Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumat...Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.展开更多
AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic seve...AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P < 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level > 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.展开更多
Objective To analyze whether association of edge to edge valve repair with artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR) . Methods From April,2001 to ...Objective To analyze whether association of edge to edge valve repair with artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR) . Methods From April,2001 to May, 2010,41 patients underwent tricuspid valve repair to treat severe TR were studied. Twenty-one patients were done artificial ring annuloplasty alone (group R) and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair (group E) . All the展开更多
Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair,and evaluate the value of real-time three-di-mensional transesophageal echocardiography in the pe...Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair,and evaluate the value of real-time three-di-mensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation展开更多
Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for dege...Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation （MR）. However, there has been limited infomlation regarding tile echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. Methods： A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients （79.8%）, artificial chordae in 20 （23.8%）, and ring annuloplasty in 79 （94.1%）. Eighty-one （96.4%） of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. Results： At a median echocardiographic follow-up of 36.0 months （interquartile range 14.3-59.4 months）, lbur patients （4.9%） developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, leli atrial diameter （LAD）, left ventricular end-diastolic diameter （LVEDD）, and let1 ventricular ejection fraction （LVEF） were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 （Z- -8.456, P 〈 0.001 ）, LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm （I - 15.131, P 〈 0.001 ）, LVEDD fiom 51.0 ± 5.0 to 43.3 ± 2.2 mm （t = 14.481, P 〈 0.001 ）, and LV EF l＇rom 67.3 ± 7.0% to 63.9 ± 5.1% （t = 4.585, P 〈 0.001 ）. Conclusion： Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.展开更多
Congenital aortic stenosis(cAS)frequently requires intervention during the neonatal or infantile period.However,surgical repair is challenging because of the narrow surgical space.We performed bicuspidization using th...Congenital aortic stenosis(cAS)frequently requires intervention during the neonatal or infantile period.However,surgical repair is challenging because of the narrow surgical space.We performed bicuspidization using the open-sleeve technique for cAS with a unicuspid aortic valve in two patients.Postoperatively,the patients were doing well without reintervention for the aortic valve for 8 and 6 years,respectively.Their aortic annular diameter increased along with somatic growth.Bicuspidization for neonates or infancy can be performed safely using the open-sleeve technique as its midterm results have been satisfactory.展开更多
Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitr...Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.展开更多
Objectives:The aim of this multicenter,prospective,single-arm pilot study(ClinicalTrials.gov number:NCT05040074)was to observe the procedural and 30-day results of the novel transcatheter mitral valve repair system,SQ...Objectives:The aim of this multicenter,prospective,single-arm pilot study(ClinicalTrials.gov number:NCT05040074)was to observe the procedural and 30-day results of the novel transcatheter mitral valve repair system,SQ-Kyrin■-M Clip(Shenqi Medical,Shanghai,China),in patients with severe mitral regurgitation(MR).Methods:The heart team considered patients from 5 centers in China with clinically significant functional mitral regurgitation≥3+despite optimal medical therapy or degenerative mitral regurgitation≥3+with high surgical risk as candidates for transcatheter repair.All patients received transcatheter edge-to-edge mitral valve repair under general anesthesia.The primary outcome was technical success,which included all of the following measured at the exit from the catheterization laboratory:(1)absence of procedural mortality;(2)successful access,delivery,and retrieval of the device delivery system;(3)successful deployment and correct positioning of the frst intended device;and(4)no emergency surgery or reintervention related to the device or access procedure.The secondary outcomes included all-cause mortality,serious adverse events,device success,and procedural success 30 d after the intervention.Results:From June 2021 to December 2021,18 patients were enrolled in this study with age(75.7±7.4)years.Fifteen patients had MR 4+,while 3 had MR 3+.Technical success was achieved in all patients,including 6 degenerative mitral regurgitation and 12 functional mitral regurgitation patients.There was no all-cause mortality at 30 d.One patient had single leaflet device attachment within 30 d,which was regarded as a serious adverse event,and the patient was successfully treated with reintervention by implanting another clip.Another patient's transmitral gradient was 6 mmHg(>5 mmHg),with an effective orifice area of 2.57 cm^(2) after the procedure.Sixteen patients had device success and procedural success at 30 d postoperation.Fourteen patients had MR 1+,3 had MR 2+,and only 1 patient had MR 3+30 d after the procedure.Conclusions:The results of this feasibility study showed the efficacy and safety of the SQ-Kyrin■-M device in the Chinese population with severe MR,laying a solid foundation for a subsequent large-scale confirmatory study.展开更多
