Objective
To evaluate the mid-long term results of application research of artificial Gore-Tex chordate in mitral valvuloplasty in patients with mitral insufficiency caused by endocarditis.
Methods
We retrospectively analyzed the clinical data of 28 consecutive infective endocarditis(IE) patients who received mitral valve repair with Gore-Tex in our hospital between January 2012 and December 2015. There were 17 males and 11 females. The age of these patients ranged from 18 to 69 (52.0±15.4) years. Echocardiography before operation showed the degree of mitral regurgitation (MR) was severe in 19 patients, moderate in 9 patients. Six patients were in New York Heart Association (NYHA) class Ⅱ, 14 in class Ⅲ, 8 in class Ⅳ. There were 26 selective surgeries and 2 emergent surgeries. One patient had concomitant coronary artery bypass graft. Six patients had aortic valve replacement. Five patients had aortic valve repair. Twenty patients had tricuspid valve repair. Five patients had Maze procedure.
Results
Follow-up was done to all the patients for 6 months to 55 (30.5±6.4) months. During the follow-up, the echocardiography showed that postoperative left atrium diameter (36.64±8.50 mm vs. 51.78±17.50 mm, P<0.05) and left ventricular end-diastolic dimension (49.30±5.05 mmvs. 57.70±7.49 mm, P<0.05) were significantly smaller than those before operation. The left ventricular ejection fraction (EF) increased from 53.86%±8.16% to 59.14%±4.23% (P<0.05). No MR was found in 16 patients, mild MR in 8 patients, mild to moderate MR in 2 patients, moderate MR in 1 patient. One patient required reoperation for recurrent infection. No death or complications related to thrombosis and embolism occurred after operation.
Conclusion
Application research of artificial Gore-Tex chordate in mitral valve repair is feasible for treating mitral valve lesions caused by endocarditis, and may provide a long-term outcome to the patients.
Objective To analyze early and midterm outcomes and summarize clinical experience of mitral valve repair with artificial chordae for degenerative mitral regurgitation （MR）. Methods Clinical data of 78 patients with degenerative MR who underwent mitral valve repair with Gore-Tex artificial chordae from October 2008 to December 2011 in General Hospita1 of Shenyang Military Command were retrospectively analyzed. There were 47 male patients and 31female patients with their age of 52.7±9.6 years，who all had degenerative MR. Operation techniques included simple GoreTex artificial chordae replacement in 15 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet in 58 patients，artificial chordae replacement plus quadrangular resection of the posterior leaflet and Sliding technique in 5 patients. One to three （2.15±1.05） Gore-Tex artificial chordae were used for each patient，and annuloplasty ring was used for all the patients. Thirty-nine patients underwent concomitant tricuspid valvuloplasty. Intraoperative transesophagealechocardiography showed none obvious MR in 62 patients，trivial MR in 13 patients and mild MR in 3 patients. All thepatients were followed up after discharge. Echocardiography was used to evaluate heart function and MR degree duringfollow-up. Results There was no in-hospital death in this group. Postoperative complications included sinus bradycardiain 5 patients，supraventricular tachycardia in 8 patients，late cardiac tamponade in 1 patient，and permanent pacemakerimplantation in 1 patient. Seventy patients were followed up for 1-2 years with the follow-up rate of 89.74% （70/78）. Duringfollow-up，1 patient died of cerebral embolism 13 months after discharge，and all the other patients remained alive. There were 60 patients with NYHA classⅠand 9 patients with NYHA classⅡ. Echocardiography at 1 year after dischargeshowed that left atrial diameter，left ventricular end-diastolic diameter，left ventricular end-systolic diameter，and pulmonary artery systolic pressure were significantly smaller or lower than preoperative values （P＜0.05），left ventricular ejection fraction （68.00%±7.00% vs. 55.00%±6.00%） and cardiac output were significantly higher than preoperative values（P＜0.05），and MR degree （ratio of regurgitation beam area and left atrial area） was significantly reduced compared with preoperative MR degree （3.45%±5.56% vs. 39.55%±9.86%，P＜0.05）. No artificial chordae rupture was found. There were47 patients without MR and 22 patients with trivial MR during follow-up. Conclusion Gore-Tex artificial chordae replacement is a safe and effective surgical technique for the treatment of degenerative MR.
Objective
To evaluate the outcomes and summarize the clinical experience of totally endoscopic mitral valve repair with artificial chordae implantation.
