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dc.contributor.authorHashim, Sabet W
dc.contributor.authorYoussef, Samuel J
dc.contributor.authorAyyash, Bassem
dc.contributor.authorRousou, Anthony J
dc.contributor.authorRagnarsson, Sigurdur
dc.contributor.authorCollazo, Susan
dc.contributor.authorGeirsson, Arnar
dc.date.accessioned2013-08-23T11:43:46Z
dc.date.available2013-08-23T11:43:46Z
dc.date.issued2012-04
dc.date.submitted2013-08-23
dc.identifier.citationJ. Thorac. Cardiovasc. Surg. 2012, 143(4 Suppl):S33-7en_GB
dc.identifier.issn1097-685X
dc.identifier.pmid22050989
dc.identifier.doi10.1016/j.jtcvs.2011.09.063
dc.identifier.urihttp://hdl.handle.net/2336/299646
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links field.en_GB
dc.description.abstractRecurrence rates as high as 30% have been observed 6 months after treatment of chronic ischemic mitral regurgitation (CIMR) with isolated annuloplasty. We postulated that the high early recurrence rates resulted from the presence of untreated pseudoprolapse of the anterior leaflet. We conducted a retrospective study of all mitral valve repairs for CIMR performed by a single surgeon (S.W.H.) from 1995 to 2011. After annuloplasty, Gore-Tex neochordae were added if the high-pressure saline test indicated the presence of pseudoprolapse of the anterior leaflet. A total of 47 patients underwent mitral valve repair for CIMR. Of the 47 patients, 24 (51%) were found to have pseudoprolapse requiring the addition of neochordae. For all patients, the average age was 65.1 years, and 65.2% were men. Fourteen (30%) had had a preoperative intra-aortic balloon pump placed by cardiologists. Fourteen (30%) had severe pulmonary hypertension. Concomitant coronary artery bypass grafting was performed in 40 patients, with an average of 2.2 grafts; 7 had previously undergone coronary artery bypass grafting. Mitral Carpentier-Edwards physio annuloplasty rings were used in all patients with a mean size of 29 mm. One patient died postoperatively. Follow-up data were available for all 47 patients at an average of 4.9 years. The 5-year survival rate was 82.5%. The mean pre- and postoperative New York Heart Association class, ejection fraction, and mitral regurgitation grade were 3 and 1.52 (P < .0001), 34% and 41% (P = .0006), and 3.51 and 1.08 (P < .0001), respectively. Two patients developed greater than moderate mitral regurgitation. Effective repair of CIMR should include surgical techniques to correct pseudoprolapse of the anterior leaflet, when present. The selective addition of Gore-Tex neochordae to an undersized annuloplasty nearly eliminates recurrent regurgitation after mitral valve repair for CIMR.
dc.language.isoenen
dc.relation.urlhttp://dx.doi.org/10.1016/j.jtcvs.2011.09.063en_GB
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S0022522311010828en_GB
dc.rightsArchived with thanks to The Journal of thoracic and cardiovascular surgeryen_GB
dc.subject.meshAgeden_GB
dc.subject.meshChronic Diseaseen_GB
dc.subject.meshConnecticuten_GB
dc.subject.meshCoronary Artery Bypassen_GB
dc.subject.meshEchocardiography, Transesophagealen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHeart Valve Prosthesis Implantationen_GB
dc.subject.meshHumansen_GB
dc.subject.meshKaplan-Meier Estimateen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMitral Valveen_GB
dc.subject.meshMitral Valve Annuloplastyen_GB
dc.subject.meshMitral Valve Insufficiencyen_GB
dc.subject.meshMitral Valve Prolapseen_GB
dc.subject.meshMyocardial Ischemiaen_GB
dc.subject.meshPredictive Value of Testsen_GB
dc.subject.meshRecurrenceen_GB
dc.subject.meshReoperationen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titlePseudoprolapse of the anterior leaflet in chronic ischemic mitral regurgitation: identification and repair.en
dc.typeArticleen
dc.contributor.departmentSection of Cardiac Surgery, Yale University School of Medicine, New Haven, CT 06520, USA. sabet.hashim@yale.eduen_GB
dc.identifier.journalJournal of thoracic and cardiovascular surgeryen_GB
dc.rights.accessNational Consortium - Landsaðganguren
html.description.abstractRecurrence rates as high as 30% have been observed 6 months after treatment of chronic ischemic mitral regurgitation (CIMR) with isolated annuloplasty. We postulated that the high early recurrence rates resulted from the presence of untreated pseudoprolapse of the anterior leaflet. We conducted a retrospective study of all mitral valve repairs for CIMR performed by a single surgeon (S.W.H.) from 1995 to 2011. After annuloplasty, Gore-Tex neochordae were added if the high-pressure saline test indicated the presence of pseudoprolapse of the anterior leaflet. A total of 47 patients underwent mitral valve repair for CIMR. Of the 47 patients, 24 (51%) were found to have pseudoprolapse requiring the addition of neochordae. For all patients, the average age was 65.1 years, and 65.2% were men. Fourteen (30%) had had a preoperative intra-aortic balloon pump placed by cardiologists. Fourteen (30%) had severe pulmonary hypertension. Concomitant coronary artery bypass grafting was performed in 40 patients, with an average of 2.2 grafts; 7 had previously undergone coronary artery bypass grafting. Mitral Carpentier-Edwards physio annuloplasty rings were used in all patients with a mean size of 29 mm. One patient died postoperatively. Follow-up data were available for all 47 patients at an average of 4.9 years. The 5-year survival rate was 82.5%. The mean pre- and postoperative New York Heart Association class, ejection fraction, and mitral regurgitation grade were 3 and 1.52 (P < .0001), 34% and 41% (P = .0006), and 3.51 and 1.08 (P < .0001), respectively. Two patients developed greater than moderate mitral regurgitation. Effective repair of CIMR should include surgical techniques to correct pseudoprolapse of the anterior leaflet, when present. The selective addition of Gore-Tex neochordae to an undersized annuloplasty nearly eliminates recurrent regurgitation after mitral valve repair for CIMR.


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