Impact of Failed Mitral Clipping on Subsequent Mitral Valve Operations

Slides:

Advertisements

Similar presentations

Surgical Indications and Results of Mitral Valve Repair in Pediatric Patients With Ventricular Septal Defects Accompanied by Mitral Valve Regurgitation

Advertisements

Leo M. Gazoni, MD, Lynn M. Fedoruk, MD, John A. Kern, MD, John M

The Annals of Thoracic Surgery

Feasibility and Intermediate Term Outcome of Repair of Prolapsing Anterior Mitral Leaflets With Artificial Chordal Replacement in 152 Patients Gerald.

Papillary muscle–to–anterior annulus stitches: Another technique to prevent systolic anterior motion after mitral valve repair Samer Kassem, MD, Hicham.

The Annals of Thoracic Surgery

A heart team’s perspective on interventional mitral valve repair: Percutaneous clip implantation as an important adjunct to a surgical mitral valve program.

The First Cardiac Operation Using Cardiopulmonary Bypass

Is the Anterior Intertrigonal Distance Increased in Patients With Mitral Regurgitation Due to Leaflet Prolapse? Rakesh M. Suri, MD, DPhil, Jasmine Grewal,

In Vitro Mitral Valve Simulator Mimics Systolic Valvular Function of Chronic Ischemic Mitral Regurgitation Ovine Model Andrew W. Siefert, MS, Jean Pierre.

Mitraclip Procedure as a Bridge Therapy in a Patient With Heart Failure Listed for Heart Transplantation Andrea Garatti, MD, Serenella Castelvecchio,

Successful Robot-Assisted Repair of Congenital Mitral Valve Regurgitation Vijayakumar Raju, MD, Harold M. Burkhart, MD, Frank Cetta, MD, Rakesh M. Suri,

George Gogoladze, MD, Sophia L

Face-to-face single patch: A new technique to repair the commissures of the mitral valve Samer Kassem, MD, PhD, Khalid Al-Faraidy, MD, Yasser Elkady,

Antonio M. Calafiore, MD The Annals of Thoracic Surgery

Jaishankar Raman, MMedBS, PhD, Lissa Sugeng, MD, MPH, David T. M

Nicolas H. Pope, MD, Scott Lim, MD, Gorav Ailawadi, MD

Complex Surgical Valve Repair After Failed Percutaneous Mitral Intervention Using the MitraClip Device Stephan Geidel, MD, Jörg Ostermeyer, MD, Michael.

Benefits of Early Surgery on Clinical Outcomes After Degenerative Mitral Valve Repair Tianyu Zhou, MD, Jun Li, MD, PhD, Hao Lai, MD, PhD, Kai Zhu, MD,

Beyond Extended Myectomy for Hypertrophic Cardiomyopathy: The Resection- Plication-Release (RPR) Repair Sandhya K. Balaram, MD, PhD, Mark V. Sherrid,

Simple and Easy Method for Chordal Reconstruction During Mitral Valve Repair Yasuhiro Shudo, MD, Kazuhiro Taniguchi, PhD, Toshiki Takahashi, PhD, Hajime.

Mitral Valve Repair With Artificial Chordae: A Review of Its History, Technical Details, Long-Term Results, and Pathology Uberto Bortolotti, MD, Aldo.

A Standardized Loop Technique for Mitral Valve Repair

Use of an Expanded Polytetrafluoroethylene Patch as an Artificial Leaflet in Mitral Valve Plasty: An Early Experience Toshiaki Ito, MD, Atsuo Maekawa,

Chordal Preservation in Mitral Valve Replacement

Survival Prediction in Patients Undergoing Open-Heart Mitral Valve Operation After Previous Failed MitraClip Procedures Stephan Geidel, MD, Peter Wohlmuth,

Samer Kassem, MD, Majed Othman, MD

Transmitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy Brody Wehman, MD, Mehrdad Ghoreishi, MD, Nathaniel Foster, BS, Libin Wang, MD,

Ventricularization of the atrialized chamber: A concept of Ebstein's anomaly repair Michael V. Ullmann, MD, Sabine Born, MD, Christian Sebening, MD, Matthias.

Mathieu Vergnat, MD, Melissa M. Levack, MD, Benjamin M

Jorge Sierra, MD, FETCS, Nadia H. Lahlaïdi, MD, Jan T

Tricuspid Valve Repair in Single Ventricle: Timing and Techniques

Paradoxical Neochords to Treat Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy Samer Kassem, MD, PhD, Maurizio Roberto, MD, PhD,

Determinants of Left Ventricular Dysfunction After Repair of Chronic Asymptomatic Mitral Regurgitation Vincent Chan, MD, MPH, Marc Ruel, MD, MPH, Elsayed.

