Objectives:The aim of this multicenter,prospective,single-arm pilot study(ClinicalTrials.gov number:NCT05040074)was to observe the procedural and 30-day results of the novel transcatheter mitral valve repair system,SQ...Objectives:The aim of this multicenter,prospective,single-arm pilot study(ClinicalTrials.gov number:NCT05040074)was to observe the procedural and 30-day results of the novel transcatheter mitral valve repair system,SQ-Kyrin■-M Clip(Shenqi Medical,Shanghai,China),in patients with severe mitral regurgitation(MR).Methods:The heart team considered patients from 5 centers in China with clinically significant functional mitral regurgitation≥3+despite optimal medical therapy or degenerative mitral regurgitation≥3+with high surgical risk as candidates for transcatheter repair.All patients received transcatheter edge-to-edge mitral valve repair under general anesthesia.The primary outcome was technical success,which included all of the following measured at the exit from the catheterization laboratory:(1)absence of procedural mortality;(2)successful access,delivery,and retrieval of the device delivery system;(3)successful deployment and correct positioning of the frst intended device;and(4)no emergency surgery or reintervention related to the device or access procedure.The secondary outcomes included all-cause mortality,serious adverse events,device success,and procedural success 30 d after the intervention.Results:From June 2021 to December 2021,18 patients were enrolled in this study with age(75.7±7.4)years.Fifteen patients had MR 4+,while 3 had MR 3+.Technical success was achieved in all patients,including 6 degenerative mitral regurgitation and 12 functional mitral regurgitation patients.There was no all-cause mortality at 30 d.One patient had single leaflet device attachment within 30 d,which was regarded as a serious adverse event,and the patient was successfully treated with reintervention by implanting another clip.Another patient's transmitral gradient was 6 mmHg(>5 mmHg),with an effective orifice area of 2.57 cm^(2) after the procedure.Sixteen patients had device success and procedural success at 30 d postoperation.Fourteen patients had MR 1+,3 had MR 2+,and only 1 patient had MR 3+30 d after the procedure.Conclusions:The results of this feasibility study showed the efficacy and safety of the SQ-Kyrin■-M device in the Chinese population with severe MR,laying a solid foundation for a subsequent large-scale confirmatory study.展开更多
Background and objective Pre-operative assessment of mitral valve (MV) anatomy is essential to surgical design in patients undergoing MV repair.Although 2-dimensional (2D) echocardiography provides precise information...Background and objective Pre-operative assessment of mitral valve (MV) anatomy is essential to surgical design in patients undergoing MV repair.Although 2-dimensional (2D) echocardiography provides precise information regarding MV anatomy,RT-3D TEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT- 3DTEE in MV repair.Methods RT-3DTEE was performed in six patients with mitral valve prolapse (MVP) by using Philips 1E33 with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valve repair,and quantitative evaluation was performed by QLab 6.0 software before and after surgical mitral valve repair.Results RT- 3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It could provide surgical views of the valves and the valvular apparatus.These results were consistent with surgical findings.The quantitative evaluation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annulus,anterior to posterior diameter of annulus,perimeter of annulus,and area of annulus in projection plane were significantly smaller after operation compared with those before operation (P【0.05).The length of posterior leaflet,the area of anterior and posterior leaflet,the maximal prolapse height,the volume of leaflet prolapse and the length of coaptation in projection plane were significantly reduced after operation (P【0. 05).Conclusion RT-3DTEE is a unique new modality for rapid and accurate evaluation ofmitral valve prolapse and mitral valve repair.展开更多
BACKGROUND:MAVERIC(Mitral Valve Repair Clinical Trial)validates the safety and effi cacy of the ARTO system.We here report the fi rst two successful cases of utilizing the ARTO system in patients with symptomatic hear...BACKGROUND:MAVERIC(Mitral Valve Repair Clinical Trial)validates the safety and effi cacy of the ARTO system.We here report the fi rst two successful cases of utilizing the ARTO system in patients with symptomatic heart failure(HF)with functional mitral regurgitation(FMR)in Asia.METHODS:Two patients,aged 70 and 63,had severe HF with FMR.Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50%with severe mitral regurgitation(MR)in both patients.Optimizing drug treatment could not mitigate their symptoms.Therefore,we used the ARTO system to repair the mitral valve for these patients on March 5 and 6,2019,respectively.RESULTS:Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients.MR was decreased immediately after the procedures in both patients.The 30-day and 3-month transthoracic echocardiography(TTE)revealed a moderate to severe MR in both patients,and the New York Heart Association(NYHA)scales were also partially improved.CONCLUSION:The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR,and the patient selection appears to be crucial.展开更多
AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic seve...AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P < 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level > 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.展开更多
Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midter...Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midterm results of leaflet augmentation in mitral valve repair of rheumatic valves with gluteraldehyde preserved autologous pericardium. Patients and Methods: In our department 48 patients were exposed to mitral valve repair by leaflet augmentation either anterior or posterior beside other technique and all patients supported by flexible annuloplasty ring and followed for five years clinically and by echocardiography. Results: Age of the patients ranging from 12 to 47 years, mean age 25.9 ± 8.9 and there were 12 males (25%) and 36 females (75%) with male to female ratio of 1:3. All patients presented with shortness of breath (100%);with 14 patients were in NYHA class III (29.17%) and 34 patients were in NYHA class IV (70.83%). During follow-up period 5 patients needed reoperation by valve replacement, causes of reoperation were restrictive valve motion in one patient, left atrial thrombus in 1 patient and sever mitral regurgitation in 3 patients. Freedom from reoperation was 87.5%. At 5 years, (92.9%) were in New York Heart Association functional class I, three patients (7.1%) were in class II. Echocardiography at follow-up showed satisfactory mitral valve function. Conclusion: leaflet augmentation is a simple and reproducible method of valve repair for rheumatic MR with good midterm result.展开更多
Objective: The utility of mitral valve repair in patients with Mitral Regurgitation (MR) and advanced CHF remains controversial. Methods: 37 patients with MR and Left Ventricular Ejection Fraction (LVEF) 25% as well a...Objective: The utility of mitral valve repair in patients with Mitral Regurgitation (MR) and advanced CHF remains controversial. Methods: 37 patients with MR and Left Ventricular Ejection Fraction (LVEF) 25% as well as patients with LVIDd Results: Operative mortality was 0% for the group. There were significant reductions in NYHA Class (p = 0.0004), mitral regurgitation (p 25%. There were no significant differences in cardiac outcome changes between patients with LVIDd 25%, and between patients with LVIDd Conclusions: MV repair in patients with low LVEF and MR can be performed safely, with significant improvement in LVEF and symptom profile. No survival difference were noted between those patients with severely depressed LVEF or those with elevated ventricular dimensions (LVIDd) when compared to those with less severe but still significant cardiac impairment. Consideration should be given to these patients as an option prior to transplantation.展开更多
Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumat...Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.展开更多
Background: Recently, the concept of “Respect rather than resect” has been proposed in an attempt to restore mitral valve function. We investigated the results of mitral valve repair for posterior leaflet disease. M...Background: Recently, the concept of “Respect rather than resect” has been proposed in an attempt to restore mitral valve function. We investigated the results of mitral valve repair for posterior leaflet disease. Methods: Between April 2008 and July 2017, mitral valve repair was performed in 78 cases at our facility. Among them, 37 cases were analyzed. We divided patients into three groups according to the repair techniques used: artificial chordae technique, which uses the anchoring-technique and measured tube technique (Group A, 23 cases), resection and suture technique (Group R, 10 cases), and artificial chordae together with resection and suture technique (Group AR, 4 cases), and compared their postoperative outcomes. Results: Residual postoperative mitral regurgitation (MR) grade in groups A, R and AR at discharge were 0.3 ± 0.4, 0.8 ± 0.9 and 0.0 ± 0.0 (p = 0.07), respectively. Mitral valve areas (cm2) in groups A, R and AR were 3.2 ± 0.6, 2.9 ± 0.6 and 3.0 ± 0.6 (p = 0.47), respectively. Freedom from severe MR at 5 years postoperatively was seen in 91.7%, 90% and 100% (p = 0.92) in groups A, R and AR, respectively. Conclusions: There was no significant difference in postoperative outcomes, as assessed echocardiographically, between the artificial chordae technique and resection and suture technique. The results of all repair techniques were satisfactory.展开更多
Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to mak...Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to make the loops preoperatively and rebuild the elongated/ruptured chordae intraoperatively. Materials and method From June 2011 to February 2012, 19 consecutive cases with mitral anterior leaflet prolapse underwent valve repair procedures. Echocardiography was used to determine the length of normal chordae that the prolapsed leaflets should have for normal coaptation. The artificial chordae was fabricated in loops according to echo-determined length. Results All patients survived the operations. 2.8 preoperatively prepared loops were used per patient to restore the anterior leaflets, as well as posterior leaflets. Artificial mitral valve rings were applied to 18 patients for mitral annuloplasty. 16 patients were underwent different concomitant operations. Echocardiographic results at discharge showed that grade of mitral regurgitation, left ventricular end-diastolic, end-systolic dimension de-creased definitely,respectively from 3.26 ± 1.10, 53.79 ± 15.03 mm, 33.00 ± 12.05 mm preoperatively to 0.47 ± 0.61 （P 〈 0.01）, 44.74±10.28 mm （P 〈 0.01）, 30.16 ± 10.58 mm （P 〈 0.05） postoperatively. All patients improved clinically and NYHA functional class Conclusion Reconstruction of prolapsed anterior decreased significantly from 2.17 ± 0.81 to 1.12 ± 0.33. leaflet chordae with artificial loops in preoperatively echo-de-termined length is safe and effective, and initial clinical outcome is satisfactory.展开更多
A case of abnormal chordae of the mitral valve (MV) associated with systolic anterior motion (SAM) is not commonly encountered in clinical practice. Here we report MV repair via the edge-to-edge technique in a 56-year...A case of abnormal chordae of the mitral valve (MV) associated with systolic anterior motion (SAM) is not commonly encountered in clinical practice. Here we report MV repair via the edge-to-edge technique in a 56-year-old male with MV regurgitation associated with papillary muscle displacement and posterior leaflet prolapse. Echocardiography revealed obstruction of the left ventricular outflow tract caused by SAM because of papillary muscle displacement and mitral regurgitation associated with posterior leaflet prolapse due to chordae rupture. MV repair was successfully performed by reconstruction with an Alfieri stitch. The outcome of this case demonstrated that this surgical technique is preferable for MV abnormalities with no complex malformations.展开更多
Summary of the Experience in Perioperative Accelerated Recovery Care of a Patient with Severe Mitral Valve Regurgitation,Mitral Valve Prolapse,Coronary Heart Disease,and Hypertension Undergoing Transesophageal Echocar...Summary of the Experience in Perioperative Accelerated Recovery Care of a Patient with Severe Mitral Valve Regurgitation,Mitral Valve Prolapse,Coronary Heart Disease,and Hypertension Undergoing Transesophageal Echocardiography-Guided Mitral Valve Chord Repair System and Artificial Chord Implantation through the Apex of the Heart The patient had a history of coronary heart disease and hypertension,and was diagnosed with mitral valve prolapse and severe mitral regurgitation at admission.According to the comprehensive evaluation of the patient's condition by the cardiac surgery and MDT(Multidisciplinary Team)team of our hospital before operation,the patient had severe degenerative mitral regurgitation.Considering the high risk of surgical valvuloplasty,the treatment plan of transapical mitral valve artificial chordae implantation with mitral chordae repair system under the guidance of esophageal ultrasound was formulated.Following the guidelines for accelerated recovery,a multidisciplinary approach was taken during the surgery to monitor the patient's condition.Preoperative waiting periods,the postoperative critical period,and the stabilization period were considered,and a rehabilitation program that included exercise,nutritional support,health education,and psychological care was developed for the entire perioperative accelerated recovery process.Nutritional support,health education and psychological nursing were throughout the whole process of perioperative enhanced recovery.The patient was implanted with 4 artificial chordae tendineae.Transesophageal echocardiography monitoring showed that the surgical treatment effect was satisfactory,and no complications occurred during the perioperative period.展开更多
Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair,and evaluate the value of real-time three-di-mensional transesophageal echocardiography in the pe...Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair,and evaluate the value of real-time three-di-mensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation展开更多
ABSTRACT Objectives We aimed to assess the clinical and echocardiographic results of MitraClip implantation in non-central de- generative mitralregurgitation （dMR） compared to central dMR. Background It is unknown ...ABSTRACT Objectives We aimed to assess the clinical and echocardiographic results of MitraClip implantation in non-central de- generative mitralregurgitation （dMR） compared to central dMR. Background It is unknown if the use of the MitraClip therapy in non-central dMR is as safe and effective as in central dMR.展开更多
Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitr...Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.展开更多
In Africa, acute rheumatic fever is endemic. Cardiac involvement is one of the most common complications in the form of valvular heart disease representing all damages to the heart valves. It is in this perspective th...In Africa, acute rheumatic fever is endemic. Cardiac involvement is one of the most common complications in the form of valvular heart disease representing all damages to the heart valves. It is in this perspective that we realized this study whose general objective was to evaluate the results of mitral repair surgery in children in Senegal and the specific objective was to state the indications for mitral repair surgery and assess the results in terms of morbidity and mortality. This is a retrospective and analytical monocentric study, in the thoracic and cardiovascular surgery department of FANN National University Hospital Center in Dakar. It took place over a period of 30 months. All the patients who underwent mitral surgery, aged less than 18 years were included. The total number of patients was 63, including 39 girls and 24 boys, a sex ratio of 0.62. The average age at the time of the surgery was 12 years old [5 - 17]. The functional symptomatology was dominated by the dyspnea found in all the patients. Cardiac ultrasound was diagnosed with mitral regurgitation in all patients. For all surgical procedures, the approach was a vertical midline sternotomy. The mitral valve was approached by left atriotomy in 40 patients (63.5%) and by transseptal way in 23 patients. All patients had undergone mitral valve repair associated or not with either aortic valve repair in 9 patients (14.2%), aortic valve replacement in 3 patients (4.8%), or one tricuspid valve repair in 31 patients (49%). The average duration of intubation was 6 hours [2 - 52]. The average length of stay in intensive care was 2 days. Postoperative complications have been observed. Surgery was performed in 10 patients with 3 mitral valve replacements, 2 aortic valve replacements, a double mitral and an aortic valve replacement associated with a tricuspid repair and in 4 cases a perfection of their mitral repair. Early and late surgical mortality was zero. The average follow-up time for our patients was 9 months [1 - 26]. During their follow-up, the evolution was favorable in 89% of patients who no longer had any functional symptoms.展开更多
基金supported by the National Key Project of Research and Development Plan during the fourteenth Five-year Plan Period(2022YFC2503400).
文摘Objectives:The aim of this multicenter,prospective,single-arm pilot study(ClinicalTrials.gov number:NCT05040074)was to observe the procedural and 30-day results of the novel transcatheter mitral valve repair system,SQ-Kyrin■-M Clip(Shenqi Medical,Shanghai,China),in patients with severe mitral regurgitation(MR).Methods:The heart team considered patients from 5 centers in China with clinically significant functional mitral regurgitation≥3+despite optimal medical therapy or degenerative mitral regurgitation≥3+with high surgical risk as candidates for transcatheter repair.All patients received transcatheter edge-to-edge mitral valve repair under general anesthesia.The primary outcome was technical success,which included all of the following measured at the exit from the catheterization laboratory:(1)absence of procedural mortality;(2)successful access,delivery,and retrieval of the device delivery system;(3)successful deployment and correct positioning of the frst intended device;and(4)no emergency surgery or reintervention related to the device or access procedure.The secondary outcomes included all-cause mortality,serious adverse events,device success,and procedural success 30 d after the intervention.Results:From June 2021 to December 2021,18 patients were enrolled in this study with age(75.7±7.4)years.Fifteen patients had MR 4+,while 3 had MR 3+.Technical success was achieved in all patients,including 6 degenerative mitral regurgitation and 12 functional mitral regurgitation patients.There was no all-cause mortality at 30 d.One patient had single leaflet device attachment within 30 d,which was regarded as a serious adverse event,and the patient was successfully treated with reintervention by implanting another clip.Another patient's transmitral gradient was 6 mmHg(>5 mmHg),with an effective orifice area of 2.57 cm^(2) after the procedure.Sixteen patients had device success and procedural success at 30 d postoperation.Fourteen patients had MR 1+,3 had MR 2+,and only 1 patient had MR 3+30 d after the procedure.Conclusions:The results of this feasibility study showed the efficacy and safety of the SQ-Kyrin■-M device in the Chinese population with severe MR,laying a solid foundation for a subsequent large-scale confirmatory study.
