Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation Gerald M.

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Presentation transcript:

Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation Gerald M. Lawrie, MD, Elizabeth A. Earle, JD, Nan Earle, MS The Journal of Thoracic and Cardiovascular Surgery Volume 141, Issue 2, Pages 368-376 (February 2011) DOI: 10.1016/j.jtcvs.2010.02.044 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Surgical technique of the “American Correction.” A, Polytetraflluoroethylene chordae are placed in the base of the papillary muscle. B, Chordae are placed in the free edge of the leaflet. C, The ventricle is inflated. The posterior annulus is pulled forward and the zone of apposition forms. The annuloplasty ring is chosen to match the annular circumference at this point. D, The ring is secured with a continuous suture of 2-0 polypropylene. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 368-376DOI: (10.1016/j.jtcvs.2010.02.044) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Left, Results of Kaplan–Meier analysis of freedom from reoperation up to 10 years after the initial operation, according to the leaflet repaired. Right, Results of Kaplan–Meier analysis of freedom from moderately severe or severe mitral regurgitation 10 years after the mitral operation. The number of patients at risk for each interval is shown in the tables on the figures. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 368-376DOI: (10.1016/j.jtcvs.2010.02.044) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Comparison of severity of mitral regurgitation assessed by echocardiography preoperatively, before discharge, and at late follow-up. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 368-376DOI: (10.1016/j.jtcvs.2010.02.044) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Systolic still frames from a study of a normal patient by transesophageal echocardiography. As the annular and left ventricular dimensions diminish progressively during systole, there is notable increase in the extent of mitral leaflet apposition. The annulus also moves toward the apex. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 368-376DOI: (10.1016/j.jtcvs.2010.02.044) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, Initial appearance of a severely myxomatous valve with bileaflet involvement and annular dilatation. B, Inflation of the left ventricle without annular support causes increasing leaflet prolapse and annular dilatation. C, Leaflet edges are aligned. Dots are placed to mark upper edge of zone of apposition. D, When the posterior annulus is advanced with the left ventricle inflated, the leaflets develop the zone of apposition defined by the dots and descend into the left ventricle. E, The posterior annulus is pulled forward until the dots on each leaflet are aligned. F, This position is maintained and the sizer that matches this dimension is chosen. G, After the ring is attached, inflation causes the leaflets to flatten and enter the ventricle. H, With inflation continued to 80 to 100 mm and the aortic root also inflated, the leaflets slope downward and the saddle shape of the anterior leaflet and annulus is developed. The Journal of Thoracic and Cardiovascular Surgery 2011 141, 368-376DOI: (10.1016/j.jtcvs.2010.02.044) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions