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Brener MI, Hamandi M, Hong E, Pizano A, Harloff MT, Garner EF, El Sabbagh A, Kaple RK, Geirsson A, Deaton DW, Islam AM, Veeregandham R, Bapat V, Khalique OK, Ning Y, Kurlansky PA, Grayburn PA, Nazif TM, Kodali SK, Leon MB, Borger MA, Lee R, Kohli K, Yoganathan AP, Colli A, Guerrero ME, Davies JE, Eudailey KW, Kaneko T, Nguyen TC, Russell H, Smith RL, George I. Early outcomes following transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Thorac Cardiovasc Surg 2024; 167:1263-1275.e3. [PMID: 36153166 DOI: 10.1016/j.jtcvs.2022.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Implantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date. METHODS Patients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality. RESULTS We analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03). CONCLUSIONS Transatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Mohanad Hamandi
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Estee Hong
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Alejandro Pizano
- Division of Cardiothoracic Surgery, University of Texas Health Science Center, Houston, Tex
| | - Morgan T Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Evan F Garner
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | | | - Ryan K Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn
| | - David W Deaton
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | - Ashequl M Islam
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | | | - Vinayak Bapat
- Division of Cardiothoracic Surgery, Minneapolis Heart Institute Foundation, Minneapolis, Minn
| | - Omar K Khalique
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Yuming Ning
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Kurlansky
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Grayburn
- Division of Cardiology, Baylor Scott and White Health, Plano, Tex
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Michael A Borger
- Division of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Raymond Lee
- Division of Cardiothoracic Surgery, Keck University of Southern California, Los Angeles, Calif
| | - Keshav Kohli
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Andrea Colli
- Department of Cardio-Thoracic-Vascular Surgery, University of Pisa, Pisa, Italy
| | - Mayra E Guerrero
- Division of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minn
| | - James E Davies
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, University of California-San Francisco, San Francisco, Calif
| | - Hyde Russell
- Division of Cardiothoracic Surgery, Northshore University HealthSystem, Evanston, Ill
| | - Robert L Smith
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
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Numaguchi R, Takaki J, Nishigawa K, Yoshinaga T, Fukui T. Outcomes of mitral valve replacement with complete annular decalcification. Asian Cardiovasc Thorac Ann 2023; 31:775-780. [PMID: 37844584 DOI: 10.1177/02184923231206237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND This study aimed to examine the clinical outcomes of mitral valve replacement (MVR) in patients with severe mitral annular calcification (MAC) who required extensive decalcification and mitral annular reconstruction. METHODS We reviewed 15 patients with severe MAC who underwent MVR between January 2016 and May 2022. In all cases, the calcified mitral annulus was resected completely using a Cavitron Ultrasound Surgical Aspirator, and a new annulus was created using bovine pericardium. In the acute postoperative phase, strict afterload reduction therapy using an intra-aortic balloon pump (IABP) was administered. RESULTS The mean age of patients was 73 ± 8 years, and 13 (86.7%) were women. Concomitant aortic valve replacement was performed in 11 (73.3%) patients, tricuspid annuloplasty in 9 (60.0%), coronary artery bypass grafting in 1 (6.7%), and arrhythmia surgery in 7 (46.7%). The mean aortic cross-clamp and cardiopulmonary bypass times were 143 ± 32 min and 175 ± 34 min, respectively. In 13 patients, an IABP was used for 2 or 3 days postoperatively. There were no in-hospital deaths, left ventricular ruptures, or other MAC-related complications. Postoperative echocardiography revealed no paravalvular leakages. CONCLUSION Our strategy for managing severe MAC is safe and reproducible even in relatively high-risk patients. Afterload reduction using an IABP in the acute postoperative phase may reduce the risk of fatal complications after extensive decalcification and mitral annular reconstruction.
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Affiliation(s)
- Ryosuke Numaguchi
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Jun Takaki
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Kosaku Nishigawa
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Takashi Yoshinaga
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
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Quentin V, Mesnier J, Delhomme C, Sayah N, Guedeney P, Barthélémy O, Suc G, Collet JP. Transcatheter Mitral Valve Replacement Using Transcatheter Aortic Valve or Dedicated Devices: Current Evidence and Future Prospects. J Clin Med 2023; 12:6712. [PMID: 37959178 PMCID: PMC10647634 DOI: 10.3390/jcm12216712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) is a novel and evolving field dedicated to addressing the therapeutic challenges posed by patients at high surgical risk with mitral valve disease. TMVR can be categorized into two distinct fields based on the type of device and its specific indications: TMVR with transcatheter aortic valves (TAV) and TMVR with dedicated devices. Similar to aortic stenosis, TMVR with TAV requires a rigid support structure to secure the valve in place. As a result, it is indicated for patients with failing bioprothesis or surgical rings or mitral valve disease associated with severe mitral annular calcification (MAC), which furnishes the necessary foundation for valve anchoring. While TMVR with TAV has shown promising outcomes in valve-in-valve procedures, its effectiveness remains more contentious in valve-in-ring or valve-in-MAC procedures. Conversely, TMVR with dedicated devices seeks to address native mitral regurgitation, whether accompanied by MAC or not, providing an alternative to Transcatheter Edge-to-Edge Repair (TEER) when TEER is not feasible or expected to yield unsatisfactory results. This emerging field is gradually surmounting technical challenges, including anchoring a valve in a non-calcified annulus and transitioning from the transapical route to the transeptal approach. Numerous devices are presently undergoing clinical trials. This review aims to furnish an overview of the supporting evidence for TMVR using TAV in each specific indication (valve-in-valve, valve-in-ring, valve-in-MAC). Subsequently, we will discuss the anticipated benefits of TMVR with dedicated devices over TEER, summarize the characteristics and clinical results of TMVR systems currently under investigation, and outline future prospects in this field.