文摘Background and objective Pre-operative assessment of mitral valve (MV) anatomy is essential to surgical design in patients undergoing MV repair.Although 2-dimensional (2D) echocardiography provides precise information regarding MV anatomy,RT-3D TEE could increase the understanding of MV apparatus and individual scallop identification.We aimed to investigate the value of RT- 3DTEE in MV repair.Methods RT-3DTEE was performed in six patients with mitral valve prolapse (MVP) by using Philips 1E33 with X7-2t probe.Preoperative RT-3DTEE studies were compared with surgical findings in patients undergoing surgical mitral valve repair,and quantitative evaluation was performed by QLab 6.0 software before and after surgical mitral valve repair.Results RT- 3DTEE could display dynamic morphology of MV,the location of prolapse,and spatial relation to the surrounding tissue.It could provide surgical views of the valves and the valvular apparatus.These results were consistent with surgical findings.The quantitative evaluation before and after surgical MV repair indicated that anterolateral to posteromedial diameter of annulus,anterior to posterior diameter of annulus,perimeter of annulus,and area of annulus in projection plane were significantly smaller after operation compared with those before operation (P【0.05).The length of posterior leaflet,the area of anterior and posterior leaflet,the maximal prolapse height,the volume of leaflet prolapse and the length of coaptation in projection plane were significantly reduced after operation (P【0. 05).Conclusion RT-3DTEE is a unique new modality for rapid and accurate evaluation ofmitral valve prolapse and mitral valve repair.
基金supported by Advanced Technique Research of Valvular Heart Disease Treatment Project(2015C03028)Role of TPP1 in anti-senescence and functional optimization of aged mesenchymal stem cells(81570233)+1 种基金Role of FAIM in survival and functional improvement for aged mesenchymal stem cells(81770253)Zhejiang Clinical Research Center for Cardiovascular and Cerebrovascular Disease(2018E50002)
文摘BACKGROUND:MAVERIC(Mitral Valve Repair Clinical Trial)validates the safety and effi cacy of the ARTO system.We here report the fi rst two successful cases of utilizing the ARTO system in patients with symptomatic heart failure(HF)with functional mitral regurgitation(FMR)in Asia.METHODS:Two patients,aged 70 and 63,had severe HF with FMR.Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50%with severe mitral regurgitation(MR)in both patients.Optimizing drug treatment could not mitigate their symptoms.Therefore,we used the ARTO system to repair the mitral valve for these patients on March 5 and 6,2019,respectively.RESULTS:Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients.MR was decreased immediately after the procedures in both patients.The 30-day and 3-month transthoracic echocardiography(TTE)revealed a moderate to severe MR in both patients,and the New York Heart Association(NYHA)scales were also partially improved.CONCLUSION:The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR,and the patient selection appears to be crucial.
文摘AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P < 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level > 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.
文摘Patients with severe mitral regurgitation (MR) should undergo surgery when they present symptoms or if asymptomatic when there is objective evidence of left ventricular dysfunction. In this work, we analyze the midterm results of leaflet augmentation in mitral valve repair of rheumatic valves with gluteraldehyde preserved autologous pericardium. Patients and Methods: In our department 48 patients were exposed to mitral valve repair by leaflet augmentation either anterior or posterior beside other technique and all patients supported by flexible annuloplasty ring and followed for five years clinically and by echocardiography. Results: Age of the patients ranging from 12 to 47 years, mean age 25.9 ± 8.9 and there were 12 males (25%) and 36 females (75%) with male to female ratio of 1:3. All patients presented with shortness of breath (100%);with 14 patients were in NYHA class III (29.17%) and 34 patients were in NYHA class IV (70.83%). During follow-up period 5 patients needed reoperation by valve replacement, causes of reoperation were restrictive valve motion in one patient, left atrial thrombus in 1 patient and sever mitral regurgitation in 3 patients. Freedom from reoperation was 87.5%. At 5 years, (92.9%) were in New York Heart Association functional class I, three patients (7.1%) were in class II. Echocardiography at follow-up showed satisfactory mitral valve function. Conclusion: leaflet augmentation is a simple and reproducible method of valve repair for rheumatic MR with good midterm result.
