Personalized Strategies of Mitral Valve Repair for Anterior Leaflet Prolapse in 67 Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHILi-qun , ZHANGJian-qun , KONGQing-yu , XIAOWei , LIANGLin , CHENXin-liang

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, P. R. China;

Corresponding author：

CHILi-qun, Email: chiliqun2002@qq.com

Keywords：

Mitral valve regurgitation; Mitral anterior leaflet prolapse; Mitral valve repair; Personalized strategy

DOI：

10.7507/1007-4848.20140217

Video：

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Objective To analyze short-and long-term results of mitral valve repair for the treatment for mitral anterior leaflet prolapse (ALP), and summarize our clinical experience. Methods Clinical data of 67 patients with mitral ALP who underwent mitral valve repair in Department of Cardiac Surgery of Beijing Anzhen Hospital from January 2002 to June 2013 were retrospectively analyzed. There were 41 male and 26 female patients with their age of 18-71 (46.34±7.68)years and body weight of 43-91 (65.30±18.60)kg. Preoperatively, there were 5 patients in New York Heart Association (NYHA)function class Ⅱ, 27 patients in class Ⅲ, and 35 patients in class Ⅳ. Surgical techniques included 'edge-to-edge' technique, artificial chordal replacement, chordal shortening and edge-to-edge chordal transformation. There were 46 patients with chordal rupture and 21 patients with chordal elongation. Mean mitral regurgitation (MR)area was 15.36±4.53 cm², and left ventricular ejection fraction (LVEF)was 29%-71%. Echocardiography was performed before discharge, 6 months and every 1 to 2 years after the operation for all the patients to observe short-and long-term results of mitral valve repair for the treatment for mitral ALP. Results There was no in-hospital death. One patient underwent mitral valve replacement because of anterior leaflet perforation 3 days after the operation. Another patient underwent a second mitral valve repair because of avulsion of mitral annulus and proteinuria 6 months after the first operation. None of the other patients received reoperation. All the 67 patients (100%)were followed up for 2-138 (65.6±17.3)months. During follow-up, there was not late death, and all the patients were in NYHA functional class I. Echocardiography showed that cross-sectional area of the mitral valve was 2.3-4.8 (3.63±0.79)cm². There was no significant MR, and mean MR area was 0.57±0.37 cm². Left atrium diameter (38.23±11.56 mm vs. 49.26±10.36 mm, P < 0.05)and left ventricular end-diastolic diameter (43.35±13.74 mm vs. 64.29±12.54 mm, P < 0.05)were significantly smaller than preoperative values. Conclusion Nearly all the patients with mitral ALP can receive personalized mitral valve repair with satisfactory surgical outcomes.

Citation： CHILi-qun, ZHANGJian-qun, KONGQing-yu, XIAOWei, LIANGLin, CHENXin-liang. Personalized Strategies of Mitral Valve Repair for Anterior Leaflet Prolapse in 67 Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 758-761. doi: 10.7507/1007-4848.20140217 Copy