Background Repair of anterior mitral leaflet （AML） prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible tec...Background Repair of anterior mitral leaflet （AML） prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the ＂edge-to-edge＂technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association （NYHA） functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve： the cross-sectional area of the mitral valve was 3.3-4.8 cm2 （mean （3.78：±0.52） cm2）, the mean regurgitation area was （0.45：±0.22） cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly （left atrium diameter： pre-operation （48.26±11.12） mm, post-operation （37.57±9.56） mm, P 〈0.05; the end-diastolic diameter of the left ventricle：pre-operation （61.43±8.24） mm, post-operation （42.35±10.79） mm, P〈0.01）.Conclusion ＂Edge-to-edge＂ chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.展开更多
Objective:The objective of this study was to investigate the mechanics of ventricular anchor for heart valve repair or replacement.Methods:Thirteen anchors were designed based on six geometric parameters of the anchor...Objective:The objective of this study was to investigate the mechanics of ventricular anchor for heart valve repair or replacement.Methods:Thirteen anchors were designed based on six geometric parameters of the anchor teeth:width,thickness,root length,radius of curvature,tip angle,and tip length.Finite element method was applied to simulate the process of the anchor compressing into a sheath.The Von-Mises strain,peak pulling force,and bite depth were evaluated.An experiment was performed to validate the simulation.Results:The maximum Von-Mises strain was at the contact region of the anchor in a sheath where the teeth were compressed against one another and were distorted.The maximum strain increased with an increase in tooth width,thickness,radius of curvature and tip angle.The peak pulling force increased as tooth thickness and width increased,and radius of curvature decreased.Both the radial and axial bite depths increased with an increase in the tip length at the tip length3 mm.The radial bite depth increased with an increase in the radius of curvature.Conclusion:1)the maximum strain depends primarily on the tooth width,thickness,radius of curvature and tip angle;2)the peak pulling force depends primarily on the tooth width,thickness,radius of curvature;3)the axial bite depth depends primarily on the tip length at the tip length3 mm.The radial bite depth depends on the radius of curvature and the tip length at the tip length>3 mm.The study provides guidance for ventricular anchor design.展开更多
<b><span style="font-family:"">Background</span></b></span><span><span><b><span style="font-family:"">: </span></b></s...<b><span style="font-family:"">Background</span></b></span><span><span><b><span style="font-family:"">: </span></b></span></span><span><span><span style="font-family:"">Concomitant repair of moderate secondary tricuspid regurgitation (STR) during mitral valve surgery is still subject of <span>controverse</span>. </span></span></span><span><span><span style="font-family:"">This </span></span></span><span><span><span style="font-family:"">research </span></span></span><span><span><span style="font-family:"">aims to </span></span></span><span><span><span style="font-family:"">study</span></span></span><span><span><span style="font-family:""> the early </span></span></span><span><span><span style="font-family:"">and mid-term </span></span></span><span><span><span style="font-family:"">postoperative</span></span></span><span><span><span style="font-family:""> influence of tricuspid repair</span></span></span><span><span><span style="font-family:""> on </span></span></span><span><span><span style="font-family:"">the clinical outcomes and</span></span></span><span><span><span style="font-family:""> right ventric</span></span></span><span><span><span style="font-family:"">ular functions. </span></span></span><span><span><b><span style="font-family:"">Methods: </span></b></span></span><span><span><span style="font-family:"">This is a </span></span></span><span><span><span style="font-family:"">retrospective</span></span></span><span><span><span style="font-family:""> cohort study of </span></span></span><span><span><span style="font-family:"">92</span></span></span><span><span><span style="font-family:""> patients with </span></span></span><span><span><span style="font-family:"">moderate STR </span></span></span><span><span><span style="font-family:"">who</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">und<span>erwent tricuspid valve repair</span></span></span></span><span><span><span style="font-family:""> b</span></span></span><span><span><span style="font-family:"">etween </span></span></span><span><span><span style="font-family:"">October</span></span></span><span><span><span style="font-family:""> 20</span></span></span><span><span><span style="font-family:"">14</span></span></span><span><span><span