Long-term follow-up of repair-like replacement of mitral valve using autologous pericardium.

Objectives: The present study assessed the late results of the operation, which consisted of the construction of a stentless mitral valve using autologous pericardium and valve implantation.

Methods: Between 2011 and 2018, among 1617 consecutive patients who underwent mitral valve operation at our institution, 15 adult patients (0.9%) with unrepairable mitral valves who wished to avoid conventional mitral valve replacement underwent this operation.

Mitral valve repair for extreme billowing and prolapsing valve.

Objectives: We describe our method and results of mitral valve repair up to 20 years in a defined group of patients with mitral regurgitation caused by an extreme billowing and prolapsing valve.

Methods: An extreme billowing and prolapsing valve was defined by the presence of excess tissue on both leaflets and prolapse of 2 or more of the 3 segments of each leaflet. Among 1344 consecutive patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2012 at the Sakakibara Heart Institute, 73 patients met our definition of an extreme billowing and prolapsing valve.

Anterior leaflet-oriented tricuspid annuloplasty using a flexible ring for severe tricuspid regurgitation.

We describe our concept and method of tricuspid annuloplasty using flexible ring for patients with severe tricuspid regurgitation accompanied by a severe tethering and a wide separation of the leaflets between the anterior leaflet and septal leaflet. The goal for our tricuspid ring annuloplasty using a flexible ring is to match the patient's own anterior leaflet configuration. We reduce the size of the tricuspid annulus respecting the individual configuration of the anterior leaflet to create a sufficient coaptation area of the leaflets.

The efficacy of sinus plication in aortic valvuloplasty for bicuspid aortic valve: experiments in a pulsatile flow simulation model.

Objectives: Sinus plication has emerged as a promising tool that can lead to better stability in bicuspid aortic valve (BAV) repair. However, the mechanisms underlying the efficacy of this technique are unclear. We evaluated the hydrodynamic effect of sinus plication using the experimental pulsatile flow simulator and our original BAV model in vitro.

Aortic root geometry following valve-sparing root replacement with reimplantation or remodeling: experimental investigation under static continuous pressure.

The differences in aortic root geometry associated with various valve-sparing root replacement (VSRR) techniques have not fully been understood. We evaluated the root configuration of current VSRR techniques by developing in vitro test apparatus. Six fresh porcine hearts were used for each model.

Management of systolic anterior motion of the mitral valve: a mechanism-based approach.

Although the mechanism of systolic anterior motion (SAM) of the mitral valve is unknown, it is known to have a multifactorial pathophysiology. Echocardiographic analysis of the mitral leaflet revealed the step-wise progression of SAM, and intraventricular flow analysis revealed the contribution of drag force generated by the misled flow below the posterior leaflet. Although several diverse clinical features of SAM are already known, some key features need to be abstracted from among them to understand the regulation of SAM establishment.

Causes of repair failure for degenerative mitral valve disease and reoperation outcomes.

Objectives: This study aimed to evaluate the causes of initial mitral valve (MV) repair failure, the details of reoperation and the long-term outcomes of mitral valve re-repair (Re-MVP).

Methods: We retrospectively reviewed 86 patients who underwent reoperation after MV repair for MR due to degenerative disease from October 1991 to December 2015. First, we analysed the initial MV repair data, causes of MV repair failure, reoperation data and long-term outcomes including survival.

Early Clinical Outcome of Mitral Valve Replacement Using a Newly Designed Stentless Mitral Valve for Failure of Initial Mitral Valve Repair.

Here we report the early outcome of mitral valve replacement using a newly designed stentless mitral valve for failure of initial mitral valve repair. Mitral valve plasty (MVP) for mitral regurgitation is currently a standard technique performed worldwide. However, whether mitral valve repair should be performed for patients with advanced leaflet damage or complicated pathology remains controversial.

In vivo assessment of novel stentless valve in the mitral position.

Background: We conducted in vivo examinations of a newly designed stentless mitral valve (SMV), formed by suturing 2 leaflets with the "legs" serving as chorda tendinea, made from bovine pericardium, to a flexible ring. METHODS AND RESULTS: Seven pigs underwent implantation of the SMV constructed with a 23-mm (n=5) or 25-mm (n=2) Duran ring. Baseline echocardiography examinations were used to evaluate the annular anteroposterior diameter, and distance between the mitral annulus (MA) and papillary muscles (PMs) to determine SMV-leg length.

Long-term outcomes of mitral valve repair for isolated commissural prolapse: up to 17-year experience.

Background: Mitral valve repair has been shown to be effective for degenerative mitral regurgitation (MR). However, outcomes of mitral valve repair for commissural prolapse has not been well defined. Commissural prolapse has been often categorized into the groups of posterior leaflet prolapse or bileaflet prolapse, and outcomes and prognosis of isolated commissural prolapse has been rarely reported.

