Concomitant Transaortic Repair for Moderate Functional Mitral Regurgitation during Surgical Treatment for Aortic Root or Aortic Valve Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MANan , ZHANGJun-wen , WUShu-bin , ZHANGYun-jiao , DINGFang-bao ,  MEIJu

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding?author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Functional mitral regurgitation; Transaortic; Mitral valvuloplasty

DOI：

10.7507/1007-4848.20140090

Video：

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Objective To explore surgical techniques and follow-up results of concomitant transaortic repair for moderate functional mitral regurgitation (MR)during surgical treatment for aortic root or aortic valve disease. Methods Clinical data of 25 patients who underwent concomitant transaortic repair for moderate functional MR during surgical treat-ment for aortic root or aortic valve disease between January 2006 and June 2012 in Xinhua Hospital were retrospectively analyzed. There were 18 male and 7 female patients with their age of 42-75 (57.9±9.6)years. All these patients had aortic root or aortic valve disease as well as concomitant moderate functional MR (type I Carpentier's classification). Aortic valve replacement or aortic root replacement and concomitant transaortic mitral valvuloplasty (MVP, commissure repair)were performed under general anesthesia, hypothermia and cardiopulmonary bypass. Patients were followed up at the outpatient department as well as with phone calls to evaluate the structures and function of the mitral valve and the heart. Results Intraoperative transesophageal echocardiography showed satisfactory MVP results as trivial residual MR in 2 patients and no MR or mitral stenosis in the other 23 patients. There was no in-hospital death in this group. Postoperative echocardiography showed that left atrial diameter and left ventricular end-diastolic dimension were significantly reduced than preoperative values (t=4.086, P=0.000;t=4.442, P=0.000), and left ventricular ejection fraction (LVEF)was significantly lower than preoperative LVEF (t=3.671, P=0.001). Postoperative mitral annulus diameter (MAD)was smaller than preoperative MAD (32.4±3.6 mm vs. 35.6±6.4 mm). Postoperative mitral valve pressure gradient (MVPG)(1.4±0.7 mm Hg vs. 1.5±0.7 mm Hg)and peak MVPG (3.7±2.2 mm Hg vs. 3.3±1.5 mm Hg)were no statistical difference than preoperative values. Twenty-three patients (92%)were followed up after discharge for 7-92 (50.4±25.3)months, and the other 2 patients were lost in follow-up. Three patients had mild MR during follow-up. Latest echocardiography examination showed MAD was 33.9±4.6 mm, MVPG was 1.3±0.6 mm Hg, and peak MVPG was 3.6±2.3 mm Hg. Conclusion Concomitant transaortic MVP during surgical treatment for aortic root or aortic valve disease is a safe, convenient and effective procedure for the treatment of moderate functional MR.

Citation： MANan, ZHANGJun-wen, WUShu-bin, ZHANGYun-jiao, DINGFang-bao, MEIJu. Concomitant Transaortic Repair for Moderate Functional Mitral Regurgitation during Surgical Treatment for Aortic Root or Aortic Valve Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 322-325. doi: 10.7507/1007-4848.20140090 Copy

