Results Of Mitral Valve Repair Research Articles

Mitral valve repair with the new semirigid partial Colvin–Galloway Future annuloplasty band

Various devices have been proposed for ring stabilization in patients with mitral valve disease. This study reports the intermediate-term results of mitral valve repair with a new semirigid partial annuloplasty ring in a large series of patients. A total of 437 consecutive patients were analyzed who underwent mitral valve reconstruction with annuloplasty using the Colvin-Galloway Future band at the German Heart Center in Munich between 2001 and 2005. A total of 237 patients (54.2%) underwent isolated mitral valve repair, and 200 patients (45.8%) underwent a combined procedure. The follow-up is 97% complete (mean follow-up of 405 survivors 2.1 +/- 1.1 years). Overall 30-day mortality was 2.7%. Twenty patients (4.6%) died later after an average of 1.1 +/- 1.1 years. Actuarial survival at 4 years after isolated mitral valve reconstruction and combined procedures was 91% +/- 4% and 87% +/- 2.5%, respectively (P < .001). Twelve patients (2.7%) required a mitral valve reoperation after an average of 4.5 +/- 4.3 months. Five of these reoperations were required for band dehiscence, and 1 reoperation was required for band fracture. Freedom from reoperation at 4 years was 97% +/- 0.9%. At the latest follow-up, 93.5% of the patients showed trivial or mild mitral valve regurgitation, and 86.4% of the patients showed New York Heart Association functional class I or II. Mitral valve annuloplasty with the Colvin-Galloway Future band can be performed with a low early and late mortality and an excellent functional outcome. The low incidence of reoperation demonstrates that the Colvin-Galloway Future band is a safe and effective device. The importance of secure anchoring of the device in the mitral annulus has to be emphasized to prevent band dehiscence.

Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (‘loop technique’)☆

Mitral valve (MV) repair with premeasured Gore-Tex loops (the 'loop technique') was introduced in 1999. We assessed the early- and mid-term outcomes for the loop technique in patients with MV prolapse. A total of 632 patients (447 male, 185 female) underwent MV repair with Gore-Tex loops for MV prolapse. A mini-thoracotomy was performed in 522 patients (mean age 58+/-12.4 years) and 110 patients received a full sternotomy (mean age 66.5+/-11.9 years). Early postoperative echo was performed in all patients and clinical follow-up was obtained in 95% of patients. Loops were used to correct prolapse of the posterior leaflet in 308 patients, the anterior leaflet in 150 patients, and both leaflets in 174 patients. The mean length of Gore-Tex loops was 20.8+/-3.4 mm for the A2 segment and 14.3+/-3.0mm for the P2 segment. Concomitant procedures consisted of atrial fibrillation ablation in 123 patients, tricuspid valve repair in 30 patients, coronary bypass surgery in 73 patients, and aortic valve surgery in 21 patients. Mean aortic cross-clamp and cardiopulmonary bypass times were 89+/-32 and 137+/-43 min, respectively. Predischarge echocardiography revealed no residual mitral regurgitation (MR) in 75%, trace or mild MR in 21% and mild-to-moderate MR in 4% of patients. Thirty-day survival was 98.6%, and one-year survival was 97.1%. Freedom from reoperation was 97.4+/-1.4%, 3 years postoperatively. MV repair with premeasured Gore-Tex loops results in excellent early- and mid-term outcomes for all types of leaflet prolapse. The loop technique facilitates minimal invasive MV repair without compromising surgical outcomes.

Mitral valve reconstruction: long-term results of triangular resection for degenerative prolapse