Long-term outcomes of artificial chordal replacement with tourniquet technique in mitral valve repair: a single-center experience of 700 cases.

Objective: Artificial chordal replacement has been shown to be effective and durable, with numerous techniques reported. However, the outcomes of each technique have remained poorly defined. We report the long-term outcomes of the tourniquet technique.

Post-repair coaptation length and durability of mitral valve repair for posterior mitral valve prolapse.

Objective: Chordal placement with no or minimal leaflet resection has been suggested as the preferred technique for mitral valve repair for posterior leaflet prolapse, because it creates a longer coaptation zone. However, whether or not a long coaptation zone improves the durability of mitral valve repairs remains unclear.

Methods: We reviewed 119 patients with chronic degenerative mitral regurgitation including posterior middle scallop prolapse who underwent mitral valve repair between June 2004 and July 2008.

Long-term outcomes of early surgery for asymptomatic severe chronic mitral regurgitation.

Background And Aim Of The Study: The long-term outcomes of early surgery in patients with asymptomatic severe chronic mitral regurgitation (MR) and the impact of preoperative left ventricular dysfunction, atrial fibrillation (AF) and/or pulmonary hypertension (PH) on outcomes in this patient group, were evaluated.

Methods: Between 1992 and 2007, a total of 212 patients (mean age 50 +/- 15 years) with asymptomatic severe chronic degenerative MR underwent early mitral valve surgery within 12 months after echocardiographic diagnosis at the authors' institution. Mitral valve repair was attempted in all cases.

[Re-do mitral valve repair].

We describe proper indication and results of re-do mitral valve (MV) repair for recurrence of mitral regurgitation( MR) after MV repair. Among 1,163 patients who received MV repair for MV prolapsed between October 1991 and December 2010, 70 patients (6.0%) underwent redo MV operation.

Do semi-rigid prosthetic rings affect left ventricular function after mitral valve repair?

Background: After reports of cardiac impairment caused by mitral annuloplasty with rigid rings, several prosthetic rings with semi-rigidity were introduced. The influence of semi-rigid rings on postoperative cardiac function remains unknown. This study compared postoperative cardiac function between patients receiving a semi-rigid prosthetic ring and those receiving a flexible ring or band.

Influence of left ventricular function on development of systolic anterior motion after mitral valve repair.

Objective: A hyperkinetic heart has been suggested as a risk factor for systolic anterior motion (SAM) after mitral valve repair, but the influence of preoperative left ventricular (LV) function on the development of SAM has not been elucidated.

Methods: Transthoracic echocardiographic data were retrospectively reviewed in 441 patients who underwent mitral valve repair for degenerative mitral regurgitation. Comparisons were made between patients with and without SAM (SAM cases vs noncases).

Morphological analysis of systolic anterior motion after mitral valve repair.

Objectives: The systolic anterior motion (SAM) of mitral valves occurs at a certain rate despite the introduction of several preventive procedures. The purpose of this study was to investigate its mechanism by analysing the change in mitral valve morphology associated with operative procedures.

Methods: Components of mitral valves were measured before and after operative procedures by transoesophageal echocardiography in 179 patients who underwent mitral valve repair.

Assessment of a novel stentless mitral valve using a pulsatile mitral valve simulator.

Background And Aim Of The Study: The study aim was to develop a novel stentless mitral valve (SMV) and to evaluate its performance, using an original pulsatile simulator developed specifically to analyze the hydrodynamic function of the mitral valve.

Methods: The SMV developed at the authors' institution consists of two major components: a large anterior leaflet with commissures, and a small posterior leaflet. The valve is formed by suturing the leaflets (made from bovine pericardium) to a flexible (Duran) ring.

Mechanisms of recurrent regurgitation after valve repair for prolapsed mitral valve disease.

Background: We assessed mitral valve (MV) function using serial echocardiography as an indicator of the durability of MV repair. The aim of this study was to analyze the mechanisms of recurrent regurgitation after MV repair for degenerative disease.

Methods: From 1991 to 2007, 736 patients had valve repair for mitral regurgitation caused by leaflet prolapse: 346 patients had posterior and 390 had anterior leaflet prolapse.

The fate of bioprostheses in middle-aged patients: the Japanese experience.

Background And Aim Of The Study: Although the trend of bioprosthesis use has been evaluated extensively, the durability of currently available bioprostheses has not been determined in middle-aged patients. The study aim was to determine the long-term fate of bioprostheses implanted in patients aged < 60 years.

Methods: Valve implantation data were collected from 43 centers in Japan.