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Affiliation(s)
- Victor Quentin
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Jules Mesnier
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Clémence Delhomme
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Neila Sayah
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
| | - Olivier Barthélémy
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
| | - Gaspard Suc
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Jean-Philippe Collet
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
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Demal TJ, Conradi L. Management of valve dysfunction in patients with mitral annular calcification. Heart 2023; 109:1639-1646. [PMID: 37137678 DOI: 10.1136/heartjnl-2022-321572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hatab T, Bou Chaaya RG, Zaid S, Wessly P, Satish P, Villanueva V, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Feasibility and Outcomes of Mitral Transcatheter Edge-To-Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification. J Am Heart Assoc 2023; 12:e031118. [PMID: 37753800 PMCID: PMC10727232 DOI: 10.1161/jaha.123.031118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
Background The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge-to-edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought to examine the prognostic value of MAC, its severity, and its impact on procedural success and durability of mitral transcatheter edge-to-edge repair. Methods and Results We reviewed the records of 280 patients with moderate-severe or severe mitral regurgitation who underwent mitral transcatheter edge-to-edge repair with MitraClip from March 2014 to March 2022. The primary end point was cumulative survival at 1 year. Independent factors associated with the primary end point were identified using multivariable Cox regression. Among 280 patients included in the final analysis, 249 had none/mild MAC, and 31 had moderate/severe MAC. Median follow-up was 23.1 months (interquartile range: 11.1-40.4). Procedural success was comparable in the MAC and non-MAC groups (92.6% versus 91.4%, P=0.79) with similar rates of residual mitral regurgitation ≤2 at 1 year (86.7% versus 93.2%, P=0.55). Moderate/severe MAC was associated with less improvement in New York Heart Association III/IV at 30 days when compared with none/mild MAC (45.8% versus 14.3%, P=0.001). The moderate/severe MAC group had lower cumulative 1-year survival (56.8% versus 80.0%, hazard ratio [HR], 1.98 [95% CI, 1.27-3.10], P=0.002). Moderate/severe MAC and Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair were independently associated with the primary end point (HR, 2.20 [1.10-4.41], P=0.02; and HR, 1.014 [1.006-1.078], P=0.02, respectively). Conclusions Mitral TEER is a safe and feasible intervention in selected patients with significant MAC and associated with similar mitral regurgitation reduction at 1 year compared with patients with none/mild MAC. Patients with moderate/severe MAC had a high 1-year mortality and less improvement in their symptoms after TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Marvin D. Atkins
- Department of Cardiovascular SurgeryHouston Methodist HospitalHoustonTX
| | | | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
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Horibe T, Hidaka H, Numaguchi R, Takaki J, Nishigawa K, Yoshinaga T, Fukui T. Mitral valve replacement with annuloplasty in a patient with infected mitral annular calcification. Clin Case Rep 2023; 11:e7802. [PMID: 37593342 PMCID: PMC10427749 DOI: 10.1002/ccr3.7802] [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: 04/09/2023] [Revised: 07/11/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023] Open
Abstract
Key Clinical Message Extensive resection of the infected calcified annulus and the reconstruction with a pericardial patch for the debrided annulus is an effective surgical option for the treatment of infectious endocarditis in patients with mitral annular calcification. Abstract A 78-year-old woman was referred to our hospital because of left-sided hemiparesis. During the treatment for cerebral infarction, the patient became feverish and lost consciousness. Transthoracic echocardiography revealed mitral annular calcification and a tumor-like mass on the posterior leaflet despite no findings of mitral regurgitation. She underwent successful mitral valve replacement with debridement of the infected mitral annulus and reconstruction of the posterior annulus (annuloplasty) with bovine pericardium after removal of the mitral annular calcification.
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Affiliation(s)
- Tatsuya Horibe
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Hideaki Hidaka
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Ryosuke Numaguchi
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Jun Takaki
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Kosaku Nishigawa
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Takashi Yoshinaga
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
| | - Toshihiro Fukui
- Department of Cardiovascular SurgeryKumamoto University HospitalKumamotoJapan
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7
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Xu X, Liu H, Gu J, Li M, Shao Y. Valve-in-valve/valve-in-ring transcatheter mitral valve implantation vs. redo surgical mitral valve replacement for patients with failed bioprosthetic valves or annuloplasty rings: A systematic review and meta-analysis. Heliyon 2023; 9:e16078. [PMID: 37234656 PMCID: PMC10208839 DOI: 10.1016/j.heliyon.2023.e16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Background Valve-in-valve (ViV)/valve-in-ring (ViR) transcatheter mitral valve implantation (TMVI) is a less invasive alternative to redo surgical mitral valve replacement (SMVR). To further verify its feasibility, we aimed to appraise early clinical outcomes after either ViV/ViR TMVI or redo SMVR for failed bioprosthetic valves or annuloplasty rings, as a comparison of long-term follow-up results are not available for these procedures. Methods We systematically searched PubMed, Cochrane Controlled Trials Register, EMBASE, and Web of Science to identify studies that compared ViV/ViR TMVI and redo SMVR. Fixed- and random-effects meta-analyses were used to compare the early clinical results between these two groups. Results A total of 3,890 studies published from 2015 to 2022 were searched, and ten articles comprising 7,643 patients (ViV/ViR TMVI, 1,719 patients; redo SMVR, 5,924 patients) were included. In this meta-analysis, ViV/ViR TMVI significantly improved in-hospital mortality (fixed-effects model: odds ratio [OR], 0.72; 95% confidence interval [CI], 0.57-0.92; P = 0.008) and for the matched populations (fixed-effects model: OR, 0.42; 95% CI, 0.29-0.61; P < 0.00001). ViV/ViR TMVI also outperformed redo SMVR in 30-day mortality and in rates of early postoperative complications. ViV/ViR TMVI resulted in less time spent in the ICU and hospital, whereas it showed no significant difference in one-year mortality. A lack of comparison of long-term clinical outcomes and postoperative echocardiographic results are important limitations of our results. Conclusions ViV/ViR TMVI is a reliable alternative to redo SMVR for failed bioprosthetic valves or annuloplasty rings as a result of lower in-hospital mortality, higher 30-day survival, and lower early postoperative complication rates, although there is no significant difference in 1-year mortality.
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Severe mitral regurgitation in nonagenarians: Impact of symptomatic status, frailty and etiology on management and outcomes. Int J Cardiol 2023; 377:92-98. [PMID: 36702362 DOI: 10.1016/j.ijcard.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Data regarding mitral regurgitation (MR) in extremely elderly patients are limited. The aim of the present study was to assess symptomatic status, frailty, etiology and outcomes for nonagenarians with severe MR. METHODS Single-center cohort study of patients ≥90 years of age with at least 3+ MR on echocardiography between September 2010 and August 2018. Out of a total of 11,998 patients with at least 3+ MR, 267 patients were included in the present study. RESULTS The average age was 93.5 ± 2.6 years, and 57% were female. At baseline, 88% were symptomatic, with mean Charlson co-morbidity index of 6 ± 2 points, and mean frailty score of 2.9 ± 1.4 points. Primary MR was present in 50%, secondary in 47%, and prosthetic valve dysfunction in 3%. Among patients with primary MR, the most common etiology was mitral annular calcification (58%). In comparison, the most common etiology of secondary MR was atrial functional MR (52%). Of all, 95% were treated conservatively, and 5% underwent interventional management. Among 253 patients who had follow-up data with a median follow-up of 14 months (25th-75th interquartile range: 3-31 months), 191 patients (75%) died. Mortality trended higher in the conservative group versus the interventional group (60% vs. 22%, log-rank P = 0.063). CONCLUSIONS Most nonagenarians with significant MR were symptomatic at presentation, had elevated Charlson co-morbidity index and frailty scores. Etiologies of MR were almost equally distributed between primary and secondary causes. The vast majority of nonagenarians with significant MR were conservatively managed.
