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. 2024 Aug 23;16(8):e67623.
doi: 10.7759/cureus.67623. eCollection 2024 Aug.

Efficacy and Outcomes of Para-Annular Plication in Mitral Valve Repair via Right Mini-Thoracotomy

Kenichi Morimoto  1 , Shigeto Miyasaka  1 , Rikuto Nii  1 , Yosuke Ikeda  1
Affiliations

Efficacy and Outcomes of Para-Annular Plication in Mitral Valve Repair via Right Mini-Thoracotomy

Kenichi Morimoto et al. Cureus. .

Abstract

Purpose: We aim to assess the efficacy and safety of left atrial plication (LAP), particularly para-annular plication, using a right mini-thoracotomy approach.

Methods: Among 90 mitral valve repair (MVr) procedures performed at our institution between 2016 and 2023, 16 left atrial plication cases for left atrial enlargement (diameter: >50 mm) were assessed; nine cases underwent median sternotomy (conventional) (Group C), and seven cases underwent minimally invasive cardiac surgery (MICS) (Group M). The surgical protocol involved mitral valve repair via a right-sided left atrial approach, incorporating para-annular plication to suture the posterior wall. The mean follow-up duration was 3.3±2.4 years.

Results: Mortality within 30 days of surgery or during hospitalization did not occur. Postoperative complications included one case in each group that required reoperation for hemorrhage originating extraneously in the left atrium. Postoperative echocardiographic assessments revealed a comparable reduction in left atrial diameter (C/M: 80.3±7.0/80.7±14.6%; p=0.94), left atrial volume index (55.6±19.3/68.3±34.1%; p=0.36), and aorto-mitral angle (AMA) enlargement (113.8±7.3/107.5±12.2%; p=0.22). The three-year survival rate (88.9%/75.0%; p=0.33) was comparable between groups.

Conclusion: The synergistic utilization of left atrial plication with para-annular plication via right mini-thoracotomy can enhance the postoperative outcomes of mitral valve repair.

Keywords: cardiac surgical procedures; left atrial plication; minimally invasive cardiac surgery; mitral valve repair; mitral valve surgery.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Review Board of Tottori Prefectural Central Hospital issued approval 2024-05. Prior to the retrospective analysis and reporting of findings, explicit patient consent was obtained. This study was conducted in accordance with the guidelines of the Institutional Review Board of Tottori Prefectural Central Hospital, ensuring adherence to ethical standards (approval number: 2024-05). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Measurement of the AMA on transthoracic echocardiography
AMA: aorto-mitral angle
Figure 2
Figure 2. Left atrial plication through right mini-thoracotomy
A right mini-thoracotomy was performed through an approximately 6-cm skin incision lateral to the midclavicular line. After confirming secure systemic perfusion with cardiopulmonary bypass, the ascending aorta was cross-clamped with a Cygnet clamp (Vitalitec, Plymouth, MA) placed through the transverse sinus. Antegrade crystalloid cardioplegia was induced using a cardioplegic catheter. The left atrium was entered through an atrial incision, and a retractor was positioned. The procedure was performed under direct thoracoscopic assistance. a: The area marked in blue represents the left atrial posterior wall enlarged in the direction of the arrow. b: The left atrial posterior wall was plicated with a width of 4-5 cm using a double layer of 4-0 polypropylene sutures. MV: mitral valve, LPV: left pulmonary vein, RPV: right pulmonary vein
Figure 3
Figure 3. Postoperative echocardiography findings
a: Left atrial shrinkage rate. b: Left atrial volume index reduction rate. c: Aorto-mitral angle enlargement rate. p-values less than 0.05 were considered statistically significant. MICS: minimally invasive cardiac surgery
Figure 4
Figure 4. Kaplan-Meier survival curve
p-values less than 0.05 were considered statistically significant. MICS: minimally invasive cardiac surgery
See this image and copyright information in PMC

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