文摘Objective: The utility of mitral valve repair in patients with Mitral Regurgitation (MR) and advanced CHF remains controversial. Methods: 37 patients with MR and Left Ventricular Ejection Fraction (LVEF) 25% as well as patients with LVIDd Results: Operative mortality was 0% for the group. There were significant reductions in NYHA Class (p = 0.0004), mitral regurgitation (p 25%. There were no significant differences in cardiac outcome changes between patients with LVIDd 25%, and between patients with LVIDd Conclusions: MV repair in patients with low LVEF and MR can be performed safely, with significant improvement in LVEF and symptom profile. No survival difference were noted between those patients with severely depressed LVEF or those with elevated ventricular dimensions (LVIDd) when compared to those with less severe but still significant cardiac impairment. Consideration should be given to these patients as an option prior to transplantation.
文摘Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.
文摘Background: Recently, the concept of “Respect rather than resect” has been proposed in an attempt to restore mitral valve function. We investigated the results of mitral valve repair for posterior leaflet disease. Methods: Between April 2008 and July 2017, mitral valve repair was performed in 78 cases at our facility. Among them, 37 cases were analyzed. We divided patients into three groups according to the repair techniques used: artificial chordae technique, which uses the anchoring-technique and measured tube technique (Group A, 23 cases), resection and suture technique (Group R, 10 cases), and artificial chordae together with resection and suture technique (Group AR, 4 cases), and compared their postoperative outcomes. Results: Residual postoperative mitral regurgitation (MR) grade in groups A, R and AR at discharge were 0.3 ± 0.4, 0.8 ± 0.9 and 0.0 ± 0.0 (p = 0.07), respectively. Mitral valve areas (cm2) in groups A, R and AR were 3.2 ± 0.6, 2.9 ± 0.6 and 3.0 ± 0.6 (p = 0.47), respectively. Freedom from severe MR at 5 years postoperatively was seen in 91.7%, 90% and 100% (p = 0.92) in groups A, R and AR, respectively. Conclusions: There was no significant difference in postoperative outcomes, as assessed echocardiographically, between the artificial chordae technique and resection and suture technique. The results of all repair techniques were satisfactory.
基金supported by the Natural Science Foundation of Guangdong Province, China (Grant No.S2011010005828)
文摘Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to make the loops preoperatively and rebuild the elongated/ruptured chordae intraoperatively. Materials and method From June 2011 to February 2012, 19 consecutive cases with mitral anterior leaflet prolapse underwent valve repair procedures. Echocardiography was used to determine the length of normal chordae that the prolapsed leaflets should have for normal coaptation. The artificial chordae was fabricated in loops according to echo-determined length. Results All patients survived the operations. 2.8 preoperatively prepared loops were used per patient to restore the anterior leaflets, as well as posterior leaflets. Artificial mitral valve rings were applied to 18 patients for mitral annuloplasty. 16 patients were underwent different concomitant operations. Echocardiographic results at discharge showed that grade of mitral regurgitation, left ventricular end-diastolic, end-systolic dimension de-creased definitely,respectively from 3.26 ± 1.10, 53.79 ± 15.03 mm, 33.00 ± 12.05 mm preoperatively to 0.47 ± 0.61 （P 〈 0.01）, 44.74±10.28 mm （P 〈 0.01）, 30.16 ± 10.58 mm （P 〈 0.05） postoperatively. All patients improved clinically and NYHA functional class Conclusion Reconstruction of prolapsed anterior decreased significantly from 2.17 ± 0.81 to 1.12 ± 0.33. leaflet chordae with artificial loops in preoperatively echo-de-termined length is safe and effective, and initial clinical outcome is satisfactory.
