![Page 1: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/1.jpg)
COMMENTS ON MV Regargitation Surgery
Sotirios Prapas, MD, FECTS
![Page 2: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/2.jpg)
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”.
![Page 3: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/3.jpg)
Pathology: Non functional MV
Regurgitation, Dilated Cardiomyopathy.
MITRAL APPARATUS PATHOLOGY
THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)
COMPONENTS: A) LEAFLETS & ANNULUS
![Page 4: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/4.jpg)
THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)
MITRAL APPARATUS PATHOLOGY
Pathology: Post Ischemic
Mitral Valve Regurgitation.
COMPONENTS: B) LV WALL
![Page 5: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/5.jpg)
THE “J” CONCEPT OF MV-LV INTERACTION (Craig Miller)
COMPONENTS:
C) PAPILLARY MUSCLES
Pathology:
Post Ischemic
Papillary Muscle interruption.
MITRAL APPARATUS PATHOLOGY
![Page 6: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/6.jpg)
Νormal
Degenerative
Reumatic
Endocarditis
MITRAL APPARATUS PATHOLOGY
A) NON FUNCTIONAL MITRAL
REGURGITATION
➢ The disease comes first, the regurgitation follows.
![Page 7: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/7.jpg)
SURGERY
![Page 8: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/8.jpg)
SURGERYTECHNIQUES for degenerative pathologies
Quadrantectomy Chords
Rings
![Page 9: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/9.jpg)
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
![Page 10: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/10.jpg)
SURGERYTECHNIQUES for degenerative pathologies
U- Technique
![Page 11: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/11.jpg)
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
![Page 12: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/12.jpg)
![Page 13: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/13.jpg)
► 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
![Page 14: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/14.jpg)
► 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
![Page 15: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/15.jpg)
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)
![Page 16: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/16.jpg)
![Page 17: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/17.jpg)
CAB + MVRepair + Stem Cells 11 Cases
Henry Dunant Hospital
![Page 18: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/18.jpg)
CAB + MVRepair + Stem Cells 11 Cases
Henry Dunant Hospital
![Page 19: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/19.jpg)
CAB + MVRepair + Cells + Ablation 1 Case
Henry Dunant Hospital
![Page 20: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/20.jpg)
Preop
Ischemic MV Regurgitation (IMR)Reshaping of lateral wall
![Page 21: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/21.jpg)
Preop
C. Ischemic MV Regurgitation (IMR)Reshaping of lateral wall
![Page 22: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/22.jpg)
Preop Postop
C. Ischemic MV Regurgitation (IMR)Reshaping of lateral wall
![Page 23: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/23.jpg)
![Page 24: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/24.jpg)
![Page 25: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/25.jpg)
![Page 26: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/26.jpg)
![Page 27: COMMENTS ON MV Regargitation Surgery · 2018-01-23 · November 2013 – October 2014 Multi-center Study 103 patients Isolated PL prolapse : 83 Bileaflet prolapse: 20 Median sternotomy](https://reader036.vdocuments.us/reader036/viewer/2022070910/5fa53e003a4be750cf5a1f1f/html5/thumbnails/27.jpg)
Ευχαριστώ…