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Surgical mitral valve repair technique considerations based on the available evidence

Mitral valve regurgitation is the second most common valve disease in the western world. Surgery is currently the best tool for generating a long-lasting elimination of mitral valve regurgitation. However, the mitral valve apparatus is a complex anatomical and functional structure, and repair result...

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Autores principales: Can, Tolga, Kirov, Hristo, Caldonazo, Tulio, Mukharyamov, Murat, Färber, Gloria, Doenst, Torsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bayçınar Medical Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473589/
https://www.ncbi.nlm.nih.gov/pubmed/36168574
http://dx.doi.org/10.5606/tgkdc.dergisi.2022.23340
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author Can, Tolga
Kirov, Hristo
Caldonazo, Tulio
Mukharyamov, Murat
Färber, Gloria
Doenst, Torsten
author_facet Can, Tolga
Kirov, Hristo
Caldonazo, Tulio
Mukharyamov, Murat
Färber, Gloria
Doenst, Torsten
author_sort Can, Tolga
collection PubMed
description Mitral valve regurgitation is the second most common valve disease in the western world. Surgery is currently the best tool for generating a long-lasting elimination of mitral valve regurgitation. However, the mitral valve apparatus is a complex anatomical and functional structure, and repair results and durability show substantial heterogeneity. This is not only due to differences in the underlying mitral valve regurgitation pathophysiology but also due to differences in repair techniques. Repair philosophies differ substantially from one surgeon to the other, and consensus for the technically best repair strategy has not been reached yet. We had previously addressed this topic by suggesting that ring sizing is "voodoo". We now review the available evidence regarding the various repair techniques described for structural and functional mitral valve regurgitation. Herein, we illustrate that for structural mitral valve regurgitation, resuspension of prolapsing valve segments or torn chordae with polytetrafluoroethylene sutures and annuloplasty can generate the most durable results paired with the best achievable hemodynamics. For functional mitral valve regurgitation, the evidence suggests that annuloplasty alone is insufficient in most cases to generate durable results, and additional subvalvular strategies are associated with improved durability and possibly improved clinical outcomes. This review addresses current strategies but also implausibilities in mitral valve repair and informs the mitral valve surgeon about the current evidence. We believe that this information may help improve outcomes in mitral valve repair as the heterogeneity of mitral valve regurgitation pathophysiology does not allow a one-size-fits-all concept.
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spelling pubmed-94735892022-09-26 Surgical mitral valve repair technique considerations based on the available evidence Can, Tolga Kirov, Hristo Caldonazo, Tulio Mukharyamov, Murat Färber, Gloria Doenst, Torsten Turk Gogus Kalp Damar Cerrahisi Derg Review Article Mitral valve regurgitation is the second most common valve disease in the western world. Surgery is currently the best tool for generating a long-lasting elimination of mitral valve regurgitation. However, the mitral valve apparatus is a complex anatomical and functional structure, and repair results and durability show substantial heterogeneity. This is not only due to differences in the underlying mitral valve regurgitation pathophysiology but also due to differences in repair techniques. Repair philosophies differ substantially from one surgeon to the other, and consensus for the technically best repair strategy has not been reached yet. We had previously addressed this topic by suggesting that ring sizing is "voodoo". We now review the available evidence regarding the various repair techniques described for structural and functional mitral valve regurgitation. Herein, we illustrate that for structural mitral valve regurgitation, resuspension of prolapsing valve segments or torn chordae with polytetrafluoroethylene sutures and annuloplasty can generate the most durable results paired with the best achievable hemodynamics. For functional mitral valve regurgitation, the evidence suggests that annuloplasty alone is insufficient in most cases to generate durable results, and additional subvalvular strategies are associated with improved durability and possibly improved clinical outcomes. This review addresses current strategies but also implausibilities in mitral valve repair and informs the mitral valve surgeon about the current evidence. We believe that this information may help improve outcomes in mitral valve repair as the heterogeneity of mitral valve regurgitation pathophysiology does not allow a one-size-fits-all concept. Bayçınar Medical Publishing 2022-04-27 /pmc/articles/PMC9473589/ /pubmed/36168574 http://dx.doi.org/10.5606/tgkdc.dergisi.2022.23340 Text en Copyright © 2022, Turkish Society of Cardiovascular Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Review Article
Can, Tolga
Kirov, Hristo
Caldonazo, Tulio
Mukharyamov, Murat
Färber, Gloria
Doenst, Torsten
Surgical mitral valve repair technique considerations based on the available evidence
title Surgical mitral valve repair technique considerations based on the available evidence
title_full Surgical mitral valve repair technique considerations based on the available evidence
title_fullStr Surgical mitral valve repair technique considerations based on the available evidence
title_full_unstemmed Surgical mitral valve repair technique considerations based on the available evidence
title_short Surgical mitral valve repair technique considerations based on the available evidence
title_sort surgical mitral valve repair technique considerations based on the available evidence
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473589/
https://www.ncbi.nlm.nih.gov/pubmed/36168574
http://dx.doi.org/10.5606/tgkdc.dergisi.2022.23340
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