SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:34
LONG-TERM RESULTS OF MITRAL VALVE REPAIR USING A MADE TO MEASURE GORE-TEX
ANNULOPLASTY RING
Javangula Kalyana 1 , Mushtaq Abid 1 , Papaspyros Sotoris 1 , Nair Unnikrishnan 1
1) Leeds General Infirmary, United Kingdom
Objectives
This study evaluates the long-term results of mitral valve repair using a made to measure Gore-tex Annuloplasty
Ring configured to the actual circumference of the valve.
Methods
A retrospective review was conducted of 39 consecutive patients (mean age 61.6 +/- 10.3 years; range: 26-80 years,
mean Euroscore 6.5) who underwent mitral valve annuloplasty between June 1996 to December 2007. The major
causes of mitral regurgitation (MR) were annular dilatation and prolapse of the posterior leaflet. Quadrangular
resection of the prolapsing posterior cusp was undertaken, when necessary. A 2 mm wide made-to-measure ring
created from a 0.6mm thick Gore-tex, configured to the valve circumference was inserted with interrupted ethibond
sutures supporting the posterior annulus.
Results
One patient with Gillian Barrie Syndrome (2.5%) died late; one (2.5%) had pacemaker insertion and one (2.5%)
needed valve replacement 12 months later following infection. Postoperatively at 8 years the actuarial survival was
92.5% and freedom from re-operation 97.1%. Clinical and echocardiography follow-up continued for a mean period
of 6.1 +/- 1.62 years (range: 1.96 to 9.55), and was complete on 21 patients. The mean NYHA functional class at
follow-up was significantly lower than the preoperative score (1.32:2.65, p=0.0008, paired t-test). Pre-operatively
3 patients (14%) had mild MR, 5 (24%) moderate MR and 13 (62%) severe MR. Post-operatively, 13 patients (62%)
had no detectable MR and 8 (38%) had mild MR.
Conclusions
Mitral valve repair using a made-to-measure Gore-tex ring configured to the actual circumference of the mitral valve
is safe, cost-effective, durable and reproducible.
P01:35
THE LEFT ATRIAL ROOF APPROACH (LARI) - AN ASSET FOR MINIMALLY INVASIVE MITRAL SURGERY
Javangula Kalyana 1 , Nair Unnikrishnan 1
1) Leeds General Infirmary, United Kingdom
Background
Adequate exposure and access is fundamental in mitral valve surgery. The conventional approach is interatrial
groove using bicaval venous cannulation. The left atrial roof incision has the potential of facilitating an excellent
exposure of mitral valve through a limited incision without major cardiac tissue trauma, which is particularly desirable
for minimally invasive mitral surgery.
We conducted this study to determine the safety, efficacy and technical ease of the LARI.
Methods
Retrospectively collected data of 95 consecutive patients who had mitral valve surgery by the same surgeon in the
last 5 years were analysed. The patients were divided into two groups. Group 1 patients had LARI through minimally
invasive sternotomy (MIS) or full sternotomy. Group 2 patients had the conventional paraseptal incision of the left
atrium through a MIS or full sternotomy. The mitral valve was exposed with LARI in 81 patients (85%). Minimally
invasive technique was used in 19% patients.
Results
More patients in the LARI group regained sinus rhythm on discharge. Concomitant procedures included AVR (25)
TVR (2) AV repair (5) CABG (28) and LA and ventricular volume reduction (5). There was 1 death in group 2.
Conclusions
LARI is a safe technique.Compared to conventional interatrial approach, LARI has short cross clamp and bypass
time. It has the added advantage of reduction in the incidence of AF, ICU stay, total hospital stay. It is feasible in
redo surgery and is ideal for supervised surgical training.
STOCKHOLM, SWEDEN 83