Correction of anterior mitral prolapse: The parachute technique

Autor: Laurens Mitchell-Heggs, Konstantinos Zannis, Valentina Di Nitto, Milena Noghin, Arrigo Lessana, Gabriel Ghorayeb, Matthias Kirsch
Rok vydání: 2012
Předmět:
Adult
Male
Reoperation
Pulmonary and Respiratory Medicine
Paris
medicine.medical_specialty
Mitral Valve Annuloplasty
Time Factors
medicine.medical_treatment
Kaplan-Meier Estimate
Regurgitation (circulation)
Risk Assessment
Postoperative Complications
Predictive Value of Tests
Recurrence
Risk Factors
Mitral valve
medicine
Humans
Registries
cardiovascular diseases
Papillary muscle
Aged
Retrospective Studies
Heart Valve Prosthesis Implantation
Mitral valve repair
Mitral regurgitation
Chi-Square Distribution
Mitral Valve Prolapse
business.industry
Mitral valve replacement
Mitral Valve Insufficiency
Middle Aged
Surgery
Treatment Outcome
medicine.anatomical_structure
Concomitant
Circulatory system
cardiovascular system
Feasibility Studies
Mitral Valve
Female
Cardiology and Cardiovascular Medicine
business
Echocardiography
Transesophageal
Zdroj: The Journal of Thoracic and Cardiovascular Surgery. 143:S24-S28
ISSN: 0022-5223
DOI: 10.1016/j.jtcvs.2011.10.034
Popis: Objectives To evaluate a new surgical technique for the correction of anterior mitral leaflet prolapse. Methods From October 2006 to November 2011, 44 consecutive patients (28 males, mean age 55 ± 13 years) underwent mitral valve repair because of anterior mitral leaflet prolapse. Echocardiography was performed to evaluate the distance from the tip of each papillary muscle to the annular plane. A specially designed caliper was used to manufacture a parachute-like device, by looping a 4-0 polytetrafluoroethylene suture between a Dacron strip and Teflon felt pledget, according to the preoperative echocardiographic measurements. This parachute was then used to resuspend the anterior mitral leaflet to the corresponding papillary muscle. Of the 44 patients, 35 (80%) required concomitant posterior leaflet repair. Additional procedures were required in 16 patients (36%). The preoperative logistic European System for Cardiac Operative Risk Evaluation was 4.3 ± 6.9. Results The clinical and echocardiographic follow-up were complete. The total follow-up was 1031 patient-months and averaged 23.4 ± 17.2 months per patient. The overall mortality rate was 4.5% (n = 2). Also, 2 patients (4.5%) with recurrent mitral regurgitation required mitral valve replacement, 1 on the first postoperative day and 1 after 13 months. In the latter patient, histologic analysis showed complete endothelialization of the Dacron strip. At follow-up, all non-reoperated survivors (n = 40) were in New York Heart Association class I, with no regurgitation in 40 patients (93%) and grade 2+ mitral regurgitation in 3 (7%). Conclusions This technique offers a simple and reproducible solution for correction of anterior leaflet prolapse. Echocardiography can reliably evaluate the length of the chordae. However, the long-term results must be evaluated and compared with other surgical strategies.
Databáze: OpenAIRE
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