TY - JOUR
T1 - One Hundred Percent Reparability of Degenerative Mitral Regurgitation
T2 - Intermediate-Term Results of a Dynamic Engineered Approach
AU - Lawrie, Gerald M.
AU - Zoghbi, William
AU - Little, Stephen
AU - Shah, Dipan
AU - Ben-Zekry, Zegit
AU - Earle, Nan
AU - Earle, Elizabeth
N1 - Funding Information:
This study was supported by The Houston Methodist Hospital Foundation through The Michael E. DeBakey Distinguished Chair of Cardiac Surgery.
Publisher Copyright:
© 2016 The Society of Thoracic Surgeons
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background Advances in understanding dynamic mitral valve function have led to a repair technique with no leaflet resection, accurate dynamic annular and chordal sizing, and preservation of left ventricular outflow tract dynamics. Methods This approach uses inflation of the left ventricle and ascending aorta with pressurized saline to achieve diastolic mitral valve locking and early isovolumic systole. The left ventricle is maximally dilated, the aorta and root are distended, and the mitral leaflets are opposed. This is used to adjust the length of the artificial chordae and size the fully flexible annuloplasty ring in three dimensions for accurate apposition of the zones of leaflet coaptation. We monitored 752 consecutive patients after repairs performed between 2001 and 2013. Results There were 510 men (68.8%). Mean age was 61.3 ± 13.54 years. The leaflet repaired was anterior in 127 patients (17%), posterior in 451 (60%), both 55 (7.3%), and Barlow's in 119 (16%). Repair was isolated in 76% (573 of 752). Reparability was 100%. No prosthetic valve was implanted in patients with myxomatous or degenerative disease. Perioperative mortality was 2.3% (17 of 752) overall and was 1.6% (9 of 573) for isolated repair and 0.2% (1 of 451) for isolated posterior leaflet. Nonsignificant leaflet systolic anterior leaflet motion was observed in 0.2% (14 of 739) of patients. At 10 years, survival by Kaplan-Meier analysis was 66.4%, and freedom from reoperation was 91.8%. Freedom from significant mitral regurgitation at 5 years was 90.3%. Cox analysis showed male gender was a predictor of reoperation (p = 0.63). Conclusions This dynamic approach enabled 100% reparability of myxomatous and degenerative valves with no occurrence of significant systolic anterior leaflet motion. Despite 100% of patients having been repaired, intermediate-term durability measured by reoperation rates, freedom from prosthetic valve, and intermediate echocardiographic follow-up have been good.
AB - Background Advances in understanding dynamic mitral valve function have led to a repair technique with no leaflet resection, accurate dynamic annular and chordal sizing, and preservation of left ventricular outflow tract dynamics. Methods This approach uses inflation of the left ventricle and ascending aorta with pressurized saline to achieve diastolic mitral valve locking and early isovolumic systole. The left ventricle is maximally dilated, the aorta and root are distended, and the mitral leaflets are opposed. This is used to adjust the length of the artificial chordae and size the fully flexible annuloplasty ring in three dimensions for accurate apposition of the zones of leaflet coaptation. We monitored 752 consecutive patients after repairs performed between 2001 and 2013. Results There were 510 men (68.8%). Mean age was 61.3 ± 13.54 years. The leaflet repaired was anterior in 127 patients (17%), posterior in 451 (60%), both 55 (7.3%), and Barlow's in 119 (16%). Repair was isolated in 76% (573 of 752). Reparability was 100%. No prosthetic valve was implanted in patients with myxomatous or degenerative disease. Perioperative mortality was 2.3% (17 of 752) overall and was 1.6% (9 of 573) for isolated repair and 0.2% (1 of 451) for isolated posterior leaflet. Nonsignificant leaflet systolic anterior leaflet motion was observed in 0.2% (14 of 739) of patients. At 10 years, survival by Kaplan-Meier analysis was 66.4%, and freedom from reoperation was 91.8%. Freedom from significant mitral regurgitation at 5 years was 90.3%. Cox analysis showed male gender was a predictor of reoperation (p = 0.63). Conclusions This dynamic approach enabled 100% reparability of myxomatous and degenerative valves with no occurrence of significant systolic anterior leaflet motion. Despite 100% of patients having been repaired, intermediate-term durability measured by reoperation rates, freedom from prosthetic valve, and intermediate echocardiographic follow-up have been good.
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U2 - 10.1016/j.athoracsur.2015.07.029
DO - 10.1016/j.athoracsur.2015.07.029
M3 - Article
C2 - 26409712
AN - SCOPUS:84973411383
VL - 101
SP - 576
EP - 584
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 2
ER -