Surgical treatment of a prolapsed anterior leaflet of the mitral valve is relatively difficult and controversial compared with management of a prolapsed posterior leaflet. The aim of this study was to assess the long-term results of mitral valve repair, focusing on triangular resection of the anterior leaflet. Between October 1991 and December 2006, surgical treatment for a prolapsed anterior leaflet was performed in 57 patients with degenerative mitral valve disease, including 49 patients who had anterior leaflet resection. Patients with mitral stenosis, ischemic mitral regurgitation, and congenital valvular disease were excluded. The mean age of the patients was 51.7 +/- 15.9 years, and the mean follow-up period was 6.2 +/- 3.8 years. The overall actuarial survival rate and noreoperation rate at 10 years were 91.7% +/- 4.1% and 92.3% +/- 3.7%, respectively. Reoperation was performed in 2 (4%) of 49 patients who had anterior leaflet resection. All patients survived after reoperation, which involved mitral valve replacement. Postoperative echocardiographic studies showed that the mitral valve area was significantly smaller after repair in patients with anterior leaflet resection, but the area was still large enough for a functional valve. Among the 57 patients, 42 had no mitral regurgitation, whereas it was mild in 7 patients and moderate in 3 patients. Triangular resection of a prolapsed anterior leaflet of the mitral valve provides durable and reliable long-term results.

Durability of mitral valve repair in Barlow disease versus fibroelastic deficiency

Durability assessment of mitral valve repair for degenerative valve incompetence is limited to reoperation as a primary indicator and valve-related risk factors for late death as a secondary indicator. We assessed serial echocardiographic follow-up of valve function as an indicator of the durability of mitral valve repair. In 348 patients having undergone mitral valve repair for degenerative valve incompetence, clinical outcome was excellent: 10 years after repair, survival was 80.1% and freedom from reoperation 94.4%. However, freedom from mitral regurgitation (>2/4), 98.7% at 1 month, decreased to 82.2% at 5 years and 64.9% at 10 years. The linearized recurrence rate of mitral regurgitation (>2/4) was 3.2% per year. Recurrence rate was higher in patients with Barlow disease (6.0%) and lower in those with fibroelastic deficiency (2.6%) (P = .01). Performing chordal shortening, the nonuse of sliding plasty and the nonuse of an annuloplasty ring were determined to be factors predicting recurrence of mitral regurgitation. In reconstructions avoiding these risk factors, recurrence rate decreased to 2.4%. There was no difference between Barlow disease and fibroelastic deficiency: 2.9% versus 2.2% (P > .05). Recurrent regurgitation is characterized by leaflet prolapse, thickening, and calcification. When optimal surgical techniques are used, the residual recurrence rate of mitral valve regurgitation remains between 2% and 3% per year and is related to progressive degeneration of the chordae and the leaflets. Long-term results of mitral valve repair in Barlow disease are essentially the same as in fibroelastic deficiency.

Results of mitral valve repair versus mitral valve replacement for isolated active infective mitral valve endocarditis: 20-year single center experience

Objective: We retrospectively compared early and long-term results of mitral valve repair (MVRep) and mitral valve replacement (MVR) in patients with isolated infective mitral valve endocarditis (MVE).

Chordal replacement versus quadrangular resection for repair of posterior mitral leaflet prolpase

Objective: The current study compared midterm results of mitral valve repair with artificial chordal replacement versus classic posterior leaflet quadrangular resection in a large group of patients with posterior mitral leaflet prolapse

Plastia da valva mitral com a técnica do "Duplo Teflon": resultados de 10 anos

The purpose of this paper is to present the late clinical results of mitral valve repair with the "Double Teflon" technique. "Double Teflon" technique consists of a quadrangular resection of the posterior leaflet, annulus plication with "pledgetted" stitches over a Teflon patch, and leaflet suture. Between 1994 and 2003, 133 patients with degenerative mitral insufficiency due to ruptured or elongated chordae in the posterior leaflet underwent repair with this technique. The mean patient age was 60.4 years and 60.9% patients were male. According to clinical evaluation, 29.3% of the patients were in New York Heart Association functional class IV, 55.7% in class III and 15.0% in class II. Associated techniques of mitral valve repair were used in 15.2% of the patients; the most common was chordal shortening. Twenty six (19.5%) patients had associated procedures. There was one (0.75%) operative death. In the late postoperative period, 95.5% of the surviving patients were in New York Heart Association functional class I. Linearized rates of thromboembolism, reoperation and death were 0.9%, 0.3% and 0.6% patient/year, respectively. The actuarial survival at 10 years was 94.7% +/- 3.6%. Actuarial freedom from thromboembolism and reoperation were 97.3 +/- 1.5% and 99.2 +/-0.8%, respectively. There were no episodes of hemolysis or endocarditis. Mitral valve repair with "Double Teflon" technique presents low morbimorbidity and good clinical late evolution.

Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease

The aim of this study was to review the clinical and echocardiographic outcomes after mitral valve repair for mitral regurgitation due to degenerative disease of the mitral valve. A total of 649 consecutive patients who had isolated mitral valve repair were prospectively followed up for 6.8 +/- 3.1 years. The mean age was 58 +/- 11 years. The operative mortality rate was 0.6%; the late mortality rate was 14.6%; and survival at 15 years was 67 +/- 5%. Age by increments of 5 years, advanced functional class, and impaired left ventricular function were independent predictors of late death. The freedom from reoperation on the mitral valve at 15 years was 92 +/- 3%, and the freedom from late, recurrent, severe mitral regurgitation was 85 +/- 4%. Most patients were in functional classes I or II at the latest follow-up contact. Mitral valve repair is associated with low operative mortality and morbidity, but it does not arrest the degenerative process. This study suggests that rates of reoperation underscore rates of late failure of the mitral valve repair.

Rest and Dobutamine stress echocardiography in the evaluation of mid-term results of mitral valve repair in Barlow's disease

BackgroundSurgical "anatomical" repair is the most frequent technique used to correct mitral regurgitation due to severe myxomatous valve disease. Debate, however, persists on the efficacy of this technique, as well as on the durability of the repaired valve, and on its functioning and hemodynamics under stress conditions. Thus, a basal and Dobutamine echocardiographic (DSE) study was carried out to evaluate these parameters at mid-term follow-up.Methods and ResultsTwenty patients selected for the study (12 men and 8 women, mean age 60 ± 9 years) underwent pre- and post-operative transthoracic echocardiography (TTE) and intra-operative transesophageal echocardiography (TEE). At mid-term follow-up (20 ± 5 months) all patients underwent rest TTE and DSE (3 min. dose increments up to 40 microg/Kg/min protocol). Pre-discharge and one-month TTE showed absence of MR in 11 pts., trivial or mild MR in 9 pts. and normal mitral valve area and gradients. Mid-term TTE showed decrease in left atrial and ventricular dimension, in pulmonary artery pressure (sPAP) and grade of MR. During DSE a significant increase in mitral valve area, maximum and mean gradients, sPAP, heart rate and cardiac output and a decrease in systolic annular diameter and left ventricular volume were found; in 6 pts. a transient left ventricular outflow tract obstruction was observed.ConclusionBasal and Dobutamine stress echocardiography proved to be valuable tools for evaluation of mid-term results of mitral valve repair. In our study population, the surgical technique employed had a favourable impact on several cardiac parameters, evaluated by these methods.

Results of mitral valve repair for active infective endocarditis: 19-year single centre experience

Objective: We retrospectively evaluated early and long-term results of mitral valve repair (MVR) in patients with isolated infective mitral valve endocarditis MVE).

A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse

A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse

454 Outcome of mitral valve repair in population with high incidence of rheumatic heart disease

454 Outcome of mitral valve repair in population with high incidence of rheumatic heart disease

Mitral Valve Annuloplasty with Carpentier-Edwards Physio Ring: Mid-term Results

The mid-term results of mitral valve repair with the Carpentier-Edwards Physio annuloplasty ring were assessed in 97 consecutive patients in a single tertiary-referral cardiothoracic surgical center. The mean follow-up time was 3.9 years (range, 1 month to 8.9 years). Most patients were in functional class II and III before the operation. Ejection fraction was < 40% in 8 patients. Causes of mitral regurgitation included degenerative disease (66%), infective endocarditis (13.4%), rheumatic disease (10.3%), and ischemic heart disease (9.3%). Thirty-day mortality was 2.1%. Actuarial survival and freedom from re-operation at 8 years were 91% and 90.8%, respectively. The only significant risk factor for re-operation was residual mitral regurgitation. Four patients suffered thromboembolic complications, giving an overall event-free survival of 93% +/- 3.7% during the follow-up period. The Carpentier-Edwards Physio ring provides safe and effective repair of mitral regurgitation on mid-term follow-up.