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9
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Agrawal A, Reardon MJ, Goel SS. Transcatheter Mitral Valve Replacement in Patients with Mitral Annular Calcification: A Review. Heart Int 2023; 17:19-26. [PMID: 37456353 PMCID: PMC10339466 DOI: 10.17925/hi.2023.17.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/31/2023] [Indexed: 07/18/2023] Open
Abstract
Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
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10
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Churchill TW, Yucel E, Deferm S, Levine RA, Hung J, Bertrand PB. Mitral Valve Dysfunction in Patients With Annular Calcification: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 80:739-751. [PMID: 35953139 PMCID: PMC10290884 DOI: 10.1016/j.jacc.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 10/15/2022]
Abstract
Mitral annular calcification (MAC) is a common clinical finding and is associated with adverse clinical outcomes, but the clinical impact of MAC-related mitral valve (MV) dysfunction remains underappreciated. Patients with MAC frequently have stenotic, regurgitant, or mixed valvular disease, and this valvular dysfunction is increasingly recognized to be independently associated with worse prognosis. MAC-related MV dysfunction is a distinct pathophysiologic entity, and importantly much of the diagnostic and therapeutic paradigm from published rheumatic MV disease research cannot be applied in this context, leaving important gaps in our knowledge. This review summarizes the current epidemiology, pathophysiology, diagnosis, and classification of MAC-related MV dysfunction and proposes both an integrative definition and an overarching approach to this important and increasingly recognized clinical condition.
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Affiliation(s)
- Timothy W Churchill
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/TimChurchillMD
| | - Evin Yucel
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Robert A Levine
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Judy Hung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philippe B Bertrand
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
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11
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Chehab O, Roberts-Thomson R, Bivona A, Gill H, Patterson T, Pursnani A, Grigoryan K, Vargas B, Bokhary U, Blauth C, Lucchese G, Bapat V, Guerrero M, Redwood S, Prendergast B, Rajani R. Management of Patients With Severe Mitral Annular Calcification: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:722-738. [PMID: 35953138 DOI: 10.1016/j.jacc.2022.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Mitral annular calcification (MAC) is a common and challenging pathologic condition, especially in the context of an aging society. Surgical mitral valve intervention in patients with MAC is difficult, with varying approaches to the calcified annular anatomy, and the advent of transcatheter valve interventions has provided additional treatment options. Advanced imaging provides the foundation for heart team discussions and management decisions concerning individual patients. This review focuses on the prognosis of, preoperative planning for, and management strategies for patients with MAC.
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Affiliation(s)
- Omar Chehab
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Ross Roberts-Thomson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Antonio Bivona
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tiffany Patterson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Amit Pursnani
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Karine Grigoryan
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Bernardo Vargas
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Ujala Bokhary
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Christopher Blauth
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Gianluca Lucchese
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Vinayak Bapat
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Redwood
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Bernard Prendergast
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom.
| | - Ronak Rajani
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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12
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Ultrasonic Emulsification of Severe Mitral Annular Calcification During Mitral Valve Replacement. Ann Thorac Surg 2022; 113:2092-2096. [PMID: 34990573 DOI: 10.1016/j.athoracsur.2021.11.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Severe mitral annular calcification (MAC) increases surgical complexity and is independently associated with increased operative mortality for mitral valve replacement (MVR). Recently we adopted ultrasonic emulsification/aspiration for annular decalcification to address these risks and describe our early experience with this new technology. DESCRIPTION Excluding previous mitral valve surgery or endocarditis, 179 patients with MAC underwent MVR at a single institution between January 2015 and March 2020. Of these, 15 consecutive patients with severe MAC (≥50% of the annulus) underwent annular decalcification with ultrasonic emulsification/aspiration as an adjunct treatment during MVR from April 2019 to March 2020. EVALUATION Mean patient age was 68 ± 12 years, and 72% (n = 128) were female. Mean preoperative left ventricular ejection fraction was 60% ± 11%, and mean mitral valve gradient was 9.1 ± 4.4 mm Hg. Concomitant procedures included antiarrhythmia (n = 52), aortic valve replacement (n = 32), and coronary artery bypass grafting (n = 20). There were no operative deaths or strokes in the group undergoing ultrasonic emulsification and aspiration. CONCLUSIONS The use of ultrasonic emulsification and aspiration in severe MAC patients may help mitigate the risks of MVR and facilitate operative success in this challenging, high-risk population.
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13
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Baudo M, Petruccelli RD, Muneretto C. Mitral valve surgery with extensive annular calcification: review of surgical techniques and postoperative complications. J Cardiovasc Med (Hagerstown) 2022; 23:285-289. [PMID: 34456242 DOI: 10.2459/jcm.0000000000001242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mitral annular calcification (MAC) represents an important risk factor in mitral valve (MV) surgery. Despite several procedures having been described, no surgical treatment of choice has been established so far: whether a decalcification should be systematically carried out, or if the MV should be preferentially repaired rather than replaced. A review of the literature on patients undergoing MV surgery associated with MAC was performed. Studies were excluded if dealing with endovascular procedures or emergency surgery for associated endocarditis. Case reports were also not considered in the final analysis. The literature search identified 1429 potentially eligible studies, and 25 papers were eventually included. Several surgical techniques were described to approach this challenging condition. During MV surgery, the presence of MAC favors the occurrence of suboptimal intraoperative outcomes. MAC-related complications such as atrioventricular groove rupture, cerebrovascular accident, new permanent pacemaker implantation, intraoperative conversion from valve repair to replacement and mortality were analyzed. MV surgery in the presence of MAC considerably impacts the postoperative outcomes in terms of morbidity and mortality. A great variability of surgical techniques is reported, suggesting the need for standardization of the approach.
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Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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14
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Fernández-Peregrina E, Pascual I, Freixa X, Tirado-Conte G, Estévez-Loureiro R, Carrasco-Chinchilla F, Benito-González T, Asmarats L, Sanchís L, Jiménez-Quevedo P, Avanzas P, Caneiro-Queija B, Molina-Ramos AI, Fernández-Vázquez F, Li CH, Flores-Umanzor E, Sans-Roselló J, Nombela-Franco L, Arzamendi D. Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification. EUROINTERVENTION 2022; 17:1300-1309. [PMID: 34483091 PMCID: PMC9743252 DOI: 10.4244/eij-d-21-00205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND MAC is commonly found in patients affected with MR, and it is associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge repair could be an alternative treatment, although there is little evidence in this population. AIMS The aim of this study was to analyse the safety, efficacy and durability of MitraClip implantation in patients affected with mitral regurgitation (MR) and mitral annulus calcification (MAC). METHODS We analysed the outcomes of 61 suitable patients affected with severe MR and moderate or severe MAC (the "MAC" group) and 791 patients with no or mild MAC (the "NoMAC" group) treated with the MitraClip device. RESULTS Procedural success was similar (91.8% vs 95.1%, p=0.268, in MAC and NoMAC, respectively), with a very low rate of complications. At one-year follow-up, 90.6% of MAC and 79.5% of NoMAC patients had MR grade ≤2 (p=0.129), 80% in both groups remained in NYHA Functional Class ≤II, and a significant reduction in cardiac readmissions was observed (65% vs 78% in MAC vs NoMAC, p=0.145). One-year mortality tended to be higher in MAC patients (19.7% vs 11.3%, p=0.050), with no difference in cardiovascular mortality (15.3% vs 9.2%, p=0.129). CONCLUSIONS MitraClip use in selected patients with moderate or severe MAC is safe, feasible and achieves good clinical and echocardiographic results at one-year follow-up.