1.	Lawrie GM, Earle EA, Earle NR. Feasibility and intermediate term outcome of repair of prolapsing anterior mitral leaflets with artificial chordal replacement in 152 patients. Ann Thorac Surg, 2006, 81(3):849-856.
2.	Sarano ME, Schaff HV, Orszulak TA, et al. Valve repair improves the outcome of surgery for mitral regurgitation. A multi-variant analysis. Circulation, 1995, 91(4):1022-1028.
3.	Stevens LM, Basmadjian AJ, Bouchard D, et al. Late echocardiographic and clinical outcomes after mitral valve repair for degenerative disease. J Card Surg, 2010, 25(1):9-15.
4.	Pfannmüller B, Seeburger J, Davierwala P, et al. Repair of the anterior mitral leaflet prolapse. Expert Rev Med Devices, 2014, 11(1):89-100.
5.	Castillo JG, Anyanwu AC, El-Eshmawi A, et al. All anterior and bileaflet mitral valve prolapses are repairable in the modern era of reconstructive surgery. Eur J Cardiothorac Surg, 2014, 45(1):139-145.
6.	David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair:a 25-year experience. J Thorac Cardiovasc Surg, 2013, 145(6):1563-1569.
7.	Castillo JG, Anyanwu AC, Fuster V, et al. A near 100% repair rate for mitral valve prolapse is achievable in a reference center:implications for future guidelines. J Thorac Cardiovasc Surg, 2012, 144(2):308-312.
8.	De Bonis M, Lapenna E, Alfieri O. Edge-to-edge Alfieri technique for mitral valve repair:which indications? Curr Opin Cardiol, 2013, 28(2):152-157.
9.	Miura T, Eishi K, Yamachika S, et al. Mitral valve repair for degenerative disease with leaflet prolapse:to improve long-term outcomes. Gen Thorac Cardiovasc Surg, 2009, 57(1):10-21.
10.	Calafiore AM, Scandura S, Iacò AL, et al. A simple method to obtain the correct length of the artificial chordae in complex chordal replacement. J Card Surg, 2008, 23(3):204-206.
11.	Mesana TG, Ibrahim M, Kulik A, et al. The "hybrid flip-over" technique for anterior leaflet prolapse repair. Ann Thorac Surg, 2007, 83(1):322-323.
12.	Gillinov AM, Banbury MK. Pre-measured artificial chordae for mitral valve repair. Ann Thorac Surg, 2007, 84(6):2127-2129.
13.	Fucci C, Cicco GD, Chiari E, et al. Edge-to-edge mitral valve repair for isolated prolapse of the anterior leaflet caused by degenerative disease. J Cardiovasc Med(Hagerstown), 2007, 8(5):354-358.
14.	孙海宁, 王巍, 宋云虎, 等.二尖瓣成形术治疗二尖瓣前叶脱垂的疗效分析.中国胸心血管外科临床杂志, 2010, 17(4):283-286.
15.	迟立群, 张健群, 孔晴宇, 等.改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析).中华胸心血管外科学杂志, 2009, 25(3):162-164.
16.	Zhang JQ, Chi LQ, Kong QY, et al. Edge-to-edge chordal transfer repair for anterior leaflet prolapse of mitral valve in 21 patients. Chin Med J, 2010, 123(17):2320-2323.
17.	李继勇, 张健群, 张富恩, 等.后叶腱索转移治疗二尖瓣前叶脱垂.中国胸心血管外科临床杂志, 2009, 16(3):170-173.
18.	Dillon J, Yakub MA, Nordin MN, et al. Leaflet extension in rheumatic mitral valve Reconstruction. Eur J Cardiothorac Surg, 2013, 44(4):682-689.
19.	Perier P, Hohenberger W, Lakew F, et al. Rate of repair in minimally invasive mitral valve surgery. Ann Cardiothorac Surg, 2013, 2(6):751-757.
20.	Seeburger J, Borger MA, Doll N, et al. Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg, 2009, 36(3):532-538.
21.	Rylski B, Beyersdorf F. Current concepts for minimally invasive mitral valve repair. Heart lung vessel, 2013, 5(4):207-212.
22.	Pfannmüller B, Seeburger J, Misfeld M, et al. Minimally invasive mitral valve repair for anterior leaflet prolapse. J Thorac Cardiovasc Surg, 2013, 146(1):109-113.
23.	Drake DH, Zimmerman KG, Hepner AM, et al. Echo-guided mitral repair. Circ Cardiovasc Imaging, 2014, 7(1):132-141.
24.	Biaggi P, Jedrzkiewicz S, Gruner C, et al. Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair. J Am Soc Echocardiogr, 2012, 25(7):758-765.25.
25.	Chen X, Sun D, Yang J, et al. Preoperative assessment of mitral valve prolapse and chordae rupture using real time three-dimensional transesophageal echocardiography. Echocardiography, 2011, 28(9):1003-1010.

