Objective To summarize the experience and results of mitral annuloplasty with modified partial flexible artificial ring. Methods Two hundred and fifteennine patients were underwent partial flexible ring annuloplasty after mitral valve plasty surgery in our hospital from an. 1998 to Aug.2006. The etiology included rheumatic (16 cases), infective endocarditis of mitral (16 cases), ischemic (13 cases), ongenital (40 cases) and degeneration (174 cases). Echocardiogram test were performed in the perioperative periods to monitor the lefe atrium (LA), left ventricular enddiastolic dimension (LVEDD), left ventricular endsystolic dimension (LVESD), left ventricular ejection fraction(LVEF), left ventricular fractional shortening (LVFS) and mitral regurgitation grades. The perioperative mortality, morbidity, reoperation rate were recorded during the followup. Results Aortic cross clamping time was 74±30 min and cardiopulmonary bypass time was 105±37min. The perioperative survival rate was 96.5% (250/259) and free from complications rate was 93.4% （242/259）. No left ventricular out flow tract obstruction and coronary artery stenosis were occurred in this group. The 60 months survival rate was 938% (243/259) and 5 years nonreoperation rate was 96.1%(249/259). The perioperative echocardiogram results showed the LVEDD decreased from 62.60±10.19mm to 52.88±8.67mm and the LVEF increased from 57.91% to 61.00%（Plt;0.05）. During the followup the mitral regurgitation grades were improved significantly (Plt;0.05),there were 188 cases of trifle mitral regurgitation (72.6%), 62 cases of mild mitral regurgitation (23.9%), 8 cases of moderate mitral regurgitation(3.1%) and 1 case of serious mitral regurgitation(0.4%). Conclusion This simplified mitral annuloplasty technique is an easy handling and effective treatment for the mitral repair.
Mitral regurgitation is the most common cardiac valve disease, with high rates of morbidity and mortality. Transcatheter mitral valve replacement (TMVR) is used as a promising intervention in non-surgical patients and in those with unsuitable anatomy for transcatheter edge-to-edge repair. TMVR can also be performed for inoperable or high-risk patients with degenerated or failed bioporstheses or failed repairs, or in patients with severe annular calcifications. The complex anatomy of the mitral valves makes the design of transcatheter mitral valve prostheses extremely challenging, and increases the difficulty of TMVR procedure, thus could led to non-negligible complications including periprocedural and post-procedural long-term complications. This review aims to discuss the potential TMVR-complications and measures implemented to mitigate these complications, in order to improve the prognosis of TMVR patients.
Over the past 20 years, transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment option for patients with severe mitral regurgitation (MR) who are at high surgical risk. Initially, several landmark clinical studies established the basis of TEER for primary and secondary MR, but they only involved clinically stable patients with appropriate mitral valve anatomy. With the increasing experience of interventional therapy, the iteration of equipment and the improvement of intraoperative imaging technology, the scope of use of TEER has been continuously expanded, and its indications have been continuously expanded to more complex mitral valve lesions and clinical situations. Therefore, in clinical practice, selecting the appropriate device according to the individual anatomical characteristics of the patient can minimize MR and complications, thereby optimizing immediate and long-term prognosis. This article mainly introduces the pathogenesis and related mechanisms of MR, the main TEER devices and their clinical evidence, the limitations of TEER, and the future development direction.
Mitral regurgitation is one of the most common valvular heart diseases, with functional mitral regurgitation being the predominant type. Ventricular functional mitral regurgitation (VFMR) occurs due to impaired left ventricular systolic function combined with left ventricular dilation, leading to mitral annular enlargement and papillary muscle displacement, which cause relative tethering of the mitral leaflets despite structurally normal valve apparatus. Patients with VFMR often present with severe heart failure, face high surgical risks, and have a poor prognosis. In recent years, mitral valve transcatheter edge-to-edge repair (TEER) has emerged as a well-established interventional technique, offering a new treatment option for VFMR patients and significantly improving clinical outcomes. This review focuses on the advances in the pathogenesis, epidemiological characteristics, diagnosis, and management of VFMR, particularly the application and efficacy-influencing factors of TEER.
ObjectiveTo evaluate the safety and efficacy of transapical mitral valve repair with moderate-to-severe or severe mitral regurgitation (MR) by using LifeClip system. Methods We retrospectively analyzed the clinical data of 7 symptomatic patients with moderate-to-severe or severe MR who received transapical mitral valve repair by using the LifeClip system in our hospital from July to November 2021. There were 5 males and 2 females with an average age of 76.0±7.5 years. ResultsThere were 2 patients with degenerative MR and 5 patients with functional MR. All of the procedures were successful and 6 patients received 1 LifeClip while the other one patient received 2. The operation time was 135.7±46.9 min, the mechanical ventilation time was 12 (3, 14) h, and the hospital stay time was 18.1±4.1 d. No serious complications or death occurred during the perioperative or follow-up period. MR reduction by ≥2 grades was achieved in all the patients at the one-month follow-up. The classification of cardiac function was improved in varying degrees. Conclusion Transapical mitral valve repair using the LifeClip system shows good safety and efficacy for severe MR patients, and MR degree is significantly improved at early follow-up. However, the benefit of LifeClip should be validated in a larger sample size of Chinese population and through long-term follow-up.
