MO65. Application of Stentless Mitral Valve Design to Repair in Infective Endocarditis
Tokyo
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Educational background:1993-1999 Tohoku University School of Medicine, Sendai, Japan. Graduated with MD
Work experience: Department：Adult Cardiovascular Surgery
1999-2002 Iwate Prefectual Iwai Hospital, Ichinoseki, Japan. Resident in General Surgery.
2002-2003 Sendai Kousei Hospital, Sendai, Japan. Resident in Cardiology.
2003-2004 Shin-Tokyo Hospital, Matsudo, Japan.Resident in Cardiovascular Surgery.
2004-2010 Chiba central medical center, Chiba, Japan. Staff surgeon in Cardiovascular Surgery.
2010-2014 Sakakibara Heart Institute, Tokyo, Japan. Resident in Cardiovascular Surgery.
2014-2017 National hospital organization Tokyo medical center, Tokyo, Japan. Staff surgeon in Cardiovascular Surgery.
2017-2019 Sakakibara Heart Institute, Tokyo, Japan. Staff surgeon in Cardiovascular Surgery.
2019-present Kawasaki Saiwai Hospital, Kawasaki, Japan. Chief Director in Department of Cardiac surgery
Published papers written as 1st author
- Acute thrombosis after endarterectomy of stented left anterior descending artery. Interact Cardiovasc and Thorac Surg. 2009;8:663-665
- A case of microscopic polyangiitis with repeated large vessel disease. J Jpn Vasc Surg 2011;20:819-822
- Coronary arterial compression caused by an aneurysm of the sinus of Valsalva with aortic prosthetic valve endocarditis. Gen Thorac Cardiovasc Surg. 2012;60:834-836
- Mitral valve replacement in dextrocardia and situs inversus. Kyobu Geka. 2012 65:858-61.
- Concomitant aortic valve replacement and coronary artery bypass grafting. J Jpn Coron Assoc. 2013;19:66-72
- Post-repair coaptation length and durability of mitral valve repair for posterior mitral valve prolapse. Gen Thorac Cardiovasc Surg. 2014;62:221-227
- Mitral valve surgery in patients with severe mitral annular calcification. Ann Thorac Surg. 2016;101:889-95
- Left ventricular free wall rupture after surgery for ventricular septal rupture. Asian Cardiovasc Thorac Ann. 2018;26:697-700.
Description
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.