C. Tourmousoglou et al. / Interactive CardioVascular and Thoracic Surgery
eComment. ePTFE neochordae in Carpentier’s functional Type II mitral regurgitation: Do all roads lead to Rome? Author: Ovidio A. Garcia-Villarreal Department of Cardiac Surgery, Hospital of Cardiology, UMAE 34, IMSS, Monterrey, Mexico doi: 10.1093/icvts/ivu330 © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. I have read with great interest the article by Tourmousoglou et al. [1]. Mitral valve repair has gained increasing popularity due to the specific techniques available which have been perfectly standardized and described by Carpentier [2]. Posterior leaflet prolapse is very easy to correct by means of quadrangular resection and closure of the gap (with or without sliding) with ring annuloplasty. The success rate here must be up to 99% [3]. Anterior leaflet prolapse has been traditionally more difficult to correct. Resection of the anterior leaflet becomes unfavourable and is not applicable when a large area of prolapse is present [4]. Chordal shortening and chordal transfer techniques for repair of anterior leaflet prolapse have been reported [2]. However, all of them have exhibited inconsistent long-term outcomes. Chordal replacement with expanded polytetrafluoroethylene (ePTFE) has been introduced to repair anterior mitral prolapse. Long-term durability and biological adaptation of the ePTFE neochordae have been acceptable [5]. At first sight, there may be concern about the level of accuracy in the measurement of ePTFE chordae. Nevertheless, with the mastering of the surgical technique, this approach has gained increasing popularity. According to the results shown by Tourmousoglou et al. [1], it is therefore reasonable to suggest that ePTFE neochordae replacement might be extended to encompass correction of posterior leaflet prolapse. All of these efforts are focussed on reducing the aortic crossclamp time. Conflict of interest: none declared. References [1] Tourmousoglou C, Lalos S, Dougenis D. Mitral valve repair of isolated posterior leaflet prolapse: resect or respect? Interact CardioVasc Thorac Surg 2014; 19:1027–35. [2] Carpentier A. Cardiac valve surgery: the “French correction.” J Thorac Cardiovasc Surg 1983;86:323–337. [3] Perier P, Stumpf J, Götz C, Lakew F, Schneider A, Clausnizer B et al. Valve repair for mitral regurgitation caused by isolated prolapse of the posterior leaflet. Ann Thorac Surg 1997;64:445–450. [4] Carpentier A, Relland J, Deloche A, Fabiani JN, D’Allaines C, Blondeau P et al. Conservative management of the prolapsed mitral valve. Ann Thorac Surg 1978;26:294–302. [5] David TE, Omran A, Armstrong S, Sun Z, Ivanov J. Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene. J Thorac Cardiovasc Surg 1998;115:1279–1286.
BEST EVIDENCE TOPIC
[3] Braunberger E, Deloche A, Berrebi A, Abdallah F, Celestin JA, Meimouun P et al. Very long-term results (more than 20 years) of valve repair with Carpentier’s techniques in nonrheumatic mitral valve insufficiency. Circulation 2001;104(Suppl I):I-8–I-11. [4] Casselman F, Van Slyke S, Wellens F, De Geest R, Degriek I, Van Praet F et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation 2003;108(Suppl II):II-48–II-54. [5] De Bonis M, Lorusso R, Lapenna E, Kassem S, De Cicco G, Torracca L et al. Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse. J Thorac Cardiovasc Surg 2006;131: 364–70. [6] Salvador L, Mirone S, Bianchini R, Regesta T, Patelli F, Minniti G et al. A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg 2008;135:1280–7. [7] Perier P, Hohenberger W, Lakew F, Batz G, Urbanski P, Zacher M et al. Toward a new paradigm for the reconstruction of posterior leaflet prolapsed: midterm results of the “Respect rather than Resect” approach. Ann Thorac Surg 2008;86:718–25. [8] Modi P, Rodriquez E, Hargrove C, Hassan A, Szeto W, Chitwood R Jr. Minimally invasive video-assisted mitral valve surgery: a 12-year, 2-center experience in 1178 patients. J Thorac Cardiovasc Surg 2009; 137:1481–7. [9] Seeburger J, Falk V, Borger M, Passage J, Walter T, Doll N et al. Chordae replacement versus resection or repair of isolated posterior mitral leaflet prolapse. Ann Thorac Surg 2009;87:1715–20. [10] DiBardino D, ElBardissi A, McClure RS, Razo-Vasquez O, Kelly N, Cohn L. