Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspective
Objective: In the current study, we present our mid-term experience with modified edge-to-edge repair technique through a transventricular and transaortic route in patients requiring left ventricular remodeling or aortic root/valve surgery. Methods: From December 2006 through April 2015, 49 high-ris...
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Elsevier
2022-04-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722000323 |
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| author | Nestoras Papadopoulos, MD, PhD Omer Dzemali, MD, PhD Luisa Bott, MD Vasileios Ntinopoulos, MD Aleksandra Miskovic, MD Anton Moritz, MD, PhD |
| author_facet | Nestoras Papadopoulos, MD, PhD Omer Dzemali, MD, PhD Luisa Bott, MD Vasileios Ntinopoulos, MD Aleksandra Miskovic, MD Anton Moritz, MD, PhD |
| author_sort | Nestoras Papadopoulos, MD, PhD |
| collection | DOAJ |
| description | Objective: In the current study, we present our mid-term experience with modified edge-to-edge repair technique through a transventricular and transaortic route in patients requiring left ventricular remodeling or aortic root/valve surgery. Methods: From December 2006 through April 2015, 49 high-risk patients (median age: 69 years; median European System for Cardiac Operative Risk Evaluation II: 11.4 [6.54-14.9]) underwent transventricular (N = 7; 14%) or transaortic (N = 42; 86%) edge-to-edge mitral valve repair. The Alfieri stitch technique was modified by MitraClip type overcorrection and solid buttressing behind the posterior leaflet. Indication was grade 2+ functional mitral valve incompetence and dilated or impaired left ventricle (N = 25; 52%), or grade 3+ (N = 22; 45%) and grade 4+ functional mitral valve regurgitation (N = 2; 4%). Surgical procedure included aortic root surgery in 65%, aortic valve replacement with surgical revascularization in 18%, and Dor-plasty with surgical revascularization in 14%. Results: Intraoperative mortality and early neurologic complications were absent in our series. Ninety-day mortality was 12.2% (N = 6). Median clinical and echocardiographic follow-up-time was 50.7 (21.5-44.1) and 39.2 (33.7-44.1) months, respectively. Median postoperative transvalvular gradient was low (2.72 [1.91-4.22] mm Hg) and did not increase during follow-up (P = .268), although peak gradient rose slightly from 7.41 to 8.12 mm Hg (P = .071). The actuarial reoperation free rate at the index valve was 96.8%. Conclusions: Transventricular or transaortic Alfieri mitral repair mimicking mitral clip overcorrection represents a quick and safe technique in the setting of high-risk patients undergoing left ventricular remodeling or aortic root/valve surgery and can be performed with low risk of creating mitral stenosis at midterm. The technique is straightforward, with reliable identification of the center of the valve leaflets being the limitation. |
| format | Article |
| id | doaj-art-b57f1002bc274c6b8eacb717d5fecc2c |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2022-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-b57f1002bc274c6b8eacb717d5fecc2c2025-08-20T03:36:37ZengElsevierJTCVS Techniques2666-25072022-04-0112395110.1016/j.xjtc.2022.01.005Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspectiveNestoras Papadopoulos, MD, PhD0Omer Dzemali, MD, PhD1Luisa Bott, MD2Vasileios Ntinopoulos, MD3Aleksandra Miskovic, MD4Anton Moritz, MD, PhD5Department of Cardiac Surgery, Triemli Hospital, Zurich, Switzerland; Address for reprints: Nestoras Papadopoulos, MD, PhD, Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zurich, Switzerland.Department of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Thoracic and Cardiovascular Surgery, Goethe University Frankfurt/Main, GermanyDepartment of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Thoracic and Cardiovascular Surgery, Goethe University Frankfurt/Main, GermanyDepartment of Thoracic and Cardiovascular Surgery, Kepler University Hospital, Linz, AustriaObjective: In the current study, we present our mid-term experience with modified edge-to-edge repair technique through a transventricular and transaortic route in patients requiring left ventricular remodeling or aortic root/valve surgery. Methods: From December 2006 through April 2015, 49 high-risk patients (median age: 69 years; median European System for Cardiac Operative Risk Evaluation II: 11.4 [6.54-14.9]) underwent transventricular (N = 7; 14%) or transaortic (N = 42; 86%) edge-to-edge mitral valve repair. The Alfieri stitch technique was modified by MitraClip type overcorrection and solid buttressing behind the posterior leaflet. Indication was grade 2+ functional mitral valve incompetence and dilated or impaired left ventricle (N = 25; 52%), or grade 3+ (N = 22; 45%) and grade 4+ functional mitral valve regurgitation (N = 2; 4%). Surgical procedure included aortic root surgery in 65%, aortic valve replacement with surgical revascularization in 18%, and Dor-plasty with surgical revascularization in 14%. Results: Intraoperative mortality and early neurologic complications were absent in our series. Ninety-day mortality was 12.2% (N = 6). Median clinical and echocardiographic follow-up-time was 50.7 (21.5-44.1) and 39.2 (33.7-44.1) months, respectively. Median postoperative transvalvular gradient was low (2.72 [1.91-4.22] mm Hg) and did not increase during follow-up (P = .268), although peak gradient rose slightly from 7.41 to 8.12 mm Hg (P = .071). The actuarial reoperation free rate at the index valve was 96.8%. Conclusions: Transventricular or transaortic Alfieri mitral repair mimicking mitral clip overcorrection represents a quick and safe technique in the setting of high-risk patients undergoing left ventricular remodeling or aortic root/valve surgery and can be performed with low risk of creating mitral stenosis at midterm. The technique is straightforward, with reliable identification of the center of the valve leaflets being the limitation.http://www.sciencedirect.com/science/article/pii/S2666250722000323transaortic mitral valve repairtransventricular mitral valve repairedge-to-edge repairfunctional mitral valve regurgitation |
| spellingShingle | Nestoras Papadopoulos, MD, PhD Omer Dzemali, MD, PhD Luisa Bott, MD Vasileios Ntinopoulos, MD Aleksandra Miskovic, MD Anton Moritz, MD, PhD Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspective JTCVS Techniques transaortic mitral valve repair transventricular mitral valve repair edge-to-edge repair functional mitral valve regurgitation |
| title | Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspective |
| title_full | Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspective |
| title_fullStr | Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspective |
| title_full_unstemmed | Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspective |
| title_short | Modified transventricular and transaortic mitral valve edge-to-edge repair mimicking MitraClip overcorrectionCentral MessagePerspective |
| title_sort | modified transventricular and transaortic mitral valve edge to edge repair mimicking mitraclip overcorrectioncentral messageperspective |
| topic | transaortic mitral valve repair transventricular mitral valve repair edge-to-edge repair functional mitral valve regurgitation |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722000323 |
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