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Affiliation(s)
- Estefanía Fernández-Peregrina
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Xavier Freixa
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | | | | | | | - Lluis Asmarats
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Sanchís
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Chi-Hion Li
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jordi Sans-Roselló
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
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15
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Kato N, Pellikka PA, Scott CG, Lee AT, Jain V, Eleid MF, Alkhouli MA, Reeder GS, Michelena HI, Pislaru SV, Bagameri G, Crestanello JA, Rihal CS, Guerrero M. Impact of mitral intervention on outcomes of patients with mitral valve dysfunction and annulus calcification. Catheter Cardiovasc Interv 2022; 99:1807-1816. [DOI: 10.1002/ccd.30093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/14/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Nahoko Kato
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | | | | | - Alexander T. Lee
- Department of Health Sciences Research Mayo Clinic Rochester Minnesota USA
| | - Vaibhav Jain
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Guy S. Reeder
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Sorin V. Pislaru
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery Mayo Clinic Rochester Minnesota USA
| | | | - Charanjit S. Rihal
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA
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16
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Nakamae K, Oshitomi T, Sassa T, Uesugi H. Surgical repair for systolic anterior motion of anterior mitral leaflet due to mitral annular calcification. Gen Thorac Cardiovasc Surg 2022; 70:398-401. [PMID: 35043386 DOI: 10.1007/s11748-021-01760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/11/2021] [Indexed: 12/01/2022]
Abstract
Systolic anterior motion of the anterior mitral leaflet with anterior displacement of the coaptation site of the bi-leaflets due to mitral annular calcification on the posterior side, causing left ventricular outflow tract obstruction, is rare. We report the case of a 72-year-old woman with exertional dyspnea due to systolic anterior motion who underwent surgical repair to decalcify the mitral annular calcification and mitral valve repair. Hence, the systolic anterior motion, mitral valve regurgitation, and symptoms improved significantly. This report illustrates the novelty of surgical technique, the indication, and the limitation of mitral valve repair for such rare cases. A proper understanding of the mechanism in each patient and enhanced techniques for decalcification of posterior mitral annular calcification are needed to treat such complex cases.
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Affiliation(s)
- Kosuke Nakamae
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan.
| | - Takashi Oshitomi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan
| | - Toshiharu Sassa
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan
| | - Hideyuki Uesugi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan
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17
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Kreibich M, Kaier K, von Zur Mühlen C, Siepe M, Zehender M, Bode C, Beyersdorf F, Stachon P, Bothe W. In-hospital outcomes of patients undergoing concomitant aortic and mitral valve replacement in Germany. Interact Cardiovasc Thorac Surg 2021; 34:349-353. [PMID: 34907441 PMCID: PMC8860409 DOI: 10.1093/icvts/ivab352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/26/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate in-hospital outcomes of concomitant mitral valve replacement (MVR) in patients undergoing conventional aortic valve replacement due to aortic stenosis in a nationwide cohort. METHODS Administrative data from all patients with aortic stenosis undergoing conventional aortic and concomitant MVR (reason for MVR not specified) between 2017 and 2018 in Germany were analysed. RESULTS A total of 2597 patients with a preoperative logistic EuroScore of 9.81 (standard deviation: 8.56) were identified. In-hospital mortality was 6.8%. An in-hospital stroke occurred in 3.4%, acute kidney injury in 16.3%, prolonged mechanical ventilation of more than 48 h in 16.3%, postoperative delirium in 15.8% and postoperative pacemaker implantation in 7.6% of the patients. Mean hospital stay was 16.5 (standard deviation: 12.1) days. Age [odds ratio (OR): 1.03; P = 0.019], New York Heart Association class III or IV (OR: 1.63; P = 0.012), previous cardiac surgery (OR: 2.85, P = 0.002), peripheral vascular disease (OR: 2.01, P = 0.031), pulmonary hypertension (OR: 1.63, P = 0.042) and impaired renal function (glomerular filtration rate <15, OR: 3.58, P = 0.001; glomerular filtration rate <30, OR: 2.51, P = 0.037) were identified as independent predictors for in-hospital mortality. CONCLUSIONS In this nationwide analysis, concomitant aortic and MVR was associated with acceptable in-hospital mortality, morbidity and length of in-hospital stay. The regression analyses may help to identify high-risk patients and further optimize treatment strategies.
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Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Magruder JT, Yadav PK, Thourani VH. Commentary: Accomplishing mission impossible: Transcatheter mitral valve-in-valve replacement for failing intra-atrial bioprosthetic mitral valves. JTCVS Tech 2021; 10:271-272. [PMID: 34977736 PMCID: PMC8690568 DOI: 10.1016/j.xjtc.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- J. Trent Magruder
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Athens, Ga
| | - Pradeep K. Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
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19
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Parchment N, Brescia AA, Ailawadi G. Commentary: Back to the future: Failed mitral valve bioprosthesis in the setting of mitral annular calcification. JTCVS Tech 2021; 10:269-270. [PMID: 34977735 PMCID: PMC8691222 DOI: 10.1016/j.xjtc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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20
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Urena M, Lemann T, Chong-Nguyen C, Brochet E, Ducrocq G, Carrasco JL, Iung B, Vahanian A, Himbert D. Causes and predictors of mortality after transcatheter mitral valve implantation in patients with severe mitral annulus calcification. Catheter Cardiovasc Interv 2021; 98:981-989. [PMID: 34263517 DOI: 10.1002/ccd.29874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/13/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the causes and predictors of mortality after valve-in-mitral annulus calcification (MAC) transcatheter mitral valve implantation (TMVI). BACKGROUND Conventional surgical mitral valve replacement is associated with a high risk in patients with mitral valve disease associated with severe MAC. In this population, TMVI may be an attractive alternative option. However, its prognostic factors are poorly understood. METHODS All patients undergoing valve-in-MAC TMVI from 2013 to 2018 in our center were included. Indication for TMVI relied on the judgment of the local heart team. Patients were followed at 30 days and 1 year. RESULTS A total of 34 patients underwent valve-in-MAC TMVI. The mean age was 79 ± 11 years and 73% of patients were women. Their mean EuroSCORE 2 was 8 ± 7%. The transseptal approach was used in 79% of patients and a hybrid transatrial in 29%. Balloon expandable transcatheter heart valves were used in all the patients. Technical success was achieved in 76% of the patients. Thirty-day and 1-year all-cause mortality rates were 14.7% and 32.4%, respectively. The main two causes of 1-year mortality were congestive heart failure (8.8%) and infective endocarditis (5.9%). In multivariate analysis, the only predictor of 1-year mortality was the presence of periprothetic mitral regurgitation grade 2 (HR, 5.69; 95%CI, 1.59-27.88, p = 0.032). CONCLUSION Early and mid-term mortality remains high after valve-in-MAC TMVI and seems to be associated with the presence of paravalvular mitral regurgitation. However, whether the latter is a prognostic factor or marker remains to be determined to improve clinical outcomes in this high-risk population.