1.	Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet, 2009, 373 (9672):1382-1394.
2.	Baskett RJ, Exner DV, Hirsch GM, et al. Mitral insufficiency and morbidity and mortality in left ventricular dysfunction. Can J Cardiol, 2007, 23 (10):797-800.
3.	Borghetti V, Campana M, Scotti C, et al. Biological versus prosthetic ring in mitral-valve repair:enhancement of mitral annulus dynamics and left ventricular function with pericardial annuloplasty at long term. Eur J Cardiothorac Surg, 2000, 17 (4):431-439.
4.	Ben Zekry S, Lang RM, Sugeng L, et al. Mitral annulus dynamics early after valve repair:preliminary observations of the effect of resectional versus non-resectional approaches. J Am Soc Echocardiogr, 2011, 24 (11):1233-1242.
5.	Suri RM, Aviernos JF, Dearani JA, et al. Management of less-than-severe mitral regurgitation:should guidelines recommend earlier surgical intervention? Eur J Cardiothorac Surg, 2011, 40 (2):496-502.
6.	張寶仁, 朱家麟, 主編.人造心臟瓣膜與瓣膜置換術.北京:人民衛生出版社, 1999.202-221.
7.	Khoo NS, Smallhorn JF. Mechanism of valvular regurgitation. Curr Opin Pediatr, 2011, 23 (5):512-517.
8.	Poglajen G, Harlander M, Gersak B. Ex vivo study of altered mitral apparatus geometry in functional mitral regurgitation. Heart Surg Forum, 2010, 13 (3):E172-E176.
9.	Komeda M, Kitamura H, Fukaya S, et al. Surgical treatment for functional mitral regurgitation. Circ J, 2009, 73 (Suppl A):A23-A28.
10.	Wan CK, Suri RM, Li Z, et al. Management of moderate functional mitral regurgitation at the time of aortic valve replacement:is conco-mitant mitral valve repair necessary? J Thorac Cardiovasc Surg, 2009, 137 (3):635-640.
11.	Mallidi HR, Pelletier MP, Lamb J, et al. Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2004, 127 (3):636-644.
12.	Najm HK, Arifi AA, Omran AS, et al. Moderate ischemic mitral regurgitation:Is there a case for early intervention? J Saudi Heart Assoc, 2010, 22 (3):115-119.
13.	Hetzer R, Delmo Walter EM. No ring at all in mitral valve repair:indications, techniques and long-term outcome. Eur J Cardiothorac Surg, 2014, 45 (2):341-351.
14.	Nardi P, Pellegrino A, Olevano C, et al. Mitral valve repair for the treatment of degenerative mitral valve disease with or without prosthetic ring annuloplasty:long-term outcomes. J Cardiovasc Surg (Torino), 2013, 54 (2):305-312.
15.	Detter C, Aybek T, Kupilik N, et al. Mitral valve annuloplasty:comparison of the mural annulus shortening suture (MASS)with the Carpentier-Edwards prosthetic ring. J Heart Valve Dis, 2000, 9 (4):478-486.
16.	Aybek T, Risteski P, Miskovic A, et al. Seven years' experience with suture annuloplasty for mitral valve repair. J Thorac Cardiovasc Surg, 2006, 131 (1):99-106.
17.	Fundarò P, Tartara PM, Villa E, et al. Mitral valve repair:is there still a place for suture annuloplasty? Asian Cardiovasc Thorac Ann, 2007, 15 (4):351-358.
18.	Alfieri O, De Bonis M. The role of the edge-to-edge repair in the surgical treatment of mitral regurgitation. J Card Surg, 2010, 25 (5):536-541.
19.	李進華, 來永強, 王炯, 等. "緣對緣"二尖瓣成形術對左心室舒張功能的影響.中國胸心血管外科臨床雜志, 2009, 16 (5):344-347.
20.	Santana O, Lamelas J. Minimally invasive transaortic repair of the mitral valve. Heart Surg Forum, 2011, 14 (4):e232-e236.
21.	K?llner G, van der Linden J, Hadjinikolaou L, et al. Transaortic approach for the Alfieri stitch. Ann Thorac Surg, 2001, 71 (1):378-380.
22.	Tsutsumi Y, Numata S, Seo H, et al. Transaortic edge-to-edge mitral valve repair and left ventricular myectomy. Gen Thorac Cardiovasc Surg, 2013, 61 (4):223-225.
23.	Santana O, Lamelas J. Minimally invasive transaortic mitral valve repair during aortic valve replacement. Tex Heart Inst J, 2011, 38 (3):298-300.
24.	Hosseini MT, Chandrasekaran V. Transaortic mitral valve repair in double valve infective endocarditis. J Card Surg, 2010, 25 (6):651-653.

1. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet, 2009, 373 (9672):1382-1394.
2. Baskett RJ, Exner DV, Hirsch GM, et al. Mitral insufficiency and morbidity and mortality in left ventricular dysfunction. Can J Cardiol, 2007, 23 (10):797-800.
3. Borghetti V, Campana M, Scotti C, et al. Biological versus prosthetic ring in mitral-valve repair:enhancement of mitral annulus dynamics and left ventricular function with pericardial annuloplasty at long term. Eur J Cardiothorac Surg, 2000, 17 (4):431-439.
4. Ben Zekry S, Lang RM, Sugeng L, et al. Mitral annulus dynamics early after valve repair:preliminary observations of the effect of resectional versus non-resectional approaches. J Am Soc Echocardiogr, 2011, 24 (11):1233-1242.
5. Suri RM, Aviernos JF, Dearani JA, et al. Management of less-than-severe mitral regurgitation:should guidelines recommend earlier surgical intervention? Eur J Cardiothorac Surg, 2011, 40 (2):496-502.
6. 張寶仁, 朱家麟, 主編.人造心臟瓣膜與瓣膜置換術.北京:人民衛生出版社, 1999.202-221.
7. Khoo NS, Smallhorn JF. Mechanism of valvular regurgitation. Curr Opin Pediatr, 2011, 23 (5):512-517.
8. Poglajen G, Harlander M, Gersak B. Ex vivo study of altered mitral apparatus geometry in functional mitral regurgitation. Heart Surg Forum, 2010, 13 (3):E172-E176.
9. Komeda M, Kitamura H, Fukaya S, et al. Surgical treatment for functional mitral regurgitation. Circ J, 2009, 73 (Suppl A):A23-A28.
10. Wan CK, Suri RM, Li Z, et al. Management of moderate functional mitral regurgitation at the time of aortic valve replacement:is conco-mitant mitral valve repair necessary? J Thorac Cardiovasc Surg, 2009, 137 (3):635-640.
11. Mallidi HR, Pelletier MP, Lamb J, et al. Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2004, 127 (3):636-644.
12. Najm HK, Arifi AA, Omran AS, et al. Moderate ischemic mitral regurgitation:Is there a case for early intervention? J Saudi Heart Assoc, 2010, 22 (3):115-119.
13. Hetzer R, Delmo Walter EM. No ring at all in mitral valve repair:indications, techniques and long-term outcome. Eur J Cardiothorac Surg, 2014, 45 (2):341-351.
14. Nardi P, Pellegrino A, Olevano C, et al. Mitral valve repair for the treatment of degenerative mitral valve disease with or without prosthetic ring annuloplasty:long-term outcomes. J Cardiovasc Surg (Torino), 2013, 54 (2):305-312.
15. Detter C, Aybek T, Kupilik N, et al. Mitral valve annuloplasty:comparison of the mural annulus shortening suture (MASS)with the Carpentier-Edwards prosthetic ring. J Heart Valve Dis, 2000, 9 (4):478-486.
16. Aybek T, Risteski P, Miskovic A, et al. Seven years' experience with suture annuloplasty for mitral valve repair. J Thorac Cardiovasc Surg, 2006, 131 (1):99-106.
17. Fundarò P, Tartara PM, Villa E, et al. Mitral valve repair:is there still a place for suture annuloplasty? Asian Cardiovasc Thorac Ann, 2007, 15 (4):351-358.
18. Alfieri O, De Bonis M. The role of the edge-to-edge repair in the surgical treatment of mitral regurgitation. J Card Surg, 2010, 25 (5):536-541.
19. 李進華, 來永強, 王炯, 等. "緣對緣"二尖瓣成形術對左心室舒張功能的影響.中國胸心血管外科臨床雜志, 2009, 16 (5):344-347.
20. Santana O, Lamelas J. Minimally invasive transaortic repair of the mitral valve. Heart Surg Forum, 2011, 14 (4):e232-e236.
21. K?llner G, van der Linden J, Hadjinikolaou L, et al. Transaortic approach for the Alfieri stitch. Ann Thorac Surg, 2001, 71 (1):378-380.
22. Tsutsumi Y, Numata S, Seo H, et al. Transaortic edge-to-edge mitral valve repair and left ventricular myectomy. Gen Thorac Cardiovasc Surg, 2013, 61 (4):223-225.
23. Santana O, Lamelas J. Minimally invasive transaortic mitral valve repair during aortic valve replacement. Tex Heart Inst J, 2011, 38 (3):298-300.
24. Hosseini MT, Chandrasekaran V. Transaortic mitral valve repair in double valve infective endocarditis. J Card Surg, 2010, 25 (6):651-653.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Concomitant Transaortic Repair for Moderate Functional Mitral Regurgitation during Surgical Treatment for Aortic Root or Aortic Valve Disease

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