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Echocardiographic Method to Determine the Length of Neochordae Reconstruction for Mitral Repair
- Source :
- The Annals of Thoracic Surgery. 111:519-528
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background We evaluated a novel formula using preoperative transesophageal echocardiographic measurements to determine neochordae length for repair of degenerative mitral regurgitation (MR). Methods The formula is based on measuring the distance from the adjacent papillary head to the intended coaptation zone of the flail/prolapsing leaflet segment and subtracting the redundant leaflet length. Between 2008 and 2017, 264 consecutive patients underwent mitral valve repair (82.2% endoscopic, minimally invasive approach and 17.8% sternotomy) with neochordae loop reconstruction (68.6% posterior, 6.4% anterior, and 25% bileaflet repair). Mean patient age was 63 ± 13.6 years, 73.5% were men, and mean left ventricular ejection fraction was 63.1% ± 6.7%. Results Mitral valve repair was successful in 100% of patients, with no patient requiring conversion to replacement. Neochordae length measurement was accurate in 259 patients (98%), with 4 patients requiring conversion to resection and 1 patient requiring longer anterior leaflet neochordae. Median anterior and posterior neochordae lengths were 27 mm (range, 18-32) and 17 mm (range, 9-27), respectively. Intraoperative transesophageal echocardiography demonstrated no or trace residual MR in 254 patients and mild residual MR in 10 patients. In-hospital mortality occurred in 1 patient, and complications included respiratory failure (2.7%) and renal failure (1.8%). At the median follow-up of 12.6 months (interquartile range, 11.1), 98.9% of patients remained free from ≥2+ MR, whereas freedom from reoperation was 100%. Conclusions Preoperative transesophageal echocardiographic measurements can accurately and reproducibly predict the required length of neochordae loop reconstruction for degenerative mitral valve repair with good results. Longer-term follow-up is necessary.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
medicine.medical_treatment
030204 cardiovascular system & hematology
Resection
03 medical and health sciences
0302 clinical medicine
Patient age
Interquartile range
medicine
Humans
Aged
Heart Valve Prosthesis Implantation
Mitral valve repair
Mitral regurgitation
Anterior leaflet
Ejection fraction
business.industry
Middle Aged
Plastic Surgery Procedures
Surgery
030228 respiratory system
Respiratory failure
Chordae Tendineae
Mitral Valve
Female
Cardiology and Cardiovascular Medicine
business
Echocardiography, Transesophageal
Subjects
Details
- ISSN :
- 00034975
- Volume :
- 111
- Database :
- OpenAIRE
- Journal :
- The Annals of Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....2ad955567180a6d55b4398b0907bc321