Modern approaches to the treatment of mitral valve insufficiency of degenerative etiology

Authors

  • Vitalie V. MOSCALU IMSP Institutul de Cardiologie

DOI:

https://doi.org/10.52692/1857-0011.2023.2-76.16

Keywords:

valve disease, valve repair surgery, valve replacement, reconstructive valve surgery

Abstract

The mitral valve (MV) is a complex, well-coordinated mechanism that can be disrupted by numerous congenital and acquired conditions. The type of lesion and the anatomical variant of valve disease determine the technical possibilities of correction. «Functional correction» is the key to success in promoting reconstructive repair surgery in atrioventricular lesions. In this article we make a synthesis of the specialized literature with reference to the modern approaches to the treatment of mitral insufficiency of degenerative etiology. Based on literature data, we can recommend reconstructive plasty surgeries for valves of degenerative, post-traumatic, ischemic, post-endocarditis etiology as effective and sustainable techniques over time, being a superior alternative to replacement with prosthetics

Author Biography

Vitalie V. MOSCALU, IMSP Institutul de Cardiologie

Scientific researcher, cardiothoracic surgeon

References

Edwards NC, Yuan M, Good IK, Moody WE, Steeds RP. Optimum management of asymptomatic moderate-severe degenerative mitral regurgitation: a role for T1 mapping in risk stratification? Journal of Cardiovascular Magnetic Resonance Imaging. 2014;16(S1):238.

Enriquez-Sarano M, Suri RM, Clavel MA, Mantovani F, Michelena HI, Pislaru S, Mahoney DW, Schaff HV. Is there an outcome penalty linked to guideline-based indications for valvular surgery? Early and long-term analysis of patients with organic mitral regurgitation. J Thorac Cardiovasc Surg. 2015;150(1):50–58.

Gammie JS, O’Brien SM, Griffith BP, Ferguson TB, Peterson ED. Influence of hospital procedural volume on care process and mortality for patients undergoing elective surgery for mitral regurgitation. Circulation. 2007;115(7):881-887.

Tietge WJ, de Heer LM, van Hessen MW et al. Early mitral valve repair versus watchful waiting in patients with severe asymptomatic organic mitral regurgitation; rationale and design of the Dutch AMR trial, a multicenter, randomised trial. Neth Heart J.2012;20(3):94-101.

Concato J, Peduzzi P, Huang GD, et al. Comparative effectiveness research: what kind of studies do we need? J Investig Med. 2010;58(6):764-769.

Hlatky MA, Douglas PS, Cook NL, et al. Future directions for cardiovascular disease comparative effectiveness research: report of a workshop sponsored by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2012;60(7): 569-580.

Haris Khan, Mahmood Ahmad, Mazhar A Warraich. Repair of the Mitral Valve Has Better Long-Term Outcomes Than Replacement. Ann Thorac Surg. 2020;110(4):1440.

Alain Carpentier. Cardiac valve surgerythe „French Cirrection”. The Journal of Thiracic and Cardiovascular Sergery, vol.86, n.3, 323-337.

Dreyfus G.D. Corbi P. Rubin S. Aubert S. Posterior leaflet preservation in mitral valve prolapse: a new approach to mitral repair. J Heart Valve Dis. 2006; 15: 528-530.

Perier P. Hohenberger W. Lakew F. Batz G. Urbanski P. Zacher M. 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: 718-725.

Gillinov AM, Cosgrove DM. Mitral valve repair for degenerative disease. J Heart Valve Dis. 2002;11 Suppl 1:S15-20.

Da Col U, Di Bella I, Bardelli G, Koukoulis G, Ramoni E, Ragni T. Triangular resection and folding of posterior leaflet for mitral valve repair. J. Card Surg. 2006; 21(3):274-6; discussion 277.

Park KJ, Woo JS, Yi JH, Park JY. Outcomes of Mitral Valve Repair: Quadrangular Resection versus Chordal Replacement. Korean J Thorac Cardiovasc Surg. 2013;46(2):124-129.

Juliano Lentz Carvalho, Hartzell V.Schaff, Rick A. Nishimura et al. Is anterior mitral valve leaflet length important in outcome of septal myectomy for obstructive hypertrophic cardiomyopathy? J Thorac Cardiovasc Surg. 2023;165(1):79-87.e1.

