The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair.
Perfusion strategies and operative techniques for minimally invasive mitral valve repair have evolved over time. During the past decade, our institution's approach has progressed from a port access platform with femoral perfusion to predominantly a central aortic cannulation through a right anterior minithoracotomy incision. We analyzed this institutional experience to evaluate the impact of approach on patient outcomes. ⋯ Central aortic cannulation through a right anterior minithoracotomy for mitral valve repair allows excellent outcomes in patients with a broad spectrum of comorbidities and has become our preferred approach for most patients undergoing mitral valve repair. Retrograde arterial perfusion is associated with an increased risk of stroke in patients with severe peripheral vascular disease and should be reserved for select patients without significant atherosclerosis.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Mitral and tricuspid valve repair and growth in unbalanced atrial ventricular canal defects.
Congenital mitral and tricuspid valve abnormalities in unbalanced atrioventricular canal defects are complex. We designed procedures to both repair and induce growth of hypoplastic atrioventricular valves and ventricles to achieve 2-ventricle repairs. Midterm data were assessed for reliability of catch-up growth, resulting quality of atrioventricular valves, and adequacy of 2-ventricle repairs. ⋯ Increasing atrioventricular valve flow reliably induced growth. Valve repair and growth achieved a 2-ventricle repair in all patients.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Mitral valve annuloplasty and papillary muscle relocation oriented by 3-dimensional transesophageal echocardiography for severe functional mitral regurgitation.
The study of the mitral valve apparatus and its modifications during functional mitral regurgitation (FMR) is better revealed by 3-dimensional (3D) transesophageal echocardiography (TOE). To plan mitral valve repair by annuloplasty and papillary muscle (PPM) relocation, we proposed a valve repair procedure oriented by the new main features obtained by real-time 3D TOE reconstruction of the mitral valve apparatus. ⋯ PPM relocation plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results for patients with severe FMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Expanding the indications for the David V aortic root replacement: early results.
To examine the early results of the David V valve-sparing aortic root replacement procedure in expanded, higher risk clinical scenarios with appropriately selected patients. ⋯ In selected patients possessing appropriate aortic cusp anatomy, the David V can be safely and effectively performed for the expanded indications of aortic dissection, severe AI, and reoperative cardiac surgery with low operative risk. Valve function has remained excellent in the short term, providing evidence of durability and a low rate of valve-related complications.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Clinical and echocardiographic outcomes after repair of mitral valve bileaflet prolapse due to myxomatous disease.
Repair of mitral regurgitation (MR) due to bileaflet prolapse poses many technical challenges. The late outcomes after repair are also not well characterized in this population. Published series have often included patients with mixed causes of prolapse and/or lack long-term echocardiographic follow-up. Myxomatous disease represents an important cause of bileaflet prolapse and MR and, thus, served as the focus of the present study. ⋯ MV repair of bileaflet prolapse due to myxomatous disease is safe and durable. Successful repair often requires a combination of surgical repair techniques.