Commentary: A shoestring catch…
| Autor: | Michael D'Angelo, Eugene A. Grossi, Les James |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult: Mitral Valve
mitral valve Pulmonary and Respiratory Medicine off-pump AF atrial fibrillation TR tricuspid regurgitation transventricular mitral repair PMR papillary muscle rupture artificial chords MV mitral valve MR mitral regurgitation papillary muscle rupture ECG electrocardiography STEMI ST elevation myocardial infarction LVEF left ventricular ejection fraction Medicine LV left ventricular PCI percutaneous coronary intervention business.industry cardiogenic shock acute mitral regurgitation TEE transesophageal echocardiography IABP intra-aortic balloon pump STS Society of Thoracic Surgeons LAD left anterior descending artery minimally invasive MI myocardial infarction Commentary Surgery business RCA right coronary artery |
| Zdroj: | JTCVS Techniques |
| ISSN: | 2666-2507 |
| Popis: | Background We report 3 cases of rescue transventricular off-pump mitral valve (MV) repair in high-risk patients with acute mitral regurgitation (MR) due to post–myocardial infarction (MI) papillary muscle rupture (PMR). Methods The 3 patients presented with acute inferior ST elevation myocardial infarction, cardiogenic shock, and pulmonary edema. Their preoperative peak troponin I levels were 1909 ng/L, 16,963 ng/L, and 8299 ng/L. All 3 patients underwent successful percutaneous intervention to the culprit coronary artery, and antiplatelet therapy was initiated. All patients required inotropic support and had an intra-aortic balloon pump inserted preoperatively. Transesophageal echocardiography (TEE) demonstrated severe eccentric MR due to the leaflet prolapse secondary to PMR. The patients’ estimated EuroSCORE II scores were 16.03%, 16.68%, and 7.81%, and their Society of Thoracic Surgeons scores were 14.77%, 18.24%, and 9.8%, respectively. All 3 patients underwent urgent transventricular off-pump MV repair using artificial chords, with 2 or 3 three neochords implanted. The duration of operation was Graphical abstract The first-in-human urgent transventricular mitral valve (MV) repair with artificial neochords was successfully performed in 3 high-risk patients with acute severe mitral regurgitation (MR) due to ischemic papillary muscle rupture, cardiogenic shock, and pulmonary edema. The primary intention of hemodynamic stabilization was achieved in all patients with intraoperative MR reduction to a mild level (1+). The NeoChord DS1000 device captured the bundle of native chords together with the ruptured portion of the papillary muscle during the procedure (schematic view provided). Predischarge echocardiography demonstrated moderate MR, likely related to left ventricular remodeling. Recurrent severe MR was noted in all patients at 2 to 5 months after the repair. All patients underwent a successful elective reoperation with MV repair or replacement. This proof-of-concept study shows that the urgent off-pump NeoChord procedure in unstable patients with acute severe MR may serve as a bridge to conventional surgery. |
| Databáze: | OpenAIRE |
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