COMMENTS ON MV Regargitation Surgery

Sotirios Prapas, MD, FECTS

MITRAL APPARATUS FUNCTION

THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)

The Mitral Apparatus function is based on interaction of 3

components, which are shaped as letter

“J”.

Pathology: Non functional MV

Regurgitation, Dilated Cardiomyopathy.

MITRAL APPARATUS PATHOLOGY

THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)

COMPONENTS: A) LEAFLETS & ANNULUS

THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)

MITRAL APPARATUS PATHOLOGY

Pathology: Post Ischemic

Mitral Valve Regurgitation.

COMPONENTS: B) LV WALL

THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)

COMPONENTS:

C) PAPILLARY MUSCLES

Pathology:

Post Ischemic

Papillary Muscle interruption.

MITRAL APPARATUS PATHOLOGY

Νormal

Degenerative

Reumatic

Endocarditis

MITRAL APPARATUS PATHOLOGY

A) NON FUNCTIONAL MITRAL

REGURGITATION

➢ The disease comes first, the regurgitation follows.

SURGERY

SURGERYTECHNIQUES for degenerative pathologies

Quadrantectomy Chords

Rings

P2 P3P1

P2P3P1 X

XXX

XX

LP

A

B

Scallops suture when chords are Scallops suture when chords are elongatedelongated

Fig. 1

SURGERYU- Callafiore Technique

SURGERYTECHNIQUES for degenerative pathologies

U- Technique

November 2013 – October 2014 ►Multi-center Study ►103 patients ►Isolated PL prolapse : 83 ►Bileaflet prolapse: 20 ►Median sternotomy in 82 cases ►Small right thoracotomy in 20 cases ►Robotic approach in one case

AATS Mitral conclave, April 2015

► EF was 55±7%. ► Mean MR grade (1 to 4) was 3.7±0.5. ► There was one in-hospital death due to

pneumonia (1%). ► No patient showed systolic anterior motion.

RESULTS

► At discharge, mean EF was 54±8%. ►Mean MR was 0.2±0.3, with 4 patients showing

MR grade 1. ► At follow-up evaluation (82 pts at 1-11 months),

EF was 55 + 6 %, MR was 0.3+ 0.5. ► All patients who underwent non-sternotomy

approaches had no residual MR.

RESULTS

MITRAL APPARATUS PATHOLOGY

B) FUNCTIONAL (DILATED) MITRAL REGURGITATION

➢ The regurgitation comes first, the disease follows.

➢ Unilateral PM displacement is typically present when a scar involves the myo- cardium around the posterior PM with or without the PM itself.

UNILATERAL

Post Ischemic (IMR)

CAB + MVRepair + Stem Cells 11 Cases

Henry Dunant Hospital

CAB + MVRepair + Stem Cells 11 Cases

Henry Dunant Hospital

CAB + MVRepair + Cells + Ablation 1 Case

Henry Dunant Hospital

Preop

Ischemic MV Regurgitation (IMR)Reshaping of lateral wall

Preop

C. Ischemic MV Regurgitation (IMR)Reshaping of lateral wall

Preop Postop

C. Ischemic MV Regurgitation (IMR)Reshaping of lateral wall

Ευχαριστώ…