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Affiliation(s)
- Marina Urena
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Thomas Lemann
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Eric Brochet
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Grégory Ducrocq
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Jose-Luis Carrasco
- Assistance Publique - Hôpitaux de Paris, Department of Anaesthesiology, Bichat-Claude Bernard Hospital, Paris, France
| | - Bernard Iung
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Alec Vahanian
- University of Paris, Paris, France.,INSERM U 1148, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
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21
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Alexis SL, Malik AH, El‐Eshmawi A, George I, Sengupta A, Kodali SK, Hahn RT, Khalique OK, Zaid S, Guerrero M, Bapat VN, Leon MB, Adams DH, Tang GHL. Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review. J Am Heart Assoc 2021; 10:e018514. [PMID: 33728929 PMCID: PMC8174336 DOI: 10.1161/jaha.120.018514] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mitral annular calcification with mitral valve disease is a challenging problem that could necessitate surgical mitral valve replacement (SMVR). Transcatheter mitral valve replacement (TMVR) is emerging as a feasible alternative in high-risk patients with appropriate anatomy. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to December 25, 2019 for studies discussing SMVR or TMVR in patients with mitral annular calcification; 27 of 1539 articles were selected for final review. TMVR was used in 15 studies. Relevant data were available on 82 patients who underwent hybrid transatrial TMVR, and 354 patients who underwent transapical or transseptal TMVR. Outcomes on SMVR were generally reported as small case series (447 patients from 11 studies); however, 1 large study recently reported outcomes in 9551 patients. Patients who underwent TMVR had a shorter median follow-up of 9 to 12 months (range, in-hospital‒19 months) compared with patients with SMVR (54 months; range, in-hospital‒120 months). Overall, those undergoing TMVR were older and had higher Society of Thoracic Surgeons risk scores. SMVR showed a wide range of early (0%-27%; median 6.3%) and long-term mortality (0%-65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years, 62.4%). The median in-hospital, 30-day, and 1-year mortality rates were 16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and 9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular calcification is a complex disease and TMVR, with a versatile option of transatrial approach in patients with challenging anatomy, offers a promising alternative to SMVR in high-risk patients. However, further studies are needed to improve technology, patient selection, operative expertise, and long-term outcomes.
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Affiliation(s)
- Sophia L. Alexis
- Department of Cardiovascular SurgeryMount Sinai Health SystemNew YorkNY
| | - Aaqib H. Malik
- Department of MedicineWestchester Medical CenterValhallaNY
| | - Ahmed El‐Eshmawi
- Department of Cardiovascular SurgeryMount Sinai Health SystemNew YorkNY
| | - Isaac George
- Division of Cardiac SurgeryNew York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY
| | - Aditya Sengupta
- Department of Cardiovascular SurgeryMount Sinai Health SystemNew YorkNY
| | - Susheel K. Kodali
- Division of CardiologyNew York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY
| | - Rebecca T. Hahn
- Division of CardiologyNew York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY
| | - Omar K. Khalique
- Division of CardiologyNew York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY
| | - Syed Zaid
- Department of CardiologyWestchester Medical CenterValhallaNY
| | | | - Vinayak N. Bapat
- Department of Cardiothoracic Surgery, Minneapolis Heart InstituteAbbott Northwestern HospitalMinneapolisMN
| | - Martin B. Leon
- Division of CardiologyNew York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY
| | - David H. Adams
- Department of Cardiovascular SurgeryMount Sinai Health SystemNew YorkNY
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22
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Notarianni AP, Neuburger PJ, Patel PA. TAVR Valves in the Mitral Position: Forever Between a Ring and a Hard Place. J Cardiothorac Vasc Anesth 2021; 35:1917-1921. [PMID: 33865685 DOI: 10.1053/j.jvca.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew P Notarianni
- Department of Anesthesiology, Cardiothoracic Division, Yale University School of Medicine, New Haven, CT
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, Cardiothoracic Division, NYU Grossman School of Medicine, New York, NY
| | - Prakash A Patel
- Department of Anesthesiology, Cardiothoracic Division, Yale University School of Medicine, New Haven, CT.
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23
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Urena M, Vahanian A, Brochet E, Ducrocq G, Iung B, Himbert D. Current Indications for Transcatheter Mitral Valve Replacement Using Transcatheter Aortic Valves. Circulation 2021; 143:178-196. [DOI: 10.1161/circulationaha.120.048147] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Use of transcatheter mitral valve replacement (TMVR) using transcatheter aortic valves in clinical practice is limited to patients with failing bioprostheses and rings or mitral valve disease associated with severe mitral annulus calcification. Whereas the use of valve-in-valve TMVR appears to be a reasonable alternative to surgery in patients at high surgical risk, much less evidence supports valve-in-ring and valve-in-mitral annulus calcification interventions. Data on the results of TMVR in these settings are derived from small case series or voluntary registries. This review summarizes the current evidence on TMVR using transcatheter aortic valves in clinical practice from the characteristics of the TMVR candidates, screening process, performance of the procedure, and description of current results and future perspectives. TMVR using dedicated devices in native noncalcified mitral valve diseases is beyond the scope of the article.
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Affiliation(s)
- Marina Urena
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Alec Vahanian
- University of Paris, France (M.U., A.V., G.D., B.I.)
| | - Eric Brochet
- University of Paris, France (M.U., A.V., G.D., B.I.)
| | - Gregory Ducrocq
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Bernard Iung
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Dominique Himbert
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
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Edelman JJ, Badhwar V, Larbalestier R, Yadav P, Thourani VH. Contemporary Surgical and Transcatheter Management of Mitral Annular Calcification. Ann Thorac Surg 2020; 111:390-397. [PMID: 32798455 DOI: 10.1016/j.athoracsur.2020.04.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The presence of mitral annular calcification (MAC) in patients with mitral valve (MV) stenosis or regurgitation is a difficult scenario for surgeons and the heart team. Patients with MAC most often have a significant number of comorbidities that exclude them as surgical candidates. This review highlights the various contemporary techniques available to manage MAC during treatment of the MV. METHODS This study is a focused review of the anatomy, pathology, and management of MAC. The review describes the surgical and transcatheter techniques with outcomes, where available. RESULTS The incidence of MAC is between 5% and 42% in patients with severe MV disease. The pathophysiology underlying MAC is not yet clear, but it most likely is related to processes of inflammation and atherosclerosis. Surgical techniques can be grouped into those in which the MAC is completely resected en bloc and those in which the MAC is incompletely resected or left in situ. Transcatheter therapies are feasible in some patients, but they have been limited by the anatomic constraints of MAC; most importantly left ventricular outflow tract obstruction and paravalvular regurgitation. CONCLUSIONS Surgeons as part of the heart team now have a range of techniques to manage MAC in those patients with severe MV disease. Transcatheter therapies may increase the options for patients whose surgical risk is too high.
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Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, Australia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, Australia
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
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25
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Van Hemelrijck M, Taramasso M, Gülmez G, Maisano F, Mestres CA. Mitral annular calcification: challenges and future perspectives. Indian J Thorac Cardiovasc Surg 2020; 36:397-403. [PMID: 33061148 PMCID: PMC7525373 DOI: 10.1007/s12055-019-00910-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/13/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022] Open
Abstract
Mitral annular calcification (MAC) is a chronic degenerative process that implies calcification on the mitral support structure. It usually appears as a bystander to other cardiac pathologies hindering surgical treatment and increasing morbidity and mortality. When addressing the mitral valve, many surgical strategies have been suggested in the past with no clear consensus on what to choose. Moreover, and as transcatheter therapies have gained popularity over the last few decades, transcatheter mitral valve implantation has appeared as another alternative to conventional surgery. In this review, we aim at describing an overview of MAC, highlighting current challenges and treatment options as well as new potential alternatives.
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Affiliation(s)
- Mathias Van Hemelrijck
- Department of Cardiac Surgery, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Gökhan Gülmez
- Department of Cardiac Surgery, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Carlos-A. Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich, Switzerland
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Tjørnild MJ, Sørensen SW, Carlson Hanse L, Skov SN, Røpcke DM, Nielsen SL, Hasenkam JM. Mitral Valve Posterior Leaflet Reconstruction Using Extracellular Matrix: In Vitro Evaluation. Cardiovasc Eng Technol 2020; 11:405-415. [PMID: 32592143 DOI: 10.1007/s13239-020-00472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the anatomical and functional effects of complete surgical reconstruction of the posterior mitral leaflet and associated chordae tendineae with a patch made of 2-ply small intestinal submucosal extracellular matrix in vitro. METHODS Seven explanted mitral valves with intact subvalvular apparatus from 80-kg pigs were evaluated in a left heart simulator and served as their own controls. After testing the native valve, the mitral posterior leaflet and associated chordae tendineae were excised and reconstructed by using the 2-ply small intestinal submucosa extracellular matrix patch. The characterization of the reconstruction was based on geometric data from digital images, papillary muscle force, annular tethering force and leaflet pressure force. RESULTS The reconstructed valves were fully functional without regurgitation, tearing or rupture during incrementally increased pressure from 0 to 120 mmHg. The leaflet areas were preserved after reconstruction, with a normal configuration of the coaptation line. However, the coaptation midpoint moved posteriorly after reconstruction (A2: 15.8 ± 1.4 vs. 18.9 ± 1.5 mm, p = 0.002, diff = 3.1 mm, 95% CI 1.3 to 4.8 mm). The anterior papillary muscle force increased significantly (3.9 vs. 4.6 N, p = 0.029, diff = 0.7 N, 95% CI 0.1 to 1.4 N at 120mmHg) after reconstruction. The posterior papillary muscle force, leaflet pressure force and annular pressure force did not change significantly. CONCLUSIONS In this in vitro model, mitral valve anatomy and function were comparable between the native mitral valve and our new surgical technique for complete reconstruction of the posterior mitral leaflet and associated chordae tendineae. These promising results warrant further in vivo evaluation.
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Affiliation(s)
- Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Orthopaedic Surgery, Randers Regional Hospital, Randers, Denmark.
| | - Søren W Sørensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Diana M Røpcke
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sten L Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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The Natural History of Severe Calcific Mitral Stenosis. J Am Coll Cardiol 2020; 75:3048-3057. [DOI: 10.1016/j.jacc.2020.04.049] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
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Edelman JJ, Yadav PK, Thourani VH. Commentary: Surgical mitral-in-mitral annular calcification: Progress but not the solution. JTCVS Tech 2020; 3:138-139. [PMID: 34317845 PMCID: PMC8302860 DOI: 10.1016/j.xjtc.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Pradeep K Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
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Pizano A, Hirji SA, Nguyen TC. Severe Mitral Annular Calcification and Mitral Valve Surgery: An Algorithmic Approach to Management. Semin Thorac Cardiovasc Surg 2020; 32:630-634. [DOI: 10.1053/j.semtcvs.2020.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 11/11/2022]
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Suh YJ, Lee S, Chang BC, Shim CY, Hong GR, Choi BW, Kim YJ. Utility of Cardiac CT for Preoperative Evaluation of Mitral Regurgitation: Morphological Evaluation of Mitral Valve and Prediction of Valve Replacement. Korean J Radiol 2019; 20:352-363. [PMID: 30799566 PMCID: PMC6389816 DOI: 10.3348/kjr.2018.0350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/05/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to investigate the diagnostic accuracy of cardiac computed tomography (CT) for the detection of mitral valve (MV) prolapse in mitral regurgitation (MR) with surgical findings as the standard reference, and to assess the predictability of MV replacement based on morphologic CT findings. MATERIALS AND METHODS A total of 156 patients who had undergone preoperative cardiac CT and subsequently received MV surgery due to severe MR were retrospectively enrolled. Non-repairable MV was defined when at least one of the following conditions was met: 1) anterior leaflet prolapse, 2) bi-leaflet prolapse, or 3) valve morphology (leaflet thickening, calcification, or mitral annular calcification [MAC]). Diagnostic performance of CT for the detection of the prolapsed segment was assessed with surgical findings as the standard reference. Logistic regression analysis was performed to evaluate the value of CT findings to predict actual valve replacement. RESULTS During surgery, MV prolapse was identified in 72.1%. The sensitivity, specificity, and diagnostic accuracy for the detection of MV prolapse were 99.1%, 81.4%, and 94.2%, respectively, per patient. One-hundred eighteen patients (75.6%) underwent MV repair and the remaining 38 patients received MV replacement. Bi-leaflet prolapse and valve morphology were independent predictors of valve replacement after adjusting for clinical variables (adjusted odds ratio, [OR] 8.63 for bi-leaflet prolapse; OR, 4.14 for leaflet thickening; and OR, 5.37 for leaflet calcium score > 5.6; p < 0.05). CONCLUSION Cardiac CT can have high diagnostic performance for detecting the prolapsed segment of the MV and predictability of valve replacement before surgery. Bi-leaflet prolapse and valve morphology, such as leaflet thickening, or calcification or MAC, are the most important predictors of valve replacement.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Chul Chang
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chi Young Shim
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu Ru Hong
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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31
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Kaneko T, Hirji S, Percy E, Aranki S, McGurk S, Body S, Heydarpour M, Mallidi H, Singh S, Pelletier M, Rawn J, Shekar P. Characterizing Risks Associated With Mitral Annular Calcification in Mitral Valve Replacement. Ann Thorac Surg 2019; 108:1761-1767. [DOI: 10.1016/j.athoracsur.2019.04.080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/24/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022]
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Go S, Furukawa T, Yamada K, Hiraoka T, Mochizuki S. A case of supra-annular mitral valve replacement using chimney technique for severe mitral stenosis with extensive mitral annular calcification. Gen Thorac Cardiovasc Surg 2019; 68:1199-1202. [PMID: 31768747 DOI: 10.1007/s11748-019-01256-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
When patients with extensive mitral annular calcification undergo mitral valve replacement, excessive debridement of calcification may result in fatal complications and may protract operation time. We report a case of supra-annular MVR using "the chimney technique" on a high-risk patient for severe mitral stenosis with extensive mitral annular calcification. This technique is usually used in small infants whose mitral annulus is smaller than the smallest available prosthetic valve. We apply this technique to minimize the debridement of calcification and shorten the operation time. The operation was successfully completed, and the postoperative course has been uneventful. This technique was safely and easily performed, and eliminated the need for aggressive debridement of the calcification. We believe this technique may be a good choice for high-risk patients with mitral annular calcification.
