Mitral valve restoration using the No-React(R) MitroFix™: a novel concept.

BACKGROUND: Mitral Valve Repair (MVRP) has been shown to be significantly superior to Mitral Valve Replacement (MVR). Since the majority of repairs involve the Posterior Mitral Leaflet (PML) and not the Anterior Mitral Leaflet (AML), the monocuspidalisation of the Mitral Valve (MV) can be achieved with a bio-posterior leaflet that imitates a closed PML. This approach may have the benefit of restoring the competence of the MV without reducing its effective orifice area. METHODS: We have used a new concept and device, the MitroFixTM, to correct MV regurgitation due to pathology of the PML. The device comes with functional sizers both of which have identical shape and size. This allows the surgeon to pre-test the success of the restoration. From December 2006 to October 2011, 51 MitroFixTM devices were implanted at three institutions. RESULTS: The mean age of the patients (32 males and 19 females) was 67.7 years. 37 of them were in NYHA class III or IV and all patients suffered from severe mitral valve regurgitation (MR). 31 patients underwent combined surgery. Successful implantation of the MitroFix™ device was performed in 51/53 patients.Mean cross-clamp time was 63.6 min (range: 29-118 min). Six patients had additional reconstructive procedures of the AML (chordae transfer, neo-chordae, triangular resection). At discharge, 33 patients showed no MR in the TTE and 17 patients exhibited trivial (I) or moderate (II) MR. The mean gradient was 4.0 mmHg and mean EOA was 2.52cm^2 (range: 1.5-4.0cm2). All patients were classified as being in NYHA class I or II. CONCLUSION: The MitroFixTM Mitral Valve Restoration Device is a new concept that offers an effective treatment of MR. The restoration of the mitral valve with the MitroFix™ device offers the advantage of preserving the AML and providing good coaptation with a prosthetic PML. Importantly, this preliminary evaluation indicates a mean effective orifice area ( EOA ) of 2.5cm2 in MV receiving a MitroFix™ device, witch is higher than EOA resulting from MVR or MVRP. The present study has also shown that severe regurgitation due to ischemic/rheumatic MR, endocarditis and complex prolapse of the PML are clear candidates for correction with the MitroFix™. Larger studies and a longer follow up period are needed to validate these promising results.

Heart valve sound of various mechanical composite grafts, and the impact on patients' quality of life.

BACKGROUND AND AIM OF THE STUDY: The closing sounds of mechanical heart valves can be disturbing for patients and their closest relatives. Although some investigations into mechanical heart valve sounds have been performed, the particularities of the valve sound when it is attached to a vascular prosthesis to replace the aortic root and the ascending aorta has not been studied to date. The study aim was to compare the closing sounds of three various mechanical composite graft prostheses, and to analyze the impact of such sounds on the patients' quality of life. METHODS: Thirty patients who had undergone aortic root replacement were prospectively randomized into three groups, receiving either a Sorin, St. Jude Medical (SJM) or ATS mechanical composite graft. Valve sounds were recorded with microphones, and sound pressures at peak measured at three months after operation. Patients were interviewed at three and six months after surgery to assess subjective disturbance, using both an analog scale from 1 to 10 and a more detailed questionnaire. RESULTS: Sound pressures at peak tended to be lower for the ATS than for the SJM and Sorin composite grafts (44.4 +/- 3.1 dB versus 47.8 +/- 3.1 dB and 46.6 +/- 6.0 dB; p = NS). The overall subjective disturbance with ATS valves scored significantly lower than the SJM and Sorin composite grafts (2.5 +/- 1.6 versus 4.1 +/- 1.7 and 4.6 +/- 2.2; p<0.05 after three months; and 2.6 +/- 1.2 versus 4.4 +/- 2.3 and 4.4 +/- 3.3; p<0.05 after six months). Scores for disturbance during daily activities, sleep disturbance and audibility to relatives were lowest for the ATS composite grafts. CONCLUSION: The sound pressure of ATS composite grafts was slightly (p = NS) lower than that of SJM and Sorin composite grafts. Patients who received an ATS composite graft were significantly less disturbed by the valve noise than those with SJM and Sorin composite grafts.

Successful use of transvenous coil electrodes as single element subcutaneous array leads.

For implantable cardioverter defibrillator a 10 J safety margin between the defibrillation threshold (DFT) and the maximum output of the device is intended. In complex cases, the additional placement of a subcutaneous array lead is a common strategy for lowering the DFT. We report the successful use of transvenous coil electrodes as single element subcutaneous array leads in order to lower the DFT.

Bizarre case of migration of a retained epicardial pacing wire.

A 71-year-old woman, who had undergone mitral valve replacement procedure 2 years previously, presented with aortic and mitral prosthetic valve endocarditis. Preoperative examination demonstrated a wire-like structure coursing from the aortic bulb to the right carotid artery. The wire-like structure was removed during the mitral and aortic valve reoperation, and identified as an epicardial pacing wire, which was placed during the patients' first mitral valve operation. We suspect that the contaminated pacing wire migrated via the left atrium and left ventricle into the right carotid artery causing an infective endocarditis of the prosthetic mitral valve and the native aortic valve.