Minimally invasive fibrillating mitral valve replacement for patients with advanced cardiomyopathy: A safe and effective approach to treat a complex problem

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 5; pp. 2045 - 2051.e1
• Main Authors: Brittain, Evan L., MD, Goyal, Sandeep K., MD, Sample, Matthew A., MD, Leacche, Marzia, MD, Absi, Tarek S., MD, Papa, Frank, PhD, Churchwell, Keith B., MD, Ball, Stephen, MD, Byrne, John G., MD, Maltais, Simon, MD, PhD, Petracek, Michael R., MD, Mendes, Lisa, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014
• Subjects: Aged; Cardiomyopathies - complications; Cardiomyopathies - diagnosis; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; Cardiothoracic Surgery; Disease-Free Survival; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Minimally Invasive Surgical Procedures; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - therapy; Recurrence; Risk Factors; Severity of Illness Index; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; Ventricular Function, Right; Ventricular Pressure; Ventricular Remodeling; 22; NYHA; LV ejection fraction; RV; right ventricular; MR; mitral regurgitation; MV replacement; LVEF; minimally invasive fibrillating mitral valve replacement; MVR; MV; LV; 36.2; New York Heart Association; mini-MVR; STS; Society of Thoracic Surgeons; mitral valve; MVA; left ventricular; 18.1; MV annuloplasty; 35.4
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2013.10.062

Objective The optimal management of mitral regurgitation (MR) in patients with cardiomyopathy has been controversial. Minimally invasive fibrillating mitral valve replacement (mini-MVR) might limit postoperative morbidity and mortality by minimizing recurrent MR. We hypothesized that mini-MVR with complete chordal sparing would offer low mortality and halt left ventricular (LV) remodeling in patients with severe cardiomyopathy and severe MR. Methods From January 2006 to August 2009, 65 patients with an LV ejection fraction (LVEF) of ≤35% underwent mini-MVR. The demographic, echocardiographic, and clinical outcomes were analyzed. Results The operative mortality compared with the Society of Thoracic Surgeons-predicted mortality was 6.2% versus 6.6%. It was 5.6% versus 7.4% for patients with an LVEF of ≤20% and 8.3% versus 17.9% among patients with a Society of Thoracic Surgeons-predicted mortality of ≥10%. At a median follow-up of 17 months, no recurrent MR or change in the LV dimensions or LVEF had developed, but the right ventricular systolic pressure had decreased ( P  = .02). At the first postoperative visit and latest follow-up visit, the New York Heart Association class had decreased from 3.0 ± 0.6 to 1.7 ± 0.7 and 2.0 ± 1.0, respectively ( P  < .0001 for both). Patients with an LVEF of ≤20% and LV end-diastolic diameter of ≥6.5 cm were more likely to meet a composite of death, transplantation, or LV assist device insertion ( P  = .046). Conclusions Our results have shown that mini-MVR is safe in patients with advanced cardiomyopathy and resulted in no recurrent MR, stabilization of the LVEF and LV dimensions, and a decrease in right ventricular systolic pressure. This mini-MVR technique can be used to address severe MR in patients with advanced cardiomyopathy.