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Impact of Surgical Techniques Used for Mitral Valve Repair on Hemodynamic Performance

Ragnarsson, Sigurdur LU (2017)
Abstract
Abstract
Background Mitral regurgitation (MR) has many etiologies; the most common is degenerative disease. If not corrected, severe MR may cause left and right ventricular heart failure. Mitral valve (MV) repair is the gold standard for treatment of MR. All repair techniques include MV annuloplasty, but various techniques are employed to repair the valvular apparatus. The classical technique of leaflet resection is associated with excellent results, but repair using artificial chordae is gaining popularity and has been shown to achieve similar results.
Aims (1) Does MV repair with artificial chordae correct the morphology and function of the MV better than leaflet resection? (2) How common are MR at rest and systolic anterior... (More)
Abstract
Background Mitral regurgitation (MR) has many etiologies; the most common is degenerative disease. If not corrected, severe MR may cause left and right ventricular heart failure. Mitral valve (MV) repair is the gold standard for treatment of MR. All repair techniques include MV annuloplasty, but various techniques are employed to repair the valvular apparatus. The classical technique of leaflet resection is associated with excellent results, but repair using artificial chordae is gaining popularity and has been shown to achieve similar results.
Aims (1) Does MV repair with artificial chordae correct the morphology and function of the MV better than leaflet resection? (2) How common are MR at rest and systolic anterior motion (SAM) when these techniques are compared
at rest and during physical exercise? (3) To what extent is the right ventricular function restored in patients with chronic MR after MV repair? (4) Is MV repair preferable for the surgical treatment of MV infective endocarditis?
Methods Study I: Retrospective study conducted in two centers that compares the results of MV repair using two different surgical techniques.
Studies II and III: Prospective studies of resting and exercise echocardiography in patients that had undergone MV repair with either artificial chordae or leaflet resection. Study III compares the hemodynamics and left ventricular
function of the repaired MV. Study IV evaluates the right ventricular function at rest and during exercise.
IV: Retrospective study of long term outcomes of patients with MV infective endocarditis (IE) who underwent surgical repair in Lund with different surgical techniques.
Results and importance
I: Both evaluated techniques for repair the MV were associated with good long-term survival and low incidence of recurrent MR, reoperation, IE and thromboembolism. No significant differences were detected between the groups.
II: Both surgical techniques were associated with low pressure gradients over the MV at rest and during exercise without any significant difference between the groups. The left ventricular function was well preserved and both groups had good exercise capacity.
III: At follow up, patients who underwent mitral valve repair had significantly worse RV function at rest and peak exercise than did healthy individuals.
IV: Mortality following surgery for mitral IE is high. Independent predictors of poor outcome are the preoperative symptoms of persisting fever, clinical stroke and heart failure and infection with S. aureus, diabetes mellitus, renal
failure and age. The surgical method (i.e. repair or prosthesis implantation) did not influence survival of IE. (Less)
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author
supervisor
opponent
  • Professor Pettersson, Gösta, Ohio
organization
publishing date
type
Thesis
publication status
published
subject
keywords
mitral valve repair, artificial chordae, outcome, right ventricular function, infective endocarditis, mitral valve repair, artificial chordae, right ventricular function, outcome, infective endocarditis
pages
94 pages
publisher
Lund University, Faculty of Medicine
defense location
Segerfalksalen, Wallenberg Neurocentrum, BMC, Lund.
defense date
2017-03-30 09:00
ISBN
978-91-7619-426-3
language
English
LU publication?
yes
id
562edf7d-b68c-4dc3-96b1-4467f4f29a35
date added to LUP
2017-03-23 20:03:50
date last changed
2017-03-27 11:39:52
@phdthesis{562edf7d-b68c-4dc3-96b1-4467f4f29a35,
  abstract     = {Abstract<br/>Background Mitral regurgitation (MR) has many etiologies; the most common is degenerative disease. If not corrected, severe MR may cause left and right ventricular heart failure. Mitral valve (MV) repair is the gold standard for treatment of MR. All repair techniques include MV annuloplasty, but various techniques are employed to repair the valvular apparatus. The classical technique of leaflet resection is associated with excellent results, but repair using artificial chordae is gaining popularity and has been shown to achieve similar results.<br/>Aims (1) Does MV repair with artificial chordae correct the morphology and function of the MV better than leaflet resection? (2) How common are MR at rest and systolic anterior motion (SAM) when these techniques are compared<br/>at rest and during physical exercise? (3) To what extent is the right ventricular function restored in patients with chronic MR after MV repair? (4) Is MV repair preferable for the surgical treatment of MV infective endocarditis?<br/>Methods Study I: Retrospective study conducted in two centers that compares the results of MV repair using two different surgical techniques.<br/>Studies II and III: Prospective studies of resting and exercise echocardiography in patients that had undergone MV repair with either artificial chordae or leaflet resection. Study III compares the hemodynamics and left ventricular<br/>function of the repaired MV. Study IV evaluates the right ventricular function at rest and during exercise.<br/>IV: Retrospective study of long term outcomes of patients with MV infective endocarditis (IE) who underwent surgical repair in Lund with different surgical techniques.<br/>Results and importance<br/>I: Both evaluated techniques for repair the MV were associated with good long-term survival and low incidence of recurrent MR, reoperation, IE and thromboembolism. No significant differences were detected between the groups.<br/>II: Both surgical techniques were associated with low pressure gradients over the MV at rest and during exercise without any significant difference between the groups. The left ventricular function was well preserved and both groups had good exercise capacity.<br/>III: At follow up, patients who underwent mitral valve repair had significantly worse RV function at rest and peak exercise than did healthy individuals.<br/>IV: Mortality following surgery for mitral IE is high. Independent predictors of poor outcome are the preoperative symptoms of persisting fever, clinical stroke and heart failure and infection with S. aureus, diabetes mellitus, renal<br/>failure and age. The surgical method (i.e. repair or prosthesis implantation) did not influence survival of IE.},
  author       = {Ragnarsson, Sigurdur},
  isbn         = {978-91-7619-426-3},
  keyword      = {mitral valve repair,artificial chordae,outcome,right ventricular function,infective endocarditis,mitral valve repair,artificial chordae,right ventricular function,outcome,infective endocarditis},
  language     = {eng},
  pages        = {94},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  title        = {Impact of Surgical Techniques Used for Mitral Valve Repair on Hemodynamic Performance},
  year         = {2017},
}