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Wang S, Zhou T, Bian J, Li G, Zhang W, Chen S, Jiang Y. Clinical outcomes following surgical mitral valve plasty or replacement in patients with infectious endocarditis: A meta-analysis. Front Surg 2023; 9:1048036. [PMID: 36700028 PMCID: PMC9869952 DOI: 10.3389/fsurg.2022.1048036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023] Open
Abstract
Background For degenerative mitral disease, more and more evidences support that mitral valve plasty (MVP) has much better clincial outcomes than mitral valve replacement (MVR). However, the advantages of MVP in patients suffering from infectious endocarditis (IE) are unclear. To evaluate the appropriateness of MVP in IE patients, we conducted this meta-analysis. Based on the difference between active and healed phase, we not only compared the result of patients with IE, but also identified the subgroup with active IE. Methods We systematically searched the clinical trials comparing clinical outcomes of MVP and MVR in patients suffering from IE. Relevant articles were searched from January 1, 2000 to March 18, 2021 in Pubmed and Cochrane Library. Studies were excluded if they were with Newcastle-Ottawa Scale (NOS) score less than 6 or lacking of direct comparisons between MVP and MVR. Results 23 studies were involved and 25,615 patients were included. Pooled analysis showed fewer adverse events and early or long-term death in the MVP group. However, more reoperations existed in this patient group. And the reinfection rate was close between two groups. Similar results were observed after identifying active IE subgroup, but there is no difference in the freedom from reoperation due to all-events. Conclusions Although limitimations exited in this study, patients suffering from IE can benefit from both MVP and MVR. For surgeons with consummate skills, MVP can be the preferred choice for suitable IE patients.
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Affiliation(s)
- Song Wang
- Department of Cardiovascular Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Nanjing, China,Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Zhou
- Health Management Center, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhui Bian
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Geng Li
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjing Zhang
- Department of Ultrasound Medicine, The Second Afliated Hospital of Harbin Medical University, Harbin, China,Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Yefan Jiang Si Chen Wenjing Zhang
| | - Si Chen
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Yefan Jiang Si Chen Wenjing Zhang
| | - Yefan Jiang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Yefan Jiang Si Chen Wenjing Zhang
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Hu YN, Wan S. Repair of infected mitral valves: what have we learned? Surg Today 2018; 48:899-908. [DOI: 10.1007/s00595-018-1637-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/18/2018] [Indexed: 01/10/2023]
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Tourmousoglou C, Karkos C, Fidanis T, Theofilogiannakos EK, Hytiroglou P, Pitsis A. An Unusual Case of Arterial Embolism in an Adolescent With a Mitral Valve Repair With a Ring. Ann Thorac Surg 2017; 104:e315-e317. [PMID: 28935324 DOI: 10.1016/j.athoracsur.2017.04.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022]
Abstract
We report a case of an adolescent young man who presented with embolism of both lower legs. The patient had undergone mitral valve repair with a Kalangos biodegradable ring (Bioring SA, Lonay, Switzerland) 9 months earlier. Bilateral embolectomy was performed. Histopathologic examination revealed minute fragments of synthetic material within the embolus, which otherwise consisted of recent thrombus.
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Affiliation(s)
| | - Christos Karkos
- Vascular Unit, 5th Department of Surgery, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Prodromos Hytiroglou
- Department of Pathology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Pitsis
- Thessaloniki Heart Institute, St. Luke's Hospital, Thessaloniki, Greece
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Ozgol I, Depboylu BC, Tongut A, Ozdemir S, Bagdatlı Y, Ainechi S, Oz B, Pache JC, Erenturk S, Kalangos A, Hatemi AC, Cikirikcioglu M. Evaluation of Infection Resistance of Biodegradable versus Conventional Annuloplasty Rings in an in vivo Rat Subcutaneous Model. Eur Surg Res 2017; 58:169-179. [DOI: 10.1159/000454918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/05/2016] [Indexed: 12/26/2022]
Abstract
Background: Biodegradable atrioventricular annuloplasty rings are theoretically more infection resistant due to their intra-annular implantation technique and nonporous structures (monofilament of poly-1,4-dioxanone). The aim of this study was to investigate the infection resistance of a biodegradable annuloplasty ring (Kalangos-Bioring®) in a rat subcutaneous implantation model and to compare it with a commonly used conventional annuloplasty ring (Edwards Physio II®). Methods: This study included 32 Wistar albino rats which were divided into 2 groups according to the implantation of sterile or infected annuloplasty rings as control and study groups. Each animal had 2 implantation pockets (made on the right and left side of the dorsal median line) where 1 cm of the biodegradable annuloplasty ring was implanted into one pocket and 1 cm of the conventional annuloplasty ring was implanted into the other pocket. The infection model was created by topical inoculation of 1 mL Staphylococcus aureus strain (2 × 107 colony-forming units/mL) into the implantation pockets before skin closure. Each group was equally divided into 4 subgroups according to different follow-up schedules. The animals were inspected for local as well as systemic infection signs, and the rings were explanted at weeks 2, 4, 9, and 14 following implantation. Implantation pockets were evaluated macroscopically as well as by histopathological examinations. Microbiological analysis of the explanted implants with surrounding tissue was done by using quantitative sonication method. Results: Conventional ring-implanted pockets showed a more prominent inflammation reaction than the biodegradable ring-implanted pockets, and this characteristic was found to be accentuated with bacterial contamination. The sterile rings did not reveal any positive cultures in either group. The number of positive cultures found in conventional rings contaminated with S. aureus was greater than in the biodegradable ring group (11/16 vs. 2/16 positive cultures, respectively; p = 0.0032). The amounts of growing bacteria in the culture environment were also statistically significantly higher in the conventional ring group (7,175 ± 5,936 vs. 181 ± 130 colony-forming units/mL, respectively; p < 0.0005). Conclusions: This is the first experimental study confirming the theoretical advantage of the infection resistance of the biodegradable annuloplasty ring (Kalangos-Bioring®) when implanted in an active infectious environment. Large animal models mimicking clinical scenarios and clinical comparative studies are needed to verify our results.
