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Advances in Mitral Valve Surgery

  • Valvular Heart Disease (J Dal-Bianco, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Mitral valve (MV) insufficiency, classified as primary and secondary mitral regurgitation (MR), is a common cause of morbidity and mortality. In industrialized countries, degenerative forms are the predominant cause of MR; however, an increasing number of patients present with secondary MR (Iung et al. EHJ 24:1231–1243, 2003). During the last decades, MV surgery experienced substantial advancements. Alain Carpentier pioneered the field of reconstructive valve surgery in the beginning of the 1970s and, since then, a plethora of innovations have led to today’s landscape of MV surgery. Modern MV repair techniques including minimally invasive approaches represent the gold standard for primary MR with reconstruction rates of > 97% in high-volume reference centers (Castillo et al. JTCS 144(2):308–312, 2012). Although there is a clear strategy for treatment of primary MR with established high-quality results, the optimal course for treatment of secondary MR remains controversial. Results for a variety of MV repair techniques for secondary MR have been uniformly disappointing and there has been a recent resurgence in interest for MV replacement surgery. Innovations in equipment and imaging have led to the development of new techniques for patients with MV disease. High-risk patients who are poor candidates for surgery have been the focus for most of these techniques, usually within the construct of a multidisciplinary heart team. Efforts have been predominantly focused on less invasive strategies, usually transcatheter technologies, in these high-risk patients. This article aims to give an overview about current surgical treatment options for primary and for secondary MR with special focus on new surgical and transcatheter developments.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Iung B, Baron G, Butchart EG. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J. 2003;24:1231–43.

    Article  PubMed  Google Scholar 

  2. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006 Sep 16;368(9540):1005–11.

  3. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J. 2010;31(16):1958–66.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chikwe J, Adams DH. State of the art: degenerative mitral valve disease. Heart Lung Circ. 2009;18(5):319–29.

    Article  PubMed  Google Scholar 

  5. Ling LH, Enriquez-Sarano M, Seward JB, Tajik AJ, Schaff HV, Bailey KR, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. 1996;335(19):1417–23.

    Article  PubMed  CAS  Google Scholar 

  6. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352(9):875–83.

    Article  PubMed  CAS  Google Scholar 

  7. Enriquez-Sarano M, Schaff HV, Orszulak TA, Tajik AJ, Bailey KR, Frye RL. Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995;91(4):1022–8.

    Article  PubMed  CAS  Google Scholar 

  8. Jokinen JJ, Hippeläinen MJ, Pitkänen OA, Hartikainen JE. Mitral valve replacement versus repair: propensity-adjusted survival and quality-of-life analysis. Ann Thorac Surg. 2007;84(2):451–8.

    Article  PubMed  Google Scholar 

  9. Anyanwu AC, Itagaki S, Chikwe J, El-Eshmawi A, Adams DH. A complexity scoring system for degenerative mitral valve repair. J Thorac Cardiovasc Surg. 2016 Jun;151(6):1661–70.

  10. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2017;135(25):e1159–95.

    Article  PubMed  Google Scholar 

  11. Suri RM, Vanoverschelde JL, Grigioni F, Schaff HV, Tribouilloy C, Avierinos JF, et al. Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA. 2013;310(6):609–16.

    Article  PubMed  CAS  Google Scholar 

  12. Goldstone AB, Patrick WL, Cohen JE, Aribeana CN, Popat R, Woo YJ. Early surgical intervention or watchful waiting for the management of asymptomatic mitral regurgitation: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2015;4(3):220–9.

    PubMed  PubMed Central  Google Scholar 

  13. Carpentier A. Cardiac valve surgery—the “French correction”. J Thorac Cardiovasc Surg. 1983;86(3):323–37.

    PubMed  CAS  Google Scholar 

  14. 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;130(5):1242–9.

    Article  PubMed  Google Scholar 

  15. David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: a 25-year experience. J Thorac Cardiovasc Surg. 2013;145(6):1563–9.

    Article  PubMed  Google Scholar 

  16. Oppell UO, Mohr FW. Chordal replacement for both minimally invasive and conventional mitral valve surgery using premeasured Gore-Tex loops. Ann Thorac Surg. 2000;70(6):2166–8.

    Article  Google Scholar 

  17. Seeburger J, Borger MA, Doll N, Walther T, Passage J, Falk V, et al. Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg. 2009;36(3):532–8.

    Article  PubMed  Google Scholar 

  18. Seeburger J, Borger MA, Falk V, Kuntze T, Czesla M, Walther T, et al. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg. 2008;34(4):760–5.

    Article  PubMed  Google Scholar 

  19. Marin Cuartas M, Javadikasgari H, Pfannmueller B, Seeburger J, Gillinov AM, Suri RM, et al. Mitral valve repair: robotic and other minimally invasive approaches. Prog Cardiovasc Dis. 2017;60(3):394–404.

    Article  PubMed  Google Scholar 

  20. Gillinov AM, Mihaljevic T, Javadikasgari H, Suri RM, Mick SL, Navia JL, et al. Early results of robotically assisted mitral valve surgery: analysis of the first 1000 cases. J Thorac Cardiovasc Surg. 2017;S0022-5223(17):31581–7.

    Google Scholar 

  21. Suri RM, Dearani JA, Mihalievic T, Chitwood W Jr, Murphy DA, Trento A, et al. Mitral valve repair using robotic technology: safe, effective and durable. J Thorac Cardiovasc Surg. 2016;151:1450–4.

    Article  PubMed  Google Scholar 

  22. Levine RA, Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation. 2005;112(5):745–58.

    Article  PubMed  Google Scholar 

  23. •• Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P, et al. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med. 2014;370(1):23–32. This multicenter, randomized trial failed to demonstrate a significant benefit of MV repair over replacement with regards to LV remodeling or other major outcomes in patients with severe ischemic MR. MV repair patients had a much higher incidence of recurrent MR during follow up.

