively within 2 weeks and at least 6 months after surgery. RT3D-TEE was performed before the operation and immediately post-operative.ResultsMean age was 55.4 ± 15.1 years and 24 were male. Annulus height/body surface area (BSA) obtained via RT3D-TEE was correlated with the degree of postoperative LA remodeling. Patients were divided into two groups by average baseline annulus height/BSA. Patients with normal annular height had a smaller postoperative LV end-diastolic dimension, LV end-systolic dimension and LA volume index than patients with decreased annular height. Preoperative annulus height/BSA values strongly predicted postoperative LA remodeling.ConclusionMA height may be a useful prognostic factor for determining the timing of surgery in patients with chronic primary MR. Annulus height/BSA assessed via RT3D-TEE may provide additional information predictive of postoperative LA remodeling after successful MV repair.

Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease.

AIMTo determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.METHODSOne hundred and eighty patients (68 ± 12 years, 79 males) underwent tricuspid annuoplasty. Cox proportional-hazards regression model for multivariate analysis was performed for variables found significant in univariate analyses.RESULTSTricuspid regurgitation etiology was functional in 154 cases (86%), organic in 16 cases (9%), and mixed in 10 cases (6%), respectively. Postoperative mortality at 30 days was 11.7%. Mean follow-up was 51.7 mo with survival at 5 years of 73.5%. Risk factors for mortality were acute endocarditis [hazard ratio (HR) = 9.22 (95%CI: 2.87-29.62), P < 0.001], ischemic heart disease requiring myocardial revascularization [HR = 2.79 (1.26-6.20), P = 0.012], and aortic valve stenosis [HR = 2.6 (1.15-5.85), P = 0.021]. Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21 (1.11-4.39), P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98 (1.04-3.92), P = 0.044]. However, successful mitral valve repair showed a protective effect [HR = 0.32 (0.10-0.98), P = 0.046]. Additionally, in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair, mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs. The explanation may lie in the fact that significant tricuspid regurgitation following left-sided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea.CONCLUSIONTricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation, although it usually reveals an overly delayed correction of a left-sided heart disease.

Optimizing the exposure in minimally invasive mitral surgery: a new left atrial retractor system.

Optimal exposure of the mitral valve is paramount in minimally invasive surgery (MIS) and a prerequisite for successful mitral valve repair or replacement. We report the concept of a new left atrial retractor (Karl Storz GmbH, Tuttlingen, Germany) dedicated to MIS. The effectiveness of the device was evaluated in a prospective series of 40 patients successfully operated at our institution.

Scleroderma and Mitral Stenosis: a New Cardiac Involvement or an Association by Chance

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Systemic Sclerosis (SSc) is an autoimmune disorder with unknown etiology, which presents with vascular lesions and fibrosis of the skin and internal organs. Cardiac, renal, and pulmonary involvements are major causes of death in systemic sclerosis. Although a major cause of scleroderma deaths is cardiac failure, scleroderma rarely causes valvular disease. This is the eighth global report on scleroderma in company with mitral stenosis and the first one in Iran.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case report:&lt;/strong&gt; The patient was a 48-year-old woman with severe mitral stenosis who was diagnosed with scleroderma 6 months before. Echocardiographic assessments had revealed no clinical manifestation of heart involvement in her previous visits. We used cardiac surgical treatment with successful outcome.&lt;/p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The present case confirms the data from the currently available literature, indicating that mitral valve involvement in systemic sclerosis is a rare occurrence. Awareness of this uncommon association and adequate management to prevent complications of the underlying disease are prerequisites for successful mitral valve repair or replacement in such patients.

Personalized mitral valve closure computation and uncertainty analysis from 3D echocardiography.

Intervention planning is essential for successful Mitral Valve (MV) repair procedures. Finite-element models (FEM) of the MV could be used to achieve this goal, but the translation to the clinical domain is challenging. Many input parameters for the FEM models, such as tissue properties, are not known. In addition, only simplified MV geometry models can be extracted from non-invasive modalities such as echocardiography imaging, lacking major anatomical details such as the complex chordae topology. A traditional approach for FEM computation is to use a simplified model (also known as parachute model) of the chordae topology, which connects the papillary muscle tips to the free-edges and select basal points. Building on the existing parachute model a new and comprehensive MV model was developed that utilizes a novel chordae representation capable of approximating regional connectivity. In addition, a fully automated personalization approach was developed for the chordae rest length, removing the need for tedious manual parameter selection. Based on the MV model extracted during mid-diastole (open MV) the MV geometric configuration at peak systole (closed MV) was computed according to the FEM model. In this work the focus was placed on validating MV closure computation. The method is evaluated on ten in vitro ovine cases, where in addition to echocardiography imaging, high-resolution μCT imaging is available for accurate validation.