文摘A case of abnormal chordae of the mitral valve (MV) associated with systolic anterior motion (SAM) is not commonly encountered in clinical practice. Here we report MV repair via the edge-to-edge technique in a 56-year-old male with MV regurgitation associated with papillary muscle displacement and posterior leaflet prolapse. Echocardiography revealed obstruction of the left ventricular outflow tract caused by SAM because of papillary muscle displacement and mitral regurgitation associated with posterior leaflet prolapse due to chordae rupture. MV repair was successfully performed by reconstruction with an Alfieri stitch. The outcome of this case demonstrated that this surgical technique is preferable for MV abnormalities with no complex malformations.
基金supported by National Key Research and Development Program of China (No.2022YFC2407406)2022 Stability Support for Innovative Capacity Building of Guangdong Provincial Scientific Research Institutions (No.KD022022015)Science and Technology Program of Guangzhou,China (No.202206010049)。
文摘Summary of the Experience in Perioperative Accelerated Recovery Care of a Patient with Severe Mitral Valve Regurgitation,Mitral Valve Prolapse,Coronary Heart Disease,and Hypertension Undergoing Transesophageal Echocardiography-Guided Mitral Valve Chord Repair System and Artificial Chord Implantation through the Apex of the Heart The patient had a history of coronary heart disease and hypertension,and was diagnosed with mitral valve prolapse and severe mitral regurgitation at admission.According to the comprehensive evaluation of the patient's condition by the cardiac surgery and MDT(Multidisciplinary Team)team of our hospital before operation,the patient had severe degenerative mitral regurgitation.Considering the high risk of surgical valvuloplasty,the treatment plan of transapical mitral valve artificial chordae implantation with mitral chordae repair system under the guidance of esophageal ultrasound was formulated.Following the guidelines for accelerated recovery,a multidisciplinary approach was taken during the surgery to monitor the patient's condition.Preoperative waiting periods,the postoperative critical period,and the stabilization period were considered,and a rehabilitation program that included exercise,nutritional support,health education,and psychological care was developed for the entire perioperative accelerated recovery process.Nutritional support,health education and psychological nursing were throughout the whole process of perioperative enhanced recovery.The patient was implanted with 4 artificial chordae tendineae.Transesophageal echocardiography monitoring showed that the surgical treatment effect was satisfactory,and no complications occurred during the perioperative period.
文摘Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair,and evaluate the value of real-time three-di-mensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation
文摘ABSTRACT Objectives We aimed to assess the clinical and echocardiographic results of MitraClip implantation in non-central de- generative mitralregurgitation （dMR） compared to central dMR. Background It is unknown if the use of the MitraClip therapy in non-central dMR is as safe and effective as in central dMR.
文摘Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.
文摘In Africa, acute rheumatic fever is endemic. Cardiac involvement is one of the most common complications in the form of valvular heart disease representing all damages to the heart valves. It is in this perspective that we realized this study whose general objective was to evaluate the results of mitral repair surgery in children in Senegal and the specific objective was to state the indications for mitral repair surgery and assess the results in terms of morbidity and mortality. This is a retrospective and analytical monocentric study, in the thoracic and cardiovascular surgery department of FANN National University Hospital Center in Dakar. It took place over a period of 30 months. All the patients who underwent mitral surgery, aged less than 18 years were included. The total number of patients was 63, including 39 girls and 24 boys, a sex ratio of 0.62. The average age at the time of the surgery was 12 years old [5 - 17]. The functional symptomatology was dominated by the dyspnea found in all the patients. Cardiac ultrasound was diagnosed with mitral regurgitation in all patients. For all surgical procedures, the approach was a vertical midline sternotomy. The mitral valve was approached by left atriotomy in 40 patients (63.5%) and by transseptal way in 23 patients. All patients had undergone mitral valve repair associated or not with either aortic valve repair in 9 patients (14.2%), aortic valve replacement in 3 patients (4.8%), or one tricuspid valve repair in 31 patients (49%). The average duration of intubation was 6 hours [2 - 52]. The average length of stay in intensive care was 2 days. Postoperative complications have been observed. Surgery was performed in 10 patients with 3 mitral valve replacements, 2 aortic valve replacements, a double mitral and an aortic valve replacement associated with a tricuspid repair and in 4 cases a perfection of their mitral repair. Early and late surgical mortality was zero. The average follow-up time for our patients was 9 months [1 - 26]. During their follow-up, the evolution was favorable in 89% of patients who no longer had any functional symptoms.
