title: Transapical approach for mitral valve repair during insertion of a left ventricular assist device.
abstract: BACKGROUND
  Severe mitral regurgitation (MR) is common in patients who are undergoing insertion of a left ventricular assist device (LVAD). This study analyzes the outcomes of a transapical approach for edge-to-edge repair of the mitral valve during insertion of a left ventricular assist device in 19 patients with MR.
  
  
  METHODS
  This retrospective study includes 19 patients who were implanted between March 21, 2011, and August 31, 2011, at the University of Chicago. Clinical data include preoperative ejection fraction, post- and preoperative pulmonary arterial pressures, cardiopulmonary bypass time, post- and preoperative mitral regurgitation severity, endotracheal CO2, and LVAD pulse index.
  
  
  RESULTS
  All of the 19 patients had a reduction in mitral regurgitation. Fourteen of the 19 patients had at least a three-point reduction in MR severity. The average postoperative pulmonary arterial pressure (PAP) decreased after the surgical procedure from 44/22 ± 14/5 mmHg to 57/28 ± 9/5 mmHg. Average CPB time was 128 ± 27 minutes. Average length-of-stay (LOS) was 21 ± 10 days.
  
  
  CONCLUSIONS
  Concomitant MV repair using a transapical approach is advantageous for this small cohort of patients. The surgical procedure is less complex and has a shorter CPB time and LOS, and all of the patients demonstrated significant improvement in postoperative MR and moderate improvement in PAP.
authors.affiliation: Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL 60637, USA. mr2143@gmail.com
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.forename: Aurelie
authors.initials: A
authors.lastname: Merlo
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Johnson
authors.forename: Shahab
authors.initials: S
authors.lastname: Akhter
authors.forename: Sean
authors.initials: S
authors.lastname: McCarney
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steiman
authors.forename: Allen
authors.initials: A
authors.lastname: Anderson
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome