January 3, 2024Journal of Clinical MedicineOpen Access

Early and Mid-Term Outcomes of Using the Chimney Technique in Redo Mitral Valve Replacement in Patients with a Small Mitral Annulus

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Why the study?

Outcomes of redo mitral valve replacement in a small mitral annulus using the chimney technique were not well documented.

Does the chimney technique improve survival and echocardiographic outcomes in patients undergoing redo mitral valve replacement with a small mitral annulus?

Structured PICO

Does the chimney technique improve survival and echocardiographic outcomes in patients undergoing redo mitral valve replacement with a small mitral annulus?

Population

77 consecutive patients with a small mitral annulus undergoing redo mitral valve replacement (Re-MVR), mean age 56.7 ± 15.98 years.

Intervention

Redo mitral valve replacement (Re-MVR) using the chimney technique.

Outcome

Perioperative complications, mortality outcomes, heart structural integrity, and echocardiographic outcomes (mitral gradient and prosthesis size).hard clinical

The chimney technique in redo mitral valve replacement for small annuli allows for larger valve sizes with acceptable intraoperative and mid-term transvalvular gradients and good survival.

Implication

May support chimney technique in small-annulus redo MVR; leaves open need for randomized confirmation.

Abstract

The outcomes of redo mitral valve replacement (Re-MVR) in a small mitral annulus with the use of the chimney technique are not well documented. The purpose of this study is to present our early experience with this group of patients, illustrating the periop-erative complications and mortality outcomes. From 2019 to 2020, 77 consecutive patients underwent Re-MVR with the use of the chimney technique because of a small mitral annulus. To evaluate heart structural integrity and clinical outcomes, postoperative clinical data and echocardiograms were examined. The mean age was 56.7 ± 15.98 years. All patients underwent mitral valve surgery, of which 62 were mitral valve replacements, 7 mitral valve repairs, and 8 double valve replacements. The preoperative mitral valve mean gradient was 18.07 ± 9.40 mmHg, and the postoperative mitral prosthesis size was 28.51 ± 1.22 mm. The median increment of mitral size enlargement was 4 (0, 6) valve sizes. The mean mitral gradient coming out of the operating room was 10.34 ± 2.12 mmHg, and at the follow-up echocardiogram performed at 3 years after the procedure, it was 10.36 ± 1.70 mmHg. One-year survival was 93.3%, while the 4-year survival rate was 89.3%, with no reoperation. The use of the chimney technique in small mitral valve re-mitral valve replacement results in larger valve sizes. Moreover, the mean gradients over the mitral valve are acceptable both intraoperatively and over time.