Objective To evaluate the outcomes and summarize the clinical experience of totally endoscopic mitral valve repair with artificial chordae implantation. Methods From May 2013 to June 2016, 71 patients with mitral valve insufficiency were admitted to our hospital who underwent totally endoscopic mitral valve repair with artificial chordae implantation. There were 47 males and 24 females with the age of 46.0±14.4 years ranging from 13-78 years. The pathogenesis included degenerative valvular diseases in 63 patients, congenital valvular diseases in 4, infectious endocarditis in 2, rheumatic disease in 1 and cardiomyopathy in 1. Prolapse of anterior, posterior, or both leaflets was present in 26 (36.6%), 19 (26.8%), and 25 (35.2%) patients, respectively; one patient (1.4%) presented valve annulus enlargement and thirteen were associated with commissure lesion. The mitral regurgitation area ranged from 4.2 to 26.3 cm2 (mean, 12.2±5.6 cm2). All the procedures were performed by total endoscopy under cardiac arrest. 5-0 Gore-tex sutures were used as the material of artificial chordae which was implanted one by one. Results There was no in-hospital death. One patient was transferred to mitral valve replacement, and one median sternotomy due to bleeding. The mean cardiopulmonary bypass time was 156.0±31.6 min and aortic cross-clamp time 110.0±20.1 min. We finally had 39 isolated mitral valve repair, 28 mitral valve repair combined tricuspid valve repair, 3 mitral valve repair combined atrial septal defect closure, and 1 mitral valve repair combined correction of partial anomalous pulmonary vein connection. Each patient was implanted artificial chordae of 2.5±1.7 (ranging from 1 to 7), and 65 patients received mitral annulus (full ring). The intraoperative transoesophageal echocardiography found no mitral regurgitation in 44 patients, the area of mitral regurgitation was 0-2 cm2 in 24, and 3 patients with mitral regurgitation>2 cm2 experienced serious systolic anterior motion. Of the 3 patients with systolic anterior motion (SAM), one transferred to mitral valve replacement, one underwent mitral re-repair, and one took conservative treatment. The mean follow-up was 12.7±10.5 months (range: 1 to 36 months), while 2 patients were lost to follow up with the follow-up rate of 97.2%. Recurrent severe regurgitation occured in 3 patients, moderate in 5, mild or trivial in 27 and no regurgitation in 36. During the follow-up, 1 patient died of myocardiopathy-induced heart failure post discharge, 1 suffered from cerebral infarction, and no patient underwent reoperation. Conclusion The totally endoscopic surgical treatment of mitral valvuloplasty with artificial chordae is reliable for patients with mitral valve prolapse, which provides favorable clinical efficacy and outcomes. The difficulty lies in how to determine the appropriate length of the chordae and keep the stability of length.
Mitral valvuloplasty is a more suitable surgical procedure than mitral valve replacement in the case of mitral valve degeneration. Quadrangular resection and artificial chordae plantation, considered to be classical procedures, are widely employed in posterior mitral valve prolapse, and have prominent long-term effects during the follow-up. However, is there any difference in mitral valve reconstruction due to completely different surgical methodology and concepts of the two procedures? Every surgeon has his own ideas and preferences for mitral valvuloplasty, and the choice of surgical procedures mostly depends on experience of surgeons. The article generally reviews variances in intraoperative and long-term clinical outcomes of both rectangular excision and artificial chordae plantation in posterior leaflet valvuloplasty, hoping to provide references for clinical decision.
ObjectiveTo evaluate outcomes of mitral valvuloplasty with artificial chord and mitral annuloplasty ring in patients with mitral valve prolapse. MethodsFrom January 2012 to March 2014, mitral valvuloplasty with artificial chord and mitral annuloplasty ring were performed for 58 patients with mitral valve prolapsed in Department of Cardiovascular Surgery, Fujian Provincial Hospital, among which 47 simple anterior or posterior mitral valvuloplasty and 11 combined anterior-posterior mitral valvuloplasty were completed. There were 33 males and 25 females aged (53.7±14.3) years. ResultsThere was no in-hospital death. Three patients received mitral valve replacement. The transoesophageal echocardiography found no or trivial mitral regurgitation in 48 patients, mild mitral regurgitation in 7 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were significantly decreased after the operation. During the follow-up of 6 months to 2 years, the cardiac function of the patients improved. ConclusionMitral valvuloplasty with artificial chord and mitral annuloplasty ring is simple, reliable and effective treatment for patients with mitral valve prolapse, and its shortand mid-term outcome is good.
