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Chasing one hundred percent repair rate in endoscopic guided mitral valve surgery using different patho-anatomical shaped annuloplasty devices
Markus Liebrich, Detlef Roser, Vladimir Voth, Julia Goette, Ulrike Walle, Timo Weimar, Wolfgang Hemmer, Nicolas Doll, Markus Czesla.
SANA Cardiac Surgery, Stuttgart, Germany.

OBJECTIVE: Although mitral valve (MV) repair is the recommended treatment for severe mitral regurgitation (MR) of primary/secondary etiology, valve replacement remains common, particularly for complex lesions or anterior leaflet (AML) involvement. We sought to characterize the feasibility and outcomes of an "all comers" repair strategy applied systematically in all cases of mitral valve disease using various annuloplasty devices, regardless of complexity, leaflet involvement or age.
METHODS: Between 11/2008 and 08/2012, 646 patients (pts) who presented with primary MR (n=455, 70%) or secondary MR (n=191, 30%) underwent endoscopic-guided MV surgery. Specific cusp pathology was isolated posterior mitral leaflet (PML) (n=353, 54.6%), isolated AML (n=41, 6.3%), and bileafelt (BL) prolapse (n=57, 8.9%). The preoperative MR grade was 3.2+/-0.6, left ventricular ejection fraction was >50% in 513 pts (79.9%), 30-50% in 112 pts (17.4%), and <30% in 17 pts (2.6%). Mean age was 64.6+/-12.7 years; 400 patients (62%) were male.
RESULTS: Overall, the MV repair rate was 98% (631 pts). 48 pts (7.4%) had previous cardiac surgery. 11 pts (1.7%) were suffering from endocarditis of the MV. Repair techniques consisted predominantly of leaflet reconstruction (n=443, 69%) with/without implantation of neochordae and leaflet resection (n=28, 4.4%), combined with ring annuloplasty. According to the MV pathology 9 different annuloplasty devices were used. Concomitant procedures were tricuspid valve surgery (n=59, 9.2%), atrial fibrillation ablation (n=203, 31.4%), closure of an atrial septal defect (n=69, 10.7%), and closure of the left atrial appendage (n=231, 35.7%). Cardiopulmonary bypass time was 154+/-47 min and aortic cross-clamp time was 91+/-32 min. The mean postoperative hospital stay was 8.6+/-5.7 days. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3+/-0.6.
CONCLUSIONS: A systematic strategy of endoscopic mitral valve repair that uses a variety of techniques and annuloplasty devices allows repair of primary and secondary MR in a reference center, with good short-term outcomes and mid-term durability.


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