Posterior mitral annuloplasty for enhancing mitral leaflet coaptation: using a strip designed for placement in the posterior annulus

作者：Kim Jong Hun; Kim Kyung Hwa; Choi Jong Bum^*; Kuh Ja Hong

来源：Journal of Cardiothoracic Surgery, 2015, 10(1): 164.

DOI：10.1186/s13019-015-0350-6

• Heart valve
• Mitral valve repair
• Surgery/techniques

Background: In patients with mitral valve regurgitation (MR), posterior mitral annuloplasty (PMA) was performed for mitral valve repair using a strip designed for placement in the posterior annulus, sparing the anterior annulus and anterior half of the commissures.
Methods: Between September 2009 and October 2013, we performed PMA using a novel strip in 74 consecutive patients with MR greater than 3+. Procedures associated with mitral valve repairs were performed in 41 patients (56.9 %), including new chord placement for leaflet prolapse (n=30), patch valvuloplasty for posterior chord rupture (n=4), and posterior leaflet augmentation (n=15). All patients were analyzed by serial echocardiographic follow-up, and preoperative and postoperative computed tomography was performed in 10 randomly selected patients.
Results: Hospital death occurred in two patients (2.7 %), and 72 survived patients were completely followed up. At a mean follow-up of 37.2 +/- 15.0 months, the MR grade was zero or 1+ in 64 patients (88.9 %), 2+ in 7 patients (9.7 %), and 3+ in one patient (1.4 %). The mean indexed valve area and mean valve gradient were 1.7 +/- 0.4 cm(2)/m(2) and 3.5 +/- 1.2 mmHg, respectively. The mean leaflet coaptation height in early systole was 12.8 +/- 3.5 mm. During the cardiac cycle, the repaired valves exhibited dynamic changes of 19.5 +/- 9.3 % in the septo-lateral dimensions. No early conversions to valve replacements or late reoperations occurred. None of the patients with remnant or recurrent MR experienced hemolysis.
Conclusions: PMA using a novel strip showed a sufficient coaptation height secondary to reduction of the septo-lateral annular dimensions and dynamic changes in the dimensions. It can be expected to be an alternative mitral annuloplasty technique with satisfactory results.

• 出版日期2015-11-13