Abstract
Objective
We aimed to assess the results of posterior leaflet augmentation with an autologous pericardial patch in atrial functional mitral regurgitation.
Methods
Data of 16 patients with atrial functional mitral regurgitation who underwent posterior leaflet patch augmentation for mitral valve repair were retrospectively analyzed. This procedure was applied to a short posterior leaflet with a height of < 10 mm in P2. The median age was 72.5 [67.8–78.3] years. Preoperative New York Heart Association functional class was II in 7 (43.8%) and III or IV in 9 (56.2%) patients. Mitral regurgitation was moderate in 2 (12.5%) and severe in 14 (87.5%) patients.
Results
Operative mortality occurred in 1 (6.2%) patient due to cerebral infarction. One patient required valve replacement because of patch perforation early after operation. Mitral regurgitation was reduced to less than mild in 15 (93.8%) patients and less than trivial in 11 (68.8%) patients (P < 0.01) postoperatively. As for mid-term results, New York Heart Association functional class improved to I or II in 12 (75%) patients (P < 0.01). Two cases of thrombotic complication were observed. Remote recurrent regurgitation occurred in one case due to small patch size. The 3-year free rate of valve-related morbidity and regurgitation recurrence was 65.6% and 87.1%, respectively. The 5-year survival rate was 93.8%.
Conclusions
Pericardial patch augmentation in atrial functional mitral regurgitation leads to good survival and mitral regurgitation recurrence-free rates. Steady anticoagulation and the use of larger patches would be necessary to reduce thrombotic complications and recurrent MR.
Similar content being viewed by others
References
Zhou X, Otsuji Y, Yoshifuku S, Yuasa T, Zhang H, Takasaki K, et al. Impact of atrial fibrillation on tricuspid and mitral annular dilatation and valvular regurgitation. Circ J. 2002;66:913–6.
Vohra HA, Whistance RN, Magan A, Sadeque SA, Livesey SA. Mitral valve repair for severe mitral regurgitation secondary to lone atrial fibrillation. Eur J Cardiothorac Surg. 2012;42:634–7.
Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J. 2020;84:2037–119.
Ito K, Abe Y, Takahashi Y, Shimada Y, Fukumoto H, Matsumura Y, et al. Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: a study using three-dimensional transesophageal echocardiography. J Cardiol. 2017;70:584–90.
Takahashi Y, Abe Y, Sasaki Y, Bito Y, Morisaki A, Nishimura S, et al. Mitral valve repair for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. Interact Cardiovasc Thorac Surg. 2015;21:163–8.
Takahashi Y, Shibata T, Hattori K, Kato Y, Motoki M, Morisaki A, et al. Extended posterior leaflet extension for mitral regurgitation in giant left atrium. J Heart Valve Dis. 2014;23:88–90.
Shibata T, Takahashi Y, Fujii H, Morisaki A, Abe Y. Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism. Gen Thorac Cardiovasc Surg. 2021;69:1041–9.
Sakaguchi T, Totsugawa T, Orihashi K, Kihara K, Tamura K, Hiraoka A, et al. Mitral annuloplasty for atrial functional mitral regurgitation in patients with chronic atrial fibrillation. J Cardiac Surg. 2019;34:767–73.
Chauvaud S, Jebara V, Chachques JC, el Asmar B, Mihaileanu S, Perier P, et al. Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair. J Thorac Cardiovasc Surg. 1991;102:171–7 (discussion 177).
Shomura Y, Okada Y, Nasu M, Koyama T, Yuzaki M, Murashita T, et al. Late results of mitral valve repair with glutaraldehyde-treated autologous pericardium. Ann Thorac Surg. 2013;95:2000–5.
Quinn RW, Wang L, Foster N, Pasrija C, Ghoreishi M, Dawood M, et al. Long-term performance of fresh autologous pericardium for mitral valve leaflet repair. Ann Thorac Surg. 2020;109:36–41.
Ogata K, Mendell-Harary J, Tachibana M, Masumoto H, Oguma T, Kojima M, et al. Clinical safety, tolerability, pharmacokinetics, and pharmacodynamics of the novel factor Xa inhibitor edoxaban in healthy volunteers. J Clin Pharmacol. 2010;50:743–53.
Ikeda N, Yamaguchi H, Takagaki M, Mitsuyama S, Ebato M, Tanno K, et al. Extended posterior leaflet augmentation for ischemic mitral regurgitation—augmented posterior leaflet snuggling up to anterior leaflet. Circ J. 2019;83:567–75.
Sawazaki M, Tomari S, Tsunekawa T, Izawa N, Tateishi N. Aggressive atrial volume reduction for bilateral giant atria improves respiratory function. Ann Thorac Surg. 2013;95:1464–6.
Yuda S, Nakatani S, Isobe F, Kosakai Y, Miyatake K. Comparative efficacy of the maze procedure for restoration of atrial contraction in patients with and without giant left atrium associated with mitral valve disease. J Am Coll Cardiol. 1998;31:1097–102.
Kim H, Park YA, Choi SM, Chung H, Kim JY, Min PK, et al. Associates and prognosis of giant left atrium; single center experience. J Cardiovasc Ultrasound. 2017;25:84–90.
Chen LW, Qiu ZH, Wu XJ. A modified atrial volume reduction technique for a giant left atrium. Ann Thorac Surg. 2018;106:e101–3.
Beppu S, Kawazoe K, Nimura Y, Nagata S, Park YD, Sakakibara H, et al. Echocardiographic study of abnormal position and motion of the posterobasal wall of the left ventricle in cases of giant left atrium. Am J Cardiol. 1982;49:467–72.
Kawazoe K, Beppu S, Takahara Y, Nakajima N, Tanaka K, Ichihashi K, Fujita T, Manabe H. Surgical treatment of giant left atrium combined with mitral valvular disease. Plication procedure for reduction of compression to the left ventricle, bronchus, and pulmonary parenchyma. J Thorac Cardiovasc Surg. 1983;85:885–92.
Acknowledgements
The authors wish to thank Dr. Yukio Abe, a Deputy Chief in the Department of cardiology, Osaka City General Hospital, for his helpful assistance to correct the clinical data. We would like to thank Editage (http://www.editage.jp) for English language editing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sakon, Y., Takahashi, Y., Fujii, H. et al. Mitral valve repair with patch augmentation for atrial functional mitral regurgitation complicated with giant left atrium. Gen Thorac Cardiovasc Surg 71, 104–112 (2023). https://doi.org/10.1007/s11748-022-01833-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-022-01833-3