Interv Akut Kardiol. 2023;22(1):12-16 | DOI: 10.36290/kar.2023.002

Surgical treatment of mitral incompetence as a gold standard

Pavel Žáček
Kardiochirurgická klinika, Univerzita Karlova, Lékařská fakulta v Hradci Králové a Fakultní nemocnice Hradec Králové

Reconstructive surgery for mitral regurgitation was initiated already in the early 1970s. A systematic assessment of a regurgitant mitral valve and a comprehensive portfolio of surgical interventions have been valuable contributions by A. Carpentier. Crucial elements are annular remodelling by means of an annuloplasty ring, unrestricted mobility of the valve leaflets, and creation of a large zone of coaptation. These principles have been shown to be consistently valid and mitral repair is nowadays performed extensively with excellent results. Over the years, some additional refinements in the surgical technique have been introduced and, currently, mitral repair can also be performed through a minimally invasive approach or robotically.

Keywords: mitral regurgitation, mitral repair, annuloplasty, cardiac surgery.

Accepted: March 27, 2023; Published: April 12, 2023  Show citation

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Žáček P. Surgical treatment of mitral incompetence as a gold standard. Interv Akut Kardiol. 2023;22(1):12-16. doi: 10.36290/kar.2023.002.
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    References

    1. Maleki M, Esmaeilzadeh M. The evolutionary development of echocardiography. Iran J Med Sci. 2012;37(4):222-32. PMID: 23390327; PMCID: PMC3565194.
    2. Jouan J. Mitral valve repair over five decades. Ann Cardiothorac Surg. 2015;4(4):322-34. doi: 10.3978/j.issn.2225-319X.2015. 01. 07. PMID: 26309841; PMCID: PMC4526505. Go to original source... Go to PubMed...
    3. Carpentier A. Cardiac valve surgery - the "French correction". J Thorac Cardiovasc Surg. 1983;86(3):323-37. PMID: 6887954. Go to original source...
    4. Durán CM, Pomar JL, Cucchiara G. A flexible ring for atrioventricular heart valve reconstruction. J Cardiovasc Surg (Torino). 1978;19(4):417-20. PMID: 150424. Go to PubMed...
    5. Carpentier AF, Lessana A, Relland JY, et al. The "physio­‑ring": an advanced concept in mitral valve annuloplasty. Ann Thorac Surg. 1995;60(5):1177-85; discussion 1185-6. doi: 10.1016/0003-4975(95)00753-8. PMID: 8526596. Go to original source... Go to PubMed...
    6. Duran CG. Repair of anterior mitral leaflet chordal rupture or elongation (the flip­‑over technique). J Card Surg. 1986;1(2):161-6. doi: 10.1111/j.1540-8191.1986.tb00705.x. PMID: 2979918. Go to original source... Go to PubMed...
    7. David TE. Replacement of chordae tendineae with expanded polytetrafluoroethylene sutures. J Card Surg. 1989;4(4):286-90. doi: 10.1111/j.1540-8191.1989.tb00291.x. PMID: 2520006. Go to original source... Go to PubMed...
    8. Frater RW, Vetter HO, Zussa C, et al. Chordal replacement in mitral valve repair. Circulation. 1990;82(5 Suppl):IV125-30. PMID: 2225397.
    9. von Oppell UO, Mohr FW. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore­‑Tex loops. Ann Thorac Surg. 2000;70(6):2166-8. doi: 10.1016/s0003-4975(00)02047-6. PMID: 11156150. Go to original source... Go to PubMed...
    10. Perier P, Hohenberger W, Lakew F, et al. Toward a new paradigm for the reconstruction of posterior leaflet prolapse: midterm results of the "respect rather than resect" approach. Ann Thorac Surg. 2008;86(3):718-25; discussion 718-25. doi: 10.1016/j.athoracsur.2008. 05. 015. PMID: 18721552. Go to original source...
    11. Lange R, Guenther T, Noebauer C, et al. Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leaflet prolapse. Ann Thorac Surg. 2010;89(4): 1163-70; discussion 1170. doi: 10.1016/j.athoracsur.­ 2009. 12. 057. PMID: 20338326. Go to original source...
