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Surgical mitral plasticity for chronic ischemic mitral regurgitation.

Authors :
Calafiore AM
Totaro A
De Amicis V
Pelini P
Pinna G
Testa N
Alfonso JJ
Mazzei V
Sacra C
Gaudino M
Di Mauro M
Source :
Journal of cardiac surgery [J Card Surg] 2020 Apr; Vol. 35 (4), pp. 772-778. Date of Electronic Publication: 2020 Mar 03.
Publication Year :
2020

Abstract

Background and Aim of the Study: The outcome of mitral valve (MV) repair for chronic ischemic mitral regurgitation (IMR) is suboptimal, due to the high recurrence rate of moderate or severe mitral regurgitation (MR) during follow-up. The MV adapts to new MR increasing its area to cover the enlarged annular area (mitral plasticity). As this process is often incomplete, we aimed to evaluate if augmenting the anterior leaflet (AL) and cutting the second-order chords (CC) together with restrictive mitral annuloplasty, a strategy we call "surgical mitral plasticity," could improve the midterm results of MV repair for IMR.<br />Materials and Methods: From November 2017 to October 2019, 22 patients with chronic IMR underwent surgical mitral plasticity. Mean age was 73 ± 7 years and six were female. Mean ejection fraction was 32% ± 11%, IMR grade was moderate in 10 and severe in 12. Mean clinical and echocardiographic follow-up was 12 ± 6 months.<br />Results: There was no early death, and one patient died 6 months after surgery. Ejection fraction improved from 32% ± 15% to 40% ± 6% (P = .031). IMR was absent or mild in all patients, and none showed recurrent moderate or more IMR. Tenting area decreased significantly from 2.5 ± 0.5 to 0.5 ± 0.3 cm² and coaptation length increased from 1.9 ± 0.7 to 7.8 ± 1.6 mm. All patients were in New York Heart Association class I or II.<br />Conclusions: Mitral plasticity, if uncomplete, is ineffective in preventing IMR to become significant. Surgical mitral plasticity, by completing incomplete process of MV adaptation, has a strong rationale, which however needs to be validated with longer follow-up.<br /> (© 2020 Wiley Periodicals, Inc.)

Details

Language :
English
ISSN :
1540-8191
Volume :
35
Issue :
4
Database :
MEDLINE
Journal :
Journal of cardiac surgery
Publication Type :
Academic Journal
Accession number :
32126160
Full Text :
https://doi.org/10.1111/jocs.14487