Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral Message
Background: We report 3 cases of rescue transventricular off-pump mitral valve (MV) repair in high-risk patients with acute mitral regurgitation (MR) due to post–myocardial infarction (MI) papillary muscle rupture (PMR). Methods: The 3 patients presented with acute inferior ST elevation myocardial i...
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Elsevier
2021-12-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250721006787 |
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| author | Mindaugas Budra, MD Vilius Janušauskas, MD, PhD Aleksejus Zorinas, MD, PhD Diana Zakarkaitė, MD, PhD Audrius Aidietis, MD, PhD Robertas Samalavičius, MD, PhD Kęstutis Ručinskas, MD, PhD |
| author_facet | Mindaugas Budra, MD Vilius Janušauskas, MD, PhD Aleksejus Zorinas, MD, PhD Diana Zakarkaitė, MD, PhD Audrius Aidietis, MD, PhD Robertas Samalavičius, MD, PhD Kęstutis Ručinskas, MD, PhD |
| author_sort | Mindaugas Budra, MD |
| collection | DOAJ |
| description | Background: We report 3 cases of rescue transventricular off-pump mitral valve (MV) repair in high-risk patients with acute mitral regurgitation (MR) due to post–myocardial infarction (MI) papillary muscle rupture (PMR). Methods: The 3 patients presented with acute inferior ST elevation myocardial infarction, cardiogenic shock, and pulmonary edema. Their preoperative peak troponin I levels were 1909 ng/L, 16,963 ng/L, and 8299 ng/L. All 3 patients underwent successful percutaneous intervention to the culprit coronary artery, and antiplatelet therapy was initiated. All patients required inotropic support and had an intra-aortic balloon pump inserted preoperatively. Transesophageal echocardiography (TEE) demonstrated severe eccentric MR due to the leaflet prolapse secondary to PMR. The patients’ estimated EuroSCORE II scores were 16.03%, 16.68%, and 7.81%, and their Society of Thoracic Surgeons scores were 14.77%, 18.24%, and 9.8%, respectively. All 3 patients underwent urgent transventricular off-pump MV repair using artificial chords, with 2 or 3 three neochords implanted. The duration of operation was <2 hours, and intraoperative and postoperative drainage was minimal in all cases. MV function was assessed by qualitative and semiquantitative TEE. Results: Intraoperative MR reduction to a mild level was achieved in all 3 patients. All patients had moderate MR at discharge, likely due to left ventricular remodeling. Severe MR recurred in all patients, at 5, 4, and 2 months of follow-up, respectively. All 3 patients underwent an elective MV reoperation via conventional approach. Conclusions: Off-pump transventricular MV repair may offer a safe and feasible alternative to stabilize high-risk patients with acute MR due to post-MI PMR. Although early MR recurrence is concerning, urgent transventricular MV repair may serve as a bridge to conventional surgery in such unstable patients. |
| format | Article |
| id | doaj-art-00156d62fb124256a7fd4c3c7a67fa78 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
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| series | JTCVS Techniques |
| spelling | doaj-art-00156d62fb124256a7fd4c3c7a67fa782025-08-20T04:01:56ZengElsevierJTCVS Techniques2666-25072021-12-011023124210.1016/j.xjtc.2021.09.047Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral MessageMindaugas Budra, MD0Vilius Janušauskas, MD, PhD1Aleksejus Zorinas, MD, PhD2Diana Zakarkaitė, MD, PhD3Audrius Aidietis, MD, PhD4Robertas Samalavičius, MD, PhD5Kęstutis Ručinskas, MD, PhD6Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Address for reprints: Mindaugas Budra, MD, Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Elbingo Str 44-5, Vilnius, Lithuania 06285.Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaCentre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaCentre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaCentre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaII Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaCentre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaBackground: We report 3 cases of rescue transventricular off-pump mitral valve (MV) repair in high-risk patients with acute mitral regurgitation (MR) due to post–myocardial infarction (MI) papillary muscle rupture (PMR). Methods: The 3 patients presented with acute inferior ST elevation myocardial infarction, cardiogenic shock, and pulmonary edema. Their preoperative peak troponin I levels were 1909 ng/L, 16,963 ng/L, and 8299 ng/L. All 3 patients underwent successful percutaneous intervention to the culprit coronary artery, and antiplatelet therapy was initiated. All patients required inotropic support and had an intra-aortic balloon pump inserted preoperatively. Transesophageal echocardiography (TEE) demonstrated severe eccentric MR due to the leaflet prolapse secondary to PMR. The patients’ estimated EuroSCORE II scores were 16.03%, 16.68%, and 7.81%, and their Society of Thoracic Surgeons scores were 14.77%, 18.24%, and 9.8%, respectively. All 3 patients underwent urgent transventricular off-pump MV repair using artificial chords, with 2 or 3 three neochords implanted. The duration of operation was <2 hours, and intraoperative and postoperative drainage was minimal in all cases. MV function was assessed by qualitative and semiquantitative TEE. Results: Intraoperative MR reduction to a mild level was achieved in all 3 patients. All patients had moderate MR at discharge, likely due to left ventricular remodeling. Severe MR recurred in all patients, at 5, 4, and 2 months of follow-up, respectively. All 3 patients underwent an elective MV reoperation via conventional approach. Conclusions: Off-pump transventricular MV repair may offer a safe and feasible alternative to stabilize high-risk patients with acute MR due to post-MI PMR. Although early MR recurrence is concerning, urgent transventricular MV repair may serve as a bridge to conventional surgery in such unstable patients.http://www.sciencedirect.com/science/article/pii/S2666250721006787mitral valveacute mitral regurgitationpapillary muscle rupturecardiogenic shockminimally invasiveoff-pump |
| spellingShingle | Mindaugas Budra, MD Vilius Janušauskas, MD, PhD Aleksejus Zorinas, MD, PhD Diana Zakarkaitė, MD, PhD Audrius Aidietis, MD, PhD Robertas Samalavičius, MD, PhD Kęstutis Ručinskas, MD, PhD Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral Message JTCVS Techniques mitral valve acute mitral regurgitation papillary muscle rupture cardiogenic shock minimally invasive off-pump |
| title | Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral Message |
| title_full | Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral Message |
| title_fullStr | Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral Message |
| title_full_unstemmed | Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral Message |
| title_short | Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupturePerspectiveCentral Message |
| title_sort | rescue transventricular off pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle ruptureperspectivecentral message |
| topic | mitral valve acute mitral regurgitation papillary muscle rupture cardiogenic shock minimally invasive off-pump |
| url | http://www.sciencedirect.com/science/article/pii/S2666250721006787 |
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