Alfieri O., Maisano F., De Bonis M., Stefano P. L., Torracca L., Oppizzi M., La Canna G. The double-orifice technique in mitral valve repair: a simple solution for complex problems. J. Thorac. Cardiovasc. Surg. 2001; 122(4): 674–681. 20.

De Bonis M, Alfieri O. The edge-to-edge technique for mitral valve repair. HSR Proc Intensive Care Cardiovasc Anesth. 2010;2(1):7-17.

Silvestry FE, Rodriguez LL, Herrmann HC. et al. Echocardiographic guidance and assessment of percutaneous repair for mitral regurgitation with the Evalve MitraClip: lessons learned from EVEREST I. J Am Soc Echocardiogr. 2007;20:1131–1140.

Brinster DR, Unic D, D’Ambra MN. et al. Midterm Results of the Edge-to-Edge Technique for Complex Mitral Valve Repair. Ann Thorac Surg. 2006;81:1612– 1617.

Morimoto Y, Sugimoto T. Alfieri stitch for temporary severe functional mitral regurgitation after aortic valve replacement. Surg Case Rep. 2018;4(1): 4. ISSN 2198-7793.

Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009, 18;373(9672):1382-94.

Khalpey Z, Shernan SK, Nascimben L, Aranki SF. Partial anterior leaflet valvuloplasty to avoid SAM after mitral valve repair. Ann Thorac Surg. 2013;95(4):1462-3.

Tomsic A Klautz R.J. Palmen M. Respect versus resect: two different repair techniques or two different tools in the box? J Thorac Cardiovasc Surg. 2018; 155: 600-601. Dis. 2002;11 Suppl 1:S15-20.

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.

Gilles D. Dreyfus, MD, et al. Respect when you can, resect when you should: A realistic approach to posterior leaflet mitral valve repair. The Journal of Thoracic and Cardiovascular Surgery. 2018;156(5):1856-1866.

Johnston DR, Gillinov AM, Blackstone EH, et al. Surgical repair of posterior mitral valve prolapse: implications for guidelines and percutaneous repair. Ann Thorac Surg. 2010;89:1385–1394.

Frater R.W. 10th Goretex Chorda anniversary. J. Heart Valve Dis. 1996; 5: 348–351.

Vetter H. O., Factor S. M., Frater R. W. The use of glycerol-treated homologous pericardium as a substitute for cusps and chordae tendineae of the mitral valve in sheep. J. Thorac. Cardiovasc. Surg. 1987; 35: 11–15.

Von Oppell U. O., Mohr F. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann. Thorac. Surg. 2000; 70: 2166–2168.

Reimink M. S., Kunzelman K. S., Cochran R. P. The effect of chordal replacement suture length on function and stresses in repaired mitral valves: a finite element study. J. Heart Valve Dis. 1996; 5: 365–375.

Hata H, Fujita T, Shimahara Y, Sato S, Ishibashi-Ueda H, Kobayashi J. A 25-year study of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair. Interact Cardiovasc Thorac Surg. 2015;20(4):463-8. ISSN 1569-9293.

David TE, David CM, Lafreniere-Roula M, Manlhiot C. Long-term outcomes of chordal replacement with expanded polytetrafluoroethylene sutures to repair mitral leaflet prolapse. J Thorac Cardiovasc Surg. 2020;160(2):385-394.e1.

Adams D. H., Kadner A., Chen R. H. Artificial mitral valve chordae replacement madesimple. Ann. Thorac. Surg. 2001; 71: 1377– 1379.

Kasegawaatal H., Kamata S., Hirata S., Kobayashi N., Mannouji E., Ida T., Kawase M. Simple method for determining proper length of artificial chordae in mitral valve repair. Ann. Thorac. Surg. 1994; 57: 237–239.

Von Oppell U. O., Mohr F. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann. Thorac. Surg. 2000; 70: 2166–2168.

Matsui Y., Fukada Y., Naito Y., Yasuda K. A new device for ensuring the correct length of artificial chordae in mitral valvuloplasty. Ann. Thorac. Surg. 2005; 79: 1064–1065.

Mandegar M. H., Yousefnia F., Roshanali M. A. Preoperative determination of artificial chordae length. Ann. Thorac. Surg. 2007; 84: 680– 682.

Chang J. P., Kao C. L. Slit stent technique for ensuring the correct length of artificial chordae in mitral repair. J. Card. Surg. 2011; 26: 259–260.