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution and long-term outcome. J Thorac Cardiovasc Surg 2010;139:76–84. [11] Lange R, Guenther T, Noebauer C, Kiefer B, Eichinger W, Voss B et al. Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leaflet prolapse. Ann Thorac Surg 2010;89: 1163–70. [12] Johnston D, Gillinov AM, Blackstone E, Griffin B, Stewart W, Sabik J III et al. Surgical repair of posterior mitral valve prolapse: implications for guidelines and percutaneous repair. Ann Thorac Surg 2010;89:1385–94. [13] Lawrie G, Earle E, Earle N. Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation. J Thorac Cardiovasc Surg 2011;141:368–76. [14] Castillo J, Anyanwu A, Fuster V, Adams D. A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines. J Thorac Cardiovasc Surg 2012;144:308–12. [15] Spiegelstein D, Sternik L, Orlov B, Shinfeld A, Feinberg M, Malachy A et al. Mitral valve repair: isolated posterior compared to anterior or bileaflet pathology. J Card Surg 2013;28:89–96. [16] Mihaljevic T, Pattakos G, Gillinov M, Bajwa G, Planinc M, Williams S et al. Robotic posterior mitral leaflet repair: neocordal versus resectional techniques. Ann Thorac Surg 2013;95:787–94. [17] David T, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: a 25-year experience. J Thorac Cardiovasc Surg 2013;145:1563–9.
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eComment. ePTFE neochordae in Carpentier’s functional Type II mitral regurgitation: Do all roads lead to Rome? Author: Ovidio A. Garcia-Villarreal Department of Cardiac Surgery, Hospital of Cardiology, UMAE 34, IMSS, Monterrey, Mexico doi: 10.1093/icvts/ivu330 © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. I have read with great interest the article by Tourmousoglou et al. [1]. Mitral valve repair has gained increasing popularity due to the specific techniques available which have been perfectly standardized and described by Carpentier [2]. Posterior leaflet prolapse is very easy to correct by means of quadrangular resection and closure of the gap (with or without sliding) with ring annuloplasty. The success rate here must be up to 99% [3]. Anterior leaflet prolapse has been traditionally more difficult to correct. Resection of the anterior leaflet becomes unfavourable and is not applicable when a large area of prolapse is present [4]. Chordal shortening and chordal transfer techniques for repair of anterior leaflet prolapse have been reported [2]. However, all of them have exhibited inconsistent long-term outcomes. Chordal replacement with expanded polytetrafluoroethylene (ePTFE) has been introduced to repair anterior mitral prolapse. Long-term durability and biological adaptation of the ePTFE neochordae have been acceptable [5]. At first sight, there may be concern about the level of accuracy in the measurement of ePTFE chordae. Nevertheless, with the mastering of the surgical technique, this approach has gained increasing popularity. According to the results shown by Tourmousoglou et al. [1], it is therefore reasonable to suggest that ePTFE neochordae replacement might be extended to encompass correction of posterior leaflet prolapse. All of these efforts are focussed on reducing the aortic crossclamp time. Conflict of interest: none declared. References [1] Tourmousoglou C, Lalos S, Dougenis D. Mitral valve repair of isolated posterior leaflet prolapse: resect or respect? Interact CardioVasc Thorac Surg 2014; 19:1027–35. [2] Carpentier A. Cardiac valve surgery: the “French correction.” J Thorac Cardiovasc Surg 1983;86:323–337. [3] Perier P, Stumpf J, Götz C, Lakew F, Schneider A, Clausnizer B et al. Valve repair for mitral regurgitation caused by isolated prolapse of the posterior leaflet. Ann Thorac Surg 1997;64:445–450. [4] Carpentier A, Relland J, Deloche A, Fabiani JN, D’Allaines C, Blondeau P et al. Conservative management of the prolapsed mitral valve. Ann Thorac Surg 1978;26:294–302. [5] David TE, Omran A, Armstrong S, Sun Z, Ivanov J. Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene. J Thorac Cardiovasc Surg 1998;115:1279–1286.
