Repairing of Ischemic Mitral Regurgitation by Chained Double Stitching without Shaping Ring_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUChang-cheng ,  GUCheng-xiong , YUYang

Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, P. R. China;

Corresponding author：

GUCheng-xiong, Email: anzhengu@sina.com

Keywords：

Ischemic mitral regurgitation; Coronary artery bypass grafting; Mitral valvuloplasty

DOI：

10.7507/1007-4848.20160169

Video：

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Objective To attempt an innovative mitral valvuloplasty by chained double stitching without shaping ring to repair ischemic mitral regurgitation (IMR) and to evaluate the clinical efficacy of this new procedure. Methods We retrospectively analyzed the clinical data of 12 patients with coronary artery disease and IMR underwent the innovative mitral valvuloplasty by chained double stitching without shaping ring in our hospital from August 2012 to December 2013. There were 10 males and 2 females at the mean age of 60±10 years ranging from 42 to 76 years. The cardiac functional parameters and condition of mitral regurgitation were compared among the period of preoperation, discharging and follow-up. Results Twelve patients were recovered and discharged from hospital with the New York Heart Association (NYHA) classification of heart function at class Ⅰ-Ⅱ. NYHA classification, grade of mitral regurgitation and regurgita- tion area were statistically improved on both the phase of discharge and follow-up compared with that of the pre-operation (P<0.05). Compared with preoperative left ventricular ejection fraction (LVEF), LVEF of discharging was statistically amelio- rative (P<0.05). And there was a statistic difference of NYHA classification of cardiac function in the phase of follow-up than that of discharging (P<0.05). Conclusion Mitral valvuloplasty by chained double stitching without shaping ring is one reliable choice of treating IMR. The cardiac function and the living quality of the patients are statistically improved on the early stage and metaphase after operation, but long-term efficacy of this surgical procedure need be further assessed.

Citation： LIUChang-cheng, GUCheng-xiong, YUYang. Repairing of Ischemic Mitral Regurgitation by Chained Double Stitching without Shaping Ring. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 706-709. doi: 10.7507/1007-4848.20160169 Copy

1.	Borger MA, Alam A, Murphy PM, et al. Chronic ischemic mitral regurgitation:repair, replace or rethink? Ann Thorac Surg, 2006, 81(3):1153-1161.
2.	Buja P, Tarantini G, Del Bianco F, et al. Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease:Impact of different treatment on survival and rehospitalization. Int J Cardiol, 2006, 111(1):26-33.
3.	Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17 (4):14-20.
4.	Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease:focused update on infec-tive endocarditis:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2008, 52(8):676-685.
5.	Lorusso R, Gelsomino S, Vizzardi E, et al. Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). J Thorac Cardiovasc Surg, 2013, 145(1):128-139.
6.	Mihaljevic T, Lam BK, Rajeswaran J, et al. Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol, 2007, 49(22):2191-2201.
7.	Bursi F, Enriquez-Sarano M, Jacobsen SJ, et al. Mitral regurgitation after myocardial infarction:a review. Am J Med, 2006, 119(2):103-112.
8.	Marwick TH, Lancellotti P, Pierard L. Ischaemic mitral regurgita-tion:mechanisms and diagnosis. Heart, 2009, 95(20):1711-1718.
9.	Crabtree TD, Bailey MS, Moon MR, et al. Recurrent mitral regurgita-tion and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation. Ann Thorac Surg, 2008, 85(5):1537-1542.
10.	Harris KM, Sundt TM 3rd, Aeppli D, et al. Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg, 2002, 74(5):1468-1475.
11.	张宝仁,徐志云,邹良建,等.老年患者二尖瓣置换术265例分析.中国胸心血管外科临床杂志, 2004, 11(3):161-164.
12.	Gillinov AM, Wierup PN, Blackstone EH, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardio-vasc Surg, 2001, 122(6):1125-1141.
13.	Dahlberg PS, Orszulak TA, Mullany CJ, et al. Late outcome of mitral valve surgery for patients with coronary artery disease. Ann Thorac Surg, 2003, 76(5):1539-1487.
14.	Goland S, Czer LS, Siegel RJ, et al. Coronary revascularization alone or with mitral valve repair:outcomes in patients with moderate ischemic mitral regurgitation. Tex Heart Inst J, 2009, 36(5):416-424.
15.	Murphy MO, Rao C, Punjabi PP, et al. In patients undergoing mitral surgery for ischaemic mitral regurgitation is it preferable to repair or replace the mitral valve? Interact Cardiovasc Thorac Surg, 2011, 12(2):218-227.
16.	Penicka M, Linkova H, Lang O, et al. Predictors of improvement of unrepaired moderate ischemic mitral regurgitation in patients undergoing elective isolated coronary artery bypass graft surgery. Circulation, 2009, 120(15):1474-1481.
17.	Gillinov AM, Faber C, Houghtaling PL, et al. Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease. J Thorac Cardiovasc Surg, 2003, 125(6):1350-1362.
18.	Pierard LA, Carabello BA. Ischaemic mitral regurgitation:pathophysiology, outcomes and the conundrum of treatment. Eur Heart J, 2010, 31(24):2996-3005.
19.	Iglesias I. Intraoperative TEE assessment during mitral valve repair for degenerative and ischemic mitral valve regurgitation. Semin Cardiothorac Vasc Anesth, 2007, 11(4):301-305.
20.	Shiota M, Gillinov AM, Takasaki K, et al. Recurrent mitral regurgi-tation late after annuloplasty for ischemic mitral regurgitation. Echocardiography, 2011, 28(2):161-166.
21.	邓学峰, 高长青. 二尖瓣成形术治疗二尖瓣关闭不全. 中国胸心血管外科临床杂志, 2008, 15(2):134-137.

1. Borger MA, Alam A, Murphy PM, et al. Chronic ischemic mitral regurgitation:repair, replace or rethink? Ann Thorac Surg, 2006, 81(3):1153-1161.
2. Buja P, Tarantini G, Del Bianco F, et al. Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease:Impact of different treatment on survival and rehospitalization. Int J Cardiol, 2006, 111(1):26-33.
3. Marasco SF. Ischaemic mitral regurgitation and the role of surgical intervention. Heart Lung Circ, 2008, 17 (4):14-20.
4. Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease:focused update on infec-tive endocarditis:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2008, 52(8):676-685.
5. Lorusso R, Gelsomino S, Vizzardi E, et al. Mitral valve repair or replacement for ischemic mitral regurgitation? The Italian Study on the Treatment of Ischemic Mitral Regurgitation (ISTIMIR). J Thorac Cardiovasc Surg, 2013, 145(1):128-139.
6. Mihaljevic T, Lam BK, Rajeswaran J, et al. Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol, 2007, 49(22):2191-2201.
7. Bursi F, Enriquez-Sarano M, Jacobsen SJ, et al. Mitral regurgitation after myocardial infarction:a review. Am J Med, 2006, 119(2):103-112.
8. Marwick TH, Lancellotti P, Pierard L. Ischaemic mitral regurgita-tion:mechanisms and diagnosis. Heart, 2009, 95(20):1711-1718.
9. Crabtree TD, Bailey MS, Moon MR, et al. Recurrent mitral regurgita-tion and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation. Ann Thorac Surg, 2008, 85(5):1537-1542.
10. Harris KM, Sundt TM 3rd, Aeppli D, et al. Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg, 2002, 74(5):1468-1475.
11. 张宝仁,徐志云,邹良建,等.老年患者二尖瓣置换术265例分析.中国胸心血管外科临床杂志, 2004, 11(3):161-164.
12. Gillinov AM, Wierup PN, Blackstone EH, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardio-vasc Surg, 2001, 122(6):1125-1141.
13. Dahlberg PS, Orszulak TA, Mullany CJ, et al. Late outcome of mitral valve surgery for patients with coronary artery disease. Ann Thorac Surg, 2003, 76(5):1539-1487.
14. Goland S, Czer LS, Siegel RJ, et al. Coronary revascularization alone or with mitral valve repair:outcomes in patients with moderate ischemic mitral regurgitation. Tex Heart Inst J, 2009, 36(5):416-424.
15. Murphy MO, Rao C, Punjabi PP, et al. In patients undergoing mitral surgery for ischaemic mitral regurgitation is it preferable to repair or replace the mitral valve? Interact Cardiovasc Thorac Surg, 2011, 12(2):218-227.
16. Penicka M, Linkova H, Lang O, et al. Predictors of improvement of unrepaired moderate ischemic mitral regurgitation in patients undergoing elective isolated coronary artery bypass graft surgery. Circulation, 2009, 120(15):1474-1481.
17. Gillinov AM, Faber C, Houghtaling PL, et al. Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease. J Thorac Cardiovasc Surg, 2003, 125(6):1350-1362.
18. Pierard LA, Carabello BA. Ischaemic mitral regurgitation:pathophysiology, outcomes and the conundrum of treatment. Eur Heart J, 2010, 31(24):2996-3005.
19. Iglesias I. Intraoperative TEE assessment during mitral valve repair for degenerative and ischemic mitral valve regurgitation. Semin Cardiothorac Vasc Anesth, 2007, 11(4):301-305.
20. Shiota M, Gillinov AM, Takasaki K, et al. Recurrent mitral regurgi-tation late after annuloplasty for ischemic mitral regurgitation. Echocardiography, 2011, 28(2):161-166.
21. 邓学峰, 高长青. 二尖瓣成形术治疗二尖瓣关闭不全. 中国胸心血管外科临床杂志, 2008, 15(2):134-137.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Repairing of Ischemic Mitral Regurgitation by Chained Double Stitching without Shaping Ring

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