Jo Keon HYON, Kim Hwan WOOK, Kim Do YEON

Posterior mitral kapak orta segment prolapsusunda rezeksiyonel olmayan, dikey katlı mitral kapak tamirinin erken dönem sonuçları

Amaç: Bu çalışmada posterior mitral kapak orta segment prolapsusunda rezeksiyonel olmayan, dikey katlı mitral kapak tamirinin erken dönem sonuçları bildirildi. Çalışma planı: Kasım 2011 - Mart 2016 tarihleri arasında posterior mitral kapak orta segment prolapsusu için rezeksiyonel olmayan, dikey katlı mitral kapak tamiri yapılan ardışık 32 hastanın (18 erkek, 14 kadın; ort. yaş: 61.3±12.5 yıl; dağılım 43-75 yıl) verileri retrospektif olarak incelendi. Bulgular: Medyan takip süresi 33 ay (dağılım, 3-48 ay) idi. Hiçbir hastada replasman gerektiren tamir başarısızlığına rastlanmadı. Takip süresince, neredeyse hastaların hiçbirinde (n=31, %96.9) mitral yetmezliğin derecesinde kötüleşme görülmedi. Sonuç: Çalışma sonuçlarımız posterior mitral kapak orta segment prolapsusunda rezeksiyonel olmayan, dikey katlı mitral kapak tamirinin cerrahi süresini harcamadan kolaylık, geriye döndürülebilirlik ve tekrar edilebilirlik gibi çeşitli avantajları olduğunu göstermektedir. Özellikle deneyimi az cerrahlar için bu teknik değerli bir alternatif olup, teknik araç olarak akılda bulundurulmalıdır.

Early results of non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse

Background: This study aims to report early results of the non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse.Methods: Data of consecutive 32 patients (18 males, 14 females; mean age 61.3±12.5 years; range 43 to 75) who underwent non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse between November 2011 and March 2016 were retrospectively analyzed.Results: The median follow-up was 33 months (range, 3 to 48 months). Repair failure requiring replacement did not occur in any patient. During follow-up, nearly none of the patients (n=31, 96.9%) experienced aggravation of the degree of mitral regurgitation.Conclusion: Our study results show that non-resectional, vertical folding mitral valve repair for mid-posterior mitral valve prolapse has several advantages such as simplicity, reversibility, and reproducibility without consuming surgical time. In particular, for surgeons with a limited experience, this technique is a valuable alternative and should be considered as a technical armamentarium.

PDF

___

17. Suri RM, Burkhart HM, Schaff HV. A novel method of leaflet reconstruction after triangular resection for posterior mitral valve prolapse. Ann Thorac Surg 2010;89:53 -6.
16. 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;21:274-6.
15. Grossi EA, Galloway AC, Kallenbach K, Miller JS, Esposito R, Schwartz DS, et al. Early results of posterior leaflet folding plasty for mitral valve reconstruction. Ann Thorac Surg 1998;65:1057-9.
14. McGoon DC. An early approach to the repair of ruptured mitral chordae. Ann Thorac Surg 1989;47:628-9.
13. McGoon DC. Repair of mitral insufficiency due to ruptured chordae tendineae. J Thorac Cardiovasc Surg 1960;39:357-62.
12. 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;86:718-25.
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;145:104-8.
10. Woo YJ, MacArthur JW Jr. Simplified nonresectional leaflet remodeling mitral valve repair for degenerative mitral regurgitation. J Thorac Cardiovasc Surg 2012;143:749-53.
9. Smith CR, Stamou SC, Boeve TJ, Patzelt LH. Folding mitral valvuloplasty without posterior leaflet resection for calcified mitral annulus. Interact Cardiovasc Thorac Surg 2012;14:143-5.
8. Hashim PW, Assi R, Hashim SW. The imbrication technique: an alternative to the sliding leaflet technique. Ann Thorac Surg 2014;98:1124-6.
7. Calafiore AM, Di Mauro M, Actis-Dato G, Iacò AL, Centofanti P, Forsennati P, et al. Longitudinal plication of the posterior leaflet in myxomatous disease of the mitral valve. Ann Thorac Surg 2006;81:1909-10.
6. Tabata M, Ghanta RK, Shekar PS, Cohn LH. Early and midterm outcomes of folding valvuloplasty without leaflet resection for myxomatous mitral valve disease. Ann Thorac Surg 2008;86:1388-90.
5. Mihaljevic T, Blackstone EH, Lytle BW. Folding valvuloplasty without leaflet resection: simplified method for mitral valve repair. Ann Thorac Surg 2006;82:46 -8.
4. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777-802.
3. Carpentier A. The sliding leaflet technique. Le Club Mitrale Newsletter 1988;1:5.
2. Carpentier A. Cardiac valve surgery--the “French correction”. J Thorac Cardiovasc Surg 1983;86:323-37.
1. Gillinov AM, Cosgrove DM, Blackstone EH, Diaz R, Arnold JH, Lytle BW, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg 1998;116:734-43.