style="font-family:""> and</span></span></span><span><span><span style="font-family:""> December</span></span></span><span><span><span style="font-family:""> 2</span></span></span><span><span><span style="font-family:"">017</span></span></span><span><span><span style="font-family:"">, in the cardiothoracic surgery department</span></span></span><span><span><span style="font-family:"">, Menoufia University Hospital</span></span></span><span><span><span style="font-family:"">. Patients were assessed clinically and by echocardiography </span></span></span><span><span><span style="font-family:"">at one month</span></span></span><span><span><span style="font-family:""> and after </span></span></span><span><span><span style="font-family:"">24 months postoperatively</span></span></span><span><span><span style="font-family:""> for the degree of tricuspid regurgitation</span></span></span><span><span><span style="font-family:""> (TR)</span></span></span><span><span><span style="font-family:"">,</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">right ventricular diameter <span>and</span> tricuspid annular plane systolic excursion (TAPSE)</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><b><span style="font-family:"">Results:</span></b></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">In this study, <span>mean</span> a</span></span></span><span><span><span style="font-family:"">ge </span></span></span><span><span><span style="font-family:"">of patients was </span></span></span><span><span><span style="font-family:"">58.33 ± 4.06 years</span></span></span><span><span><span style="font-family:"">. We had a significant improvement in the grade of TR from <span>preoperative</span> period to <span>follow up</span> data observed at 1-month postoperative and 2-years <span>follow</span></span></span></span><span><span><span style="font-family:"">-</span></span></span><span><span><span style="font-family:"">up</span></span></span><span><span><span style="font-family:""> (P = 0.0001). After one month postoperatively, no TR was detected in 74 cases (80.4%), and in 71 (84.5%) after two years. Mean right ventricular diameter decr</span></span></span><span><span><span style="font-family:"">eased significantly from 23 ± 3.32 mm preoperatively to 21.9 ± 3 mm at 2-years postoperatively. An increase of TAPSE</span></span></span><span><span><span style="font-family:""> was</span></span></span><span><span><span style="font-family:""> from 19.96 ± 3.7 mm preoperatively to 20.3 ± 3.9 mm at 1-month postoperative (p = 0.55) and there was <span>significant</span> increase in late postoperative value. </span></span></span><span><span><b><span style="font-family:"">Conclusion:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:"">W</span></span></span><span><span><span style="font-family:"">e highly recommend repair for</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">moderate </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:""> during mitral valve surgery</span></span></span><span><span><span style="font-family:""> t</span></span></span><span><span><span style="font-family:"">o avoid progression of </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><span style="font-family:"">Tricuspid</span></span></span><span><span><span style="font-family:""> repair</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">was</span></span></span><span><span><span style="font-family:""> able to reduce the grade of </span></span></span><span><span><span style="font-family:"">regurgitation</span></span></span><span><span><span style="font-family:""> after </span></span></span><span><span><span style="font-family:"">two years of </span></span></span><span><span><span style="font-family:"">surgery and </span></span></span><span><span><span style="font-family:"">improved</span></span></span><span><span><span style="font-family:""> right ventricular functions.展开更多
Tetralogy of fallot （TOF） occurs in approximately 1 in 5000 live births and accounts for 12% - 14% of congenital heart disease. Surgical repair was first introduced in the 1950s and there is now a large population o...Tetralogy of fallot （TOF） occurs in approximately 1 in 5000 live births and accounts for 12% - 14% of congenital heart disease. Surgical repair was first introduced in the 1950s and there is now a large population of adults with repaired TOF. Some of them may suffer from significant pulmonary regurgitation （PR）, progressive right ventricle （RV） dilation, RV dysfunction and restrictive right ventricular physiology（RRVP）.展开更多
Background： Right minithoracotomy （RM） has been proven to be a sate and effective approach for mitral valve surgery, but the differences of artificial chordae technique between RM and median sternotomy （MS） were ...Background： Right minithoracotomy （RM） has been proven to be a sate and effective approach for mitral valve surgery, but the differences of artificial chordae technique between RM and median sternotomy （MS） were seldom reported. Here, we compared the outcomes of modified artificial chordae technique for mitral regurgitation （MR） through RM or MS approaches. Methods： One hundred and eighteen consecutive adult patients who received mitral valve repair with artificial chordae and annuloplasty for MR through RM （n = 58） or MS （n = 60） from January 2006 to January 2015 were analyzed. Results： All of the selected patients underwent mitral valve repair successfully without