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Mitral Valve Anatomy and Current Surgical and Percutaneous Approaches to Mitral Regurgitation

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Atlas of Percutaneous Edge-to-Edge Mitral Valve Repair

Abstract

The mitral valve apparatus consists of numerous anatomic elements which must interact in a coordinated manner to ensure normal leaflet movement and coaptation. Specifically, pathologies of the mitral annulus, chordae tendineae, papillary muscles, left ventricle, and left atrium can all result in mitral regurgitation (MR). In this chapter, we review current surgical and emerging percutaneous approaches for MR correction, with specific attention to anatomic targets for therapy, as well as the challenges faced by percutaneous techniques.

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References

  1. Kaji S, Nasu M, Yamamuro A, et al. Annular geometry in patients with chronic ischemic mitral regurgitation: three-dimensional magnetic resonance imaging study. Circulation. 2005;112(9 Suppl):I409–14.

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  4. Barlow JB, Pocock WA. The significance of late systolic murmurs and mid-late systolic clicks. Md State Med J. 1963;12:76–7.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  6. 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.

    CAS  PubMed  Google Scholar 

  7. Seeburger J, Falk V, Borger MA, et al. Chordae replacement versus resection for repair of isolated posterior mitral leaflet prolapse: a egalite. Ann Thorac Surg. 2009;87(6):1715–20.

    PubMed  Google Scholar 

  8. Bax JJ, Braun J, Somer ST, et al. Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. Circulation. 2004;110(11 Suppl 1):II103–8.

    PubMed  Google Scholar 

  9. Wu AH, Aaronson KD, Bolling SF, Pagani FD, Welch K, Koelling TM. Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol. 2005;45(3):381–7.

    PubMed  Google Scholar 

  10. Hung J, Papakostas L, Tahta SA, et al. Mechanism of recurrent ischemic mitral regurgitation after annuloplasty: continued LV remodeling as a moving target. Circulation. 2004;110(11 Suppl 1):II85–90.

    PubMed  Google Scholar 

  11. Marwick TH. Restrictive annuloplasty for ischemic mitral regurgitation: too little or too much? J Am Coll Cardiol. 2008;51(17):1702–3.

    PubMed  Google Scholar 

  12. McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004;128(6):916–24.

    PubMed  Google Scholar 

  13. Braun J, van de Veire NR, Klautz RJ, et al. Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg. 2008;85(2):430–6; discussion 436–7.

    PubMed  Google Scholar 

  14. Magne J, Pibarot P, Dagenais F, Hachicha Z, Dumesnil JG, Senechal M. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation. 2007;115(6):782–91.

    PubMed  Google Scholar 

  15. Calafiore AM, Gallina S, Di Mauro M, et al. Mitral valve procedure in dilated cardiomyopathy: repair or replacement? Ann Thorac Surg. 2001;71(4):1146–52; discussion 1152–53.

    CAS  PubMed  Google Scholar 

  16. Bleumink GS, Knetsch AM, Sturkenboom MC, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure. The Rotterdam Study. Eur Heart J. 2004;25(18):1614–9.

    PubMed  Google Scholar 

  17. Mirabel M, Iung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358–65.

    PubMed  Google Scholar 

  18. O’Brien SM, Shahian DM, Filardo G, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2–isolated valve surgery. Ann Thorac Surg. 2009;88(1 Suppl):S23–42.

    PubMed  Google Scholar 

  19. Chiam PT, Ruiz CE. Percutaneous transcatheter mitral valve repair: a classification of the technology. JACC Cardiovasc Interv. 2011;4(1):1–13.

    PubMed  Google Scholar 

  20. Rogers JH, Franzen O. Percutaneous edge-to-edge MitraClip therapy in the management of mitral regurgitation. Eur Heart J. 2011;32(19):2350–7.

    PubMed  Google Scholar 

  21. Alfieri O, Maisano F, De Bonis M, et al. The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg. 2001;122(4):674–81.

    CAS  PubMed  Google Scholar 

  22. Maisano F, La Canna G, Colombo A, Alfieri O. The evolution from surgery to percutaneous mitral valve interventions: the role of the edge-to-edge technique. J Am Coll Cardiol. 2011;58(21):2174–82.

    PubMed  Google Scholar 

  23. Bhudia SK, McCarthy PM, Smedira NG, Lam BK, Rajeswaran J, Blackstone EH. Edge-to-edge (Alfieri) mitral repair: results in diverse clinical settings. Ann Thorac Surg. 2004;77(5):1598–606.

    PubMed  Google Scholar 

  24. De Bonis M, Lapenna E, La Canna G, et al. Mitral valve repair for functional mitral regurgitation in end-stage dilated cardiomyopathy: role of the “edge-to-edge” technique. Circulation. 2005;112(9 Suppl):I402–8.

    PubMed  Google Scholar 

  25. Maisano F, Schreuder JJ, Oppizzi M, Fiorani B, Fino C, Alfieri O. The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique. Eur J Cardiothorac Surg. 2000;17(3):201–5.

    CAS  PubMed  Google Scholar 

  26. Maisano F, Torracca L, Oppizzi M, et al. The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg. 1998;13(3):240–5; discussion 245–6.

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  28. Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg. 1998;116(5):734–43.

    CAS  PubMed  Google Scholar 

  29. DiBardino DJ, ElBardissi AW, McClure RS, Razo-Vasquez OA, Kelly NE, Cohn LH. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome. J Thorac Cardiovasc Surg. 2010;139(1):76–83; discussion 83–4.

    PubMed  Google Scholar 

  30. Maisano F, Vigano G, Blasio A, Colombo A, Calabrese C, Alfieri O. Surgical isolated edge-to-edge mitral valve repair without annuloplasty: clinical proof of the principle for an endovascular approach. EuroIntervention. 2006;2(2):181–6.

    PubMed  Google Scholar 

  31. Magne J, Girerd N, Senechal M, et al. Mitral repair versus replacement for ischemic mitral regurgitation: comparison of short-term and long-term survival. Circulation. 2009;120(11 Suppl):S104–11.

    CAS  PubMed  Google Scholar 

  32. Argenziano M, Skipper E, Heimansohn D, et al. Surgical revision after percutaneous mitral repair with the MitraClip device. Ann Thorac Surg. 2010;89(1):72–80; discussion p. 80.

    PubMed  Google Scholar 

  33. Rogers JH, Yeo KK, Carroll JD, et al. Late surgical mitral valve repair after percutaneous repair with the MitraClip system. J Card Surg. 2009;24(6):677–81.

    PubMed  Google Scholar 

  34. Glower D, Young JN, Alexander J, et al. EVEREST II randomized clinical trial: a critical assessment of anatomical predictors of de novo mitral valve replacement or following the MitraClip procedure. J Am Coll Cardiol. 2010;56(13, Supplement 1):B25.

    Google Scholar 

  35. Webb JG, Maisano F, Vahanian A, et al. Percutaneous suture edge-to-edge repair of the mitral valve. EuroIntervention. 2009;5(1):86–9.

    PubMed  Google Scholar 

  36. Maselli D, Guarracino F, Chiaramonti F, Mangia F, Borelli G, Minzioni G. Percutaneous mitral annuloplasty: an anatomic study of human coronary sinus and its relation with mitral valve annulus and coronary arteries. Circulation. 2006;114(5):377–80.

    PubMed  Google Scholar 

  37. Tops LF, Van de Veire NR, Schuijf JD, et al. Noninvasive evaluation of coronary sinus anatomy and its relation to the mitral valve ­annulus: implications for percutaneous mitral annuloplasty. Circulation. 2007;115(11):1426–32.

