This book is designed to illustrate contemporary and sometimes diverse surgical techniques for various types of mitral valve repair with contributions from many. Over the past few decades, it has become apparent that mitral valve repair is. Highvolume surgeons get best results with mitral valve surgery. The first section is entitled fundamentals and describes our understanding of mitral valve disease based on pathophysiological triad and carpentiers approach of valve analysis using functional classification. Several surgical procedures exist to repair or replace mitral valves, including openheart surgery or minimally invasive heart surgery. Simon swift, medical director of the small animal hospital at the university of floridas college of veterinary. Problems with the posterior leaflet are generally corrected by a small series of chords or a small resection of the abnormal portion of the valve. The mitral valve is the inflow valve for the left side of the heart.
Doctors may recommend surgery to repair or replace mitral valves for some people with mitral valve disease. In a few patients, another approach employing an incision over the middle of the chest for better exposure may be used. Successful aortic valve repair as opposed to savr would allow the patient to avoid anticoagulation as well as structural valve. Surgical repair of the mitral valve oxford medicine. Indications and surgical techniques for mitral valve repair. A novel approach to assess the threedimensional anatomy of a mitral valve. These techniques usually mimic wellknown surgical techniques. At nyu langones heart valve center, our physicians are internationally recognized for their expertise in minimally invasive mitral valve repair, including robotic mitral valve repair. At present, mitral repair is becoming the dominant procedure for treatment of virtually all patients with mitral valve disease. In the only randomized trial comparing mitral valve repair versus replacement for imr, the cardiothoracic surgical trials network allocated 251 patients with severe imr to mitral valve repair with restrictive annuloplasty n 126 or chordalsparing mitral valve.
On its own, the number of mitral valve surgeries doesnt necessarily predict that youll have a good repair. Mitral valve repair operative techniques in thoracic and. Operative mitral and tricuspid valve surgery narain. Atlas of cardiac surgical techniques sciencedirect. Both approaches are still considered openheart surgery. Reconstructive valve surgery encompasses a comprehensive system of valve analysis and related techniques based on three basic principles as described by alain carpentier and colleagues. It poses special surgical difficulties because of the wide spectrum of morphological abnormalities requiring meticulous modifications of the valve repair techniques, a high incidence of associated cardiac anomalies, and relatively limited experience in each.
Mcgoon of the mayo clinic in the journal of thoracic and cardiovascular surgery in 1960. The surgeon then inserts surgical instruments to access the heart and repair the valve. This book is distributed under the terms of the creative commons. Percutaneous mitral valve repair techniques sciencedirect. Randy martin take an indepth look at indications for mitral valve repair and the importance of durability.
Farzan filsoufi mitral disease mitral valve surgery. It aids the surgeon in the intraoperative evaluation of the mitral valve and in the assessment of both the immediate and longterm results of valve repair. Jan 20, 2019 a mitral valve replacement operation usually takes between three to five hours in which the patient is under general anesthesia and on the heartlung machine. Most patients with mitral valve prolapse do not have a leaky valve and do not require surgery. Chikwe adds that volume is used as a surrogate for expertise, but it doesnt tell the full story. Evolving concepts and technologies in mitral valve repair. Mar 02, 2015 the first mitral valve repair for mitral insufficiency was performed by dr.
You might be referred to a medical center with surgeons and a surgical team who have the needed expertise in conducting minimally invasive procedures. Initial surgical attempts to treat mitral insufficiency included maneuvers to block the regurgitant jet. The atlas provides an excellent illustrative guide to teach echocardiographicanatomic correlations and educates the reader on the techniques of mitral valve repair. Atlas of cardiac surgical techniques 9780323462945 us. Mitral valve surgery presents a detailed background of the mitral valve, its pathology, evaluation, repair and replacement from a range of experts in the field, providing a detailed reference for clinicians in cardiology, cardiac surgery. Mitral valve repair is the recommended surgical therapy for all prolapsing degenerative mitral valves. Mitral valve repair is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis narrowing or regurgitation leakage of the mitral valve. Outcomes from surgical edgetoedge repair francesco maisano.
Mitral valve replacement johns hopkins textbook of. Blood flows from the lungs and enters a pumping chamber of the heart called the left atrium. This chapter describes established and emerging percutaneous mitral valve repair techniques. The mitral valve is located between these two chambers. This book provides the fundamental background information to fuel interest, initiate novel prevention, refine surgical and therapeutic strategies, and inform the. Alternative approaches for mitral valve repair goldstone. Subsequently, the forerunner of the modern techniques for mitral valve repair was reported by dr. We offer treatments for a wide variety of heart valve conditions, using the most advanced and least invasive techniques available. During the procedure, the surgeon will remove the diseased mitral valve and replace it with a mechanical heart valve replacement or a bioprosthetic tissue heart valve replacement. According to the cleveland clinic, the mount sinai hospital, michigan medicine and northwestern medicine, mitral valve repair surgery is the preferred method of treatment. Although the standard of care for mitral valve mv pathology due to degenerative changes is surgical repair, patient outcomes depend on multiple factors including preoperative status, the severity of mitral regurgitation mr, the technique of repair and surgeon and center experience. Minimally invasive mitral valve surgery nova science publishers.
Different transcatheter mitral valve repair techniques have been developed over the past few years addressing the leaflets, the mitral annulus, or the left ventricle. Mitral valve repair dubai valve repair surgery abu dhabi. More patients were likely to be alive at one year if they had their mitral valve repair done by a highvolume surgeon. Minimally invasive heart surgery is a complex surgical procedure that requires training and experience. Mitral valve prolapse is diagnosed by echocardiography. The surgical techniques used for mitral valve repair varied according to the mitral valve morphology, and included annuloplasty, annuloplasty ring, cleft closure, reconstruction of the posterior. Mitral valve repair surgery does exist in several places outside of the usa. Pdf evolution of surgical techniques for mitral valve repair. After surgical mitral valve repair, it has been recommended that the zone of coaptation be at least 8 mm in length. The advantages of mitral valve repair over prosthetic replacement for degenerative mitral insufficiency are well established, including lower early and late mortality rates, superior preservation of left ventricular function, and greater freedom from thromboembolism, anticoagulantrelated complications, and endocarditis. The book minimally invasive mitral valve surgery describes the whole journey through the. Ng and coauthors is an extraordinary presentation of the relation between echocardiographic display of mitral valve pathology and reconstructive mitral valve surgery. Items that may help you relax, such as portable music players or books.
A damaged mitral valve often can be repaired, and its common for mitral valve repair to be performed using a minimally invasive approach, rather than with a sternotomy incision. Mitral valve disease should be regularly monitored by your physician so that both of you can determine the best course of treatment. The severity of mitral insufficiency can sometimes be reduced with medications, however the most definitive treatment involves surgical repair of the valve or replacement with a prosthetic valve. Dec 21, 2017 mitral valve repair is the recommended surgical therapy for all prolapsing degenerative mitral valves. Mitral valve repair mvr surgery has some advantages over mitral. How to help dogs with mitral valve disease fidose of reality. Improved visualization of valves through the robot and the ability to perform complex repair techniques have increased repair. Physicians, at that time, rebuked his concept because it was thought that heart failure in mitral stenosis was because of myocardial. Targeting the papillary muscles in mitral valve repair for. Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart. Mitral valve repair an overview sciencedirect topics.
Mitral valve repair the biological solution roland hetzer. Choosing the best surgical techniques for mitral valve. Mitral valve repair is mainly used to treat stenosis narrowing or regurgitation leakage of the mitral valve aortic valve repair. Surgeons choose from a wide variety of mitral repair techniques, with the. Repair of the mv is feasible in more than 95% of such patients and restores valve function and preserve ventricular function. What are the indications for surgical repair of a leaking mitral valve. A new era in surgery was introduced as well as the reality of mitral valve repair.
The pathophysiology of mitral regurgitation blase a. Minimally invasive treatment of mitral valve disease. Mitral valve repair surgery wont be available in the united states any time soon, but dr. Aortic valve repair is a surgical procedure used to correct some aortic valve disorders as an alternative to aortic valve replacement. Minimally invasive mitral valve surgery mimvs is technically challenging with a learning curve of 75125 cases, and aspects of the procedure such as a 4 cm incision, no rib spreading, endoaortic balloon occlusion and a totally thoracoscopic technique. There are two treatment options available for patients with severe mitral valve disease mitral valve repair and mitral valve replacement. Percutaneous mitral leaflet repair 1st edition free books. Blood flows from the lungs, where it picks up oxygen, through the pulmonary veins, to the left atrium of the heart. Patients agree to surgical mitral valve repair earlier when they realize they can get back to work after two weeks. He performed more than 500 mitral valve repairs and described new repair techniques such as the papillary muscle repositioning for anterior leaflet and posterior commissural prolapse. Several surgical procedures exist to repair or replace mitral valves. Chief in cardiac surgery, g pasquinucci heart hospital, massa, italy. Then a doctor sutures together the edges and cinches the circumference of the valve with an annuloplasty band to support the valve, as shown in the bottom image. The second section, disease specific approach, analyzes the stateoftheart knowledge of predominant etiologies of mitral valve disease.
Both approaches are techniques that prove extremely useful in unique situations, namely surgery in which the left ventricle must be opened, or in cases of aortic valve. In the only randomized trial comparing mitral valve repair versus replacement for imr, the cardiothoracic surgical trials network allocated 251 patients with severe imr to mitral valve repair with restrictive annuloplasty n 126 or chordalsparing mitral valve replacement n 125. When a valve with prolapse has a severe leak, surgery should be considered. The indications for mv replacement in mitral stenosis are the following.
