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A Single Centre Experience With Percutaneous Mitral Valve Repair
Abstracts
Canadian Society of Cardiac Surgeons (CSCS) Oral MITRAL VALVE Saturday, October 19, 2013 699 A SINGLE CENTRE EXPERIENCE WITH PERCUTANEOUS MITRAL VALVE REPAIR G Cohen, EA Cohen, R Wolf, S Wong, E Hockman, C Laflamme Toronto, Ontario
Percutaneous mitral repair (MitraclipTM) is currently available via special access in Canada. The following describes a single centre experience with this novel procedure. METHODS: Between April 2011 and March 2013, 25 patients with severe 3-4+ mitral regurgitation (MR) underwent percutaneous mitral repair at our institution. Amongst these, 11 were characterized as degenerative MR, and the remainder (14), functional MR. Mean estimated Euroscore was 5.8%, with 88% of patients in NYHA functional class 3-4 preoperatively. Mean follow up time was 6+/-8 months. RESULTS: There were a mean of 2 clips implanted per patient (range1-4). Acute procedural success was achieved in 24(96%) patients. Mean device time was 128+/-66 min., with 23 (92%) patients being extubated in the cath lab. There was one periprocedural death (4%; non-device related). Three patients required reoperation for recurrent MR. Amongst these, two were found to have partially dehisced clips. Mean postoperative hospital length of stay was 5 days (Range 2-16). At discharge, 23 (92%) patients demonstrated a reduction in their MR to 1 or 2+. This decreased to 78% at 6 months follow up. At 6 months, 64 % of patients were in NYHA functional class 1-2. CONCLUSION: Percutaneous mitral valve repair was effective in reducing MR with a low rate of major adverse events. Repairs were durable through 6 months, with evidence of clinical improvement in the majority of patients. Mitraclip therapy is a viable option for the management of patients with severe functional or degenerative MR, and may be of particular use in patients at high risk for conventional repair. BACKGROUND:
700 PERIOPERATIVE MORTALITY FOLLOWING MITRAL VALVE SURGERY MAY BE OVERESTIMATED BY CONTEMPORARY RISK MODELS V Chan, A Ahrari, M Ruel, E Elmestekawy, T Mesana Ottawa, Ontario BACKGROUND:
Percutaneous therapies to manage mitral regurgitation are emerging as an alternative to conventional surgery, especially for patients with a high estimated perioperative risk. However, contemporary risk models used to risk stratify patients may not accurately reflect outcomes from dedicated surgery centers. The purpose of this study was to
S365
describe perioperative mortality following mitral valve surgery in a contemporary Canadian cohort. METHODS: Between 2001 and 2011, 1155 patients underwent mitral valve surgery at a dedicated mitral valve clinic. Of these, 852 underwent mitral valve repair and 303 mitral valve replacement. Concomitant coronary artery bypass grafting (CABG) was performed in 198 (17%), aortic valve repair/ replacement in 108 (9%), tricuspid valve repair in 199 (17%), and maze procedure in 259 (22%). The Society of Thoracic Surgeons risk score and Euroscore II were used to estimate perioperative mortality risk. RESULTS: Overall perioperative mortality was 0.9%. Perioperative mortality was 0.4% for patients who underwent mitral valve repair, 0.7% after mitral valve repair plus CABG, 2.0% after mitral valve replacement, and 2.0% mitral valve replacement plus CABG. Estimated STS risk score was higher for each of the above listed subgroups supported by the STS calculator (All p<0.001). Overall 401 patients underwent at least one concomitant procedure at the time of mitral valve repair or replacement. The estimated mortality from the Euroscore II was greater for isolated and combined procedures (Both p<0.001). CONCLUSION: Although current risk models aid in risk stratifying patients, the contemporary perioperative mortality at a dedicated Canadian center is significantly lower than expected. The use of alternate therapies must therefore take into consideration differences in perioperative risk based on the treating center.
701 PRE-OPERATIVE ECHOCARDIOGRAPHIC METHOD TO ACCURATELY DETERMINE THE LENGTH OF NEOCHORDAE RECONSTRUCTION FOR MITRAL VALVE REPAIR MW Chu, KL Losenno, C Adams, B Kiaii London, Ontario BACKGROUND: Implantation of PTFE neochordae has become an increasingly common mitral valve (MV) repair technique for degenerative mitral regurgitation (MR). Many methods of neochordae length estimation have been described, but issues of accuracy, ease and reproducibility remain paramount. We describe a novel formula utilizing preoperative transesophageal echocardiographic (TEE) measurements to determine neochordae loop reconstruction length for repair of most types of myxomatous mitral valve disease including posterior, anterior and bileaflet pathology. METHODS: Between 2008 and 2013, 105 consecutive patients underwent mitral valve repair with neochordae loop reconstruction (58% posterior, 8% anterior and 34% bileaflet repair). Mean age was 63 years (range, 22-87 years), 71% were male, mean LVEF was 628%, and functional NYHA class 2.50.9. Mitral valve repair was performed through an endoscopic, right minithoracotomy in 89 patients and sternotomy in 16 patients. Five patients also received planned leaflet resection and 45 (43%) patients underwent concomitant procedures.