Tricuspid Leaflet Augmentation to Eliminate Residual Regurgitation in Severe Functional Tricuspid Regurgitation Jong Bum Choi, MD, Nan Yeol Kim, MD,

Commissural Closure for Repair of Mitral Commissural Prolapse

A Systematic Review of Mitral Valve Repair With Autologous Pericardial Leaflet Augmentation for Rheumatic Mitral Regurgitation Christos G. Mihos, DO,

Philip Y.K. Pang, MD, Susan Garwood, MBChB, Sabet W. Hashim, MD

A Novel Method of Leaflet Reconstruction After Triangular Resection for Posterior Mitral Valve Prolapse Rakesh M. Suri, MD, DPhil, Harold M. Burkhart,

Bulging Subaortic Septum: An Important Risk Factor for Systolic Anterior Motion After Mitral Valve Repair Sameh M. Said, MD, Hartzell V. Schaff, MD,

How to Adjust Neochordae Length Accurately in Degenerative Mitral Regurgitation Jorge Rodriguez-Roda, MD, Javier Miguelena, MD, Jose Lopez, MD, PhD, Miren.

Fitsum Lakew, MD, Paul P. Urbanski, MD, PhD

Simple, Safe and Easy Technique to Ensure the Correct Length of Artificial Chordae in Mitral Valve Repair Khalil Fattouch, MD, PhD, Giuseppe Bianco,

Beating-Heart Totally Endoscopic Tricuspid Valvuloplasty in Reoperative Cardiac Surgery Zerui Chen, MD, Yingjie Ke, MD, Xujing Xie, MD, Jinsong Huang,

Tricuspid Valve Repair: How I Teach It

Midterm Follow-Up of Tricuspid Valve Reconstruction Due to Active Infective Endocarditis Roman Gottardi, MD, Jan Bialy, MD, Elena Devyatko, MD, Heinz.

Early and Midterm Outcomes of Folding Valvuloplasty Without Leaflet Resection for Myxomatous Mitral Valve Disease Minoru Tabata, MD, MPH, Ravi K. Ghanta,

Gilles D. Dreyfus, MD, Pierre J. Corbi, MD, K. M

Tirone E. David, MD, Carolyn M. David, BN, Cedric Manlhiot, MS

Use of Barbed Suture in Robot-Assisted Mitral Valvuloplasty

A New Device for Ensuring the Correct Length of Artificial Chordae in Mitral Valvuloplasty Yoshiro Matsui, MD, Yasuhisa Fukada, MD, Yuji Naito, MD, Shigeyuki.

L. Wiley Nifong, MD, Evelio Rodriguez, MD, W. Randolph Chitwood, MD

Wobbe Bouma, MD, Chikashi Aoki, MD, Mathieu Vergnat, MD, Alison M

Unilateral Postoperative Pulmonary Edema After Minimally Invasive Cardiac Surgical Procedures: A Case-Control Study Mark P. Tutschka, MD, FRCPC, Daniel.

Tricuspid and Aortic Valve and Ventricular Septal Defect Endocarditis: An Unusual Presentation of Acute Q Fever Sebastian Pagni, MD, Anthony Dempsey,

Mitral Valve Repair for Infective Endocarditis in Children

Posterior Chordal Cutting in Rheumatic Mitral Regurgitation Due to Hypomobility of the Posterior Leaflet Antonio Maria Calafiore, MD, Ibrahim Farah,

Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification Tomoya Uchimuro, MD, Toshihiro Fukui, MD, Atsushi Shimizu, MD, Shuichirou Takanashi,

J. Scott Rankin, MD, Ricardo E. Orozco, Tracey L. Rodgers, David D

Preservation of Anterior and Posterior Leaflet in Mitral Valve Replacement With a Tilting- Disc Valve Joong H Choh The Annals of Thoracic Surgery Volume.

Simplified nonresectional leaflet remodeling mitral valve repair for degenerative mitral regurgitation Y. Joseph Woo, MD, John W. MacArthur, MD The.

The Annals of Thoracic Surgery

The Impact of New Technology on Cardiothoracic Surgical Practice

Artificial mitral valve chordae replacement made simple

Selecting patients with mitral regurgitation and left ventricular dysfunction for isolated mitral valve surgery Constance K. Haan, MD, Cristina I. Cabral,

Absence of Posterior Mitral Leaflet With Secundum Atrial Septal Defect

Papillary muscle sling: a new functional approach to mitral repair in patients with ischemic left ventricular dysfunction and functional mitral regurgitation

Evelio Rodriguez, MD, L. Wiley Nifong, MD, Michael W. A

Masakazu Aoki, MD, Toshiaki Ito, MD, PhD

Repair of Left Ventricular Inflow Tract Lesions in Shone's Anomaly: Valve Growth and Long-Term Outcome Eva Maria B. Delmo Walter, MD, PhD, Richard Van.

