How to Do A Mitral Valve Repair for Rheumatic Valve Disease Taweesak Chotivatanapong, MD. AATS 2015:...
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Transcript of How to Do A Mitral Valve Repair for Rheumatic Valve Disease Taweesak Chotivatanapong, MD. AATS 2015:...
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How to Do A Mitral Valve Repair for Rheumatic Valve Disease
Taweesak Chotivatanapong, MD. AATS 2015: Adult Cardiac Skills Course
25th April 2015 Seattle, USA.
Department of CVT Surgery, Central Chest Institute of Thailand Nonthaburi, Thailand.
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• Goals of MV Repair• To restore normal mitral dynamics BOTH
Diastole and Systole.
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• Focus :• Rheumatic : MS MR : MS
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Severe MS with Large LA Clot
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Severe MS with very severe Subvalvular Fibrosis
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Severe Calcified MS
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MS MR Post PBMV
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Long Term Fate of Autologous Pericardium
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• Rheumatic Mitral Valve Repair : Current Approaches and Results at Central Chest Institute of Thailand
• Taweesak Chotivatanapong, MD.
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Between March 2003 – June 2014
420♦ patients : RHD MV repair
MR : 157 , MS MR : 178 , MS : 85 ♦
F : 271 M : 149 , AV age : 46.05 y ♦
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• Follow up :• Range : 11 Y 3 m – 1 m• Lost FU: 22 patients• Mean : Overall : 35.65 m• MR : 43.93 m• MS MR : 18.40 m• MS : 20.10 m
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Pre-op. Post-opLVEDD 52.93 47.99
LVESD 36.22 33.75
EF 58.95 57.97
MR 2.47 0.19 MVA
1.78 2.33
NYHA FC 2.35 1.15
Technique 5.45
P.O Mean gradient 4.96 Max gradient 9.11
Overall
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Pre-op. Post-opLVEDD 59.32 49.76
LVESD 39.27 35.94
EF 60.86 55.37
MR 2.81 0.23
MVA 3.31 2.28
NYHA FC 2.44 1.17
Technique 4.13
PO . Mean gradient 4 Max. gradient 7.08
MR
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Pre-op. Post-opLVEDD 50.75 47.08
LVESD 35.38 32.51
EF 57.83 58.27
MR 2.19 0.18
MVA 1.31 2.62
NYHA FC 2.27 1.12
Technique 6.21
PO. Mean gradient 5.24 Max. gradient 9.32
MS MR
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Pre-op. Post-opLVEDD 46.36 45.27
LVESD 32.61 30.55
EF 57.57 61.31
MR 1.21 0.2 MVA
1.02 1.78
NYHA FC 2.34 1.18
Technique 6.29
PO. Mean gradient 5.67 Max. gradient 10.42
MS
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Operations :MV repair = 137
MV repair + TV repair = 95
MV repair + MAZE = 67
MV repair + TV repair + MAZE = 62
MV repair + AVR + TV repair = 22
MV repair + AVR = 20
MV repair+ CABG = 7
MV repair+ TV repair + ASD = 2
MV repair + Other = 8
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• Results :• Hospital mortality = 8 (1.9% )• Late death : 6 ; 3 cardiac, 3 non-cardiac• Readmission• - Pericardial effusion 19 • - CHF 18• - Coumadin overdose 8• - Severe MR 3• - Transient CVA 1
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• Reoperation :
- Redo MVR 4 - Redo MV re-repair 2
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Current MV Repair Strategy• Restore sinus rhythm • Restore mobility : - Type I - 3 dimensional movements -Up& down, transverse , billowing• Tissue repair - Good quality and adequate tissue.• Coaptation surface• Remodelling of annulus
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Decision Making• We should try our best to repair rheumatic
MV especially in :• Young patients• Need for pregnancy• Poor compliance for medication• Inappropriate health care system• For those elderly with complex pathology,
high co-morbidity, MVR with bioprosthesis should be proceeded.
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Conclusion• Rheumatic inflammation affects every part of
MV complex.• Fibrotic with calcified mitral valve is a complex
pathology that impairs mitral dynamics BOTH diastole and systole.
• Rheumatic MS is often associated with severe tissue retraction and subvalvular problem that needs both tissue and chordal repair.
• Autologous pericardium and PTFE chordal replacement are useful and reliable tools.