ObjectiveTo review the experience of the surgical treatment of child patients with anomalous left coronary artery from the pulmonary artery (ALCAPA).
MethodsWe retrospectively analyzed the clinical data of 56 children patients with ALCAPA underwent coronary re-implantation in our hospital from April 2004 through February 2015. There were 35 males and 21 females at mean age of 25.5 (7.3-60.0) months. Nineteen patients (33.9%) were less than 1 year of age. The mean weight was 11.8 (7.8-19.8) kg.
ResultsThere was one death in-hospital. The mean cardiopulmonary bypass time and cross-clamp time was 131.8± 61.2 min and 83.4± 32.1min, respectively. The mean mechanical ventilation time and intensive care unit time was 12.5 (6.5-43.8) h and 49.0 (21.0-116.0) h, respectively. Three patients underwent extracorporeal membrane oxygenation (ECMO) support and weaned off successfully. The mean postoperative left ventricular ejection fraction (LVEF, 63.4%± 15.8% vs. 50.6%± 18.7%) and left ventricular end diastolic diameter (LVEDD, 36.4± 32.5 mm vs. 42.3± 7.4 mm) significantly improved compared postoperative (P < 0.05). The mitral regurgitation (MR) distribution in the 15 patients underwent mitral valve repair was:moderate in 2 patients, mild in 8 patients, trivial in 2 patients and none in 3 patients. The MR in the other 41 patients improved or did not change. The survivors completed the follow-up for a mean time of 45.4± 23.6 months. During the follow-up period, one patient died due to noncardiac reason. No patient required reoperation or readmission. All the patients survived with New York Heart Association heart function classⅠor classⅡ. At the latest echocardiography, the mean LVEF (62.8%± 5.0%) significantly improved compared with the LVEF of discharge. The MR distribution was moderate in 6 patients, mild in 24 patients, trivial in 4 patients and none in 21 patients.
ConclusionThe coronary re-implantation has a satisfactory mid-term result for patients with ALCAPA. Mitral valve repair is recommended for the patients with severe regurgitation and evident ischemic lesions of the papillary muscles.
ObjectiveTo summarize mid- to long-term results of edge to edge mitral repair for mitral regurgitation (MR).
MethodsClinical data of 31 patients who underwent edge to edge mitral repair in Nanjing Drum Tower Hospital from June 2002 to June 2008 were retrospectively reviewed. There were 13 male and 18 female patients with their age of 14-77 (43±21) years. Clinical and echocardiographic data were analyzed.
ResultsThree patients died in hospital,and 28 patients finished mid- to long-term follow-up for 5-10 years. During follow-up, 1 patient died of acute decompensated heart failure in the 2nd year after discharge. Two patients had recurrent moderate MR, and 6 patients had recurrent moderate-to-severe MR including 3 patients who underwent mitral valve replacement in the 5th,6th and 7th postoperative year respectively because of severe MR. Five-year reoperation-free rate was 88.9% (24/27). Five-year mortality was 3.6% (1/28). The incidence of recurrent moderate or severe MR within 5 postoperative years was 28.6% (8/28).
ConclusionFor complex MR or as an emergency substitute strategy for failed routine mitral valvuloplasty, edgeto- edge mitral repair can produce good mid- to long-term outcomes except for Carpentier Ⅲb MR.
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.
Abstract： Compared with mitral valve replacement, there areseveral advantages in mitral valvuloplasty, so recently more and more sights are caught on mitral valve repair. According to different etiology, the surgeon can apply annuloplasty, triangular resection, quadrangular resection, replacement or transposition of chordae tendineae and so on to treat mitral regurgitation(MR). With the development of minimally invasive surgical technology, robotic mitral valve reconstruction evolve rapidly and percutaneous interventional therapy also commence from lab to bedside.We believe surgeons can repair MR safely and successfully in the majority of patients with proficiency in the basic techniques.
Mitral regurgitation is one of the most common heart valve diseases. Transcatheter edge-to-edge repair (TEER) is currently the most developed and commonly used interventional technique for mitral regurgitation and is recommended by the latest European and American guidelines for patients who are at high surgical risk. TEER device usually consists of a clamping device and a delivery system. The trajectory of the clamping device is called the trajectory, and the trajectory can be well established with the five dimensions movement of the delivery system: left-right oscillation, anterior-posterior oscillation, overall parallel movement, the clamping device's own clockwise rotation, and vertical up-and-down movement. The delivery system's anteroposterior and lateral oscillations are concentrated on the virtual puncture site. Furthermore, the location of the septal puncture site has a significant impact on the establishemnt of the trajectory. The evulation of three variables and adherence to the "4M principles" are necessary for the successful TEER. The three variables are: the position of the clip in the center of the regurgitation,the arm orientation of the clip perpendicular to the boundary of anterior and posterior leaflets, as well as the appropriate length of clamping. The "4M principles" include favorable valve morphology, residual mitral regurgitation below grade 2+, mean transvalvular pressure≤5 mm Hg, and an appropriate amount of leaflets clamping. Patients' baseline situation, the degree of mitral regurgitation and ventricular remodeling, as well as the valve morphology and the outcome of the procedure, are the factors determining the prognosis of patients after TEER.