Canadian Society of Cardiac Surgeons (CSCS) Oral MITRAL VALVE Saturday, October 19, 2013 699 A SINGLE CENTRE EXPERIENCE WITH PERCUTANEOUS MITRAL VALVE REPAIR G Cohen, EA Cohen, R Wolf, S Wong, E Hockman, C Laflamme Toronto, Ontario
Percutaneous mitral repair (MitraclipTM) is currently available via special access in Canada. The following describes a single centre experience with this novel procedure. METHODS: Between April 2011 and March 2013, 25 patients with severe 3-4+ mitral regurgitation (MR) underwent percutaneous mitral repair at our institution. Amongst these, 11 were characterized as degenerative MR, and the remainder (14), functional MR. Mean estimated Euroscore was 5.8%, with 88% of patients in NYHA functional class 3-4 preoperatively. Mean follow up time was 6+/-8 months. RESULTS: There were a mean of 2 clips implanted per patient (range1-4). Acute procedural success was achieved in 24(96%) patients. Mean device time was 128+/-66 min., with 23 (92%) patients being extubated in the cath lab. There was one periprocedural death (4%; non-device related). Three patients required reoperation for recurrent MR. Amongst these, two were found to have partially dehisced clips. Mean postoperative hospital length of stay was 5 days (Range 2-16). At discharge, 23 (92%) patients demonstrated a reduction in their MR to 1 or 2+. This decreased to 78% at 6 months follow up. At 6 months, 64 % of patients were in NYHA functional class 1-2. CONCLUSION: Percutaneous mitral valve repair was effective in reducing MR with a low rate of major adverse events. Repairs were durable through 6 months, with evidence of clinical improvement in the majority of patients. Mitraclip therapy is a viable option for the management of patients with severe functional or degenerative MR, and may be of particular use in patients at high risk for conventional repair. BACKGROUND:
700 PERIOPERATIVE MORTALITY FOLLOWING MITRAL VALVE SURGERY MAY BE OVERESTIMATED BY CONTEMPORARY RISK MODELS V Chan, A Ahrari, M Ruel, E Elmestekawy, T Mesana Ottawa, Ontario BACKGROUND:
Percutaneous therapies to manage mitral regurgitation are emerging as an alternative to conventional surgery, especially for patients with a high estimated perioperative risk. However, contemporary risk models used to risk stratify patients may not accurately reflect outcomes from dedicated surgery centers. The purpose of this study was to
S365
describe perioperative mortality following mitral valve surgery in a contemporary Canadian cohort. METHODS: Between 2001 and 2011, 1155 patients underwent mitral valve surgery at a dedicated mitral valve clinic. Of these, 852 underwent mitral valve repair and 303 mitral valve replacement. Concomitant coronary artery bypass grafting (CABG) was performed in 198 (17%), aortic valve repair/ replacement in 108 (9%), tricuspid valve repair in 199 (17%), and maze procedure in 259 (22%). The Society of Thoracic Surgeons risk score and Euroscore II were used to estimate perioperative mortality risk. RESULTS: Overall perioperative mortality was 0.9%. Perioperative mortality was 0.4% for patients who underwent mitral valve repair, 0.7% after mitral valve repair plus CABG, 2.0% after mitral valve replacement, and 2.0% mitral valve replacement plus CABG. Estimated STS risk score was higher for each of the above listed subgroups supported by the STS calculator (All p<0.001). Overall 401 patients underwent at least one concomitant procedure at the time of mitral valve repair or replacement. The estimated mortality from the Euroscore II was greater for isolated and combined procedures (Both p<0.001). CONCLUSION: Although current risk models aid in risk stratifying patients, the contemporary perioperative mortality at a dedicated Canadian center is significantly lower than expected. The use of alternate therapies must therefore take into consideration differences in perioperative risk based on the treating center.
701 PRE-OPERATIVE ECHOCARDIOGRAPHIC METHOD TO ACCURATELY DETERMINE THE LENGTH OF NEOCHORDAE RECONSTRUCTION FOR MITRAL VALVE REPAIR MW Chu, KL Losenno, C Adams, B Kiaii London, Ontario BACKGROUND: Implantation of PTFE neochordae has become an increasingly common mitral valve (MV) repair technique for degenerative mitral regurgitation (MR). Many methods of neochordae length estimation have been described, but issues of accuracy, ease and reproducibility remain paramount. We describe a novel formula utilizing preoperative transesophageal echocardiographic (TEE) measurements to determine neochordae loop reconstruction length for repair of most types of myxomatous mitral valve disease including posterior, anterior and bileaflet pathology. METHODS: Between 2008 and 2013, 105 consecutive patients underwent mitral valve repair with neochordae loop reconstruction (58% posterior, 8% anterior and 34% bileaflet repair). Mean age was 63 years (range, 22-87 years), 71% were male, mean LVEF was 628%, and functional NYHA class 2.50.9. Mitral valve repair was performed through an endoscopic, right minithoracotomy in 89 patients and sternotomy in 16 patients. Five patients also received planned leaflet resection and 45 (43%) patients underwent concomitant procedures.