Very long-term outcomes of twisted auto-pericardial mitral annuloplasty
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ORIGINAL ARTICLE
Very long‑term outcomes of twisted auto‑pericardial mitral annuloplasty Takashi Miura1 · Kikuko Obase1 · Ichiro Matsumaru1 · Shogo Yokose1 · Shun Nakaji1 · Yuichi Tasaki1 · Tessho Kitamura1 · Eijun Sueyoshi2 · Junya Miyamato3 · Kiyoyuki Eishi1 Received: 29 October 2019 / Accepted: 18 February 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives During mitral annuloplasty, we twisted the harvested auto-pericardium to enable adequate ring sizing and implanted it to prevent ring-related complications. Indication for twisted auto-pericardial band (APB) was limited to patients with less than severe annular dilation to ensure high reproducibility and durability. The aim of this study was to investigate the long-term outcomes of twisted APB annuloplasty. Methods From 1999 to 2009, 107 patients (62 ± 12 years, degenerative 92 and infective endocarditis 15) with isolated posterior mitral leaflet (PML) prolapse with inter-commissural distance of 32 mm or smaller underwent twisted APB annuloplasty. Of these, 104 patients without early leaflet repair failure were studied. Leaflet repairs were predominantly performed by quadrangular resection. Median APB size was 28 mm. Results Follow-up rate was 98.1% and duration was 10.9 ± 4.8 years. There were two early and 34 late deaths. Survival and freedom from cardiac-related death at 15 years were 61.7% ± 5.6% and 83.8% ± 4.7%, respectively. Age and male sex were independent predictors of mortality. There were four late reoperations for recurrent severe mitral regurgitation (MR), three of which were due to new chordal rupture. Freedom from reoperation and freedom from moderate or severe MR at 15 years were 93.1% ± 3.5% and 81.3% ± 6.2%, respectively. No patients developed hemolysis, ring dehiscence, or infective endocarditis. Conclusions The long-term outcomes of twisted APB for isolated PML prolapse without severe annular dilation are satisfactory. Twisted APB annuloplasty may be a preferable option to reduce ring-related complications with sufficient durability. Keywords Mitral annuloplasty · Autologous pericardium · Posterior leaflet prolapse · Long-term outcomes
Introduction Ring-related complications such as hemolysis and ring dehiscence are some of the major causes of reoperation after mitral valve (MV) repair [1–5]. An autologous pericardium Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01324-3) contains supplementary material, which is available to authorized users. * Takashi Miura [email protected] 1
Department of Cardiovascular Surgery, Nagasaki University Hospital, 1‑7‑1 Sakamoto, Nagasaki City, Japan
2
Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan
3
Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
can be used as the materials for mitral annuloplasty [6–10], and its flexibility and the nature of non-foreign substances may contribute to preventing those types of ring-related complications. A pre
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