1. Lawrie GM, Earle EA, Earle NR. Feasibility and intermediate term outcome of repair of prolapsing anterior mitral leaflets with artificial chordal replacement in 152 patients. Ann Thorac Surg, 2006, 81(3):849-856.
2. Sarano ME, Schaff HV, Orszulak TA, et al. Valve repair improves the outcome of surgery for mitral regurgitation. A multi-variant analysis. Circulation, 1995, 91(4):1022-1028.
3. Stevens LM, Basmadjian AJ, Bouchard D, et al. Late echocardiographic and clinical outcomes after mitral valve repair for degenerative disease. J Card Surg, 2010, 25(1):9-15.
4. Pfannmüller B, Seeburger J, Davierwala P, et al. Repair of the anterior mitral leaflet prolapse. Expert Rev Med Devices, 2014, 11(1):89-100.
5. Castillo JG, Anyanwu AC, El-Eshmawi A, et al. All anterior and bileaflet mitral valve prolapses are repairable in the modern era of reconstructive surgery. Eur J Cardiothorac Surg, 2014, 45(1):139-145.
6. David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair:a 25-year experience. J Thorac Cardiovasc Surg, 2013, 145(6):1563-1569.
7. Castillo JG, Anyanwu AC, Fuster V, et al. A near 100% repair rate for mitral valve prolapse is achievable in a reference center:implications for future guidelines. J Thorac Cardiovasc Surg, 2012, 144(2):308-312.
8. De Bonis M, Lapenna E, Alfieri O. Edge-to-edge Alfieri technique for mitral valve repair:which indications? Curr Opin Cardiol, 2013, 28(2):152-157.
9. Miura T, Eishi K, Yamachika S, et al. Mitral valve repair for degenerative disease with leaflet prolapse:to improve long-term outcomes. Gen Thorac Cardiovasc Surg, 2009, 57(1):10-21.
10. Calafiore AM, Scandura S, Iacò AL, et al. A simple method to obtain the correct length of the artificial chordae in complex chordal replacement. J Card Surg, 2008, 23(3):204-206.
11. Mesana TG, Ibrahim M, Kulik A, et al. The "hybrid flip-over" technique for anterior leaflet prolapse repair. Ann Thorac Surg, 2007, 83(1):322-323.
12. Gillinov AM, Banbury MK. Pre-measured artificial chordae for mitral valve repair. Ann Thorac Surg, 2007, 84(6):2127-2129.
13. Fucci C, Cicco GD, Chiari E, et al. Edge-to-edge mitral valve repair for isolated prolapse of the anterior leaflet caused by degenerative disease. J Cardiovasc Med(Hagerstown), 2007, 8(5):354-358.
14. 孙海宁, 王巍, 宋云虎, 等.二尖瓣成形术治疗二尖瓣前叶脱垂的疗效分析.中国胸心血管外科临床杂志, 2010, 17(4):283-286.
15. 迟立群, 张健群, 孔晴宇, 等.改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析).中华胸心血管外科学杂志, 2009, 25(3):162-164.
16. Zhang JQ, Chi LQ, Kong QY, et al. Edge-to-edge chordal transfer repair for anterior leaflet prolapse of mitral valve in 21 patients. Chin Med J, 2010, 123(17):2320-2323.
17. 李继勇, 张健群, 张富恩, 等.后叶腱索转移治疗二尖瓣前叶脱垂.中国胸心血管外科临床杂志, 2009, 16(3):170-173.
18. Dillon J, Yakub MA, Nordin MN, et al. Leaflet extension in rheumatic mitral valve Reconstruction. Eur J Cardiothorac Surg, 2013, 44(4):682-689.
19. Perier P, Hohenberger W, Lakew F, et al. Rate of repair in minimally invasive mitral valve surgery. Ann Cardiothorac Surg, 2013, 2(6):751-757.
20. Seeburger J, Borger MA, Doll N, et al. Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg, 2009, 36(3):532-538.
21. Rylski B, Beyersdorf F. Current concepts for minimally invasive mitral valve repair. Heart lung vessel, 2013, 5(4):207-212.
22. Pfannmüller B, Seeburger J, Misfeld M, et al. Minimally invasive mitral valve repair for anterior leaflet prolapse. J Thorac Cardiovasc Surg, 2013, 146(1):109-113.
23. Drake DH, Zimmerman KG, Hepner AM, et al. Echo-guided mitral repair. Circ Cardiovasc Imaging, 2014, 7(1):132-141.
24. Biaggi P, Jedrzkiewicz S, Gruner C, et al. Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair. J Am Soc Echocardiogr, 2012, 25(7):758-765.25.
25. Chen X, Sun D, Yang J, et al. Preoperative assessment of mitral valve prolapse and chordae rupture using real time three-dimensional transesophageal echocardiography. Echocardiography, 2011, 28(9):1003-1010.

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