medigraphic.com
ISSN 2448-5640 (Print)
Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2018, Number 3

<< Back Next >>

Cir Card Mex 2018; 3 (3)

Reparación valvular mitral en enfermedad degenerativa: 100% de efectividad

García-Villarreal OA

Language: Spanish
References: 21
Page: 78-85
PDF size: 507.34 Kb.


ABSTRACT

Degenerative mitral valve regurgitation si amenable to be repaired in nearly all cases. Standardization in surgical techniques allows a very important improvement in respect thereof. We show herein a series of cases underwent mitral valve repair with 100% of successful utilizing standardized techniques.
Material. Fourteen patiens undergoing mitral valve repair mostly due to degenerative mitral regurgitation. From October 2015 to May 2018, all of them were operated on by applying the "French Correction" principles. All cases were performed at several private hospitals.
Results. Mitral repair was achieved in 100% of cases, with no residual or recurrent regurgitation › 1 after more than two years of follow-up. There was no operative or late mortality. The etiology of pure mitral regurgitation was degenerative in 85.7%, and chronic ischemic in 14.3%. No cases for rheumatic etiology. Most cases had P2 prolapse (78.5%). Cuadrangular resection, gap closure and annuloplasty ring was the standardized technique for posterior prolapse. An anuloplasty prosthetic complete ring was inserted in all cases. There were no cases for recurrent or residual mitral regurgitation from 3 months to 2.5 years follow-up.
Conclusions. Mitral valve repair is feasible to successfully perform in 100% of cases of degenerative disease, especially in type II prolapse in P2 segment. The standardization of surgical techniques, with the least possible variation, allows this degree of excellence in the final results. The use of a complete prosthetic ring for mitral annuloplasty is a key element in mitral valve repair.


REFERENCES

  1. Carpentier A. Reconstructive valvuloplasty. A new technique of mitral valvuloplasty.Presse Med 1969;77:251-3.

  2. Carpentier A, Deloche A, Dauptain J, et al. A new reconstructive operation for correctionof mitral and tricuspid insufficiency. J Thorac Cardiovasc Surg 1971;61:1-13.

  3. Carpentier A. Cardiac valve surgery--the "French correction". J Thorac CardiovascSurg 1983;86:323-37.

  4. Comunicación personal 1993. Dr. Héctor Pérez-Redondo Ramírez

  5. Carpentier A, Chauvaud S, Fabiani JN, et al. Reconstructive surgery of mitralvalve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg. 1980;79:338-48.

  6. David TE. Durability of mitral valve repair for mitral regurgitation due to degenerativemitral valve disease. Ann Cardiothorac Surg 2015;4:417-21.

  7. Correia PM, Coutinho GF, Branco C, Garcia A, Antunes MJ. Surgical Treatmentof Posterior Mitral Valve Prolapse: Towards 100% Repair. J Heart Valve Dis2015;24:752-9.

  8. Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repairfor degenerative disease. J Thorac Cardiovasc Surg 1998;116:734-43.

  9. Fucci C, Sandrelli L, Pardini A, Torracca L, Ferrari M, Alfieri O. Improved resultswith mitral valve repair using new surgical techniques. Eur J Cardiothorac Surg1995;9:621-6.

  10. Bolling SF, Pagani FD, Deeb GM, Bach DS. Intermediate-term outcome of mitralreconstruction in cardiomyopathy. J Thorac Cardiovasc Surg 1998;115:381-6.

  11. Li B, Wu H, Sun H, et al. Predicting functional mitral stenosis after restrictive annuloplastyfor ischemic mitral regurgitation. Cardiol J. 2018 Mar 7. doi: 10.5603/CJ.a2018.0023. [Epub ahead of print]

  12. Perier P, Hohenberger W, Lakew F, Diegeler A. Prolapse of the posterior leaflet:resect or respect. Ann Cardiothorac Surg 2015;4:273-7.

  13. Spratt JA. Non-resectional repair of myxomatous mitral valve disease: the 'AmericanCorrection'. J Heart Valve Dis 2011;20:407-14.

  14. Lawrie GM. 'American correction' resembles the 'respect or resect' approach. JHeart Valve Dis 2012; 21:686-7.

  15. Aubert S, Flecher E. Is an anterior mitral leaflet prolapse still a challenge? ArchCardiovasc Dis 2010;103:192-5.

  16. Bortolotti U, Milano AD, Frater RW. Mitral valve repair with artificial chordae:a review of its history, technical details, long-term results, and pathology. AnnThorac Surg 2012;93:684-91.

  17. David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylenesutures for mitral valve repair: a 25-year experience. J Thorac CardiovascSurg 2013;145:1563-9.

  18. Garcia-Villarreal OA. eComment. Let's get real: the problem is how to safely measurethe neochordae. Interact Cardiovasc Thorac Surg 2015;20:469.

  19. David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. A comparison of outcomesof mitral valve repair for degenerative disease with posterior, anterior, andbileaflet prolapse. J Thorac Cardiovasc Surg 2005;130:1242-9.

  20. Castillo JG, Anyanwu AC, Fuster V, Adams DH. A near 100% repair rate for mitralvalve prolapse is achievable in a reference center: implications for future guidelines.J Thorac Cardiovasc Surg 2012; 144:308-12.

  21. García-Villarreal OA, Heredia-Delgado JA. Left atrial appendage in rheumaticmitral valve disease: The main source of embolism in atrial fibrillation. Arch CardiolMex 2017;87:286-91.




2020     |     www.medigraphic.com