any complication during the surgery. There was no significant difference between RM group and MS group in cardiopuhnonary bypass time, aortic cross-clamp time, and early postoperative complications. However, compared with the MS group, the RM group had shorter hospital stay and taster surgical recovery. At a mean follow-up of 44.8 ± 25.0 months, the freedom from more than moderate MR was 93.9% ± 3.5% in RM group and 94.8% ± 2.9% in MS group at 3 years postoperatively. Log-rank test showed that there was no significant difference in the freedom from recurrent significant MR between the two groups （Х^2= 0.247, P = 0.619）. Multivariate analysis revealed that the presence of mild MR at discharge was the independent risk factor for the recurrent significant MR. Conclusion： Right minithoracotomy can achieve the similar therapeutic effects with MS for the patients who received modified artificial chordae technique for treating MR.展开更多
Helical anchors are used in transcatheter mitral valve repair,The alin of the curent study was to invest igate effectof helical anchor dsign,anchored position and biting depth on the detachment force in an in vitro ep...Helical anchors are used in transcatheter mitral valve repair,The alin of the curent study was to invest igate effectof helical anchor dsign,anchored position and biting depth on the detachment force in an in vitro eperiment.Mitral annulus was excised from 36 fresh porcine hearts and mounted in an unaxdal test ng.Seven helical anchorswere made of stainles ste based on the geometric parameters outer dlameter,wire diameter,and pich Thehelical anchors were serewedin at 3 to 9 odock positions of the psteroranuhis,namely,P3-9,and puld out.The pullout fore was measured with the maximal pullout force defined as the detachment force,The detachmentforce within the medlal ateal and central positions were comparable(p≥0.069),The detachmnen force at P6was bowest compared wih the medlal and lateral positons,and was 5.459±0.193 N,5.586±0.113 N,8.910.250 for the anchos in the outer dlameters of3,4,5 mm,respectivelyat the pitch of 2 mm and thewire dlameter of.4 mm and blting depth of 3 colls The detachment force hncreased with the outer and wiredlameters but was not fected by thepichat the bitig depthof 3 cols(@≥0.279).The detachment force of thehelieal anchor is lowest in the central posterlor annulus region,and the biting depth in 3 or more coll is rec.ommended.The helical anchor is stronger than the suture.展开更多
文摘Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.
文摘AIM To investigate one-year outcomes after percutaneous mitral valve repair with Mitra Clip~? in patients with severe mitral regurgitation(MR). METHODS Our study investigated consecutive patients with symptomatic severe MR who underwent Mitra Clip~?implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.RESULTS The study population consisted of 46 consecutive patients(mean logistic Euro SCORE 32% ± 21%). The degree of MR decreased significantly(severe MR before Mitra Clip~? 100% vs after Mitra Clip~? 13%; P < 0.001),and the NYHA functional classes improved(NYHA III/IV before Mitra Clip~? 98% vs after Mitra Clip~? 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%,respectively. During the follow-up of 473 ± 274 d,11 patients died(90% due to cardiovascular death). A preprocedural plasma B-type natriuretic peptide level > 817 pg/m L was associated with all-cause mortality(hazard ratio,6.074; 95%CI: 1.257-29.239; P = 0.012).CONCLUSION Percutaneous mitral valve repair with Mitra Clip~? has positive effects on hemodynamics and symptoms. Despite the study patients' multiple comorbidities and extremely high operative risk,one-year outcomes after Mitra Clip~? are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.
文摘Objective To analyze whether association of edge to edge valve repair with artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR) . Methods From April,2001 to May, 2010,41 patients underwent tricuspid valve repair to treat severe TR were studied. Twenty-one patients were done artificial ring annuloplasty alone (group R) and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair (group E) . All the
文摘Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair,and evaluate the value of real-time three-di-mensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation
文摘Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation （MR）. However, there has been limited infomlation regarding tile echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. Methods： A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients （79.8%）, artificial chordae in 20 （23.8%）, and ring annuloplasty in 79 （94.1%）. Eighty-one （96.4%） of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. Results： At a median echocardiographic follow-up of 36.0 months （interquartile range 14.3-59.4 months）, lbur patients （4.9%） developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, leli atrial diameter （LAD）, left ventricular end-diastolic diameter （LVEDD）, and let1 ventricular ejection fraction （LVEF） were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 （Z- -8.456, P 〈 0.001 ）, LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm （I - 15.131, P 〈 0.001 ）, LVEDD fiom 51.0 ± 5.0 to 43.3 ± 2.2 mm （t = 14.481, P 〈 0.001 ）, and LV EF l＇rom 67.3 ± 7.0% to 63.9 ± 5.1% （t = 4.585, P 〈 0.001 ）. Conclusion： Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.
