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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Surgical mitral plasticity for chronic ischemic mitral regurgitation
Antonio M Calafiore1, Antonio Totaro1, Vincenzo De Amicis2
1Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy.
Journal of Cardiac Surgery
|March 4, 2020
Summary
Surgical mitral plasticity improved outcomes for chronic ischemic mitral regurgitation (IMR). This technique enhanced mitral valve function and reduced IMR recurrence, offering a promising approach for patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Interventional Cardiology
Background:
- Chronic ischemic mitral regurgitation (IMR) repair outcomes are often suboptimal due to recurrent mitral regurgitation (MR).
- The mitral valve (MV) exhibits adaptive plasticity in response to MR, but this process can be incomplete.
Purpose of the Study:
- To evaluate the midterm efficacy of "surgical mitral plasticity"—a technique augmenting the anterior leaflet and cutting second-order chords combined with restrictive annuloplasty—for IMR repair.
- To assess if this surgical strategy can improve upon the natural adaptive response of the MV.
Main Methods:
- A cohort of 22 patients with chronic IMR underwent surgical mitral plasticity between November 2017 and October 2019.
- Patients had a mean age of 73 years, mean ejection fraction of 32%, and moderate to severe IMR.
Main Results:
- No early deaths occurred; one late death at 6 months. Ejection fraction improved significantly (32% to 40%, P=.031).
- All patients achieved absent or mild IMR post-surgery, with no recurrence of moderate or severe MR.
- Significant improvements were observed in tenting area (2.5 to 0.5 cm²) and coaptation length (1.9 to 7.8 mm), with all patients in NYHA class I or II.
Conclusions:
- Surgical mitral plasticity demonstrates a strong rationale for improving MV adaptation and preventing IMR recurrence.
- This technique effectively addresses incomplete natural mitral valve adaptation, leading to favorable midterm clinical and echocardiographic results.
- Further validation with longer follow-up is necessary to confirm these promising midterm findings.
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