Artificial chord reconstruction for mitral valve repair - PowerPoint Presentation

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Artificial chord reconstruction for mitral valve repairMid-term results of restoration strategy

Department of Cardiovascular Surgery, Nagasaki University HospitalIchiro Matsumaru, Takashi Miura, Shun Nakaji, Tessho Kitamura, Akihiko Tanigawa, Taku Inoue,Hiroko Taguchi, Junichiro Eishi, Kikuko Obase, Kiyoyuki Eishi

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

The Japanese Association for Thoracic Surgery

COI Disclosure

The author has no conflict of interest to disclose with respect to this presentation.

Presenting author: Ichiro Matsumaru

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

【 OBJECTIVE 】

The characteristics of degenerative mitral regurgitation is myxomatous change that occurs at rough zone.The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Auricularis(A), Spongiosa(S), Fibrosa(F),

Ventricularis

(V)

A

S

F

V

Normal cross section

Billowing mitral leaflet

Restoration method

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Leaflet volume reduction by triangular resection in rough zone

Realignment of coaptation line by PTFE neo-chordoplasty

【 METHODS 】

275 pts MV repair with PTFE neochordoplastyMean follow-up was 42 months. The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Patients

Etiology of valve

Prolapse site

Patient characteristics (n = 275)

Age (year, range)

64 ±15 (14-92）

Female

112 (40.7%)

Preoperative CHF(NYHA

Ⅲ

-Ⅳ)123 (44.7%)Hypertension122 (44.4%)

Atrial fibrillation93 (35.6%)Chronic renal failure52 (18.9%)

Diabetes mellitus

40 (14.5%)

Previous cardiac surgery

20 (7.2%)

Coronary artery disease

16 (5.8%)

Previous stroke

13 (4.7%)

LVEF

66 ± 11

(%)

4+ MR

197 (71.6%)

Japan Score (30-d mortality, %)

8.0 ± 10.3

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Prolapsed-segment numberChordal conditions

Mean: 1.4 ± 0.7

N = 275

Total ring

134 (49%)

Partial ring

139 (51%)

Ring size (mm, IQR)

30 (26-34)

Right mini-thoracotomy approach

152 (55.5%)Tricuspid repair

64 (23.3%)

Maze procedure

67 (24.5%)

CABG

17 (6.2%)

Aortic valve surgery

14 (5.1%)

CPB time (min, IQR)

162 (129-197)

Cross-clamp time (min, IQR)

95 (78-122)

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

【 RESULTS 】

:

Operative details

Reconstructive techniques

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Chordal reconstruction numbers

Resection & suture numbers

Mean: 1.1 ± 0.4

Mean: 0.9 ± 0.7

【 Operative outcome 】

Overall (n = 275)

Length of ICU stay (IQR, days)

1 (1-2)

No major complications

245 (89.1%)

In-hospital days

3 (1.1%)The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

【 Survival curve

】The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Overall

PML

AML

BML

According to leaflet prolapse

P = 0.1826

97.3 ± 1.0% @ 1yr90.9 ± 2.2% @ 4

yr

Patient at risk

84.0 

±

 3.4% @ 7yr

275

225

173

143

109

83

61

34

AML

110

95

78

66

51

37

27

15

PML

94

69

48

37

31

22

13

7

BML

71

62

47

40

28

25

21

15

Patient at risk

【

Freedom from re-operation 】The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

12

24

36

48

6072

84275216166139103

77

58

31

97.7

±

1.0% @ 1

yr

95.2

±

1.7% @ 7

yr

Overall

According to leaflet prolapse

PML

BML

AML

P = 0.0412

AML

110

89

74

64

48

34

24

12

PML

94

67

47

37

31

22

13

7

BML

71

61

45

38

27

23

21

15

Patient at risk

Patient at risk

【 Freedom from ≧

moderate MR 】The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Overall

98.5 ± 0.8% @ 1

yr

95.1 ± 1.6% @ 5

yr

12243648

60

72

84

275

209

151

119

86

61

43

22

AML

PML

BML

94.9 ± 2.3%

97.9 ± 2.1%

91.7 ± 4.0%

P = 0.8699

AML

110

86

67

54

41

26

20

9

PML

94

67

45

32

25

19

8

5

BML

71

57

39

33

22

18

17

11

According to leaflet prolapse

Patient at risk

Re-operation in early phase

Case

Age

Sex

Primary

Etilogy

Lesions

Cause of redo　Cause of re-do

1

45

M

FED

AML

MR

Ineffectiveness of neo-chordae (AML)

Ring detachment

2

81

M

FED

AML

MR

Ineffectiveness of neo-chordae (AML)

3

75

M

FED

AML

IE

NA

4

77

M

AIE

BML

MR, Hemolysis

Ring detachment

5

47

M

AIE

AML

Hemolysis

NA

6

72

M

FED

AML

MR, Hemolysis

Ineffectiveness of neo-chordae (AML)

7

69

M

FED

AML

Hemolysis

Ineffectiveness of neo-chordae (AML)

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Risk evaluation for re-do

Demographics

Redo - , n = 264

Redo +, n = 11

P-value

Female

111 (42.1%)

1 (9.1%)

0.0308*IE19 (7.2%)4 (36.4%)0.0084*

Including AML lesion

170 (64.4%)

11 (100%)

0.0182*

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery

Risk evaluation for MR recurrence

MR -, n = 262

MR +

, n = 13

P-value

Partial ring for AML lesion

36 (13.7%)

3 (23.1%)

<.0001*

【 CONCLUSION 】

The Restoration method using appropriate neo-chords depending on the volume and range of the prolapse leaflets was able to apply to all degenerative MV disease and to be feasible with good mid-term durability.The U-shaped fixation of the artificial chordae tendineae to the papillary muscle was sufficient, and it was easy to apply to the right mini-thoracotomy approach due to its simplified procedure.

The 73rd Annual Scientific Meetings of the Japanese Association for Thoracic Surgery