The success of mitral valve repair in treating mitral regurgitation has prompted the development of repair techniques for aortic regurgitation. Surgical management of mitral valve disease in infants and children has been a major therapeutic challenge for many years. Surgical repair of the dysfunctional mitral valve dates back to the early twentieth century when several surgeons developed techniques to try to correct mitral stenosis. Physicians, at that time, rebuked his concept because it was thought that heart failure in mitral. Although the benefits of mitral valve repair surgery outweigh the use of mitral valve replacement devices, most surgeons are not profiicient at mitral valve repair techniques. Medications may provide symptomatic relief for lowtomoderate mitral valve stenosis, but once mitral valve disease becomes severe, surgical repair or replacement of the valve or a transcatheter heart valve. Treatment for mitral valve disease depends on the severity of your condition. Mitral valve repair and the recently published aortic root surgery are book publications arising from the berlin heart valve symposium 2008 entitled the biological solution. Five surgical techniques can repair 95 percent of degenerative mitral valves. An overview of the literature on surgical mitral valve repair sophie jones, michael argenziano, allan schwartz. The present article describes two efficient, unconventional approaches for mitral valve surgery through which surgeons may repair or replace the mitral valve. Oct 14, 2017 indications for minimally invasive surgical mitral valve repair mr is the secondmost frequent indication for valve surgery in europe. Evolution of the concept and practice of mitral valve repair.
The goal of any percutaneous procedure is to achieve a durable correction of mitral disease with clinical efficacy similar to that of wellestablished open surgical. In the united states, mitral valve surgery on dogs does not exist. Mitral valve posterior leaflet prolapse valve repair surgery. Aortic valve repair is performed less often and is more technically difficult than mitral valve repair. These advances in diagnosis, surgical treatment, and followup have shown mitral valve repair to be the procedure of choice for many patients with mitral valve. Mitral valve repair surgery surgical techniques cleveland clinic surgeons have been instrumental in the development and application of modern mitral valve repair techniques. Next, the surgical techniques used for valve repair for different mitral pathologies are summarized, in particular the use of leaflet resection or neochordae for. Current american heart associationamerican college of cardiology guidelines state that mitral valve repair for asymptomatic patients with preserved left ventricular function is reasonable when the likelihood of a successful and durable repair is greater than 95%, with an expected mortality rate of less than 1% when performed at a heart valve. Mitral valve disease treatments northwestern medicine.
If you have mitral valve regurgitation, your doctor may recommend one of several treatments. Cardiothoracic surgeons at nyu langone are often able to repair the mitral valve using minimally invasive techniques that involve a small incision on the right side of the chest, either above or below the breast. This book is designed to illustrate contemporary and sometimes diverse surgical techniques for various types of mitral valve repair. Mitral valve surgery has evolved over 4 decades from one based on the. Mitral valve repair in mitral valve repair, a doctor removes the portion of the mitral valve that doesnt close properly, as shown in the top image. Surgical teams at nyu langone have developed advanced repair techniques. In many cases, the mitral valve can be repaired by reconstructing the native valve. Indications for surgery as well as different surgical approaches including different repair techniques and valve replacement to correct tricuspid valve regurgitation are discussed in detail.
For this reason, it is extremely important that patients take the time to find the right surgeon to perform a mitral valve repair procedure. This approach begins with identification of the anatomic locations of prolapse and the application of five core repair techniques. The minimallyinvasive roboticassisted valve surgery uses even smaller incisions. The evolution of the surgical treatment for mitral valve disease began in 1902, when brunton1 became frustrated by the morbid prognosis of patients with mitral stenosis and suggested the feasibility of a surgical approach to an obviously stenotic mitral valve. Chapter 9 is a new chapter from earlier editions of practical perioperative transoesophageal echocardiography. Carpentier established a new era in heart valve surgery. Mitral valve repair surgery saved our dog harper news vin. Walton lillehei at the university of minnesota in 1957 3,4. We studied 185 propensitymatched patient pairs 370 patients undergoing isolated conventional open vs robotic mitral valve repair with identical repair techniques and care teams between july 1. This video demonstrates a systematic approach to mitral valve repair, which is utilized at the cleveland clinic to repair the vast majority of degenerative mitral valve cases. All prolapsing valves are repairable while using minimally invasive surgical techniques. A transcatheter approach for tricuspid valve repair or replacement is attractive, desirable, and beneficial to this highrisk population as an. Evolution of surgical techniques for mitral valve repair. Mitral valve repair procedure details cleveland clinic.
In many cases, the mitral valve can be repaired by reconstructing the native valve tissues to restore normal valvular structure and function. Mr wells has the largest experience in the united kingdom and among the largest in the world with over 3,000 cases completed achieving a near 100% repair rate for leaking mitral. His specialist area of cardiac surgical interest is the management of all forms of heart valve disease, especially mitral valve reconstruction. Mitral valve repair and the recently published aortic root surgery are book publications arising from the berlin heart valve.
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