Mitral valve replacement in ischemic mitral regurgitation. Preservation of both anterior and posterior mitral

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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
08:31

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair

Published on: October 16, 2021

A Morishita1, T Shimakura, M Nonoyama

  • 1Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama-shi, Hiroshima, Japan. atsumori@gol.com

The Journal of Cardiovascular Surgery
|March 12, 2002
PubMed
Abstract

Insights

Mitral valve replacement preserving leaflets, chordae, and papillary muscles shows potential for ischemic mitral regurgitation. This technique maintained cardiac function despite preoperative left ventricular dysfunction.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair and Replacement
  • Heart Failure Management

Background:

  • Ischemic mitral regurgitation (IMR) carries higher surgical risks compared to other forms.
  • Traditional mitral valve surgery may involve more extensive resection, potentially impacting left ventricular function.
  • Preservation of native mitral valve structures (leaflets, chordae tendineae, papillary muscles) is explored as a less invasive approach.

Purpose of the Study:

  • To retrospectively evaluate the long-term clinical outcomes and left ventricular (LV) performance after mitral valve replacement (MVR) in IMR patients.
  • To assess the efficacy of MVR using St. Jude Medical bileaflet prostheses with preservation of native mitral valve components.

Main Methods:

  • A cohort of 15 patients with IMR underwent mitral valve replacement between 1988 and 2000.
  • The surgical technique involved preserving both mitral valve leaflets, chordae tendineae, and papillary muscles.
  • Preoperative assessment included evaluation of NYHA functional class, cardiogenic shock, LV ejection fraction, and LV end-systolic volume index.

Main Results:

  • Hospital mortality was 33.3% (5/15), with 1 early and 1 late death during follow-up.
  • The 5-year actuarial survival rate was 60%.
  • Despite preoperative depressed LV function, the procedure demonstrated maintenance of cardiac function, evidenced by preserved LV dimensions and fractional shortening.

Conclusions:

  • Mitral valve replacement with preservation of leaflets, chordae tendineae, and papillary muscles may be a suitable option for IMR.
  • This approach appears to maintain or improve left ventricular performance even in severely compromised patients.
  • Further investigation into this technique for IMR is warranted.

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