Presentation transcript:

Impact of Failed Mitral Clipping on Subsequent Mitral Valve Operations Stephan Geidel, MD, Michael Schmoeckel, MD The Annals of Thoracic Surgery Volume 97, Issue 1, Pages 56-63 (January 2014) DOI: 10.1016/j.athoracsur.2013.07.038 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Technique of clip explantation. (A) For regular clip explantation, the lock harness was passed with a 4-0 Gore-Tex suture. (B) A conventional suction tube was pushed toward the clip by pulling the suture. Two forceps were used to open the arms and the grippers. (C) Open clip that is still connected to a nitinol wire. The Annals of Thoracic Surgery 2014 97, 56-63DOI: (10.1016/j.athoracsur.2013.07.038) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Intraoperative findings after multiple clip implantations. (A) Mitral valve area reduction and tissue damage after implantation of 4 clips in an 81-year-old woman (European System for Cardiac Operative Risk Evaluation II, 89%) 2 hours before. Five segments are involved, P2/P1, and the anterior commissure (AC), A1/A2. The valve was resected because of the obvious seriousness of the tissue damage. (B and C) Damage of segments P2/P3, the posterior commissure (PC), and A3/A2 after implantation of 3 clips in a 64-year-old man with a left ventricular ejection fraction of 0.25 and a prior operation; artificial atrial septal defect (ASD) with a dimension of about 10 mm. The Annals of Thoracic Surgery 2014 97, 56-63DOI: (10.1016/j.athoracsur.2013.07.038) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Acute artificial lesions 10 days after unsuccessful clip-intervention in a 78-year old woman with chronic ischemic MV-disease and a global myocardial remodelling process (European System for Cardiac Operative Risk Evaluation II, 45%). The large figure shows that the clip is fixed only at the posterior P2-segment and that there are artificial lesions at the A1- and A2-segments where the clip had unsuccessfully grasped the anterior leaflet tissue. The clipping had moreover caused a leaflet perforation at the P2-segment. Small figures: After explanting the clip, anterior and posterior leaflet repair was performed with (top left inset) 5-0-Cardionyl-sutures and (bottom left inset) conventional ring annuloplasty was done using a 3-dimensional configured ring (size 26) for moderate down-sizing to reduce the anterior/posterior annulus dimension adequately. Even if the clip-explantation technique was applied as described above, the clip could not be opened regularly in this patient (the bottom right inset shows that the clip is still closed). The Annals of Thoracic Surgery 2014 97, 56-63DOI: (10.1016/j.athoracsur.2013.07.038) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Leaflet perforation. (A) Findings in a 74-year-old woman with functional mitral regurgitation (left ventricular ejection fraction: 0.30, reoperation) 11 days after implantation of 2 clips, with severe inflammation of the posterior leaflet and the posterior annulus with additional perforation in the P2 segment. (B) Intraoperative findings 193 days after implantation of 2 MitraClips in a 72-year-old man with functional mitral regurgitation showing leaflet perforation in the segments P2/P3 and A2 chordal rupture. (C) After resection of the valve, the ventricular side became visible: the clips were intensely in-grown, and therefore, it was impossible to explant them properly. The Annals of Thoracic Surgery 2014 97, 56-63DOI: (10.1016/j.athoracsur.2013.07.038) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Mitral repair leaving an in-grown clip in a 69-year-old man with cardiomyopathy. (A) Findings 133 days after regular clip implantation with inadequate reduction of the anterior/posterior dimension of the annulus and the attempted implantation of a second clip. Note the deterioration with tissue damage and chordal-rupture 6 days before. (B and C) For mitral repair, the implanted clip was preserved, and annuloplasty was performed in which the annulus was downsized with a 2-dimensional ring (size 30). The Annals of Thoracic Surgery 2014 97, 56-63DOI: (10.1016/j.athoracsur.2013.07.038) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Impact of clip number on mitral repair. Whereas mitral repair was feasible in most patients with only 1 clip implant, the probability for reconstruction was greatly reduced with a second clip (p = 0.0188, Wilcoxon–Mann-Whitney test). The Annals of Thoracic Surgery 2014 97, 56-63DOI: (10.1016/j.athoracsur.2013.07.038) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions