A Surgical Technique to Preserve the Subvalvular Apparatus in Patients Undergoing Mitral Valve Replacement for Severe Ischemic Regurgitation

Zeitani, Jacob; Likaj, Ermal; Kuci, Saimir; Pellegrino, Antonio

doi:10.21470/1678-9741-2021-0320

Jacob Zeitani Correspondence Address: Jacob Zeitani Department of Neuroscience and Rehabilitation, University of Ferrara, Via Ariosto 35, Ferrara, Italy, Zip Code: 44121, E-mail: zeitani@hotmail.com

Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.

https://orcid.org/0000-0001-6107-591X

Ermal Likaj

Department of Cardiac Surgery, University Hospital Center “Mother Teresa”, Tirana, Albania.

Saimir Kuci

Department of Cardiac Surgery, University Hospital Center “Mother Teresa”, Tirana, Albania.

Antonio Pellegrino

Department of Cardiac Surgery, University of Rome Tor Vergata, Rome, Italy.

Correspondence Address: Jacob Zeitani Department of Neuroscience and Rehabilitation, University of Ferrara, Via Ariosto 35, Ferrara, Italy, Zip Code: 44121, E-mail: zeitani@hotmail.com

No conflict of interest.

Figures (2)
Tables (5)

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Fig. 1
Images of a step-by-step anterior mitral leaflet anchoring using a fresh swine heart for illustration. A) Polyester sutures positioned in the mitral annulus and in the prosthesis cuff (those in correspondence to the anterior leaflet) and a 4-0 polypropylene suture passed in the anterior leaflet and in the polyester material of the bioprosthesis strut (*). B) Complete positioning of the prosthesis in the mitral orifice. C) Left ventricular view of the anchoring polypropylene stitch (arrow) and complete subvalvular apparatus. D) Free left ventricular outflow tract (arrow).

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Fig. 2
Postoperative transthoracic echocardiographic images demonstrating limited anterior leaflet motion (A), and echo doppler showing no subaortic valve gradient (B).

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Abbreviations, Acronyms & Symbols AF = Atrial fibrillation ICU = Intensive care unit AL = Anterior leaflet LVEF = Left ventricular ejection fraction CABG = Coronary artery bypass grafting LVOTO = Left ventricular outflow tract obstruction COPD = Chronic obstructive pulmonary disease MI = Myocardial infarction CPB = Cardiopulmonary bypass MR = Mitral regurgitation CRF = Chronic renal failure MVR = Mitral valve replacement EDV = End-diastolic volume NYHA = New York Heart Association ESV = End-systolic volume PMR = Papillary muscle rupture FMR = Functional mitral regurgitation TEE = Transesophageal echocardiogram FU = Follow-up

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Table 1
Patients’ characteristics.

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Table 2
Intraoperative and postoperative data.

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Table 3
Echocardiographic data.

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Authors’Roles & Responsibilities JZ Substantial contributions to the conception and design of the work; final approval of the version to be published EL Substantial contributions to the acquisition and interpretation of data for the work; final approval of the version to be published SK Substantial contributions to the acquisition and interpretation of data for the work; final approval of the version to be published AP Drafting the work and revising it critically for important intellectual content; final approval of the version to be published

Abbreviations, Acronyms & Symbols
AF	= Atrial fibrillation	ICU	= Intensive care unit
AL	= Anterior leaflet	LVEF	= Left ventricular ejection fraction
CABG	= Coronary artery bypass grafting	LVOTO	= Left ventricular outflow tract obstruction
COPD	= Chronic obstructive pulmonary disease	MI	= Myocardial infarction
CPB	= Cardiopulmonary bypass	MR	= Mitral regurgitation
CRF	= Chronic renal failure	MVR	= Mitral valve replacement
EDV	= End-diastolic volume	NYHA	= New York Heart Association
ESV	= End-systolic volume	PMR	= Papillary muscle rupture
FMR	= Functional mitral regurgitation	TEE	= Transesophageal echocardiogram
FU	= Follow-up

Variables
Age (years)	71±4.3
Male	4
Preoperative NYHA dyspnea class
III	1
IV	4
Angina class
3	3
4	0
MI	5
LVEF (%)	43±15
MR
3+	2
4+	3
Diabetes	3
COPD	5
CRF	2
Hypertension	4

Variables	No.
CABG (patients)	5
Mean grafts/patient	2.6±0.8
Prosthesis size
27 mm	1
29 mm	3
31 mm	1
CPB time (min)	94±48
Aortic cross-clamping time (min)	72±26
Intubation time (hours)	7±4
ICU stay (hours)	36±20
Postoperative AF	2
Postoperative in-hospital stay (days)	7.5±3

Variables	Preoperative	Postoperative	FU
LVEF (%)	43±15	47±9	50±4
MR		_	_
3+	2	_	_
4+	3	_	_
EDV (ml)	153±48	149±56	131±61
ESV (ml)	120±41	98±55	95±62

Authors’Roles & Responsibilities
JZ	Substantial contributions to the conception and design of the work; final approval of the version to be published
EL	Substantial contributions to the acquisition and interpretation of data for the work; final approval of the version to be published
SK	Substantial contributions to the acquisition and interpretation of data for the work; final approval of the version to be published
AP	Drafting the work and revising it critically for important intellectual content; final approval of the version to be published

[1] Correspondence Address: Jacob Zeitani Department of Neuroscience and Rehabilitation, University of Ferrara, Via Ariosto 35, Ferrara, Italy, Zip Code: 44121, E-mail: zeitani@hotmail.com

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A Surgical Technique to Preserve the Subvalvular Apparatus in Patients Undergoing Mitral Valve Replacement for Severe Ischemic Regurgitation

ABSTRACT