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Benetis R, Orda P, Vaškelytė JJ, Ivanauskas V, Ereminienė E, Jakuška P, Jankauskienė L. Non-ischaemic mitral valve suture annuloplasty: late follow-up results. Perfusion 2016; 31:568-75. [DOI: 10.1177/0267659116645398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate late outcomes after posterior mitral valve (MV) annulus double-suture annuloplasty for degenerative (non-ischaemic) MV insufficiency. Design: Between 2005 and 2011, 138 patients underwent MV repair using posterior MV double-suture annuloplasty and an additional 105 patients underwent tricuspid valve repair. The study protocol included operative mortality, reoperation rate and reasons, as well as echocardiographic parameters at pre- and postoperative and follow-up periods (2-9 years). Results: In-hospital mortality was 2/138 (1.45%). Early post operation, no regurgitation was noted in 74/136 (54.4%) patients, Io regurgitation was observed in 55/136 (40.4%), IIo was observed in 6/136 (4.4%) and IIIo was observed in 1/136 (0.7%); during late follow-up (from 2 to 9 years), no regurgitation was observed in 21.6% patients, Io was observed in 58%, IIo was observed in 17% and IIIo was observed in 3.4%. The mean preoperative anterolateral diameter of the MV annulus was 39.02±4.97 mm and, at late follow-up, it was 27.66±3.94 mm (p=0.000); at these same time points, left ventricular end-diastolic diameter (LVEDD) was 55.74±7.29 mm and 49.17±6.01 mm (p=0.000), respectively, and the left ventricular ejection fraction (LVEF) was 53.08±8.93% and 50.92±6.78%, respectively (p=0.007). Conclusions: This study demonstrates suture annuloplasty to be an effective treatment up to 9 years for degenerative mitral valve disease. This technique enables preservation of the posterior mitral valve annulus diameter with stable long-term (up to 9 years) reduction, a competent (no regurgitation/⩽IIo regurgitation) MV in 96.6% of cases and positive left ventricular (LV) remodelling.
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Affiliation(s)
- Rimantas Benetis
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Orda
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Vytenis Ivanauskas
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Ereminienė
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuška
- Cardiology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Loreta Jankauskienė
- Cardiac Surgery Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Myers PO, Cikirikcioglu M, Kalangos A. Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street? BMC Surg 2014; 14:48. [PMID: 25087015 PMCID: PMC4131057 DOI: 10.1186/1471-2482-14-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/24/2014] [Indexed: 01/29/2023] Open
Abstract
Background One third of patients with infective endocarditis will require operative intervention. Given the superiority of valve repair over valve replacement in many indications other than endocarditis, there has been increasing interest and an increasing number of reports of excellent results of valve repair in acute infective endocarditis. The theoretically ideal material for valve repair in this setting is non-permanent, “vanishing” material, not at risk of seeding or colonization. The goal of this contribution is to review currently available data on biodegradable materials for valve repair in infective endocarditis. Discussion Rigorous electronic and manual literature searches were conducted to identify reports of biodegradable materials for valve repair in infective endocarditis. Articles were identified in electronic database searches of Medline, Embase and the Cochrane Library, using a predetermined search strategy. 49 manuscripts were included in the review. Prosthetic materials needed for valve repair can be summarized into annuloplasty rings to remodel the mitral or tricuspid annulus, and patch materials to replace resected valvar tissue. The commercially available biodegradable annuloplasty ring has shown interesting clinical results in a single-center experience; however further data is required for validation and longer follow-up. Unmodified extra-cellular matrix patches, such as small intestinal submucosa, have had promising initial experimental and clinical results in non-infected valve repair, although in valve repair for endocarditis has been reported in only one patient, and concerns have been raised regarding their mechanical stability in an infected field. Summary These evolving biodegradable devices offer the potential for valve repair with degradable materials replaced with autologous tissue, which could further improve the results of valve repair for infective endocarditis. This is an evolving field with promising experimental or initial clinical results, however long-term outcomes are lacking and further data is necessary to validate this theoretically interesting approach to infective endocarditis.
