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ISOLATED CONGENITAL MITRAL REGURGITATION LONG-TERM RESULTS AND THE ROLE OF PROSTHETIC RING Hung Dung VAN.MD.PhD, Hoang Khang HUYNH HCMC Heart Institute - VIETNAM... Patients and Meth

ISOLATED CONGENITAL MITRAL REGURGITATION

LONG-TERM RESULTS AND THE ROLE OF

PROSTHETIC RING

Hung Dung VAN.MD.PhD, Hoang Khang HUYNH

HCMC Heart Institute - VIETNAM

Patients and Methodology

Patients Demographic Pre-op

Echocardiographic Findings

• Type I : normal leaflet motion

annulus dilatation : 112

cleft mitral valve : 16 (14/2)

• Type II : leaflet prolapse

Double orifice MR

SURGICAL TECHNIQUES

Techniques N %

Annuloplasty

Ring annuloplasty

Posterior annuloplasty (pericardial/PTFE )

Closure of mitral cleft

Triangular resection (anterior leaflet)

Quadrangular resection (posterior leaflet)

Leaflet extension (anterior leaflet)

Shortening of chordae Transposition of chordae Marginalization of chordae Plication of redundant leaflet Artificial Chord Commissurotomy Fenestration of chordae Papillary muscle splitting 118

93

25

23

29

17

21

7

30

7

5

5

4

4

3

72.6 19.5 17.9 22.6 13.2 16.4

6.3 23.4 5.4 3.9 3.9 3.1 3.1 2.3

P

VAN H DUNG-HNPTTMLN 2016-HCM

Follow-up

• Mean time of FU : 94.8 ± 70.5 months

(6 – 240 months)

• Lost FU : 5 pts

• Late death : 2 pts ( 1 CVA, 1 unknown)

• 19 years actuarial survival = 96.8 ± 2.2%

(KM)

VAN H DUNG-HNPTTMLN 2016-HCM

Re-operation

• Early re-operation : 1 ( 1 week)

• Late re-operation : 10 (11-180 months)

- Re-plasty : 07 ( remove prosthetic ring)

- Replace : 03

- Biopros deterioration : 1 ( 51 months)

• 19 yrs free of re-op : 84 ± 7.2% (KM)

VAN H DUNG-HNPTTMLN 2016-HCM

1

2

3

4

Long-term Mitral Regurgitation Evaluation ( N = 110)

• Absent or Mild : 88 (80%)

• Moderate : 15 (13.6%)

• Severe : 7 (6.4%)

VAN H DUNG-HNPTTMLN 2016-HCM

MV re-operation: ring or without ring

Authors (N) Prosth Ring Post.Band Plication/Compress

2/5 (40%)

3/11 (27%)

Our Study

(2015) N = 128

3/93 (3.2%)

4/25 (16%) Yoshimura

Timing of Surgery

• Age of Patients : >3 - 6 months or as older as possible

• Anatomic Lesions : less complex

• Clinical Status ( delay until the onset of severe symptom)

• Size of Mitral Annulus ≥ 20

Goal: maximum the changes for a more successful and satisfactory repair

VAN H DUNG-HNPTTMLN 2016-HCM

Authors Repair Replace Hop.Mort Re-Op

Mitral valve repair with Carpentier’s techniques

has very good long-term results with very low

mortality and acceptable re-operation rate

VAN H DUNG-HNPTTMLN 2016-HCM

THANK YOU FOR YOUR ATTENTION