Modified Mitral Valve Repair with Its Insufficiency of Ischemic Genesis

V E Vaykin¹, M V Ryazanov², D D Zhiltsov¹, S A Zhurko¹, A B Gamzaev³, G V Bolshukhin⁴, S A Fedorov¹, A P Medvedev⁵

Affiliations

¹ Cardiovascular Surgeon, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, 209 Vaneeva St., Nizhny Novgorod, 603136, Russia.
² Associate Professor, Department of Hospital Surgery named after B.A. Korolyov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
³ Professor, Department of X-ray Endovascular Diagnostics and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia; Cardiovascular Surgeon, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, 209 Vaneeva St., Nizhny Novgorod, 603136, Russia.
⁴ PhD Student, Department of Hospital Surgery named after B.A. Korolyov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia; Cardiovascular Surgeon, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, 209 Vaneeva St., Nizhny Novgorod, 603136, Russia.
⁵ Professor, Department of Hospital Surgery named after B.A. Korolyov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.

PMID: 34513078
PMCID: PMC8353715
DOI: 10.17691/stm2021.13.2.07

Modified Mitral Valve Repair with Its Insufficiency of Ischemic Genesis

V E Vaykin et al. Sovrem Tekhnologii Med. 2021.

. 2021;13(2):59-66.

doi: 10.17691/stm2021.13.2.07. Epub 2021 Jan 1.

Authors

V E Vaykin¹, M V Ryazanov², D D Zhiltsov¹, S A Zhurko¹, A B Gamzaev³, G V Bolshukhin⁴, S A Fedorov¹, A P Medvedev⁵

Affiliations

¹ Cardiovascular Surgeon, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, 209 Vaneeva St., Nizhny Novgorod, 603136, Russia.
² Associate Professor, Department of Hospital Surgery named after B.A. Korolyov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.
³ Professor, Department of X-ray Endovascular Diagnostics and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia; Cardiovascular Surgeon, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, 209 Vaneeva St., Nizhny Novgorod, 603136, Russia.
⁴ PhD Student, Department of Hospital Surgery named after B.A. Korolyov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia; Cardiovascular Surgeon, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, 209 Vaneeva St., Nizhny Novgorod, 603136, Russia.
⁵ Professor, Department of Hospital Surgery named after B.A. Korolyov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia.

PMID: 34513078
PMCID: PMC8353715
DOI: 10.17691/stm2021.13.2.07

Abstract

The aim of the study was to assess the effectiveness of modified mitral valve repair in comparison with traditional methods of correcting ischemic mitral regurgitation.

Materials and methods: The results of surgical treatment of 80 patients with coronary artery disease complicated by ischemic mitral regurgitation were analyzed. The mean age of the patients was 58.95±8.36 years; the ratio of men and women was 67:13. Heart failure of FC II (according to the NYHA classification) was detected in 6 patients (7.50%), FC III - in 69 (86.25%) patients, FC IV - in 5 (6.25%) patients.Echocardiographic examination was used to determine the significance and genesis of mitral regurgitation in the preoperative period. 57 patients (71.25%) were detected with grade II mitral regurgitation, 23 (28.75%) had grade III.Annuloplasty was chosen as the operation for the correction of the valve apparatus. The patients of group 1 (n=23) underwent reconstructive surgery on the mitral valve using an autopericardial strip according to the technique, which we have developed, in combination with coronary artery bypass grafting (CABG), the patients of group 2 (n=26) underwent plastic surgery using a support ring in combination with CABG, patients of group 3 (n=31) had myocardial revascularization without correction of the valve apparatus.

Results: The patients of group 2 underwent restrictive mitral annuloplasty performed with rigid support rings, group 1 - with an autopericardial strip as a soft support ring, the patients of group 3 underwent CABG alone.One patient from group 2 died in the early postoperative period due to acute perioperative myocardial infarction.The most common complications were pleurisy, acute cardiovascular failure, acute respiratory failure, and cardiac arrhythmias. The smallest number of complications was noted in the group 3, where patients underwent CABG alone. After surgery, all the patients showed a decrease in mitral regurgitation, which was most pronounced in the groups with annuloplasty.When analyzing the immediate results of the operations, it was revealed that the patients of groups 1 and 2, who underwent combined interventions, had a higher percentage of complications, and the length of their stay in the ICU increased. However, these groups showed a significant improvement in mitral valve functioning. Plasty of the mitral valve with an autopericardial strip according to the technique, which we have developed, demonstrated a good hemodynamic effect, the absence of significant regurgitation in the postoperative period.

Keywords: coronary artery disease; ischemic mitral regurgitation; mitral valve reconstruction.

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Conflict of interest statement

Conflict of interest. There is no conflict of interest among the authors and other interested parties.

Figures

**Figure 1. Mechanism of ischemic mitral insufficiency**

**Figure 2. Mitral valve with U-shaped sutures along the base of the posterior leaflet (1) and 1 cm beyond the anterior (2) and posterior (3) commissures**

**Figure 3. Measurement of the distance between the front (1) and back (2) commissures**

**Figure 4. Stitched autopericardial strip (indicated by an arrow) is “planted” on the annulus fibrosus of the mitral valve**

**Figure 5. End result of plasty: all the sutures are tied, the annulus fibrosus of the mitral valve has been reduced, satisfactory leaflet coaptation has been achieved**

See this image and copyright information in PMC

References

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Modified Mitral Valve Repair with Its Insufficiency of Ischemic Genesis

Affiliations

Modified Mitral Valve Repair with Its Insufficiency of Ischemic Genesis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

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