Development of a minimally invasive mitral valve surgery program – The Innsbruck experience

BACKGROUND: Minimally invasive mitral valve surgery has become popular in a few selected cardiac surgery centers worldwide. This article summarizes the initial experience of a minimally invasive mitral valve surgery program at the Medical University Innsbruck. METHODS: From 2001 to 2005 a total of 42 patients were selected for minimally invasive mitral valve surgery (miniMV) at our department. During the same period, another 64 patients underwent isolated mitral valve repair for non-ischemic and non-infective disease using conventional surgical technique (conMV). RESULTS: There were no perioperative deaths within both groups. Mean age was 54.1 ± 11.8 years in the miniMV group and 63.7 ± 11.3 years in the conMV group (p < 0.001). Port-access technique with endovascular aortic clamping was performed in the initial 3 procedures (7.3%) and left in favour of transthoracic clamping (Chitwood clamp). Conversion rate to sternotomy was 2.4% (1 patient) in the early phase of this program. One reexploration for bleeding in the conMV group (1.6%) and 1 in the miniMV group (2.4%, thoracoscopic) had to be performed. There were 2 valvular reoperations in the conMV group (3.1%) and none in the miniMV group (0%). In the follow-up, asymptomatic lung herniation occurred in one patient (2.4%) and lymph fistulation in 7 patients (17.1%). Functional results of mitral valve repair were similar in both groups. CONCLUSIONS: Minimally invasive mitral valve surgery has evolved to be a reliable method with reproducible results and excellent cosmetic and functional results. This technique, however, should not be applied in patients with severe aortic atherosclerosis or pleural/parenchymatous pulmonary disease.

Midterm outcome of mitral valve repair for congenital mitral regurgitation in infants and children

We analyzed the midterm results of children undergoing mitral valve repair without the use of prosthetic materials focusing on mitral annulus growth. From 1991 to 2004, 17 children (median age: 11 months) underwent mitral valve repair (grade III=9, IV=8). Regurgitation was due to prolapsed leaflet in 8 patients, annular dilatation in 4, and restrictive leaflet motion in 5. Preoperative indexed mitral valve diameter and Z-value were compared with those obtained at follow-up. There were no early or late deaths. All patients had an improved regurgitation grade after surgery. MV repair resulted in reduction in the indexed mitral valve diameter (58.2+/-22.9 vs. 47.3+/-18.9 mm/m2, P<0.05) and Z-value (3.3+/-2.3 vs. 0.79+/-2.2, P<0.05). One patient underwent re-repair, but no patients required mitral valve replacement during the median follow-up period of 95 months. The latest regurgitation grade was absent or I in 4 patients, II in 10 patients, and III in 3 patients. Mitral valve annulus increased by 23% at 3 years and by 49% at 5 years compared with that at surgery. Mitral valve repair without the use of prosthetic materials is feasible for the majority of patients and carries an appropriate growth pattern of the mitral valve annulus after surgery.

Results of mitral valve repair in rheumatic mitral regurgitation

Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4+/-10.1 years) underwent mitral valve (MV) repair. Five hundred and sixty-five patients (63%) had pre-operative atrial fibrillation. Six hundred and ten (68%) patients were in NYHA class III or IV. Four hundred and twelve (45.9%) had pure mitral regurgitation (MR) and 486 (54.1%) had mixed mitral stenosis and MR. The pathology was leaflet prolapse (n=270, 30%), annular dilatation (n=717, 79.8%) and calcification (n=39, 4.3%). Reparative procedures included annuloplasty (n=793, 88%), commissurotomy (n=530, 59%), chordal shortening (n=225, 25%), cusp excision/plication (n=41, 4.5%), cuspal thinning (n=325, 36%), cleft suture (n=142, 16%), decalcification (n=30, 3.3%), chordal transfer (n=13, 1.4%), and neo chordae construction (n=3, 0.3%). Early mortality was 32 (3.6%). Follow-up ranged from 6 to 180 months (mean 62.7+/-31.8 months) and was 96% complete. Six hundred and twenty-one patients (69%) had no, or trivial, or mild MV. Two hundred and seventy-seven of the 866 survivors had MR which was moderate in 153 (18%) and severe in 124 (14%) patients. Thirty-five patients underwent re-operation. There were 21 late deaths (2.4%). Actuarial and re-operation-free survival at 10 years were 92+/-1.1% and 81+/-5.2%, respectively. Freedom from moderate or severe MR was 32+/-3.9%. MV repair in the rheumatic population is feasible with acceptable long-term results.