文摘Congenital aortic stenosis(cAS)frequently requires intervention during the neonatal or infantile period.However,surgical repair is challenging because of the narrow surgical space.We performed bicuspidization using the open-sleeve technique for cAS with a unicuspid aortic valve in two patients.Postoperatively,the patients were doing well without reintervention for the aortic valve for 8 and 6 years,respectively.Their aortic annular diameter increased along with somatic growth.Bicuspidization for neonates or infancy can be performed safely using the open-sleeve technique as its midterm results have been satisfactory.
文摘Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.
基金supported by the National Key Project of Research and Development Plan during the fourteenth Five-year Plan Period(2022YFC2503400).
文摘Objectives:The aim of this multicenter,prospective,single-arm pilot study(ClinicalTrials.gov number:NCT05040074)was to observe the procedural and 30-day results of the novel transcatheter mitral valve repair system,SQ-Kyrin■-M Clip(Shenqi Medical,Shanghai,China),in patients with severe mitral regurgitation(MR).Methods:The heart team considered patients from 5 centers in China with clinically significant functional mitral regurgitation≥3+despite optimal medical therapy or degenerative mitral regurgitation≥3+with high surgical risk as candidates for transcatheter repair.All patients received transcatheter edge-to-edge mitral valve repair under general anesthesia.The primary outcome was technical success,which included all of the following measured at the exit from the catheterization laboratory:(1)absence of procedural mortality;(2)successful access,delivery,and retrieval of the device delivery system;(3)successful deployment and correct positioning of the frst intended device;and(4)no emergency surgery or reintervention related to the device or access procedure.The secondary outcomes included all-cause mortality,serious adverse events,device success,and procedural success 30 d after the intervention.Results:From June 2021 to December 2021,18 patients were enrolled in this study with age(75.7±7.4)years.Fifteen patients had MR 4+,while 3 had MR 3+.Technical success was achieved in all patients,including 6 degenerative mitral regurgitation and 12 functional mitral regurgitation patients.There was no all-cause mortality at 30 d.One patient had single leaflet device attachment within 30 d,which was regarded as a serious adverse event,and the patient was successfully treated with reintervention by implanting another clip.Another patient's transmitral gradient was 6 mmHg(>5 mmHg),with an effective orifice area of 2.57 cm^(2) after the procedure.Sixteen patients had device success and procedural success at 30 d postoperation.Fourteen patients had MR 1+,3 had MR 2+,and only 1 patient had MR 3+30 d after the procedure.Conclusions:The results of this feasibility study showed the efficacy and safety of the SQ-Kyrin■-M device in the Chinese population with severe MR,laying a solid foundation for a subsequent large-scale confirmatory study.
文摘Background Repair of anterior mitral leaflet （AML） prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the ＂edge-to-edge＂technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association （NYHA） functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve： the cross-sectional area of the mitral valve was 3.3-4.8 cm2 （mean （3.78：±0.52） cm2）, the mean regurgitation area was （0.45：±0.22） cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly （left atrium diameter： pre-operation （48.26±11.12） mm, post-operation （37.57±9.56） mm, P 〈0.05; the end-diastolic diameter of the left ventricle：pre-operation （61.43±8.24） mm, post-operation （42.35±10.79） mm, P〈0.01）.Conclusion ＂Edge-to-edge＂ chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.
基金supported by Youth Project of Jiangsu Natural Science Foundation of China(BK20170552).
文摘Objective:The objective of this study was to investigate the mechanics of ventricular anchor for heart valve repair or replacement.Methods:Thirteen anchors were designed based on six geometric parameters of the anchor teeth:width,thickness,root length,radius of curvature,tip angle,and tip length.Finite element method was applied to simulate the process of the anchor compressing into a sheath.The Von-Mises strain,peak pulling force,and bite depth were evaluated.An experiment was performed to validate the simulation.Results:The maximum Von-Mises strain was at the contact region of the anchor in a sheath where the teeth were compressed against one another and were distorted.The maximum strain increased with an increase in tooth width,thickness,radius of curvature and tip angle.The peak pulling force increased as tooth thickness and width increased,and radius of curvature decreased.Both the radial and axial bite depths increased with an increase in the tip length at the tip length3 mm.The radial bite depth increased with an increase in the radius of curvature.Conclusion:1)the maximum strain depends primarily on the tooth width,thickness,radius of curvature and tip angle;2)the peak pulling force depends primarily on the tooth width,thickness,radius of curvature;3)the axial bite depth depends primarily on the tip length at the tip length3 mm.The radial bite depth depends on the radius of curvature and the tip length at the tip length>3 mm.The study provides guidance for ventricular anchor design.
