Surgical mitral plasticity for chronic ischemic mitral regurgitation.

BACKGROUND AND AIM OF THE STUDY: The outcome of mitral valve (MV) repair for chronic ischemic mitral regurgitation (IMR) is suboptimal, due to the high recurrence rate of moderate or severe mitral regurgitation (MR) during follow-up. The MV adapts to new MR increasing its area to cover the enlarged annular area (mitral plasticity). As this process is often incomplete, we aimed to evaluate if augmenting the anterior leaflet (AL) and cutting the second-order chords (CC) together with restrictive mitral annuloplasty, a strategy we call "surgical mitral plasticity," could improve the midterm results of MV repair for IMR. MATERIALS AND METHODS: From November 2017 to October 2019, 22 patients with chronic IMR underwent surgical mitral plasticity. Mean age was 73 ± 7 years and six were female. Mean ejection fraction was 32% ± 11%, IMR grade was moderate in 10 and severe in 12. Mean clinical and echocardiographic follow-up was 12 ± 6 months. RESULTS: There was no early death, and one patient died 6 months after surgery. Ejection fraction improved from 32% ± 15% to 40% ± 6% (P = .031). IMR was absent or mild in all patients, and none showed recurrent moderate or more IMR. Tenting area decreased significantly from 2.5 ± 0.5 to 0.5 ± 0.3 cm² and coaptation length increased from 1.9 ± 0.7 to 7.8 ± 1.6 mm. All patients were in New York Heart Association class I or II. CONCLUSIONS: Mitral plasticity, if uncomplete, is ineffective in preventing IMR to become significant. Surgical mitral plasticity, by completing incomplete process of MV adaptation, has a strong rationale, which however needs to be validated with longer follow-up.

Intermittent Antegrade Warm Blood Cardioplegia: What Is Next?

The introduction of warm heart surgery was a radical change in the concept of myocardial protection. In 1992, we applied a protocol for intermittent antegrade warm blood cardioplegia (CPL), which acquired some popularity for its simplicity and effectiveness. The possibility to deliver the warm blood CPL intermittently using the antegrade route attracted the attention of the scientific world, as the surgical procedure was less complicated. In this report, our aim is to focus on the changes that the protocol underwent over time and the reasons why these changes were made.

Full Orifice Patching without Annuloplasty for Severe Functional Tricuspid Valve Regurgitation.

Surgical treatment of severe functional tricuspid regurgitation associated with dilated right ventricle and increased chordal tethering (>8 mm) is challenging. We designed a technique where the anterior and posterior leaflets are detached from 50% of the annulus and a patch as large as the tricuspid orifice is sewn to augment the leaflets' tissue to force the coaptation with the septal leaflet. Annuloplasty is not performed, as it can only increase the chordal tethering, reducing the benefit of tissue augmentation. Early and midterm results in a subgroup of patients with unfavorable anatomical aspects are encouraging.

Predictive value of intraoperative transit-time flow measurement for short-term graft patency in coronary surgery.

OBJECTIVE: The aim of this retrospective study was to evaluate the possibility to predict postoperative graft patency in coronary surgery by means of intraoperative transit-time flow measurement. METHODS: Of 3567 patients submitted to isolated myocardial revascularization from June 1997 through June 2003, 157 (4.4%) underwent both intraoperative transit-time flow measurement and angiography at follow-up. Thirty-six have been revascularized on a beating heart. Three hundred four grafts, 227 arterial conduits, and 77 saphenous vein grafts were checked. RESULTS: No patients died, and none of them had an acute myocardial infarction within 12 months after the operation. After a mean of 6.7 +/- 4.8 months from the operation, 266 grafts (group A) were completely functioning, whereas 38 grafts (group B) had failed. The transit-time flow parameters recorded in the latter group had significantly lower mean flow and higher pulsatility index and percentage of backward flow values at both univariate and multivariate analysis. Moreover, mean flow values of 15 mL/min or less, pulsatility index values of 3.0 or greater, and percentage of backward flow values of 3.0% or greater were found to be independent variables for higher incidence of graft failure. CONCLUSIONS: Transit-time flow measurement represents a quick, easy, and reproducible method for intraoperative evaluation of graft function. The combination of the 3 major parameters (mean flow, pulsatility index, and percentage of backward flow) results in the chance to predict a graft failure (either anatomic or functional) within the first postoperative year.