Selective reduction of the septolateral dimensions in functional mitral regurgitation by modified-shape ring annuloplasty.
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Biomedical subjects
Andrea Blasio
Publications and source records attributed to Andrea Blasio.
A method to avoid annular downsizing during knot tying.
Pericardial annuloplasty has been used as an alternative to prosthetic annuloplasty. One drawback of pericardial annuloplasty is the risk of cinching of tissues during knot tying, possibly leading to uncontrolled downsizing and to complications such as mitral stenosis and systolic anterior motion of the anterior leaflet. A simple modification of the sequence of knot tying is described to avoid this complication.
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Midterm results of edge-to-edge mitral valve repair without annuloplasty.
OBJECTIVE: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. METHODS: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. RESULTS: There were 3 hospital and 4 late deaths, for a 4-year survival of 85% +/- 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% +/- 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% +/- 22% vs 95% +/- 4.6% freedom from reoperation, P =.03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. CONCLUSIONS: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.
Calcinosis↗
Surgical restoration of the left ventricle for postinfarction aneurysm.
BACKGROUND: Surgical left ventricular reduction is under investigation as an alternative to, or a bridge for, heart transplantation in patients with a left ventricular aneurysm. In fact, acute myocardial infarction can result in the development of a dyskinetic or akinetic left ventricular aneurysm which may in turn cause congestive heart failure, ventricular arrhythmias, and the formation of mural thrombi. The aim of this study was to evaluate the current operative risk of surgical restoration of the left ventricle and the early and late clinical results. METHODS: From January 1997 to December 2001, 94 patients (84 males and 10 females) presenting with a postinfarction aneurysm were submitted to surgical restoration of the left ventricle. All patients presented with symptoms of heart failure and/or angina. The preoperative NYHA functional class was: I in 6 patients, II in 22 patients, and III in 66 patients. No patient was in NYHA class IV at the time of surgery. The preoperative ejection fraction was 30 +/- 7.9%. In 25 patients mural thrombi were identified and surgically removed. In patients with preoperative evidence of ventricular arrhythmias the Harken procedure was performed intraoperatively. The ventricular preoperative and postoperative performances were also studied in 10 patients using P-V loops obtained through a conductance catheter. RESULTS: The in-hospital mortality was 3.2%. The mean length of hospitalization was 7 +/- 2.9 days. At follow-up (mean 26 +/- 14.8 months) we observed an early improvement in the ejection fraction (30 +/- 7.9 vs 48 +/- 8.0%) and a decrease in the end-diastolic and end-systolic volumes and mean pulmonary pressure (139 +/- 37 vs 84 +/- 17 ml/m2, 105 +/- 39 vs 52 +/- 20 ml/m2, 35 +/- 8.4 vs 23 +/- 4.3 mmHg). CONCLUSIONS: These results suggest that ventricular restoration is indicated in all patients with a postinfarction dyskinetic or akinetic aneurysm. The operation, if performed appropriately, is associated with a low in-hospital mortality and morbidity. A postoperative improvement in the early and long-term cardiac functions was demonstrated. An improvement in symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.
Cardiac Surgical Procedures↗