    Article  PubMed  CAS  Google Scholar 

  24. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease: The task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017;38:2739–91.

    Article  PubMed  Google Scholar 

  25. Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol. 2015;65(12):1231–48.

    Article  PubMed  Google Scholar 

  26. Spoor MT, Geltz A, Bolling SF. Flexible versus nonflexible mitral valve rings for congestive heart failure: differential durability of repair. Circulation. 2006;114(1 Suppl):I67–71.

    PubMed  Google Scholar 

  27. De Bonis M, Lapenna E, Barili F, Nisi T, Calabrese M, Pappalardo F, et al. Long-term results of mitral repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: does the technique matter? Eur J Cardiothorac Surg. 2016;50(5):882–9.

    Article  PubMed  Google Scholar 

  28. Goldstein D, Moskowitz AJ, Gelijns AC, Ailawadi G, Parides MK, Perrault LP, et al. CTSNTwo-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med. 2016;374(4):344–53.

    Article  PubMed  CAS  Google Scholar 

  29. Maisano F, Torracca L, Oppizzi M, Stefano PL, D’Addario G, La Canna G, et al. The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg. 1998;13(3):240–5.

    Article  PubMed  CAS  Google Scholar 

  30. Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011;364(15):1395–406.

    Article  PubMed  CAS  Google Scholar 

  31. Glower DD, Kar S, Trento A, Lim DS, Bajwa T, Quesada R, et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 2014;64(2):172–81.

    Article  PubMed  Google Scholar 

  32. • Feldman T, Kar S, Elmariah S, Smart SC, Trento A, Siegel RJ, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol. 2015;66(25):2844–54. Five-year results of this multicenter, randomized trial demonstrated less recurrent MR and MV reoperation in the conventional surgery group when compared to MitraClip. LV reverse remodeling was slightly better in the surgery group, but quality of life was similar.

    Article  PubMed  Google Scholar 

  33. Maisano F, Franzen O, Baldus S, Schäfer U, Hausleiter J, Butter C, et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol. 2013;62(12):1052–61.

    Article  PubMed  Google Scholar 

  34. Seeburger J, Rinaldi M, Nielsen SL, Salizzoni S, Lange R, Schoenburg M, et al. Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation: the TACT Trial (Transapical Artificial Chordae Tendinae) proof of concept. J Am Coll Cardiol. 2014;63(9):914–9.

    Article  PubMed  Google Scholar 

  35. Colli A, Manzan E, Zucchetta F, Bizzotto E, Besola L, Bagozzi L, et al. Transapical off-pump mitral valve repair with neochord implantation: early clinical results. Int J Cardiol. 2016;204:23–8.

    Article  PubMed  Google Scholar 

  36. Gammie JS, Wilson P, Bartus K, Gackowski A, Hung J, D’Ambra MN, et al. Transapical beating-heart mitral valve repair with an expanded polytetrafluoroethylene cordal implantation device: initial clinical experience. Circulation. 2016;134(3):189–97.

    Article  PubMed  CAS  Google Scholar 

  37. Siminiak T, Wu JC, Haude M, Hoppe UC, Sadowski J, Lipiecki J, et al. Treatment of functional mitral regurgitation by percutaneous annuloplasty: results of the TITAN Trial. Eur J Heart Fail. 2012;14(8):931–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Lipiecki J, Siminiak T, Sievert H, Müller-Ehmsen J, Degen H, Wu JC, et al. Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial. Open Heart. 2016;3(2):e000411.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Nickenig G, Hammerstingl C, Schueler R, Topilsky Y, Grayburn PA, Vahanian A, et al. Transcatheter mitral annuloplasty in chronic functional mitral regurgitation: 6-month results with the cardioband percutaneous mitral repair system. JACC Cardiovasc Interv. 2016;9(19):2039–47.

    Article  PubMed  Google Scholar 

  40. Nickenig G, Schueler R, Dager A, Martinez Clark P, Abizaid A, Siminiak T, et al. Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. J Am Coll Cardiol. 2016;67(25):2927–36.

    Article  PubMed  Google Scholar 

  41. Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Schofer N, Eschenbach L, et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed Annuloplasty rings. J Am Coll Cardiol. 2017;70(9):1121–31.

    Article  PubMed  Google Scholar 

  42. Guerrero M, Dvir D, Himbert D, Urena M, Eleid M, Wang DD, et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcification: Results From the First Multicenter Global Registry. JACC Cardiovasc Interv. 2016;9(13):1361–71.

    Article  PubMed  Google Scholar 

  43. Muller DW, Farivar RS, Jansz P, Bae R, Walters D, Clarke A, et al. Transcatheter mitral valve replacement for patients with symptomatic mitral regurgitation: a global feasibility trial. J Am Coll Cardiol. 2017;69(4):381–91.

    Article  PubMed  Google Scholar 

  44. Castillo JG, Anyanwu AC, Fuster V, Adams DH. A near 100% repair for future guidelines. J Thorac Cardiovasc Surg. 2012;144(2):308–12.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany

    Sabine Meier MD, Joerg Seeburger MD, PhD & Michael A. Borger MD, PhD

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  1. Sabine Meier MD
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  2. Joerg Seeburger MD, PhD
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  3. Michael A. Borger MD, PhD
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Correspondence to Michael A. Borger MD, PhD.

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This article is part of the Topical Collection on Valvular Heart Disease

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Meier, S., Seeburger, J. & Borger, M.A. Advances in Mitral Valve Surgery. Curr Treat Options Cardio Med 20, 75 (2018). https://doi.org/10.1007/s11936-018-0666-3

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