[HSF] MV Repair Failure

Sun Sep 2 03:52:33 EDT 2007

References below

Flamengs 2003 paper lists some risk factors for failure including non-use of annuloplasty, non-use of sliding plasty, use of flexible bands and chordal shortening.

Ani

Braunberger E, Deloche A, Berrebi A, Abdallah F, Celestin JA, Meimoun P, et al. Very long-term results (more than 20 years) of valve repair with carpentier's techniques in nonrheumatic mitral valve insufficiency. Circulation 2001 Sep 18;104(12 Suppl 1):I8-11.

Flameng W, Herijgers P, Bogaerts K. Recurrence of mitral valve regurgitation after mitral valve repair in degenerative valve disease. Circulation 2003 Apr 1;107(12):1609-13.

David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse. J Thorac Cardiovasc Surg 2005 Nov;130(5):1242-9.

Flameng W, Meuris B, Herijgers P, Herregods MC. Durability of mitral valve repair in Barlow's disease versus fibroelastic deficiency. J Thorac Cardiovasc Surg 2007 in press.

> From: damle at cableone.net> To: OpenHeart-L at lists.hsforum.com> Date: Sat, 1 Sep 2007 18:52:26 -0500> CC: > Subject: [HSF] MV Repair Failure> > Ani, and Forum members,> > Can you quote the references for these?> 1. Incidence of MR after repair> 2. Re-operation after repair> 3.Rosk factors for these.> > Thanks!> > Ajit> > > > > > -----Original Message-----> From: openheart-l-bounces at lists.hsforum.com> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ani Anyanwu> Sent: Saturday, September 01, 2007 5:39 PM> To: openheart-l at lists.hsforum.com> Subject: RE: AW: [HSF] Mitral Repair with a Calcified Annulus> > Hal> > I don't think your recurrences are an inordinate number, but the fact is> that the ordinate number is not insignificant. We have to come clean about> this when counselling patients for degenerative mitral valve repair - the> reality is at least 20% will have recurrent MR within 10 to 15 years. At> least this is what all the best available data show. If you do not know of> any recurrences, they are either undiagnosed or simply not being brought to> your attention. In the Mayo series remember over half were due to> progression of natural disease which is invariable in some patients.> > > In the fibroelastic deficiency case, however, i would argue that sliding> plasty should not be a tool to allow a more aggressive resection but rather> if one needs a sliding plasty in fibroelastic disease for the purpose of> achieving reapposition then it means the resection was too excessive. The> solution is not sliding plasty but not to over resect. If tissue is limited> in P1 and P3 the resection should probably be minimal (even triangular)> resecting part and not al of P2 and if the residual reapposed leaflet is> unsupported then it can be resuspended with other means (chordal transfer or> gortex). Remember that if you read Jebara's original paper on sliding> plasty, the whole essence was to prevent SAM by reducing leaflet height and> not to allow more aggressive resection.> > Dr Adams still plicates the annulus but is doing much less resection and> plication than he used to - he now believes that the end result probably> matters much more than the means used to achieve it, which is a change in> thinking since our last mitral course. The proviso however is that the end> results meet the essential Carpentier principles of restoring geometry and> adequate surface of coaptation, so I would not say he is any less> Carpenterian!> > Ani> > > > > > From: Hgrmd at aol.com> Date: Fri, 31 Aug 2007 21:50:54 -0400> Subject: Re:> AW: [HSF] Mitral Repair with a Calcified Annulus> To:> OpenHeart-L at lists.hsforum.com> CC: > > Ani,> I've no idea how many actual> significant recurrences I've had, because, > like nearly every surgeon,> followup is incomplete. However, I feel confident > that if there were an> inordinate number, this would have been brought to my > attention long ago.> > I disagree that sliding plasty would almost never be needed for FED if >> resection was undertaken. Sliding plasty isn't done just to reduce the> height > of the posterior leaflet. It's also done if a large prolapsed> section of the > posterior leaflet is removed so that the annulus isn't> distorted by a > quadrangular resection. Using the sliding plasty, up to 50%> of the posterior > leaflet can be resected. > On a related topic, does Dr.> Adams still use that vertical compression > stitch technique in addition to> the horizontal compression sutures when doing a > sliding plasty? I saw him> use this at the Sinai valve meeting last October. > I understand the logic> of further reducing the amount of annulus to be > covered with the slide,> but it sure looked like the potential for kinking the > circumflex would be> significant.> BTW, the fact that you say Adams now uses resuspension more> frequently is > a testament to where things are headed. I guess he's no> longer solely > "drinking the Kool-Aid" of Carpentier.> > Hal> > > >> ************************************** Get a sneak peek of the all-new AOL> at > http://discover.aol.com/memed/aolcom30tour>> _______________________________________________> OpenHeart-L mailing list> >> Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to> CHANGE email address, or to view archives:>> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted> by the OpenHeart-L are subject to the policies and > disclaimers posted at:>> http://www.hsforum.com/listdisclaim>> -----------------------------------------> _________________________________________________________________> 100's of Music vouchers to be won with MSN Music> https://www.musicmashup.co.uk_______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------> > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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