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Clinical Implication of Transaortic Mitral Pannus Removal During Repeat Cardiac Surgery for Patients With Mechanical
Byungjoon Park1, Kiick Sung1, Pyo Won Park1
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Background:
This study aimed to evaluate the safety and feasibility of transaortic mitral pannus removal (TMPR).
Methods And Results:
Between 2004 and 2016, 34 patients (median age, 57 years; 30 women) with rheumatic disease underwent pannus removal on the ventricular side of a mechanical mitral valve through the aortic valve during reoperation. The median time interval from the previous surgery was 14 years. TMPR was performed after removal of the mechanical aortic valve (n=21) or diseased native aortic valve (n=11). TMPR was performed in 2 patients through a normal aortic valve. The mitral transprosthetic mean pressure gradient (TMPG) was ≥5 mmHg in 11 patients, including 3 with prosthetic valve malfunction. Prophylactic TMPR was performed in 23 patients. There were no early deaths. Concomitant operations included 22 tricuspid valve surgeries (13 replacements, 15 repairs) and 32 aortic valve replacements (24 repeats, 8 primary). The mean gradient in patients who had mitral TMPG ≥5 mmHg was significantly decreased from 6.46±1.1 to 4.37±1.17 mmHg at discharge (P<0.001). No mechanical valve malfunction was apparent on last echocardiography.
Conclusions:
TMPR is a safe and effective procedure for patients with malfunction or stenosis of a mechanical mitral valve and may be considered an alternative approach in patients with pannus overgrowth in such valves.
Insights
Transaortic mitral pannus removal (TMPR) is a safe and effective procedure for patients with mechanical mitral valve issues. This study shows TMPR successfully addresses pannus overgrowth, improving valve function.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Medical Device Technology
Background:
- Pannus overgrowth on mechanical mitral valves can cause stenosis or malfunction.
- Transaortic mitral pannus removal (TMPR) is a less common surgical approach.
- Rheumatic heart disease is a common indication for mitral valve surgery.
Purpose of the Study:
- To evaluate the safety and feasibility of transaortic mitral pannus removal (TMPR).
- To assess the efficacy of TMPR in improving mitral valve function.
Main Methods:
- Retrospective analysis of 34 patients undergoing TMPR between 2004 and 2016.
- TMPR performed via the aortic valve during reoperation for rheumatic heart disease.
- Concomitant procedures included tricuspid valve surgery and aortic valve replacement.
Main Results:
- No early deaths were reported in the study cohort.
- Significant reduction in mean mitral transprosthetic mean pressure gradient (TMPG) post-procedure (6.46±1.1 to 4.37±1.17 mmHg).
- No mechanical valve malfunction observed on follow-up echocardiography.
Conclusions:
- Transaortic mitral pannus removal (TMPR) is a safe and effective option for managing mechanical mitral valve pannus overgrowth.
- TMPR can be considered an alternative to other surgical strategies for specific patient populations.
- The procedure effectively resolves pannus-related stenosis and improves hemodynamic function.
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