Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†
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Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†. / Pausch, Jonas; Harmel, Eva; Sinning, Christoph; Reichenspurner, Hermann; Girdauskas, Evaldas.
In: EUR J CARDIO-THORAC, Vol. 56, No. 5, 01.11.2019, p. 968-975.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†
AU - Pausch, Jonas
AU - Harmel, Eva
AU - Sinning, Christoph
AU - Reichenspurner, Hermann
AU - Girdauskas, Evaldas
N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - OBJECTIVES: Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures.METHODS: A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups.RESULTS: Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041).CONCLUSIONS: Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.
AB - OBJECTIVES: Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures.METHODS: A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups.RESULTS: Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041).CONCLUSIONS: Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.
KW - Adult
KW - Aged
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Minimally Invasive Surgical Procedures
KW - Mitral Valve/surgery
KW - Mitral Valve Annuloplasty/adverse effects
KW - Mitral Valve Insufficiency/surgery
KW - Prospective Studies
U2 - 10.1093/ejcts/ezz114
DO - 10.1093/ejcts/ezz114
M3 - SCORING: Journal article
C2 - 31005995
VL - 56
SP - 968
EP - 975
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 5
ER -