ObjectiveTo summarize our clinical experience and improve clinical outcomes of chordal transfer and artificial chordae in mitral valvuloplasty (MVP). MethodsClinical data of 74 patients who received chordal transfer or artificial chordae in MVP for the treatment of anterior mitral leaflet prolapse[degenerative mitral regurgitation (MR)] from January 2008 to February 2013 were retrospectively analyzed. There were 34 male and 40 female patients with their age of 22-64 (48.00±6.40)years. According to different surgical techniques, all the 74 patients were divided into 2 groups. In the chordal transfer group, there were 42 patients who received chordal transfer with posterior leaflet chordae transferred to anterior leaflet. In the artificial chordae group, there were 32 patients who received artificial chordae with loop technique. Postoperative mortality, morbidity and MR were analyzed. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)and end-systolic diameter (LVESD)were examined by echocardiography during follow-up. ResultsThere was no perioperative death in either group. Two patients underwent reexploration for postoperative bleeding. Nine patients had paroxysmal atrial fibrillation postoperatively, and were cured by intravenous administration of amiodarone. Echocardiography before discharge showed mild MR in 5 patients, trivial MR in 12 patients, and none MR in 25 patients in the chordal transfer group, and mild MR in 6 patients, trivial MR in 15 patients and none MR in 11 patients in the artificial chordae group. Seventy patients[94.59%(70/74)] were followed up after discharge. In both groups, LVEF at 6 months after MVP was significantly higher than that before discharge (chordal transfer group:64.00%±4.20% vs. 55.00%±5.10%; artificial chordae group:63.00%±3.50% vs. 56.00%±4.20%). LVEDD (chordal transfer group:47.00±2.20 mm vs. 58.00±6.90 mm; artificial chordae group:45.00±3.80 mm vs. 57.00±5.10 mm, P < 0.05)and LVESD at 6 months after MVP were significantly smaller than preoperative values. There was no statistical difference in LVEF, LVEDD or LVESD preop-eratively, before discharge and 6 months after MVP respectively between the chordal transfer group and artificial chordae group (P > 0.05). One patient in the chordal transfer group underwent mitral valve replacement for severe MR 14 months after MVP. One patient in the artificial choadae group underwent mitral valve replacement for persistent hemoglobinuria 6 months after MVP. ConclusionChordal transfer and artificial chordae technique are both suitable for the treatment of complex anterior leaflet prolapse. Artificial chordae has wider range of application, and chordae transfer needs advanced and flexible surgical skills. Both techniques have good short-term clinical outcomes and deserve clinical application.
ObjectiveTo explore the result of of modified artificial chordae technique and annuloplasty in mitral valvuloplasty for mitral leaflet prolapse. MethodsWe retrospectively analyzed the clinical data of 112 patients underwent mitral valve repair with artificial chordae (expanded polytetrafluoroethylene, ePTFE) and annuloplasty in our hospital from January 2006 through June 2014.There were 69 males and 43 females at age of 5-73 (51.4±14.4) years.The double-armed ePTFE chordae was fixed at papillary muscle head using U shaped suture without pledget and passed through the prolapsing portion of leaflet twice.Then, annuloplasty was performed and correct chordal length was adjusted.After that, the chordae was passed through prolapsing scallop one more time and tied. ResultsAverage of 2.4±0.7 (range from 1 to 3) ePTFE artificial chordaes were implanted in each patient.Intra-operative transthoracic echocardiography showed no mitral regurgitation (MR) in 78 patients and tricuspid regurgitation in 34 patients.At discharge, no MR was in 72 patients, trivial MR in 39 patients, and mild MR in 1 patient.At end of follow-up of 41.5±24.8 months, moderate MR was in 3 patients.The freedom from moderate or severe regurgitation at 5 years after mitral valve repair was 95.1%±3.0%. ConclusionThis modified artificial chordae technique and annuloplasty are safe, simple, and effective in mitral valvuloplasty for mitral leaflet prolapsed.And the early and long-term results are satisfactory.
ObjectiveTo research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. MethodsTwelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). ConclusionIn off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.