BEST EVIDENCE TOPIC
[3] Braunberger E, Deloche A, Berrebi A, Abdallah F, Celestin JA, Meimouun P et al. Very long-term results (more than 20 years) of valve repair with Carpentier’s techniques in nonrheumatic mitral valve insufficiency. Circulation 2001;104(Suppl I):I-8–I-11. [4] Casselman F, Van Slyke S, Wellens F, De Geest R, Degriek I, Van Praet F et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation 2003;108(Suppl II):II-48–II-54. [5] De Bonis M, Lorusso R, Lapenna E, Kassem S, De Cicco G, Torracca L et al. Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse. J Thorac Cardiovasc Surg 2006;131: 364–70. [6] Salvador L, Mirone S, Bianchini R, Regesta T, Patelli F, Minniti G et al. A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg 2008;135:1280–7. [7] Perier P, Hohenberger W, Lakew F, Batz G, Urbanski P, Zacher M et al. Toward a new paradigm for the reconstruction of posterior leaflet prolapsed: midterm results of the “Respect rather than Resect” approach. Ann Thorac Surg 2008;86:718–25. [8] Modi P, Rodriquez E, Hargrove C, Hassan A, Szeto W, Chitwood R Jr. Minimally invasive video-assisted mitral valve surgery: a 12-year, 2-center experience in 1178 patients. J Thorac Cardiovasc Surg 2009; 137:1481–7. [9] Seeburger J, Falk V, Borger M, Passage J, Walter T, Doll N et al. Chordae replacement versus resection or repair of isolated posterior mitral leaflet prolapse. Ann Thorac Surg 2009;87:1715–20. [10] DiBardino D, ElBardissi A, McClure RS, Razo-Vasquez O, Kelly N, Cohn L. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution and long-term outcome. J Thorac Cardiovasc Surg 2010;139:76–84. [11] Lange R, Guenther T, Noebauer C, Kiefer B, Eichinger W, Voss B et al. Chordal replacement versus quadrangular resection for repair of isolated posterior mitral leaflet prolapse. Ann Thorac Surg 2010;89: 1163–70. [12] Johnston D, Gillinov AM, Blackstone E, Griffin B, Stewart W, Sabik J III et al. Surgical repair of posterior mitral valve prolapse: implications for guidelines and percutaneous repair. Ann Thorac Surg 2010;89:1385–94. [13] Lawrie G, Earle E, Earle N. Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation. J Thorac Cardiovasc Surg 2011;141:368–76. [14] Castillo J, Anyanwu A, Fuster V, Adams D. A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines. J Thorac Cardiovasc Surg 2012;144:308–12. [15] Spiegelstein D, Sternik L, Orlov B, Shinfeld A, Feinberg M, Malachy A et al. Mitral valve repair: isolated posterior compared to anterior or bileaflet pathology. J Card Surg 2013;28:89–96. [16] Mihaljevic T, Pattakos G, Gillinov M, Bajwa G, Planinc M, Williams S et al. Robotic posterior mitral leaflet repair: neocordal versus resectional techniques. Ann Thorac Surg 2013;95:787–94. [17] David T, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: a 25-year experience. J Thorac Cardiovasc Surg 2013;145:1563–9.
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