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Mitral Repair (mitral + repair)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Papillary Muscle Approximation for Ischemic Mitral Valve Regurgitation

JOURNAL OF CARDIAC SURGERY, Issue 6 2008
Akhtar Rama M.D.
Several procedures were described to restore a more normal alignment between the mitral annulus and the laterally displaced papillary muscles. We report a new approach to relocate the displaced papillary toward the mitral annulus and to reduce tethering. This procedure is believed to be technically easy and beneficial in terms of mitral repair. [source]

Atrial Remodeling After Mitral Valve Surgery in Patients with Permanent Atrial Fibrillation

JOURNAL OF CARDIAC SURGERY, Issue 5 2004
Fernando Hornero M.D., Ph.D.
Mitral surgery allows an immediate surgical auricular remodeling and besides in those cases in which sinus rhythm is reached, it is followed by a late remodeling. The aim of this study is to investigate the process of postoperative auricular remodeling in patients with permanent atrial fibrillation undergoing mitral surgery. Methods: In a prospective randomized trial, 50 patients with permanent atrial fibrillation and dilated left atrium, submitted to surgical mitral repair, were divided into two groups: Group I contained 25 patients with left auricular reduction and mitral surgery, and Group II contained 25 patients with isolated valve surgery. Both groups were considered homogeneous in the preoperative assessment. Results: After a mean follow-up of 31 months, 46% of patients included in Group I versus 18% of patients included in Group II restarted sinus rhythm (p = 0.06). An auricular remodeling with size regression occurred in those patients who recovered from sinus rhythm, worthy of remark in Group II (,10.8% of left auricular volume reduction in Group I compared to ,21.5% in Group II; p < 0.05). A new atrial enlargement took place in those patients who remained with atrial fibrillation (+16.8% left auricular volume in Group I vs. +8.4% in Group II; p < 0.05). Conclusions: Mitral surgery produces an atrial postoperative volume that decrease especially when reduction techniques are employed. Late left atrial remodeling depended on the type of atrial rhythm and postoperative surgical volume. [source]

Left Ventricular Reconstruction for Ischemic Cardiomyopathy

JOURNAL OF CARDIAC SURGERY, Issue 3 2002
Vincent Dor M.D.
The technique is conducted under a totally arrested heart; coronary revascularization is accomplished first. The mitral valve is checked by TEE and repaired if necessary. Endocardectomy and cryotherapy are used in case of ventricular tachycardia. At the limit between scarred and normal tissue, a continuous suture is tied on a balloon inflated at the theoretical diastolic volume of the patient, and a patch is fixed inside the ventricle. Autologous tissue can be also used. The experience of the author is more than 1000 cases since 1984. The global hospital mortality of the whole series is 7.3%, and 13% in patients with very poor ejection fraction (<30%). In the series of the last 3 years, these mortality rates are 4.8% and 7.9%, respectively. Both geometry and performances of the LV are improved, and the mean increase of ejection fraction is between 10 and 15 points. Three causes can explain delayed impairment; continuum in remodeling, lack in diastolic capacity, or absence of mitral repair. After an infarct, with or without successful coronary recanalization, that leaves a large asynergic scarred ventricle (50% of LV circumference), LVR is recommended to avoid or prevent permanent congestive heart failure with global dilatation. In end-stage ischemic cardiomyopathy with congestive heart failure, and poor response to full medical therapy, LVR, with acceptable risk, could slow down the remodeling and avoid or delay heart transplantation. [source]

Percutaneous Mitral Valve Repair for Mitral Regurgitation

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003
PETER C. BLOCK M.D.
Mitral regurgitation (MR) associated with, ischemic, and degenerative (prolapse) disease, contributes to left ventricular (LV) dysfunction due to remodeling, and LV dilation, resulting in worsening of MR. Mitral valve (MV) surgical repair has provided improvement in survival, LV function and symptoms, especially when performed early. Surgical repair is complex, due to diverse etiologies and has significant complications. The Society for Thoracic Surgery database shows that operative mortality for a 1st repair is 2% and for re-do repair is 4 times that. Cardiopulmonary bypass and cardiac arrest are required. The attendant morbidity prolongs hospitalization and recovery. Alfieri simplified mitral repair using an edge-to-edge technique which subsequently has been shown to be effective for multiple etiologies of MR. The MV leaflers are typically brought together by a central suture producing a double orifice MV without stenosis. Umana reported that MR decreased from grade 3.6 +/,0.5 to0.8 +/,0.4 (P < 0.0001)and LV ejection fraction increased from 33 +/,13% to 45 +/,11%(P = 0.0156). In 121 patients, Maisano reported freedom from re-operation of 95 +/,4.8% with up to 6 year follow-up. Oz developed a MV "grasper" that is directly placed via a left ventriculotomy and coapts both leaflets which are then fastened by a graduated spiral screw. An in-vitro model using explanted human valves showed significant reduction in MR and in canine studies, animals followed by serial echo had persistent MV coaptation. At 12 weeks the device was endothelialized. These promising results have paved the way for a percutaneous or minimally invasive off pump mitral repair. Evalve has developed catheter-based technology, which, by apposing the edges of a regurgitant MV, results in edge-to-edge repair. Release of the device is done after echo and fluoroscopic evaluation under normal loading conditions. If the desired effect is not produced the device can be repositioned or retrieved. Animal studies show excellent healing, with incorporation of the device into the leaflets at 6,10 weeks with persistent coaptation. Another percutaneous approach has been to utilize the proximity of the coronary sinus (CS) to the mitral annulus (MA). Placement of a self-compressing device in the CS along the region of the posterior MA has, in canine models, reduced MR and addresses the issues of MA dilation and its contribution to MR. Ongoing studies are underway for both techniques. (J Interven Cardiol 2003;16:93,96) [source]