ObjectiveTo summarize our clinical experience of artificial chordal replacement with loop technique for the treatment of mitral insufficiency (MI) due to mitral valve prolapse. MethodsFrom January 2008 to August 2011, pre-measured expanded polytetrafluoroethylene (ePTFE) loops were used for the treatment of MI in 22 patients in the Department of Cardiac Surgery,Beijing Anzhen Hospital. There were 15 males and 7 females with their age of 26-69(53.1±8.5) years. Six patients were in NYHA class Ⅱ and 16 patients were in NYHA class Ⅲ. There were 14 patients with anterior mitral leaflet chordal rupture,2 patients with anterior mitral leaflet chordal elongation,4 patients with both anterior and posterior mitral leaflet chordal rupture,and 2 patients with posterior mitral leaflet chordal rupture. All the patients had severe MI. One patient had concomitant cor triatriatum,and another patient had coronary heart disease. Left ventricular end-diastolic diameter (LVEDD) was 49-67 (58.1±3.9) mm,ejection fraction (EF) was 58%-69% (61.8±2.1%) and cardiothoracic ratio was 0.53±0.16. We measured the length of normal chordae adjacent to the ruptured or elongated chordae with a caliper for reference,and constructed the artificial chordal loops on the caliper with ePTFE suture according to the scope of mitral valve prolapse,then fixed the loops to the corresponding papillary muscles and free edge of the prolapsed mitral leaflets. Ring annuloplasty was routinely performed for all the patients. One patient received concomitant repair for cor triatriatum, and another patients underwent concomitant coronary artery bypass grafting. All the patients received oral anticoagulation with warfarin for 3 months after discharge. ResultsThere was no in-hospital death. Postoperatively,1 patient had hemoglobinuria and another patient had wound infection,both of whom were cured after treatment. Pre-discharge echocardiography showed mild or no MI in 1 patients and trivial MI in 21 patients. Postoperative LVEDD was 43-53 (48.1±2.1) mm and significantly smaller than preoperative LVEDD. All the patients were follow up for 4-39 (18.3±5.2) months after discharge. During follow-up,there were 5 patients with mild MI and 17 patients with none or trivial MI. Seventeen patients were in NYHA class Ⅰ,5 patients were in NYHA class Ⅱ,and their heart function was significantly improved than preoperative heart function. ConclusionArtificial chordal replacement with loop technique is easy to perform with satisfactory short-to mid-term results for the treatment of MI due to mitral valve prolapse.
Objective To evaluate the mid-long term results of application research of artificial Gore-Tex chordate in mitral valvuloplasty in patients with mitral insufficiency caused by endocarditis. Methods We retrospectively analyzed the clinical data of 28 consecutive infective endocarditis(IE) patients who received mitral valve repair with Gore-Tex in our hospital between January 2012 and December 2015. There were 17 males and 11 females. The age of these patients ranged from 18 to 69 (52.0±15.4) years. Echocardiography before operation showed the degree of mitral regurgitation (MR) was severe in 19 patients, moderate in 9 patients. Six patients were in New York Heart Association (NYHA) class Ⅱ, 14 in class Ⅲ, 8 in class Ⅳ. There were 26 selective surgeries and 2 emergent surgeries. One patient had concomitant coronary artery bypass graft. Six patients had aortic valve replacement. Five patients had aortic valve repair. Twenty patients had tricuspid valve repair. Five patients had Maze procedure. Results Follow-up was done to all the patients for 6 months to 55 (30.5±6.4) months. During the follow-up, the echocardiography showed that postoperative left atrium diameter (36.64±8.50 mm vs. 51.78±17.50 mm, P<0.05) and left ventricular end-diastolic dimension (49.30±5.05 mmvs. 57.70±7.49 mm, P<0.05) were significantly smaller than those before operation. The left ventricular ejection fraction (EF) increased from 53.86%±8.16% to 59.14%±4.23% (P<0.05). No MR was found in 16 patients, mild MR in 8 patients, mild to moderate MR in 2 patients, moderate MR in 1 patient. One patient required reoperation for recurrent infection. No death or complications related to thrombosis and embolism occurred after operation. Conclusion Application research of artificial Gore-Tex chordate in mitral valve repair is feasible for treating mitral valve lesions caused by endocarditis, and may provide a long-term outcome to the patients.
Artificial chord is a mature mitral valve repair technique, especially in adult mitral valve repair. It is still challenging to repair mitral valve in children with artificial chords because the quality of mitral valve is soft and immature. There are some differences in the methods of suture, the choice of suture size and the number of artificial chords. Although the artificial chords could not grow naturally, we found through the long-term research that most children did not have mitral valve restriction or even chords rupture due to itself can compensate through the growth of the flap and papillary muscle. This article summarizes the recent research progress on the treatment of mitral valve insufficiency in children with artificial chords, providing reference for clinical treatment.