초록접수 현황
| 14F-039 | 포럼 발표 |
Comparison between Mitral Valve Indentation and Triangular Resection Technique; Early Clinical and Echocardiographic Results.
박종명, 제형곤, 정혜선, 조옥희, 손봉수, 최광호, 김형태, 김도형, 이상권, 성시찬
부산대학교 의과대학 흉부외과학교실
Background : Currently, leaflet resection or new chorda formation is the most common technique of mitral valve repair for degenerative mitral regurgitation. Both techniques include complicated processes, such as reattachment of leaflet following extensive resection and precise estimation of neochorda. Herein, we compare simple leaflet indentation with traditional triangular resection technique.
Methods : Eight patients with leaflet indentation repair (Group I) compared to 28 patients with triangular resection (Group R). A CV5 Gore-Tex suture was placed into the papillary muscle underneath the prolapsing segment as a neochorda. This double armed suture was then used to indentate the prolapsed segment into the left ventricle, creating a smooth, broad, non-prolapsed coapting surface on a leaflet with preserved mobility.
Results : Repair was successful for all patients in both groups and 35 of 36 repairs were finished with minimally invasively approach. Preoperative data such as age, gender, left ventricular ejection fraction were comparable. The mean MR grade was 4.0 in group I and 3.85 in group R. Although concomitant surgery was more common in indentation group (I:75% vs. R:32.1%; p=0.039), which had significantly shorter cardiopulmonary bypass time (I: 101.5±18.0 versus R:128.6±28.4; p=0.016). The cross-clamp times (I: 74.0±14.7 versus R:85.0±21.7; p=0.189) and mean length of stay (I:6.1±3.6 versus R:7.5±7.4; p>0.1) were comparable. The greater than +1 residual MR was not found at discharge and 1 year follow-up in group I, however in group R it was found 10.7% (3/27) and 11.8% (2/17), respectively. The 1 year echo follow-up showed significant difference in mitral valve area (I:3.1±0.3 versus R:2.4±0.3; p=0.017).
Conclusion : This mitral valve indentation technique facilitated reliable repair of the prolapsed mitral valve with minimal complexity. Suggested 1-year hemodynamic superiority of this technique needs to be proven with larger population and longer follow-up of imaging study.
Methods : Eight patients with leaflet indentation repair (Group I) compared to 28 patients with triangular resection (Group R). A CV5 Gore-Tex suture was placed into the papillary muscle underneath the prolapsing segment as a neochorda. This double armed suture was then used to indentate the prolapsed segment into the left ventricle, creating a smooth, broad, non-prolapsed coapting surface on a leaflet with preserved mobility.
Results : Repair was successful for all patients in both groups and 35 of 36 repairs were finished with minimally invasively approach. Preoperative data such as age, gender, left ventricular ejection fraction were comparable. The mean MR grade was 4.0 in group I and 3.85 in group R. Although concomitant surgery was more common in indentation group (I:75% vs. R:32.1%; p=0.039), which had significantly shorter cardiopulmonary bypass time (I: 101.5±18.0 versus R:128.6±28.4; p=0.016). The cross-clamp times (I: 74.0±14.7 versus R:85.0±21.7; p=0.189) and mean length of stay (I:6.1±3.6 versus R:7.5±7.4; p>0.1) were comparable. The greater than +1 residual MR was not found at discharge and 1 year follow-up in group I, however in group R it was found 10.7% (3/27) and 11.8% (2/17), respectively. The 1 year echo follow-up showed significant difference in mitral valve area (I:3.1±0.3 versus R:2.4±0.3; p=0.017).
Conclusion : This mitral valve indentation technique facilitated reliable repair of the prolapsed mitral valve with minimal complexity. Suggested 1-year hemodynamic superiority of this technique needs to be proven with larger population and longer follow-up of imaging study.
책임저자: 제형곤
부산대학교 의과대학 흉부외과학교실
연락처 : 박종명, Tel: 055-360-2127 , E-mail : jehg7332@gmail.com