Methods
From May 2013 to June 2016, 71 patients with mitral valve insufficiency were admitted to our hospital who underwent totally endoscopic mitral valve repair with artificial chordae implantation. There were 47 males and 24 females with the age of 46.0±14.4 years ranging from 13-78 years. The pathogenesis included degenerative valvular diseases in 63 patients, congenital valvular diseases in 4, infectious endocarditis in 2, rheumatic disease in 1 and cardiomyopathy in 1. Prolapse of anterior, posterior, or both leaflets was present in 26 (36.6%), 19 (26.8%), and 25 (35.2%) patients, respectively; one patient (1.4%) presented valve annulus enlargement and thirteen were associated with commissure lesion. The mitral regurgitation area ranged from 4.2 to 26.3 cm2 (mean, 12.2±5.6 cm2). All the procedures were performed by total endoscopy under cardiac arrest. 5-0 Gore-tex sutures were used as the material of artificial chordae which was implanted one by one.
Results
There was no in-hospital death. One patient was transferred to mitral valve replacement, and one median sternotomy due to bleeding. The mean cardiopulmonary bypass time was 156.0±31.6 min and aortic cross-clamp time 110.0±20.1 min. We finally had 39 isolated mitral valve repair, 28 mitral valve repair combined tricuspid valve repair, 3 mitral valve repair combined atrial septal defect closure, and 1 mitral valve repair combined correction of partial anomalous pulmonary vein connection. Each patient was implanted artificial chordae of 2.5±1.7 (ranging from 1 to 7), and 65 patients received mitral annulus (full ring). The intraoperative transoesophageal echocardiography found no mitral regurgitation in 44 patients, the area of mitral regurgitation was 0-2 cm2 in 24, and 3 patients with mitral regurgitation>2 cm2 experienced serious systolic anterior motion. Of the 3 patients with systolic anterior motion (SAM), one transferred to mitral valve replacement, one underwent mitral re-repair, and one took conservative treatment. The mean follow-up was 12.7±10.5 months (range: 1 to 36 months), while 2 patients were lost to follow up with the follow-up rate of 97.2%. Recurrent severe regurgitation occured in 3 patients, moderate in 5, mild or trivial in 27 and no regurgitation in 36. During the follow-up, 1 patient died of myocardiopathy-induced heart failure post discharge, 1 suffered from cerebral infarction, and no patient underwent reoperation.
Conclusion
The totally endoscopic surgical treatment of mitral valvuloplasty with artificial chordae is reliable for patients with mitral valve prolapse, which provides favorable clinical efficacy and outcomes. The difficulty lies in how to determine the appropriate length of the chordae and keep the stability of length.
Artificial chord is a mature mitral valve repair technique, especially in adult mitral valve repair. It is still challenging to repair mitral valve in children with artificial chords because the quality of mitral valve is soft and immature. There are some differences in the methods of suture, the choice of suture size and the number of artificial chords. Although the artificial chords could not grow naturally, we found through the long-term research that most children did not have mitral valve restriction or even chords rupture due to itself can compensate through the growth of the flap and papillary muscle. This article summarizes the recent research progress on the treatment of mitral valve insufficiency in children with artificial chords, providing reference for clinical treatment.
Mitral valvuloplasty is a more suitable surgical procedure than mitral valve replacement in the case of mitral valve degeneration. Quadrangular resection and artificial chordae plantation, considered to be classical procedures, are widely employed in posterior mitral valve prolapse, and have prominent long-term effects during the follow-up. However, is there any difference in mitral valve reconstruction due to completely different surgical methodology and concepts of the two procedures? Every surgeon has his own ideas and preferences for mitral valvuloplasty, and the choice of surgical procedures mostly depends on experience of surgeons. The article generally reviews variances in intraoperative and long-term clinical outcomes of both rectangular excision and artificial chordae plantation in posterior leaflet valvuloplasty, hoping to provide references for clinical decision.
ObjectiveTo research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. MethodsTwelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). ConclusionIn off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.
ObjectiveTo evaluate outcomes of mitral valvuloplasty with artificial chord and mitral annuloplasty ring in patients with mitral valve prolapse.
MethodsFrom January 2012 to March 2014, mitral valvuloplasty with artificial chord and mitral annuloplasty ring were performed for 58 patients with mitral valve prolapsed in Department of Cardiovascular Surgery, Fujian Provincial Hospital, among which 47 simple anterior or posterior mitral valvuloplasty and 11 combined anterior-posterior mitral valvuloplasty were completed. There were 33 males and 25 females aged (53.7±14.3) years.
ResultsThere was no in-hospital death. Three patients received mitral valve replacement. The transoesophageal echocardiography found no or trivial mitral regurgitation in 48 patients, mild mitral regurgitation in 7 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were significantly decreased after the operation. During the follow-up of 6 months to 2 years, the cardiac function of the patients improved.
ConclusionMitral valvuloplasty with artificial chord and mitral annuloplasty ring is simple, reliable and effective treatment for patients with mitral valve prolapse, and its shortand mid-term outcome is good.