文摘<b><span style="font-family:"">Background</span></b></span><span><span><b><span style="font-family:"">: </span></b></span></span><span><span><span style="font-family:"">Concomitant repair of moderate secondary tricuspid regurgitation (STR) during mitral valve surgery is still subject of <span>controverse</span>. </span></span></span><span><span><span style="font-family:"">This </span></span></span><span><span><span style="font-family:"">research </span></span></span><span><span><span style="font-family:"">aims to </span></span></span><span><span><span style="font-family:"">study</span></span></span><span><span><span style="font-family:""> the early </span></span></span><span><span><span style="font-family:"">and mid-term </span></span></span><span><span><span style="font-family:"">postoperative</span></span></span><span><span><span style="font-family:""> influence of tricuspid repair</span></span></span><span><span><span style="font-family:""> on </span></span></span><span><span><span style="font-family:"">the clinical outcomes and</span></span></span><span><span><span style="font-family:""> right ventric</span></span></span><span><span><span style="font-family:"">ular functions. </span></span></span><span><span><b><span style="font-family:"">Methods: </span></b></span></span><span><span><span style="font-family:"">This is a </span></span></span><span><span><span style="font-family:"">retrospective</span></span></span><span><span><span style="font-family:""> cohort study of </span></span></span><span><span><span style="font-family:"">92</span></span></span><span><span><span style="font-family:""> patients with </span></span></span><span><span><span style="font-family:"">moderate STR </span></span></span><span><span><span style="font-family:"">who</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">und<span>erwent tricuspid valve repair</span></span></span></span><span><span><span style="font-family:""> b</span></span></span><span><span><span style="font-family:"">etween </span></span></span><span><span><span style="font-family:"">October</span></span></span><span><span><span style="font-family:""> 20</span></span></span><span><span><span style="font-family:"">14</span></span></span><span><span><span style="font-family:""> and</span></span></span><span><span><span style="font-family:""> December</span></span></span><span><span><span style="font-family:""> 2</span></span></span><span><span><span style="font-family:"">017</span></span></span><span><span><span style="font-family:"">, in the cardiothoracic surgery department</span></span></span><span><span><span style="font-family:"">, Menoufia University Hospital</span></span></span><span><span><span style="font-family:"">. Patients were assessed clinically and by echocardiography </span></span></span><span><span><span style="font-family:"">at one month</span></span></span><span><span><span style="font-family:""> and after </span></span></span><span><span><span style="font-family:"">24 months postoperatively</span></span></span><span><span><span style="font-family:""> for the degree of tricuspid regurgitation</span></span></span><span><span><span style="font-family:""> (TR)</span></span></span><span><span><span style="font-family:"">,</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">right ventricular diameter <span>and</span> tricuspid annular plane systolic excursion (TAPSE)</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><b><span style="font-family:"">Results:</span></b></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">In this study, <span>mean</span> a</span></span></span><span><span><span style="font-family:"">ge </span></span></span><span><span><span style="font-family:"">of patients was </span></span></span><span><span><span style="font-family:"">58.33 ± 4.06 years</span></span></span><span><span><span style="font-family:"">. We had a significant improvement in the grade of TR from <span>preoperative</span> period to <span>follow up</span> data observed at 1-month postoperative and 2-years <span>follow</span></span></span></span><span><span><span style="font-family:"">-</span></span></span><span><span><span style="font-family:"">up</span></span></span><span><span><span style="font-family:""> (P = 0.0001). After one month postoperatively, no TR was detected in 74 cases (80.4%), and in 71 (84.5%) after two years. Mean right ventricular diameter decr</span></span></span><span><span><span style="font-family:"">eased significantly from 23 ± 3.32 mm preoperatively to 21.9 ± 3 mm at 2-years postoperatively. An increase of TAPSE</span></span></span><span><span><span style="font-family:""> was</span></span></span><span><span><span style="font-family:""> from 19.96 ± 3.7 mm preoperatively to 20.3 ± 3.9 mm at 1-month postoperative (p = 0.55) and there was <span>significant</span> increase in late postoperative value. </span></span></span><span><span><b><span style="font-family:"">Conclusion:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:"">W</span></span></span><span><span><span style="font-family:"">e highly recommend repair for</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">moderate </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:""> during mitral valve surgery</span></span></span><span><span><span style="font-family:""> t</span></span></span><span><span><span style="font-family:"">o avoid progression of </span></span></span><span><span><span style="font-family:"">TR</span></span></span><span><span><span style="font-family:"">. </span></span></span><span><span><span style="font-family:"">Tricuspid</span></span></span><span><span><span style="font-family:""> repair</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:"">was</span></span></span><span><span><span style="font-family:""> able to reduce the grade of </span></span></span><span><span><span style="font-family:"">regurgitation</span></span></span><span><span><span style="font-family:""> after </span></span></span><span><span><span style="font-family:"">two years of </span></span></span><span><span><span style="font-family:"">surgery and </span></span></span><span><span><span style="font-family:"">improved</span></span></span><span><span><span style="font-family:""> right ventricular functions.
