4.6 Article

Mitral Valve Translocation: A Novel Operation for the Treatment of Secondary Mitral Regurgitation

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ANNALS OF THORACIC SURGERY
卷 112, 期 6, 页码 1954-1961

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ELSEVIER SCIENCE INC
DOI: 10.1016/j.athoracsur.2021.07.043

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  1. American Heart Association Post-Doctoral Fellowship [18POST34030404]
  2. University of Maryland's Division of Cardiac Surgery
  3. University of Maryland

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The novel translocation repair technique effectively treats ischemic mitral regurgitation by addressing geometric alterations of the mitral valve apparatus. Compared with conventional repair, translocation creates a larger coaptation surface and preserves leaflet mobility, leading to better outcomes in treating mitral regurgitation.
BACKGROUND Conventional annuloplasty repair of secondary (functional) ischemic mitral regurgitation (IMR) is associated with a 60% recurrence of moderate or greater mitral regurgitation at 2 years. We developed a novel repair technique for IMR that addresses the underlying geometric alterations of the mitral valve apparatus and compared outcomes with those of conventional repair in a swine model. METHODS Chronic IMR was induced by percutaneous embolization of the circumflex artery. Swine with severe IMR (median 9 weeks after infarction) underwent undersized rigid annuloplasty (n = 5) or translocation repair (n = 6). Translocation repair consisted of detaching the mitral valve en bloc at the annulus, creating a 1 cm wide frustum-shaped pericardial patch, and suturing the outer circumference of the patch to the annulus and inner circumference to the mitral valve. RESULTS Operative survival was 92% (11 of 12). All animals had none/trace residual central mitral regurgitation, and mean inflow gradients were similar (1 mm Hg [interquartile range, 1 to 2] vs 2 mm Hg [interquartile range, 1 to 2]; P = .75) in the annuloplasty and translocation groups, respectively. Median coaptation length marginally improved in conven-tional swine (3 to 4 mm, P = .05), but dramatically improved in translocation swine (3 to 8 mm, P = .003). Posterior leaflet angle increased from 39 to 80 degrees (P = .05) in annuloplasty swine but decreased from 50 to 31 degrees (P = .03) in translocation swine. The posterior leaflet was immobile after annuloplasty but had preserved motion after translocation (excursion, 1 degree vs 24 degrees; P = .045). CONCLUSIONS Mitral valve translocation effectively treats mitral regurgitation by relieving leaflet tethering. Compared with annuloplasty, mitral valve translocation creates a larger surface of coaptation and preserves leaflet mobility without compromising diastolic function. (Ann Thorac Surg 2021;112:1954-61) (c) 2021 by The Society of Thoracic Surgeons

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