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Contemporary techniques for mitral valve repair—the Mayo Clinic experience

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Abstract

Mitral valve repair for patients with degenerative or functional mitral valve regurgitation improves symptoms and prognosis, and several techniques have been described. Important principles in operation are simplicity, reproducibility, and durability of repair. At Mayo Clinic, we have operated on more than 6000 patients with degenerative mitral valve disease and valve prolapse, and this review details our approach to mitral valve repair, including robotic and minimally invasive techniques. Most patients with isolated leaflet prolapse can be managed with leaflet plication or triangular resection, and chordal replacement is reserved for repair of anterior leaflet prolapse. Posterior annuloplasty with a standard-sized flexible band is used to reduce annular circumference and improve leaflet coaptation. With these methods, early risk of mortality for mitral valve repair is low in the current era (< 1%), and rate of recurrent valve leakage is 1.5 per 100 patient-years during the first year post-repair and 0.9 per 100 patient-years thereafter. This paper also briefly summarizes important considerations for patients with mitral valve regurgitation and severe calcification, perforations due to endocarditis, and rheumatic heart disease.

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References

  1. Carpentier A. Cardiac valve surgery--the “French correction”. J Thorac Cardiovasc Surg. 1983;86:323–37.

    Article  CAS  Google Scholar 

  2. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148:e1–e132.

    Article  Google Scholar 

  3. Ling LH, Enriquez-Sarano M, Seward JB, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. 1996;335:1417–23.

    Article  CAS  Google Scholar 

  4. Suri RM, Clavel MA, Schaff HV, et al. Effect of recurrent mitral regurgitation following degenerative mitral valve repair: long-term analysis of competing outcomes. J Am Coll Cardiol. 2016;67:488–98.

    Article  Google Scholar 

  5. McGoon DC. Repair of mitral insufficiency due to ruptured chordae tendineae. J Thorac Cardiovasc Surg. 1960;39:357–62.

    Google Scholar 

  6. Seccombe JF, Schaff HV. Mitral valve repair: current techniques and indications. In: Franco KL, Verrier ED, editors. Advanced Therapy in Cardiac Surgery. Hamilton: BC Decker; 1999. p. 220–31.

    Google Scholar 

  7. Frater RW, Vetter HO, Zussa C, Dahm M. Chordal replacement in mitral valve repair. Circulation. 1990;82:IV125–30.

    CAS  PubMed  Google Scholar 

  8. Perier P, Hohenberger W, Lakew F, et al. Toward a new paradigm for the reconstruction of posterior leaflet prolapse: midterm results of the “respect rather than resect” approach. Ann Thorac Surg. 2008;86:718–25.

    Article  Google Scholar 

  9. Jebara VA, Mihaileanu S, Acar C, et al. Left ventricular outflow tract obstruction after mitral valve repair. Results of the sliding leaflet technique. Circulation. 1993;88:II30–4.

    CAS  PubMed  Google Scholar 

  10. Orszulak TA, Schaff HV, Danielson GK, et al. Mitral regurgitation due to ruptured chordae tendineae. Early and late results of valve repair. J Thorac Cardiovasc Surg. 1985;89:491–8.

    Article  CAS  Google Scholar 

  11. Cevasco M, Myers PO, Elbardissi AW, Cohn LH. Foldoplasty: a new and simplified technique for mitral valve repair that produces excellent medium-term outcomes. Ann Thorac Surg. 2011;92:1634–7.

    Article  Google Scholar 

  12. Falk V, Seeburger J, Czesla M, et al. How does the use of polytetrafluoroethylene neochordae for posterior mitral valve prolapse (loop technique) compare with leaflet resection? A prospective randomized trial. J Thorac Cardiovasc Surg. 2008;136:1205.

    Article  Google Scholar 

  13. Lawrie GM, Earle EA, Earle N. Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation. J Thorac Cardiovasc Surg. 2011;141:368–76.

    Article  Google Scholar 

  14. Saunders PC, Grossi EA, Schwartz CF, et al. Anterior leaflet resection of the mitral valve. Semin Thorac Cardiovasc Surg. 2004;16:188–93.

    Article  Google Scholar 

  15. David TE. Artificial chordae. Semin Thorac Cardiovasc Surg. 2004;16:161–8.

    Article  Google Scholar 

  16. Kuntze T, Borger MA, Falk V, et al. Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (’loop technique'). Eur J Cardiothorac Surg. 2008;33:566–72.

    Article  Google Scholar 

  17. Alfieri O, Maisano F, De Bonis M, et al. The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg. 2001;122:674–81.

    Article  CAS  Google Scholar 

  18. Ben Zekry S, Spiegelstein D, Sternik L, et al. Simple repair approach for mitral regurgitation in Barlow disease. J Thorac Cardiovasc Surg. 2015;150:1071–7.

    Article  Google Scholar 

  19. Reed GE, Tice DA, Clauss RH. A symmetric exaggerated mitral annuloplasty: repair of mitral insufficiency with hemodynamic predictability. J Thorac Cardiovasc Surg. 1965;49:752–61.

    Article  CAS  Google Scholar 

  20. Kay JH, Egerton WS, Zubiate P. The surgical treatment of mitral insufficiency and combined mitral stenosis and insufficiency with use of the heart-lung machine. Surgery. 1961;50:67–74.

    CAS  PubMed  Google Scholar 

  21. Wooler GH, Nixon PG, Grimshaw VA, Watson DA. Experiences with the repair of the mitral valve in mitral in competence. Thorax. 1962;17:49–57.

    Article  CAS  Google Scholar 

  22. Duran CG, Pomar JL, Revuelta JM, et al. Conservative operation for mitral insufficiency: critical analysis supported by postoperative hemodynamic studies of 72 patients. J Thorac Cardiovasc Surg. 1980;79:326–37.

    Article  CAS  Google Scholar 

  23. Odell JA, Schaff HV, Orszulak TA. Early results of a simplified method of mitral valve annuloplasty. Circulation. 1995;92:II150–4.

    Article  CAS  Google Scholar 

  24. Brown ML, Schaff HV, Li Z, Suri RM, Daly RC, Orszulak TA. Results of mitral valve annuloplasty with a standard-sized posterior band: is measuring important? J Thorac Cardiovasc Surg. 2009;138:886–91.

    Article  Google Scholar 

  25. Hueb AC, Jatene FB, Moreira LF, Pomerantzeff PM, Kallás E, de Oliveira SA. Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy: new insights from anatomic study. J Thorac Cardiovasc Surg. 2002;124:1216–24.

    Article  Google Scholar 

  26. Suri RM, Grewal J, Mankad S, Enriquez-Sarano M, Miller FA, Schaff HV. Is the anterior intertrigonal distance increased in patients with mitral regurgitation due to leaflet prolapse? Ann Thorac Surg. 2009;88:1202–8.

    Article  Google Scholar 

  27. Murzi M, Cerillo AG, Miceli A, et al. Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: a propensity score analysis on 1280 patients. Eur J Cardiothorac Surg. 2013;43:e167–72.

    Article  Google Scholar 

  28. Grossi EA, Loulmet DF, Schwartz CF, et al. Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg. 2012;143:S68–70.

    Article  Google Scholar 

  29. Suri RM, Schaff HV, Meyer SR, Hargrove WC 3rd. Thoracoscopic versus open mitral valve repair: a propensity score analysis of early outcomes. Ann Thorac Surg. 2009;88:1185–90.

    Article  Google Scholar 

  30. Suri RM, Dearani JA, Mihaljevic T, et al. Mitral valve repair using robotic technology: Safe, effective, and durable. J Thorac Cardiovasc Surg. 2016;151:1450–4.

    Article  Google Scholar 

  31. Suri RM, Taggarse A, Burkhart HM, et al. Robotic mitral valve repair for simple and complex degenerative disease: midterm clinical and echocardiographic quality outcomes. Circulation. 2015;132:1961–8.

    Article  Google Scholar 

  32. Dreyfus G, Serraf A, Jebara VA, et al. Valve repair in acute endocarditis. Ann Thorac Surg. 1990;49:706–11.

    Article  CAS  Google Scholar 

  33. Kanemitsu H, Nakamura K, Fukunaga N, Koyama T. Long-term outcomes of mitral valve repair for active endocarditis. Circ J. 2016;80:1148–52.

    Article  Google Scholar 

  34. Sternik L, Zehr KJ, Orszulak TA, Mullany CJ, Daly RC, Schaff HV. The advantage of repair of mitral valve in acute endocarditis. J Heart Valve Dis. 2002;11:91–7.

    PubMed  Google Scholar 

  35. Evans CF, DeFilippi CR, Shang E, Griffith BP, Gammie JS. Fresh autologous pericardium for leaflet perforation repair in mitral valve infective endocarditis. J Heart Valve Dis. 2013;22:560–6.

    PubMed  Google Scholar 

  36. Sareyyupoglu B, Schaff HV, Suri RM, Connolly HM, Daly RC, Orszulak TA. Safety and durability of mitral valve repair for anterior leaflet perforation. J Thorac Cardiovasc Surg. 2010;139:1488–93.

    Article  Google Scholar 

  37. Antunes MJ. Challenges in rheumatic valvular disease: surgical strategies for mitral valve preservation. Glob Cardiol Sci Pract. 2015;2015:9.

    Article  Google Scholar 

  38. Dillon J, Yakub MA, Kong PK, Ramli MF, Jaffar N, Gaffar IF. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for “burnt-out” rheumatic disease still inferior to repair for degenerative disease in the current era? J Thorac Cardiovasc Surg. 2015;149:771–7.

    Article  Google Scholar 

  39. Dillon J, Yakub MA, Pau KK, Taib ME. Leaflet extension for repairing rheumatic mitral valve regurgitation. Ann Cardiothorac Surg. 2015;4:301–3.

    PubMed  PubMed Central  Google Scholar 

  40. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg. 2006;82:819–26.

    Article  Google Scholar 

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Funding

This work was supported by the Paul and Ruby Tsai Family.

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  1. Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA

    Hartzell Vernon Schaff & Anita Nguyen

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  1. Hartzell Vernon Schaff
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  2. Anita Nguyen
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Correspondence to Hartzell Vernon Schaff.

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Schaff, H.V., Nguyen, A. Contemporary techniques for mitral valve repair—the Mayo Clinic experience. Indian J Thorac Cardiovasc Surg 36 (Suppl 1), 18–26 (2020). https://doi.org/10.1007/s12055-019-00801-6

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