Early- and Mid-term Results of Mitral Valve Repair for Multiple Segments Prolapse

Mikhail Nuzhdin ¹, Denis Loganenko ¹, Anton Baranov ¹, Artem Tsarkov ², Ilya Melnikov ¹, Pavel Vereshagin ¹, Yuriy Malinovskiy ¹, Garik Asatryan ¹

¹ Chelyabinsk Regional Clinical Hospital, Department of Cardiac Surgery, Chelyabinsk, Russia; ² Chelyabinsk Regional Clinical Hospital, Department of Anaesthesiology, Chelyabinsk, Russia;

Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: We present our results for surgical treatment of severe mitral insufficiency(MI) in patient with complex lesion.

Methods: From 2013 to 2017, 75 consecutive patients with severe MI underwent surgical repair. The mean age was 43,5±18,5 years. The quantification of MI was standardized by measuring regurgitant orifice area, regurgitant volume, coaptation height, dominant and supplementary jets and risk for SAM. The chord rupture with leaflet prolapse were in 44 cases, bi-leaflet prolapse (BLP) were in 24 cases, the BLP with leaflet tear or perforation – in 7 cases The cause of MI were degenerative disease, infective endocarditis. Barlow’s disease was in 15 cases.

Results: Cardiopulmonary bypass, myocardial protection and operative approach were standard in all patients. Intraoperative data suggested for more than two pathological segments and different surgical techniques were addressed to all segments. The segments associated with a dominant jet were repaired by means of resection technique in all cases. In addition to triangular or quadriangular resection, for leaflet reconstruction we used chords plication, leaflet height reduction, annular placation or sliding-plasty, leaflet reposition, free margin remodeling, patch repair. Any additional prolapse was corrected by free margin remodeling, simple neo-chords implantation or loop-technique in 60(80%). In cases of commissural prolapse we used plicating stitch 15(20%). For annular stabilization complete rigid or semi-rigid rings were used in all cases. There was no in-hospital or 30-day mortality. There was 1 case (1,3%) of deep sternal wound infection. All patients were discharged with only trivial MI. The 1- and 3-year freedom from reoperation was 100%, 1- and 3-year freedom from moderate MI was 100% and 98%.

Conclusion: In patients with complex MI acceptable results may be achieved by utilizing different surgical techniques provided it addressed to all pathological segments. Leaflet reconstruction accompanied by neo-chord repair is our procedure of choice.