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Affiliation(s)
- Seimei Go
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Nakashimacho 3-30, Nakaku Hiroshima City, Hiroshima, Japan.
| | - Tomokuni Furukawa
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Nakashimacho 3-30, Nakaku Hiroshima City, Hiroshima, Japan
| | - Kazunori Yamada
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Nakashimacho 3-30, Nakaku Hiroshima City, Hiroshima, Japan
| | - Toshifumi Hiraoka
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Nakashimacho 3-30, Nakaku Hiroshima City, Hiroshima, Japan
| | - Shingo Mochizuki
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Nakashimacho 3-30, Nakaku Hiroshima City, Hiroshima, Japan
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33
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Ribeiro RVP, Yanagawa B, Légaré JF, Hassan A, Ouzounian M, Verma S, Friedrich JO. Clinical outcomes of mitral valve intervention in patients with mitral annular calcification: A systematic review and meta-analysis. J Card Surg 2019; 35:66-74. [PMID: 31692124 DOI: 10.1111/jocs.14325] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mitral valve (MV) disease with mitral annular calcification (MAC) poses a surgical challenge and the clinical outcomes of MV surgery as well as transcatheter mitral valve replacement (TMVR) remain relatively unexplored. We performed a systematic review and meta-analysis to assess the effects of MAC on clinical outcomes following MV surgery and TMVR. METHODS We searched MEDLINE and EMBASE databases until February 2019 for studies comparing clinical outcomes of MV surgery or TMVR in patients with and without MAC. Data were extracted by two independent investigators. Outcomes were perioperative and midterm complications and mortality. RESULTS Seven observational studies enrolling 2902 patients were included. MAC patients were older, more likely to be female with greater chronic lung disease and kidney failure. Perioperative mortality was similar between patients with and without MAC undergoing MV surgery (risk ratio [RR], 1.15; 95% confidence interval [CI], 0.50-2.65; P = .74). MAC was associated with a higher risk of bleeding, permanent pacemaker implantation, and periprosthetic leak. Midterm mortality was greater in MAC patients undergoing MV surgery (incident rate ratio [IRR], 1.32; 95% CI, 1.05-1.67; P = .02). MAC patients undergoing TMVR had higher perioperative (RR, 4.65; 95% CI, 2.93-7.38; P < .01) and 1-year (RR, 5.44; 95% CI, 3.49-8.49; P < .01) mortality, decreased procedural success, greater left ventricular outflow tract obstruction and need for conversion to surgery when compared with patients undergoing TMVR for dysfunction of a bioprosthetic valve or annuloplasty ring. CONCLUSION MV procedures in patients with MAC are associated with higher mortality and morbidity. This is largely driven by the high-risk patient profile associated with MAC. TMVR holds promise but has important limitations and should be reserved for select patients.
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Affiliation(s)
- Roberto V P Ribeiro
- Division of Cardiovascular Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiovascular Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jean-François Légaré
- Division of Cardiovascular Surgery, New Brunswick Heart Centre, Dalhousie University, Saint John, New Brunswick, Canada
| | - Ansar Hassan
- Division of Cardiovascular Surgery, New Brunswick Heart Centre, Dalhousie University, Saint John, New Brunswick, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiovascular Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jan O Friedrich
- Critical Care and Medicine Department, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Loulmet DF, Ranganath NK, Neragi-Miandoab S, Koeckert MS, Galloway AC, Grossi EA. Advanced experience allows robotic mitral valve repair in the presence of extensive mitral annular calcification. J Thorac Cardiovasc Surg 2019; 161:80-88. [PMID: 31983525 DOI: 10.1016/j.jtcvs.2019.10.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Mitral annular calcification is underdiagnosed in patients with mitral regurgitation. After excision, it may require reconstruction of the atrioventricular groove and decreases the probability of valve repair. We reviewed the safety and efficacy of totally endoscopic robotic mitral valve repair in the presence of mitral annular calcification, with an emphasis on pathology and repair techniques. METHODS Between May 2011 and August 2017, the same 2-surgeon team attempted totally endoscopic robotic mitral valve repair in 64 mitral annular calcification cases, accounting for 12.8% of our experience. Mitral annular calcification associated with a calcified posterior leaflet was not considered for totally endoscopic robotic mitral valve repair. When possible, the mitral annular calcification was excised en bloc using electrocautery, the posterior leaflet separated from the mitral annular calcification and spared, the atrioventricular groove was reconstructed, the posterior leaflet was reattached to the neoannulus, and the repair was completed with annuloplasty. RESULTS The median age of patients was 65 years, with 21 (32.8%) aged less than 60 years, and 34 (53.1%) were women. The etiology was Barlow's disease in 54 patients (84%). Repair was converted to replacement in 2 patients (3.1%). Cryoablation was performed in 8 patients (12.5%), hybrid percutaneous coronary intervention was performed in 5 patients (7.8%), and tricuspid annuloplasty was performed in 2 patients (3.1%). Median aortic occlusion was 122 minutes, excluding cases with concomitant tricuspid repair. Thirty-three patients (52%) were extubated in the operating room. The median length of stay was 4 days. Residual mitral regurgitation on discharge transthoracic echocardiogram was none to mild in all patients. None of the patients had a perioperative stroke or needed a pacemaker. Thirty-day mortality was 2 (3.1%). CONCLUSIONS Mitral annular calcification is present in a significant percentage of patients with mitral regurgitation, especially in Barlow's disease, including younger patients. By using a variety of repair techniques, totally endoscopic robotic mitral valve repair can be performed safely and effectively in most mitral annular calcification cases with a noncalcified posterior leaflet.
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Affiliation(s)
- Didier F Loulmet
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Neel K Ranganath
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | | | | | - Aubrey C Galloway
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY.
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Russell HM, Guerrero ME, Salinger MH, Manzuk MA, Pursnani AK, Wang D, Nemeh H, Sakhuja R, Melnitchouk S, Pershad A, Fang HK, Said SM, Kauten J, Tang GHL, Aldea G, Feldman TE, Bapat VN, George IM. Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification. J Am Coll Cardiol 2019; 72:1437-1448. [PMID: 30236304 DOI: 10.1016/j.jacc.2018.07.033] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important. OBJECTIVES The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes. METHODS A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented. RESULTS Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1. CONCLUSIONS The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.
