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Mitral valve repair with a malleable bovine pericardium ring
M A Volpe1, D M Braile, R W Vieira
1Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP, Brazil.
Objective:
To describe a surgical procedure utilizing a malleable bovine pericardium ring in mitral valve repair and clinical and Doppler echocardiographic results.
Methods:
Thirty-two (25 female and 7 male) patients, aged between 9 and 66 (M=36.4+/-17.2) years, were studied over a 16-month period, with 100% follow-up. In 23 (72%) of the patients, the mitral approach was the only one applied; 9 patients underwent associated operations. The technique applied consisted of measuring the perimeter of the anterior leaflet and implanting, according to this measurement, a flexible bovine pericardium prosthesis for reinforcement and conformation of the posterior mitral annulus, reducing it to the perimeter of the anterior leaflet with adjustment of the valve apparatus.
Results:
The patient survival ratio was 93.8%, with 2 (6.2%) fatal outcomes, one from unknown causes, the other due to left ventricular failure. Only one reoperation was performed. On Doppler echocardiography, 88% of the patients had functional recovery of the mitral valve (50% without and 38% with mild insufficiency and no hemodynamic repercussions). Of four (12%) of the remaining patients, 6% had moderate and 6% had accented insufficiency. Twenty-eight percent of class II patients and 72% of class III patients passed into classes I (65%), II (32%), and III (3%), according to NYHA classification criteria.
Conclusion:
Being flexible, the bovine pericardium ring fit perfectly into the valve annulus, taking into account its geometry and contractility. Valve repair was shown to be reproducible, demonstrating significant advantages during patient evolution, which did not require anticoagulation measures.
Insights
Malleable bovine pericardium rings offer a reproducible technique for mitral valve repair, showing excellent functional recovery and improved patient outcomes without requiring anticoagulation.
Area of Science:
- Cardiovascular Surgery
- Biomaterials in Medicine
- Cardiac Valve Repair
Background:
- Mitral valve insufficiency is a common cardiac condition requiring surgical intervention.
- Traditional mitral valve repair techniques can be complex and may require lifelong anticoagulation.
- The development of novel biomaterials aims to improve surgical outcomes and patient quality of life.
Purpose of the Study:
- To evaluate the efficacy and clinical outcomes of a novel surgical procedure for mitral valve repair using a malleable bovine pericardium ring.
- To assess the functional recovery of the mitral valve using Doppler echocardiography post-repair.
- To determine the long-term survival rates and need for reoperation in patients undergoing this procedure.
Main Methods:
- A cohort of 32 patients (9-66 years) underwent mitral valve repair using a flexible bovine pericardium prosthesis to reshape the posterior mitral annulus.
- The prosthesis size was determined by the anterior leaflet perimeter, ensuring precise adjustment of the valve apparatus.
- Follow-up included clinical assessment, echocardiography, and NYHA functional classification.
Main Results:
- A high survival rate of 93.8% was observed, with only two fatal outcomes.
- Doppler echocardiography revealed functional recovery in 88% of patients, with 50% having no insufficiency and 38% with mild, hemodynamically insignificant insufficiency.
- Significant improvement in NYHA functional class was noted, with 65% of previously class II/III patients improving to class I.
Conclusions:
- The flexible bovine pericardium ring conforms well to the mitral annulus geometry and contractility, facilitating reproducible valve repair.
- This technique demonstrates significant advantages in patient recovery, notably eliminating the need for anticoagulation therapy.
- The procedure shows promising results for mitral valve repair, improving functional status and long-term prognosis.