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Affiliation(s)
- Patrick O Myers
- Cardiovascular Surgery, Geneva University Hospitals & Faculty of Medicine, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.
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Myers PO, Cikirikcioglu M, Kalangos A. Sutureless repair of ventricular free wall rupture. J Card Surg 2014; 29:804. [PMID: 24750495 DOI: 10.1111/jocs.12338_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Patrick O Myers
- Cardiovascular Surgery, Geneva University Hospitals & School of Medicine, Geneva, Switzerland
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Endocardites: nouveautés, pièges et controverses. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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9
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Akinosoglou K, Apostolakis E. Reply to Myers et al. Eur J Cardiothorac Surg 2012; 43:874. [PMID: 23125286 DOI: 10.1093/ejcts/ezs567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Myers PO, Cikirikcioglu M, Kalangos A. Biodegradable materials for tricuspid valve repair in infective endocarditis. Eur J Cardiothorac Surg 2012; 43:873. [PMID: 23125287 DOI: 10.1093/ejcts/ezs566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Baird CW, Myers PO, Marx G, Del Nido PJ. Mitral valve operations at a high-volume pediatric heart center: Evolving techniques and improved survival with mitral valve repair versus replacement. Ann Pediatr Cardiol 2012; 5:13-20. [PMID: 22529595 PMCID: PMC3327008 DOI: 10.4103/0974-2069.93704] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Mitral valve disease is quite variable and can occur as an isolated defect or in association with other complex left sided lesions. These lesions are often best described with detailed pre-operative imaging studies to define the valve anatomy and to access associated left heart disease. Depending on the type of mitral valve disease, various surgical repair techniques have led to improved survival in the recent era. We describe lesion specific approach to mitral valve repair and results.
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Affiliation(s)
- Christopher W Baird
- Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, USA
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12
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Riza Karaci A, Harmandar B, Ali Aydemir N. Response to the Letter to the Editor Entitled “Biodegradable Ring Annuloplasty for Valve Repair in Children with Endocarditis”. J Card Surg 2012. [DOI: 10.1111/j.1540-8191.2012.01473.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge. Many factors affect the outcome of this serious disease, including virulence of the microorganism, characteristics of the patients, presence of underlying disease, delays in diagnosis and treatment, surgical indications, and timing of surgery. We review the strengths and limitations of present therapeutic strategies and propose future directions for better management of endocarditis according to the most recent research. Novel perspectives on the management of endocarditis are emerging and offer hope for decreasing the rate of residual deaths by accelerating the process of diagnosis and risk stratification, reducing delays in starting antimicrobial therapy, rapid transfer of high-risk patients to specialised medico-surgical centres, development of new surgical methods, and close long-term follow-up.
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Affiliation(s)
- Franck Thuny
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France; Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France
| | - Dominique Grisoli
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Frederic Collart
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Gilbert Habib
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France.
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Myers PO, Kalangos A, Pektok E, Cikirikcioglu M. Biodegradable ring annuloplasty for valve repair in children with endocarditis. J Card Surg 2012; 27:393; author reply 394. [PMID: 22348622 DOI: 10.1111/j.1540-8191.2011.01413.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Current world literature. Curr Opin Cardiol 2011; 26:165-73. [PMID: 21307667 DOI: 10.1097/hco.0b013e328344b569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pektok E, Kalangos A. Biodegradable ring annuloplasty for acute endocarditis. Ann Thorac Surg 2010; 90:2089-90. [PMID: 21095385 DOI: 10.1016/j.athoracsur.2010.06.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 04/07/2010] [Accepted: 06/11/2010] [Indexed: 10/18/2022]
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Myers PO, Christenson JT, Cikirikcioglu M, Tissot C, Aggoun Y, Kalangos A. Leaflet suspension to the contralateral annulus to address restriction or tethering-induced mitral and tricuspid regurgitation in children: results of a case-control study. J Thorac Cardiovasc Surg 2010; 140:1110-6. [DOI: 10.1016/j.jtcvs.2010.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 07/30/2010] [Accepted: 08/09/2010] [Indexed: 11/28/2022]
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Affiliation(s)
- Derek Muehrcke
- Cardiothoracic and Vascular Surgical Associates, 300 Health Park Blvd, Ste 5000, St. Augustine, FL 32086, USA.
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