Early results of mitral valve repair in ischemic cardiomyopathy

Early results of mitral valve repair in ischemic cardiomyopathy

Midterm results of mitral valve repair with the Carpentier-Edwards rigid ring

Prosthetic annuloplasty rings play an important role in mitral valve repair. This clinical study was undertaken to evaluate the midterm results obtained with the Carpentier-Edwards rigid ring. Between October 1991 and March 2005, 112 patients (mean age 53.0 years) underwent mitral valve repair with a Carpentier-Edwards rigid ring at our institution. Degenerative disease was the most frequent cause and a small number had other conditions such as endocarditis and rheumatic disease. Ten patients were in Carpentier's functional class Type I, 101 patients in Type II and 1 patient in Type III, based on valve pathology. Ischemic mitral regurgitation was excluded. The mean follow-up time was 5.3+/-3.6 years (range: 8 days to 12.3 years). All patients were completely followed by echocardiography. The rigid ring ranged from 26 to 36 mm in diameter and the most common size was 30 mm. Although the mitral orifice area was decreased after mitral valve repair in all patients, none of them required reoperation because of mitral stenosis or left ventricular outflow tract obstruction (systolic anterior motion). Reduction of both systolic and diastolic left ventricular volumes was observed postoperatively. Ejection fractions were preserved in all cases. The actuarial survival rate was 92.0+/-3.0% at 10 years and the reoperation-free rate at 10 years was 96.0+/-2.0%. The rigid ring has produced promising midterm results in terms of reoperation-free and survival rates.

Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse

The results of mitral valve repair for anterior leaflet prolapse have been less gratifying than those reported for posterior leaflet prolapse. We compared the long-term durability of 2 different surgical techniques: the edge-to-edge repair, which is used for the treatment of anterior leaflet prolapse, and quadrangular resection, which has been adopted for correction of posterior leaflet prolapse. From 1991 through April 2004, 133 patients with anterior leaflet prolapse and 605 with posterior leaflet prolapse caused by degenerative mitral disease underwent valve repair. The edge-to-edge repair was used for correction of anterior leaflet prolapse, and quadrangular resection of the posterior leaflet, with or without sliding plasty, was used for correction of posterior leaflet prolapse. All patients received a concomitant annuloplasty procedure. No hospital deaths occurred in the anterior leaflet prolapse group, whereas 2 (0.3%) patients died in the posterior leaflet prolapse group (P = .7). Follow-up was 100% and 97.2% complete in the anterior and posterior leaflet prolapse groups, respectively. At 10 years, overall survival was 91% +/- 4.06% for anterior leaflet prolapse and 93.5% +/- 1.81% for posterior leaflet prolapse (P = .18), and freedom from cardiac death was 95.8% +/- 2.83% for anterior leaflet prolapse and 97.4% +/- 0.95% posterior leaflet prolapse (P = .27). Freedom from reoperation was 96% +/- 2.3% in the anterior leaflet prolapse group and 96.5% +/- 1.18% in the posterior leaflet prolapse group (P = .37). At follow-up (mean, 4.5 +/- 3.12 years; range, 1 month-13.2 years), New York Heart Association functional class I or II was documented in 93.2% of patients in the anterior leaflet prolapse group and 92.8% in the posterior leaflet prolapse group (P = .98). The long-term results of the edge-to-edge repair in the setting of anterior leaflet prolapse are similar to those obtained with quadrangular resection for the treatment of posterior leaflet prolapse.

Novel left ventriculoplasty for nonischemic dilated cardiomyopathy with functional mitral regurgitation

Novel left ventriculoplasty for nonischemic dilated cardiomyopathy with functional mitral regurgitation