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One Hundred Percent Reparability of Degenerative Mitral Regurgitation: Intermediate- Term Results of a Dynamic Engineered Approach  Gerald M. Lawrie, MD,

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Presentation on theme: "One Hundred Percent Reparability of Degenerative Mitral Regurgitation: Intermediate- Term Results of a Dynamic Engineered Approach  Gerald M. Lawrie, MD,"— Presentation transcript:

1 One Hundred Percent Reparability of Degenerative Mitral Regurgitation: Intermediate- Term Results of a Dynamic Engineered Approach  Gerald M. Lawrie, MD, William Zoghbi, MD, Stephen Little, MD, Dipan Shah, MD, Zegit Ben-Zekry, MD, Nan Earle, MS, Elizabeth Earle, JD  The Annals of Thoracic Surgery  Volume 101, Issue 2, Pages (February 2016) DOI: /j.athoracsur Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Pathology of 161 patients who received a prosthetic mitral valve by year of operation between 1995 and No patient after 2001 had myxomatous (myx) or degenerative (deg) pathology. The annual incidence of each pathology is represented in each vertical bar by the various shadings of the sections shown on the right margin. (isch = ischemic; rheum = rheumatic.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 (Left) A fully flexible annuloplasty ring has been attached anteriorly to the margins of the aortic-mitral continuity. The left ventricle is inflated. The anterior portion of the ring is elevated upward and posteriorly, reflecting the effects of aortic root expansion and rotation. (Right) Three-dimensional annular tracking image of the mitral membrane extending superiorly to the aortic valve annulus. The red dotted line joins the fibrous trigones (large red dots). The black and red dotted line follows the curvature of the edge of the aortic-mitral continuity with the aortic root inflated. (A = anterior; Al = anterolateral commissure; Ao = aortic root; IVT = intervalvular triangle; LCS = left coronary sinus; NCS = noncoronary sinus; P = posterior; PL = posterolateral commissure.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 (A) Results of preoperative, predischarge, and postdischarge echocardiographic findings. Severity of mitral regurgitation (MR): MR0 = none, MR1 = mild, MR2 = moderate, MR3 = moderately severe; MR4 = severe. (B) Freedom from recurrent significant MR (3+, 4+) in 236 patients at 5 years by Kaplan-Meier analysis. Anterior, dotted-dashed line; both, dashed line; neither, dotted line; post, black line. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 (A) Kaplan-Meier analysis of probability of freedom from reoperation by leaflet repaired. (B) Kaplan-Meier analysis of probability of freedom from prosthetic valve replacement. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 In vitro preparation of porcine anterior mitral leaflet, annulus, left ventricular outflow tract and aortic root. The blue dots mark the trigone-to-trigone line of attachment and line of aorto-mitral continuity (above). The blue polypropylene knots are in the trigones. (Left) The flexible ring suture line is attached trigone-to-trigone. (Right) Ring attachment is to the aorto-mitral continuity. Systolic expansion of the aortic root and ascending aorta is simulated. On the left, the anterior leaflet and outflow tract are restrained from expansion and upward motion. Normal expansion and upward motion is seen on the right. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

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