Fukuoka M., Nonaka M., Masuyama S., Shimamoto T., Tambara K., Yoshida H., Ikeda T., Komeda M. Chordal «translocation» for functional mitral regurgitation with severe valve tenting: an effort to preserve left ventricular structure and function. J. Tehran Heart Cent. 2008 Aug; 7(3): 92–99.

Cuartas MM, Davierwala PM. Minimally invasive mitral valve repair. Indian J Thorac Cardiovasc Surg. 2020;36(Suppl 1):44-52.

Mihos CG, Yucel E, Santana O. A systematic review and meta-analysis of chordal replacement versus leaflet resection for isolated posterior mitral valve prolapse. J Cardiovasc Surg (Torino). 2017;58(5):779-786.

Bourguignon T, Mazine A, Laurin C, Bouchard D, Demers P, Pellerin M. Repair of Anterior Mitral Leaflet Prolapse: Comparison of Mid-Term Outcomes with Chordal Transposition and Chordal Replacement Techniques. J Heart Valve Dis. 2016;25(2):187-194.

Anyanwu A.C. Bridgewater B. Adams D.H. The lottery of mitral valve repair surgery. Heart. 2010; 05: 1964-1967.

Gillinov M, Burns DJP, Wierup P. Commentary: A problem with the anterior mitral leaflet? J Thorac Cardiovasc Surg. 2021;162(4):1097-1098.

Zanobini M, Ricciardi G, Mammana FL, Kassem S, Poggio P, Di Minno A, Cavallotti L, Saccocci M. The respect rather than resect principle in mitral valve repair: the lateral dislocation of the P2 technique. J Cardiovasc Med (Hagerstown). 2017;18(9):687-690.

Gelsomino S, Lorusso R, De Cicco G, et al. Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation. Eur Heart J. 2008;29:231–40.

Robb JD, Minakawa M, Koomalsingh KJ, et al. Posterior leaflet augmentation improves leaflet tethering in repair of ischemic mitral regurgitation. Eur J Cardiothorac Surg. 2011;40:1501-7.

Gillinov AM, Blackstone EH, Nowicki ER, Slisatkorn W, Al-Dossari G, Johnston DR, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg. 2008;135: 885-93.

Bolling SF, Li S, O’Brien SM, Brennan JM, Prager RL, Gammie JS. Predictors of mitral valve repair: clinical and surgeon factors. Ann Thorac Surg. 2010;90: 1904-11.

Tsukui H, Umehara N, Saito H, Saito S, Yamazaki K. Early outcome of folding mitral valve repair technique without resection for mitral valve prolapse in 60 patients. J Thorac Cardiovasc Surg. 2013;145(1):104-8.

McCarthy P.M. Mitral leaflet clefts: innocent bystander or covert foe? Heart. 2015; 101: 1087-1088.

Tabata M. Nakatsuka D. Nishida H.Takanashi S. Hiraiwa N. Kawano Y. A simple nonresectional technique for degenerative mitral regurgitation with a very large posterior leaflet: chordal Foldoplasty. Ann Thorac Surg. 2016; 101: e179-e181.

Alexander A.Brescia, Tessa M.F.Watt, Liza M.Rosenbloom et al. Anterior versus posterior leaflet mitral valve repair: A propensity-matched analysis. J Thorac Cardiovasc Surg. 2021;162(4):1087-1096.e3.

Tabata M. Nishida H. Watanabe S. Uchimuro T. Takanashi S. Interscallop indentation closure as an adjunctive technique in mitral valve repair for degenerative mitral valve disease. Gen Torac Cardiovasc Surg. 2020; 68: 233-239.

Abicht T.O. Andrei A.C. Kruse J. McDonald E. Li Z. McCarthy P.M. O abordare simplă a reparației valvei mitrale: ajustarea înălțimii foilei posterioare folosind un pliu parțial al marginii libere. J Thorac Cardiovasc Surg. 2014; 148: 2780-2786.

Fuster G.R., et al. Artificial chordae in the setting of complex mitral valve repair. Interact Cardiovasc Thorac Surg. 2014; 18: 586-595.

Tabata M. Nakatsuka D. Nishida H. Takanashi S, et al. A Simple Nonresectional Technique for Degenerative Mitral Regurgitation With a Very Large Posterior Leaflet: Chordal Foldoplasty. Ann Thorac Surg. 2016; 101: e179-e181.

Gosev I. et al. Long term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation. Ann Cardiothorac Surg. 2015; 4: 428-432.

Aniek L. van Wijngaarden, Anton Tomsic, Bart J.A.Mertens et al. Mitral valve repair for isolated posterior mitral valve leaflet prolapse: The effect of respect and resect techniques on left ventricular function. The Journal of Thoracic and Cardiovascular Surgery. 2022;164(5):1488-1497.e3.

A.Marc Gillinov, Eugene H.Blackstone, Edward R. Nowicki et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg. 2008 ;135(4):885-93, 893.e1-2.

Abicht T.O., et al. A simple approach to mitral valve repair: posterior leaflet height adjustment a partial fold of the free edge. J Thorac Cardiovasc Surg. 2014; 148: 2780-2786.

Minoru Tabata, and Hiromi Yanagisawa. Nonresectional folding repair techniques for posterior leaflet lesions in degenerative mitral regurgitation. JTCVS Tech. 2021; 10: 68-731.

Dreyfus G.D. et al. “Respect when you can, resect when you should”: a realistic approach to posterior leaflet mitral valve repair. J Thorac Cardiovasc Surg. 2018; 156: 1856-1866.e3.

Yandrapalli S, Biswas M, Kaplan J. Mitral Valve Minimally Invasive Surgical Treatment. 2021 Dec 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 33620807

Marin Cuartas M, Javadikasgari H, Pfannmueller B, et al. Repararea valvei mitrale: Abordări robotice și alte abordări minim invazive. Prog Cardiovasc Dis. 2017;60:394–404.

Rostagno C. Heart valve disease in elderly. World J Cardiol. 2019,26;11(2):71-83.

Goel SS, et al. Prevalence and outcomes of unoperated patients with severe symptomatic mitral regurgitation and heart failure: comprehensive analysis to determine the potential role of MitraClip for this unmet need. J Am Coll Cardiol. 2014,21;63(2):185-6.

Van Praet KM, Stamm C, Sündermann SH, Meyer A, Unbehaun A, Montagner M, Nazari Shafti TZ, Jacobs S, Falk V, Kempfert J. Minimally Invasive Surgical Mitral Valve Repair: State of the Art Review. Interv Cardiol. 2018;13(1):14-19.

Moscarelli Marco, Fattouch Khalil, Casula Roberto, Speziale Giuseppe, Lancellotti Patrizio, Athanasiou Thanos. What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies. The Annals of Thoracic Surgery. 2016;101(3):981–989.

Marin Cuartas M, Saldaña LD, Quintero AA, Jaramillo JS, Rendon JC. Minimally invasive cardiac surgery through periareolar approach. s: CTSNet, Inc; July 2018. 10.25373/ctsnet.6815693

Santana O, Reyna J, Grana R, Buendia M, Lamas GA, Lamelas J. Rezultate ale chirurgiei valvulare minim invazive versus sternotomie standard la pacienții obezi supuși unei intervenții chirurgicale valvulare izolate. Ann Thorac Surg. 2011;91:406–410.

Goldstone AB, Atluri P, Szeto WY, et al. Abordarea minim invazivă oferă rezultate cel puțin echivalente pentru corectarea chirurgicală a insuficienței mitrale: o comparație potrivită cu tendința. J Thorac Cardiovasc Surg. 2013;145:748–756.

Lange R, Voss B, Kehl V, Mazzitelli D, Tassani-Prell P, Günther T. Right Minithoracotomy Versus Full Sternotomy for Mitral Valve Repair: A Propensity Matched Comparison. Ann Thorac Surg. 2017;103(2):573-579.

Rostagno C. Heart valve disease in elderly. World J Cardiol. 2019,26;11(2):71-83.

Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017, 21;38(36):2739-2791.

Welp H, Martens S. Minimally invasive mitral valve repair. Curr Opin Anaesthesiol. 2014;27(1):65-71.

Van Praet KM, Stamm C, Sündermann SH, Meyer A, Unbehaun A, Montagner M, Nazari Shafti TZ, Jacobs S, Falk V, Kempfert J. Minimally Invasive Surgical Mitral Valve Repair: State of the Art Review. Interv Cardiol. 2018;13(1):14-19.

Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation. 2013;128(5):483-91.

Galloway AC, Schwartz CF, Ribakove GH, Crooke GA, Gogoladze G, Ursomanno P, Mirabella M, Culliford AT, Grossi EA. A decade of minimally invasive mitral repair: long-term outcomes. Ann Thorac Surg. 2019;88(4):1180-4.

Published

2023-11-24

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Research Article

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