    PubMed  Google Scholar 

  38. Schofer J, Siminiak T, Haude M, et al. Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARILLON Mitral Annuloplasty Device European Union Study. Circulation. 2009;120(4):326–33.

    PubMed  PubMed Central  Google Scholar 

  39. Webb JG, Harnek J, Munt BI, et al. Percutaneous transvenous mitral annuloplasty: initial human experience with device implantation in the coronary sinus. Circulation. 2006;113(6):851–5.

    PubMed  Google Scholar 

  40. Harnek J, Webb JG, Kuck KH, et al. Transcatheter implantation of the MONARC coronary sinus device for mitral regurgitation: 1-year results from the EVOLUTION phase I study (Clinical Evaluation of the Edwards Lifesciences Percutaneous Mitral Annuloplasty System for the Treatment of Mitral Regurgitation). JACC Cardiovasc Interv. 2011;4(1):115–22.

    PubMed  Google Scholar 

  41. Sack S, Kahlert P, Bilodeau L, et al. Percutaneous transvenous mitral annuloplasty: initial human experience with a novel coronary sinus implant device. Circ Cardiovasc Interv. 2009;2(4):277–84.

    PubMed  Google Scholar 

  42. Kim JH, Kocaturk O, Ozturk C, et al. Mitral cerclage annuloplasty, a novel transcatheter treatment for secondary mitral valve regurgitation: initial results in swine. J Am Coll Cardiol. 2009;54(7):638–51.

    PubMed  PubMed Central  Google Scholar 

  43. Rogers JH, Macoviak JA, Rahdert DA, Takeda PA, Palacios IF, Low RI. Percutaneous septal sinus shortening. A novel procedure for the treatment of functional mitral regurgitation. Circulation. 2006;113(19):2329–32.

    PubMed  Google Scholar 

  44. Palacios IF, Condado JA, Brandi S, et al. Safety and feasibility of acute percutaneous septal sinus shortening: first-in-human experience. Catheter Cardiovasc Interv. 2007;69(4):513–8.

    PubMed  Google Scholar 

  45. Burr LH, Krayenbuhl C, Sutton MS. The mitral plication suture: a new technique of mitral valve repair. J Thorac Cardiovasc Surg. 1977;73(4):589–95.

    CAS  PubMed  Google Scholar 

  46. Aybek T, Risteski P, Miskovic A, et al. Seven years’ experience with suture annuloplasty for mitral valve repair. J Thorac Cardiovasc Surg. 2006;131(1):99–106.

    PubMed  Google Scholar 

  47. Nagy ZL, Bodi A, Vaszily M, Szerafin T, Horvath A, Peterffy A. Five-year experience with a suture annuloplasty for mitral valve repair. Scand Cardiovasc J. 2000;34(5):528–32.

    CAS  PubMed  Google Scholar 

  48. Heuser RR, Witzel T, Dickens D, Takeda PA. Percutaneous treatment for mitral regurgitation: the QuantumCor system. J Interv Cardiol. 2008;21(2):178–82.

    PubMed  Google Scholar 

  49. Mishra YK, Mittal S, Jaguri P, Trehan N. Coapsys mitral annuloplasty for chronic functional ischemic mitral regurgitation: 1-year results. Ann Thorac Surg. 2006;81(1):42–6.

    PubMed  Google Scholar 

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Correspondence to Jason Rogers M.D., FACC, FSCAI .

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Rogers, J., Franzen, O., Bolling, S.F. (2013). Mitral Valve Anatomy and Current Surgical and Percutaneous Approaches to Mitral Regurgitation. In: Feldman, T., Franzen, O., Low, R., Rogers, J., Yeo, K.K. (eds) Atlas of Percutaneous Edge-to-Edge Mitral Valve Repair. Springer, London. https://doi.org/10.1007/978-1-4471-4294-2_1

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  • DOI: https://doi.org/10.1007/978-1-4471-4294-2_1

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