Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion

Patrick O. Myers, Zain Khalpey, Ann M. Maloney, Derek R. Brinster, Michael N. D'Ambra, Lawrence H. Cohn

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: The edge-to-edge technique has been proposed to prevent systolic anterior motion (SAM) of the mitral valve. There is limited clinical data available on outcomes of this technique for this indication. We reviewed the midterm results of this technique for SAM prevention and treatment. Methods: A total of 2226 patients had mitral valve repair between 2000 and 2011, 1148 of which were for myxomatous mitral regurgitation. Beginning in 2000, predictability of postrepair SAM based on the prebypass, intraoperative transesophageal echocardiogram arose in our program. The edge-to-edge technique was used in 65 patients (5.7%) for SAM management, in 53 patients preemptively for transesophageal echocardiogram-based SAM prediction, and in 12 patients for postrepair SAM treatment. Results: There was no operative mortality. Postoperative mitral regurgitation was significantly improved in all patients compared with the preoperative grade (P <.001). SAM was completely eliminated, the mean mitral regurgitation grade in the postoperative period was 0.7 ± 0.9, and the mean transmitral gradient was 1.3 ± 2.2 mm Hg. During a mean follow-up of 26 months, 1 patient in the SAM treatment group presented late recurrence of SAM and no patients developed mitral stenosis (mean transmitral gradient, 2.0 ± 2.6 mm Hg; P =.12). Without SAM prediction and preemptive edge-to-edge technique, the expected rate of SAM would have been 5.7%; however, the observed rate was 1% (12 of 1148 patients). Conclusions: Initiating an expectation for prebypass SAM prediction, combined with a surgical SAM prevention strategy, resulted in a reduced prevalence of SAM compared with our model of observed to-expected-ratios and to published norms.

Original languageEnglish (US)
Pages (from-to)836-840
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume146
Issue number4
DOIs
StatePublished - Oct 1 2013

Keywords

  • A2
  • CPB
  • E2E
  • LVOT
  • MV
  • SAM
  • TEE
  • cardiopulmonary bypass
  • edge-to-edge
  • left ventricular outflow tract
  • middle scallop of the anterior mitral leaflet
  • mitral valve
  • systolic anterior motion
  • transesophageal echocardiography

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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