What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability?
Background This study assessed risk factors for mitral regurgitation (MR) recurrence or functional mitral stenosis during long‐term follow‐up in patients undergoing mitral valve repair for isolated posterior mitral leaflet prolapse. Methods and Results We assessed a consecutive series of 511 patient...
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Wiley
2023-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.028607 |
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| author | Takashi Kakuta Satsuki Fukushima Kimito Minami Satoshi Kainuma Naonori Kawamoto Naoki Tadokoro Ayumi Ikuta Kohei Tonai Yoshikatsu Saiki Tomoyuki Fujita |
| author_facet | Takashi Kakuta Satsuki Fukushima Kimito Minami Satoshi Kainuma Naonori Kawamoto Naoki Tadokoro Ayumi Ikuta Kohei Tonai Yoshikatsu Saiki Tomoyuki Fujita |
| author_sort | Takashi Kakuta |
| collection | DOAJ |
| description | Background This study assessed risk factors for mitral regurgitation (MR) recurrence or functional mitral stenosis during long‐term follow‐up in patients undergoing mitral valve repair for isolated posterior mitral leaflet prolapse. Methods and Results We assessed a consecutive series of 511 patients who underwent primary mitral valve repair for isolated posterior leaflet prolapse between 2001 and 2021. Annuloplasty using a partial band was selected in 86.3%. The leaflet resection technique was used in 83.0%, whereas the chordal replacement without resection was used in 14.5%. Risk factors were analyzed for MR recurrence ≥grade 2 or functional mitral stenosis with mean transmitral pressure gradient ≥5 mm Hg using a multivariable Fine–Gray regression model. The 1‐, 5‐, and 10‐year cumulative incidence of MR ≥grade 2 was 7.8%, 22.7%, and 30.1%, respectively, whereas that of mean transmitral pressure gradient ≥5 mm Hg was 8.1%, 20.6%, and 29.3%, respectively. Risk factors for MR ≥grade 2 included chordal replacement without resection (hazard ratio [HR], 2.50, P<0.001) and larger prosthesis size (HR, 1.13, P=0.023), whereas factors for functional mitral stenosis were use of a full ring (partial band versus full ring, HR, 0.53, P=0.013), smaller prosthesis size (HR, 0.74, P<0.001), and larger body surface area (HR, 3.03, P=0.045). Both MR ≥grade 2 and mean transmitral pressure gradient ≥5 mm Hg at 1 year post surgery were significantly associated with the long‐term incidence of reoperation. Conclusions Leaflet resection with a large partial band may be an optimal strategy for isolated posterior mitral valve prolapse. |
| format | Article |
| id | doaj-art-2b998ef8a90e45ef8fb085cb4882ea21 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-2b998ef8a90e45ef8fb085cb4882ea212025-08-20T01:51:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-06-01121110.1161/JAHA.122.028607What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability?Takashi Kakuta0Satsuki Fukushima1Kimito Minami2Satoshi Kainuma3Naonori Kawamoto4Naoki Tadokoro5Ayumi Ikuta6Kohei Tonai7Yoshikatsu Saiki8Tomoyuki Fujita9Department of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanDepartment of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanSurgical Intensive Care National Cerebral and Cardiovascular Research Center Suita Osaka JapanDepartment of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanDepartment of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanDepartment of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanDepartment of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanDepartment of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanDepartment of Cardiovascular Surgery Tohoku University Graduate School of Medicine Aoba‐ku Sendai JapanDepartment of Cardiovascular Surgery National Cerebral and Cardiovascular Research Center Osaka Suita JapanBackground This study assessed risk factors for mitral regurgitation (MR) recurrence or functional mitral stenosis during long‐term follow‐up in patients undergoing mitral valve repair for isolated posterior mitral leaflet prolapse. Methods and Results We assessed a consecutive series of 511 patients who underwent primary mitral valve repair for isolated posterior leaflet prolapse between 2001 and 2021. Annuloplasty using a partial band was selected in 86.3%. The leaflet resection technique was used in 83.0%, whereas the chordal replacement without resection was used in 14.5%. Risk factors were analyzed for MR recurrence ≥grade 2 or functional mitral stenosis with mean transmitral pressure gradient ≥5 mm Hg using a multivariable Fine–Gray regression model. The 1‐, 5‐, and 10‐year cumulative incidence of MR ≥grade 2 was 7.8%, 22.7%, and 30.1%, respectively, whereas that of mean transmitral pressure gradient ≥5 mm Hg was 8.1%, 20.6%, and 29.3%, respectively. Risk factors for MR ≥grade 2 included chordal replacement without resection (hazard ratio [HR], 2.50, P<0.001) and larger prosthesis size (HR, 1.13, P=0.023), whereas factors for functional mitral stenosis were use of a full ring (partial band versus full ring, HR, 0.53, P=0.013), smaller prosthesis size (HR, 0.74, P<0.001), and larger body surface area (HR, 3.03, P=0.045). Both MR ≥grade 2 and mean transmitral pressure gradient ≥5 mm Hg at 1 year post surgery were significantly associated with the long‐term incidence of reoperation. Conclusions Leaflet resection with a large partial band may be an optimal strategy for isolated posterior mitral valve prolapse.https://www.ahajournals.org/doi/10.1161/JAHA.122.028607annuloplastychordal replacementleaflet resectionmitral valve repairposterior leaflet prolapse |
| spellingShingle | Takashi Kakuta Satsuki Fukushima Kimito Minami Satoshi Kainuma Naonori Kawamoto Naoki Tadokoro Ayumi Ikuta Kohei Tonai Yoshikatsu Saiki Tomoyuki Fujita What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability? Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease annuloplasty chordal replacement leaflet resection mitral valve repair posterior leaflet prolapse |
| title | What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability? |
| title_full | What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability? |
| title_fullStr | What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability? |
| title_full_unstemmed | What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability? |
| title_short | What Is the Optimal Mitral Valve Repair for Isolated Posterior Leaflet Prolapse to Achieve Long‐Term Durability? |
| title_sort | what is the optimal mitral valve repair for isolated posterior leaflet prolapse to achieve long term durability |
| topic | annuloplasty chordal replacement leaflet resection mitral valve repair posterior leaflet prolapse |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.028607 |
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