Anesthetic Management of a Percutaneous Mitral Valve Repair (MVR) with the MitraClip System in a Twice Renal Transplanted Patient

Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation play an important role in prediction of morbidity and mortality in patients on dialysis. Percutaneous mitral valve repair (MVR) with the MitraClip system, which has begun to be used in severe mitral insufficiency patients with multiple comorbid medical conditions, including renal disease, is a new, alternative method. This intervention is not associated with cardiopulmonary bypass, thus; it has been proven to be safe and effective in risky patients. In this report, we would like to share our anesthetic experience in successful mitral valve repair by MitraClip system in a patient who had undergone renal transplantation twice.

Abstract 17282: Concordance of Mitral Leaflet Chordal Measurements Using Different Echocardiographic Techniques and Surgical Approaches: Implications for Mitral Valve Repair

Objectives: In patients with significant primary mitral regurgitation (PMR), the success of mitral valve repair (MVr) depends upon precise preop planning, including accurate assessment of chordal length. Both 2-dimentional (2D) &amp; 3-dimentional (3D) transthoracic (TTE) &amp; transesophageal (TEE) echocardiography visualize anterior and posterior chords. We sought to assess concordance of echo-based MV chordal measurements against direct intraop (robotic vs. midline) measurements. Methods: After informed consent, we prospectively enrolled 56 consecutive patients (59±11 years, 86% men) who underwent MVr (52% robotic, 48% sternotomy) between 12/14-6/15 by a single experienced surgeon. The lengths of anterior &amp; posterior MV chords were measured in 2-, 3-, &amp; 4-chamber views on preop 2D/3D TTE &amp; 2D/3D TEE (Philips &amp; General Electric) &amp; were compared to intraop length of the most perpendicular normal anterior &amp; posterior chords. All measurements were performed in a blinded manner &amp; noninvasive measurements were compared against intraop measurements using intraclass correlation coefficient (ICC). Results: Intraoperatively, the mean lengths of anterior &amp; posterior chords were 2.02±0.4 &amp; 1.81±0.4 cm, respectively. For the anterior chords, the mean lengths on 2D &amp; 3D TTE were 1.96±0.3 &amp; 1.96±0.3 cm, respectively, while they were 1.99±0.3 &amp; 1.93±0.3 cm on 2D &amp; 3D TEE, respectively. Similarly, for posterior chords, the mean length on 2D &amp; 3D TTE was 1.90±0.3 &amp; 1.89±0.3 cm, while they were 1.91±0.3 &amp; 1.90±0.3 cm on 2D &amp; 3D TEE, respectively. Data on ICC’s (for the concordance of the whole group &amp; separated on different surgical approaches) are shown in Figure. Conclusion: There is high concordance in measurement of anterior MV chords by 2D/3D TTE/TEE with surgical techniques. However, concordance for posterior chord measurement is less accurate, especially when a robotic approach is used. In such patients, precise preop planning using imaging (including tomography) may be crucial.

Mitral valve repair for degenerative mitral insufficiency: likelihood of success, early and-long term results at 20 years

The 2014 Guidelines for the Management of Patients with Valvular Heart Disease require to know the probability of success and operative mortality of Mitral Valve Repair (MVR) for Degenerative Mitral Insufficiency (DMI) at a given institution. To assess the probability of success, operative mortality and long-term results of MVR for DMI. The database of the Cardiovascular Surgery Service was reviewed for the period December 1991 to December 2013. Long-term survival information was obtained from death certificate records of the Chilean Identification Service. One hundred forty seven patients with DMI were identified, all operated by one author (RZ). In 28 (19%) the mitral valve was replaced, including three patients in whom a MVR was intended without success. A successful MVR was performed in 119 patients (81%). The probability of a successful MVR was 97.5% (119 of 122). Prolapsed posterior leaflet was present in 81% and annulus dilatation in 60% of cases. The most frequent surgical procedures were quadrilateral resection (83%) and chordal transfer (13%). A mitral annuloplasty was performed in 92% of cases. Operative mortality was 0.8%. At the end of a 9.9 (0 - 22.7) years follow-up, 87 patients (73%) were alive and mean survival was 16.9 years. Survival rates at 5, 10, 15 and 20 years were 91%, 78%, 71% and 50%, respectively. Six patients were re-operated, due to mitral valve dysfunction in three. Mean re-operation free survival was 21.4 years. Echocardiographic follow-up was 75% completed at an average of 64 months; 84% of cases had no or only 1+ mitral regurgitation. In our experience, MVR for DMI had an operative mortality below 1% and a probability of success greater than 95%, with excellent long-term results.