Application of stentless mitral valve design to repair in infective endocarditis
Presented During:
Friday, May 5, 2023: 7:45AM - 7:50AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO065
Submission Type:
Abstract Submission
Authors:
Tomoya Uchimuro (1), Shuichiro Takanashi (2), Hitoshi Kasegawa (3)
Institutions:
(1) Kawasaki Saiwai Hospital, Tokyo, Japan, (2) Kawasaki Saiwai Hospital, Kanagawa, Japan, (3) International University of Health and Welfare, Mita Hospital, Tokyo
Submitting Author:
Tomoya Uchimuro
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Kawasaki Saiwai Hospital
Kawasaki Saiwai Hospital
Co-Author(s):
*Shuichiro Takanashi
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Kawasaki Saiwai Hospital
Kawasaki Saiwai Hospital
Hitoshi Kasegawa
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International University of Health and Welfare, Mita Hospital
International University of Health and Welfare, Mita Hospital
Presenting Author:
Tomoya Uchimuro
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Abstract:
Objective: Mitral valve repair (MVr) in patients with active infective endocarditis (IE) can be challenging. MVr is more preferable in patients who had better avoid warfarin use because of preoperative characteristics or comorbidities. We developed repair technique for active IE using an original stentless mitral valve "NORMO" design. We present our repair technique.
Methods: There were 22 patients of active IE among 343 undergoing MV surgery between April 2019 and December 2022 at our institution. MVr was performed in 9 (40.9%), and MV replacement (MVR) in 13 (59.1%). Mean age was 46.4 years in MVr and 60.6 years in MVR. In patients undergoing MVr, we applied the "NORMO" design to 6 (66.7%) that infection was widely spread over both clear zone and rough zone of several scallops. Figure 1 presents 3 typical cases of repair. We applied a concept of stentless MV, "NORMO" valve, invented by Hitoshi Kasegawa. It is characterized by the design that a single pericardial sheet can be formed three-dimensionally to create a folded structure at the commissure. Infected scallops of leaflet and chordae were resected completely and reconstructed using autologous pericardium in 5, and A3 scallop of anterior leaflet in 1. In 4 cases, pericardial sheet or native anterior leaflet. Prosthetic ring annuloplasty was added in 5 cases except case 5 with entire circumference of severe mitral annular calcification.
Results：In MV repair cases, hospital mortality was 88.9%. 1 patient using "NORMO" design died because of liver cirrhosis on postoperative day 30. Postoperative echocardiography revealed excellent performance of the valve with residual mitral regurgitation (MR) of less than mild. At 3 years, rates of survival and freedom from reoperation were 88.8% and 87.5%, respectively. 1 patient using "NORMO" design required redo MVR for recurrent MR due to rupture of GORE-TEX neo-chordae at 8 months after surgery.
Conclusions："NORMO" design was useful to achieve MV repair for patients of active IE with extensive infection involving several scallops.
Methods: There were 22 patients of active IE among 343 undergoing MV surgery between April 2019 and December 2022 at our institution. MVr was performed in 9 (40.9%), and MV replacement (MVR) in 13 (59.1%). Mean age was 46.4 years in MVr and 60.6 years in MVR. In patients undergoing MVr, we applied the "NORMO" design to 6 (66.7%) that infection was widely spread over both clear zone and rough zone of several scallops. Figure 1 presents 3 typical cases of repair. We applied a concept of stentless MV, "NORMO" valve, invented by Hitoshi Kasegawa. It is characterized by the design that a single pericardial sheet can be formed three-dimensionally to create a folded structure at the commissure. Infected scallops of leaflet and chordae were resected completely and reconstructed using autologous pericardium in 5, and A3 scallop of anterior leaflet in 1. In 4 cases, pericardial sheet or native anterior leaflet. Prosthetic ring annuloplasty was added in 5 cases except case 5 with entire circumference of severe mitral annular calcification.
Results：In MV repair cases, hospital mortality was 88.9%. 1 patient using "NORMO" design died because of liver cirrhosis on postoperative day 30. Postoperative echocardiography revealed excellent performance of the valve with residual mitral regurgitation (MR) of less than mild. At 3 years, rates of survival and freedom from reoperation were 88.8% and 87.5%, respectively. 1 patient using "NORMO" design required redo MVR for recurrent MR due to rupture of GORE-TEX neo-chordae at 8 months after surgery.
Conclusions："NORMO" design was useful to achieve MV repair for patients of active IE with extensive infection involving several scallops.
Mitral Conclave:
Mitral Valve Endocarditis
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