Objective To explore the safety, effectiveness, and mid-term efficacy of total thoracoscopic mitral valvuloplasty (MVP) with chordal replacement (CR) and quadrangular resection (QR) for the treatment of mitral regurgitation (MR), and to provide reference for guiding the development and selection of clinical diagnosis and treatment methods for MR patients. Methods A prospective randomized controlled study was performed to collect patients with MR who underwent MVP at the Department of Cardiovascular Surgery, Leshan People's Hospital from January 2021 to March 2022. They were randomly divided into a CR group and a QR group by using a random number table, and were followed up for 12 months after the operation. The medical history, perioperative data and adverse cardiac endpoint events during the follow-up period were collected. The differences in surgical efficacy between the two groups were evaluated and compared, and the Kaplan-Meier method was used to compare the differences in survival rates between the two groups of patients. Results A total of 100 patients were enrolled. There were 46 patients in the CR group, including 27 males and 19 females with an average age of 49.50±9.23 years; there were 46 patients in the QR group, including 24 males and 22 females with an average age of 49.91±11.48 years. The aortic occlusion time in the CR group was longer than that in the QR group (P<0.05). Other surgical indicators, including total surgical time, extracorporeal circulation time, ventilator-assisted time, ICU hospitalization time, size of the valve ring, concomitant surgery during the same period, and the incidence of perioperative complications were not statistically different between the two groups (P>0.05). The left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) of the two groups before discharge after the surgery were significantly improved compared to those before surgery (P<0.05). There was a statistical difference in LVEF between the two groups before discharge after the surgery (P<0.05). There was no statistical difference in clinical efficacy between the two groups (P>0.05). Kaplan-Meier analysis showed that the overall incidence of exemption from mild and above mitral regurgitation 12 months after the surgery in the CR group and QR group was 84.8% and 89.1%, respectively. According to the log-rank test, there was no statistical difference in the overall survival curve between the two groups (χ2=0.356, P=0.551). Conclusion CR and QR are both safe and effective methods for the treatment of simple posterior MR.
Objective To summarize surgical techniques，advantages and clinical outcomes of mitral valvuloplasty for anterior mitral leaflet prolapse with looped artificial chordae. Methods Clinical data of 13 patients with anteriormitral leaflet prolapse and severe mitral regurgitation （MR） who underwent mitral valvuloplasty with looped artificial chordaefrom January 2009 to December 2011 in Beijing Anzhen Hospital were retrospectively analyzed. There were 8 male and 5 female patients with their age of 21-61 （39.5±12.9） years. There were 10 patients with anterior mitral leaflet chordal rupture and 3 patients with anterior mitral leaflet elongation. Preoperative left ventricular end-diastolic diameter （LVEDD） was 52-65 （58.3±1.7） mm，and left ventricular ejection fraction （LVEF） was 53%-65% （58.8%±2.8%）. All the patients underwent mitral valvuloplasty. We measured the neighboring normal chordae with a caliper for reference and constructed the artificial chordal loops on the caliper with expended polytetrafluoroethylene（ePTFE） CV4 Gore-Tex suture lines. Three to five loops were made and fixed to the papillary muscle with a Gore-Tex suture line and the free edge of the prolapsedanterior mitral leaflet with another Gore-Tex suture line，with the intervals between the loops of 5 mm. Left ventricular watertesting was performed to evaluate MR status，annuloplasty ring implantation or “edge to edge” technique was used if nece-ssary，and left ventricular water testing was performed again to confirm satisfactory closure of the mitral valve. Patientsreceived re-warming on cardiopulmonary bypass and the heart incision was closed. The effect of mitral annuloplasty was alsoassessed by transesophageal echocardiography （TEE） after heart rebeating. Warfarin anticoagulation was routinely used for 3 months after discharge. Results There was no perioperative death in this group. Twelve patients received satisfactory outcomes after 1-stage mitral valvuloplasty with looped artificial chordae and annuloplasty ring implantation. One patient didn’t receive satisfactory outcomes in the left ventricular water testing after mitral valvuloplasty with looped artificial chordae，but satisfactory outcome was achieve after “edge to edge” technique was used，and annuloplasty ring was not used for this patient. Postoperative echocardiography showed trivial to mild MR in all the patients，their LVEDD was significantly reducedthan preoperative LVEDD （47.5±2.1 mm vs. 58.3±1.7 mm，P＜0.05），and there was no statistical difference between postoperative and preoperative LVEF（58.5%±2.6% vs. 58.8%±2.8%，P＞0.05）. All the patients were followed up for 3-36 （19.5±3.7） months. Echocardiography showed mild MR in 4 patients and none or trivial MR in 9 patients during follow-up.Conclusion Mitral valvuloplasty with looped artificial chordae is an effective surgical technique for the treatment of anterior mitral leaflet prolapse with satisfactory clinical outcomes，and this technique is also easy to perform.