文摘Tetralogy of fallot （TOF） occurs in approximately 1 in 5000 live births and accounts for 12% - 14% of congenital heart disease. Surgical repair was first introduced in the 1950s and there is now a large population of adults with repaired TOF. Some of them may suffer from significant pulmonary regurgitation （PR）, progressive right ventricle （RV） dilation, RV dysfunction and restrictive right ventricular physiology（RRVP）.
文摘Background： Right minithoracotomy （RM） has been proven to be a sate and effective approach for mitral valve surgery, but the differences of artificial chordae technique between RM and median sternotomy （MS） were seldom reported. Here, we compared the outcomes of modified artificial chordae technique for mitral regurgitation （MR） through RM or MS approaches. Methods： One hundred and eighteen consecutive adult patients who received mitral valve repair with artificial chordae and annuloplasty for MR through RM （n = 58） or MS （n = 60） from January 2006 to January 2015 were analyzed. Results： All of the selected patients underwent mitral valve repair successfully without any complication during the surgery. There was no significant difference between RM group and MS group in cardiopuhnonary bypass time, aortic cross-clamp time, and early postoperative complications. However, compared with the MS group, the RM group had shorter hospital stay and taster surgical recovery. At a mean follow-up of 44.8 ± 25.0 months, the freedom from more than moderate MR was 93.9% ± 3.5% in RM group and 94.8% ± 2.9% in MS group at 3 years postoperatively. Log-rank test showed that there was no significant difference in the freedom from recurrent significant MR between the two groups （Х^2= 0.247, P = 0.619）. Multivariate analysis revealed that the presence of mild MR at discharge was the independent risk factor for the recurrent significant MR. Conclusion： Right minithoracotomy can achieve the similar therapeutic effects with MS for the patients who received modified artificial chordae technique for treating MR.
基金The authors acknowledge financial support from the National Natural Science Foundation of China(No.51805218).
文摘Helical anchors are used in transcatheter mitral valve repair,The alin of the curent study was to invest igate effectof helical anchor dsign,anchored position and biting depth on the detachment force in an in vitro eperiment.Mitral annulus was excised from 36 fresh porcine hearts and mounted in an unaxdal test ng.Seven helical anchorswere made of stainles ste based on the geometric parameters outer dlameter,wire diameter,and pich Thehelical anchors were serewedin at 3 to 9 odock positions of the psteroranuhis,namely,P3-9,and puld out.The pullout fore was measured with the maximal pullout force defined as the detachment force,The detachmentforce within the medlal ateal and central positions were comparable(p≥0.069),The detachmnen force at P6was bowest compared wih the medlal and lateral positons,and was 5.459±0.193 N,5.586±0.113 N,8.910.250 for the anchos in the outer dlameters of3,4,5 mm,respectivelyat the pitch of 2 mm and thewire dlameter of.4 mm and blting depth of 3 colls The detachment force hncreased with the outer and wiredlameters but was not fected by thepichat the bitig depthof 3 cols(@≥0.279).The detachment force of thehelieal anchor is lowest in the central posterlor annulus region,and the biting depth in 3 or more coll is rec.ommended.The helical anchor is stronger than the suture.