    12. Seeburger J, Falk V, Borger MA, et al. Chordae replacement versus resection for repair of isolated posterior mitral leaflet prolapse: à ègalité. Ann Thorac Surg. 2009;87(6):1715-20. doi: 10.1016/j.athoracsur.2009. 03. 003. PMID: 19463584. Go to original source...
    13. Fucci C, Sandrelli L, Pardini A, et al. Improved results with mitral valve repair using new surgical techniques. Eur J Cardiothorac Surg. 1995;9(11):621-6 discuss 626-7. doi: 10.1016/s1010-7940(05)80107-1. PMID: 8751250. Go to original source... Go to PubMed...
    14. Bolling SF, Deeb GM, Brunsting LA, et al. Early outcome of mitral valve reconstruction in patients with end­‑stage cardiomyopathy. J Thorac Cardiovasc Surg. 1995;109(4):676-82; discussion 682-3. doi: 10.1016/S0022-5223(95)70348-9. PMID: 7715214. Go to original source... Go to PubMed...
    15. De Bonis M, Taramasso M, Grimaldi A, et al. The GeoForm annuloplasty ring for the surgical treatment of functional mitral regurgitation in advanced dilated cardiomyopathy. Eur J Cardiothorac Surg. 2011;40(2):488-95. doi: 10.1016/j.ejcts.2010. 11. 048. Epub 2011 Jan 12. PMID: 21232967. Go to original source...
    16. Gatti G, Pinamonti B, Dell'Angela L, et al. Mitral annuloplasty with IMR ETlogix ring for ischemic mitral regurgitation and left ventricular dysfunction. J Heart Valve, DiS. 2012;21(5):556-63. PMID: 23167218. Go to PubMed...
    17. Kincaid EH, Riley RD, Hines MH, et al. Anterior leaflet augmentation for ischemic mitral regurgitation. Ann Thorac Surg. 2004;78(2):564-8; discussion 568. doi: 10.1016/j.athoracsur.2004. 02. 040. PMID: 15276520. Go to original source...
    18. Goetz WA, Lim HS, Lansac E, et al. Anterior mitral basal 'stay' chords are essential for left ventricular geometry and function. J Heart Valve, DiS. 2005;14(2):195-202; discussion 202-3. PMID: 15792179. Go to PubMed...
    19. Hvass U, Tapia M, Baron F, et al. Papillary muscle sling: a new functional approach to mitral repair in patients with ischemic left ventricular dysfunction and functional mitral regurgitation. Ann Thorac Surg. 2003;75(3):809-11. doi: 10.1016/s0003-4975(02)04678-7. PMID: 12645698. Go to original source... Go to PubMed...
    20. Kron IL, Green GR, Cope JT. Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation. Ann Thorac Surg. 2002;74(2):600-1. doi: 10.1016/s0003-4975(02)03749-9. PMID: 12173864. Go to original source... Go to PubMed...
    21. Menicanti L, Di Donato M, Frigiola A, et al; RESTORE Group. Ischemic mitral regurgitation: intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration. J Thorac Cardiovasc Surg. 2002;123(6):1041-50. doi: 10.1067/mtc.2002.121677. PMID: 12063449. Go to original source... Go to PubMed...
    22. Ueno T, Sakata R, Iguro Y, et al. New surgical approach to reduce tethering in ischemic mitral regurgitation by relocation of separate heads of the posterior papillary muscle. Ann Thorac Surg. 2006;81(6):2324-5. doi: 10.1016/j.athoracsur.2005. 03. 059. PMID: 16731191. Go to original source...
    23. Pausch J, Girdauskas E, Conradi L, et al. Secondary mitral regurgitation repair techniques and outcomes: Subannular repair techniques in secondary mitral regurgitation type IIIb. JTCVS Tech. 2021;10:92-97. doi: 10.1016/j.xjtc.2021. 09. 019. PMID: 34977710; PMCID: PMC8691802. Go to original source... Go to PubMed...
    24. Kang DH, Kim MJ, Kang SJ, et al. Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. Circulation. 2006;114(1 Suppl):I499-503. doi: 10.1161/CIRCULATIONAHA.105.000398. PMID: 16820626. Go to original source... Go to PubMed...
    25. McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004;128(6):916-24. doi: 10.1016/j.jtcvs.2004. 07. 037. PMID: 15573077. 26. Go to original source...
    26. Carpentier A, Loulmet D, Aupecle B et al. (1998) [Computer assisted open heart surgery. First case operated on with success]. C R Acad Sci III 321:437-42 Go to original source... Go to PubMed...

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