Advertisement

Autologous pericardial patch leaflet augmentation in the setting of mitral valve repair

  • J. Chikwe
  • A.B. Goldstone
  • A. Akujuo
  • J. Castillo
  • D.H. Adams

Abstract

Mitral valve repair is the standard of care for correction of significant mitral regurgitation for a wide range of etiologies as it confers a significant survival advantage in selected patients, has demonstrated equivalent or superior durability compared to bioprosthetic replacement particularly in young patients, reduces the thromboembolic complications of mechanical replacement, and avoids the need for anticoagulation. Leaflet augmentation with glutaraldehydefixed autologous pericardium is a useful adjunct when there is insufficient leaflet tissue to produce a reliable repair using standard techniques, as it is a cheap and readily available substrate with excellent resistance to infection and calcific degeneration. Autologous pericardial patch augmentation has been described in the setting of rheumatic mitral insufficiency, ischemic mitral regurgitation, endocarditis, congenital mitral valve disease, and re-repair. Here, we provide a brief overview of the historical background, a technical description of our approach to mitral valve repair requiring pericardial patch leaflet augmentation, followed by a summary of the operative technique and results reported according to etiology.

Keywords

Mitral Valve Mitral Regurgitation Mitral Valve Repair Anterior Leaflet Posterior Leaflet 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bonow RO, Carabello BA, Kanu C, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114:e84–e231PubMedCrossRefGoogle Scholar
  2. 2.
    Romano MA, Patel HJ, Pagani FD, Prager RL, Deeb GM, Bolling SF (2005) Anterior leaflet repair with patch augmentation for mitral regurgitation. Ann Thorac Surg 79:1500–1504; discussion 1504Google Scholar
  3. 3.
    Kincaid EH, Riley RD, Hines MH, Hammon JW, Kon ND (2004) Anterior leaflet augmentation for ischemic mitral regurgitation. Ann Thorac Surg 78:564–568; discussion 568Google Scholar
  4. 4.
    Ushijima T, Kikuchi Y, Takata M, Yamamoto Y, Kawachi K, Watanabe G (2009) Commissural autologous pericardial patch repair: a novel technique for active mitral valve endocarditis involving the mitral annulus. Ann Thorac Surg 88:e29–e30PubMedCrossRefGoogle Scholar
  5. 5.
    Chauvaud S, Fuzellier JF, Houel R, Berrebi A, Mihaileanu S, Carpentier A (1998) Reconstructive surgery in congenital mitral valve insufficiency (Carpentier’s techniques): long-term results. J Thorac Cardiovasc Surg 115:84–92; discussion 93PubMedCrossRefGoogle Scholar
  6. 6.
    Suri RM, Schaff HV, Dearani JA, et al. (2006) Recurrent mitral regurgitation after repair: should the mitral valve be re-repaired? J Thorac Cardiovasc Surg 132:1390–1397PubMedCrossRefGoogle Scholar
  7. 7.
    van der Spuy JC (1972) Mitral valve pericardioplasty—a long-term follow-up study. Thorax 27:207–211PubMedCrossRefGoogle Scholar
  8. 8.
    Carpentier A (2007) Lasker Clinical Research Award. The surprising rise of nonthrombogenic valvular surgery. Nat Med 13:1165–1168PubMedCrossRefGoogle Scholar
  9. 9.
    Vincentelli A, Zegdi R, Prat A, et al. (1998) Mechanical modifications to human pericardium after a brief immersion in 0.625% glutaraldehyde. J Heart Valve Dis 7:24–29PubMedGoogle Scholar
  10. 10.
    Anyanwu AC, Adams DH (2007) The intraoperative »ink test«: a novel assessment tool in mitral valve repair. J Thorac Cardiovasc Surg 133:1635–1636PubMedCrossRefGoogle Scholar
  11. 11.
    Chauvaud S, Jebara V, Chachques JC, et al. (1991) Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair. J Thorac Cardiovasc Surg 102:171–177; discussion 177–178Google Scholar
  12. 12.
    Zegdi R, Debieche M, Latremouille C, et al. (2005) Long-term results of mitral valve repair in active endocarditis. Circulation 111:2532–2536PubMedCrossRefGoogle Scholar
  13. 13.
    Aubert S, Flecher E, Rubin S, Acar C, Gandjbakhch I (2007) Anterior mitral leaflet augmentation with autologous pericardium. Ann Thorac Surg 83:1560–1561PubMedCrossRefGoogle Scholar
  14. 14.
    Zegdi R, Khabbaz Z, Chauvaud S, Latremouille C, Fabiani JN, Deloche A (2007) Posterior leaflet extension with an autologous pericardial patch in rheumatic mitral insufficiency. Ann Thorac Surg 84:1043–1044PubMedCrossRefGoogle Scholar
  15. 15.
    Chauvaud S, Fuzellier JF, Berrebi A, Deloche A, Fabiani JN, Carpentier A (2001) Long-term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency. Circulation 104:I12–I15PubMedCrossRefGoogle Scholar
  16. 16.
    Gillinov AM, Cosgrove DM, Lytle BW, et al. (1997) Reoperation for failure of mitral valve repair. J Thorac Cardiovasc Surg 113:467–473; discussion 473–475Google Scholar
  17. 17.
    Oppido G, Davies B, McMullan DM, et al. (2008) Surgical treatment of congenital mitral valve disease: midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg 135:1313–1320; discussion 1320–1321Google Scholar
  18. 18.
    Carpentier A, Adams DH, Filsoufi F (2010) Carpentier’s Valve Reconstruction. ElsevierGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • J. Chikwe
    • 1
  • A.B. Goldstone
    • 1
  • A. Akujuo
    • 1
  • J. Castillo
    • 1
  • D.H. Adams
    • 1
  1. 1.Department of Cardiothoracic SurgeryMount Sinai School of MedicineNew York, NYUSA

Personalised recommendations