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Affiliation(s)
- Hyde M Russell
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois.
| | - Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota
| | - Michael H Salinger
- Division of Cardiology and Cardiovascular Surgery, Froedtert/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Melissa A Manzuk
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Amit K Pursnani
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - Hassan Nemeh
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - Rahul Sakhuja
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashish Pershad
- Banner-University Medicine Heart Institute, Phoenix, Arizona
| | - H Kenith Fang
- Banner-University Medicine Heart Institute, Phoenix, Arizona
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - James Kauten
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York
| | - Gabriel Aldea
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Ted E Feldman
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Vinnie N Bapat
- Division of Vascular, Thoracic and Cardiac Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Isaac M George
- Division of Vascular, Thoracic and Cardiac Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
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36
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Carino D, Agostinelli A, El Qarra S, Gripshi F, Nicolini F. Mitral annulus calcification: current management and future challenges. Asian Cardiovasc Thorac Ann 2019; 27:565-572. [PMID: 31342756 DOI: 10.1177/0218492319867237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mitral annulus calcification is a chronic degenerative process in the fibrous base of the mitral valve. Assessment and treatment of mitral valve disease in patients with severe mitral annulus calcification is challenging, and a multimodal approach is helpful to delineate its severity and anatomic features, and to guide the therapeutic strategy. This article reviews the current literature to provide a clinically relevant description of mitral annulus calcification, analyze the diagnostic pathway of a patient with mitral annulus calcification, and summarize the therapeutic options.
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Affiliation(s)
- Davide Carino
- Cardiac Surgery Department, Parma University Hospital, Parma, Italy
| | | | - Suad El Qarra
- Cardiac Surgery Department, Parma University Hospital, Parma, Italy
| | - Florida Gripshi
- Cardiac Surgery Department, Parma University Hospital, Parma, Italy
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Aphram G, De Kerchove L, Mastrobuoni S, Navarra E, Solari S, Tamer S, Baert J, Poncelet A, Rubay J, Astarci P, Noirhomme P, El Khoury G. Re-repair of the failed mitral valve: insights into aetiology and surgical management. Eur J Cardiothorac Surg 2019; 54:774-780. [PMID: 29547941 DOI: 10.1093/ejcts/ezy111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/13/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Mitral valve (MV) repair is the gold standard for treatment of degenerative mitral regurgitation. A variety of surgical techniques allow surgeons to achieve a high rate of MV repair even with MV diseases of other aetiologies. However, a certain number of repairs fail over time. The aim of this study was to review our single-centre experience of MV re-repair and analyse the mode of repair failure, re-repair safety and efficiency in relation to the initial aetiology. METHODS Between 1997 and 2015, 91 patients underwent redo MV re-repair. The first MV repair was performed in our institution in 59% of cases. Follow-up information was available for 93% of our patients. The median follow-up was 56 months. RESULTS The initial aetiology was degenerative disease in 40 (44%) patients, rheumatic disease in 25 (27.5%), endocarditis in 10 (11%), ischaemic in 6 (7%), severe mitral annulus calcification in 5 (5.5%), congenital disease in 4 (4%) and unknown in 1 (1%). The mean age was 58 ± 15 years. The median delay between the 1st and 2nd repair was 49 months with 6 early re-repairs. Re-repair was urgent or emergent in 19% of cases; indications for surgery were mitral regurgitation in 48%, stenosis in 19%, endocarditis in 19%, mitral disease in 11%, ring thrombosis in 2% and systolic anterior motion in 1%. The main mechanisms of failure included technical error (30%), progression of disease (35%), new disease (29%) and unknown (6%.) Re-repair was performed through a median sternotomy in 96% of cases, and 34% of patients had concomitant procedures. Eight (9%) postoperative deaths (4 of mitral annulus calcification, 2 of endocarditis, 1 of degenerative disease, 1 of ischaemia) and 5 (6%) early failures occurred (3 of rheumatic disease, 1 of degenerative disease, 1 of a congenital condition), requiring MV replacement in 4 and new repair in 1. Overall survival at 5 and 10 years was 76% and 57%, 83% and 49% in patients with degenerative diseases and 95% and 95% in patients with rheumatic disease. Overall freedom from reoperation at 5 and 10 years was 82% and 61%, 94% and 87% with degenerative disease and 60% and 45% with rheumatic disease. CONCLUSIONS MV re-repair is feasible and has good mid-term results in patients with degenerative MV disease. Rheumatic MV disease is associated with a certain risk of failure over time; nevertheless, these patients show excellent survival after re-repair.
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Affiliation(s)
- Gaby Aphram
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Laurent De Kerchove
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Stefano Mastrobuoni
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Emiliano Navarra
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Silvia Solari
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Saadallah Tamer
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Jerome Baert
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Alain Poncelet
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Jean Rubay
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Parla Astarci
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Philippe Noirhomme
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Thoracic and Cardiovascular Surgery, Catholic University of Louvain, Saint Luc Hospital, Brussels, Belgium
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van der Merwe J, Van Praet F, Stockman B, Degrieck I, Vermeulen Y, Casselman F. Reasons for conversion and adverse intraoperative events in Endoscopic Port Access™ atrioventricular valve surgery and minimally invasive aortic valve surgery. Eur J Cardiothorac Surg 2019; 54:288-293. [PMID: 29462272 DOI: 10.1093/ejcts/ezy027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/10/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study reports the factors that contribute to sternotomy conversions (SCs) and adverse intraoperative events in minimally invasive aortic valve surgery (MI-AVS) and minimally invasive Endoscopic Port Access™ atrioventricular valve surgery (MI-PAS). METHODS In total, 3780 consecutive patients with either aortic valve disease or atrioventricular valve disease underwent minimally invasive valve surgery (MIVS) at our institution between 1 February 1997 and 31 March 2016. MI-AVS was performed in 908 patients (mean age 69.2 ± 11.3 years, 45.2% women, 6.2% redo cardiac surgery) and MI-PAS in 2872 patients (mean age 64.1 ± 13.3 years, 46.7% women, 12.2% redo cardiac surgery). RESULTS A cumulative total of 4415 MIVS procedures (MI-AVS = 908, MI-PAS = 3507) included 1537 valve replacements (MI-AVS = 896, MI-PAS = 641) and 2878 isolated or combined valve repairs (MI-AVS = 12, MI-PAS = 2866). SC was required in 3.0% (n = 114 of 3780) of MIVS patients, which occurred in 3.1% (n = 28 of 908) of MI-AVS patients and 3.0% (n = 86 of 2872) of MI-PAS patients, respectively. Reasons for SC in MI-AVS included inadequate visualization (n = 4, 0.4%) and arterial cannulation difficulty (n = 7, 0.8%). For MI-PAS, SC was required in 54 (2.5%) isolated mitral valve procedures (n = 2183). Factors that contributed to SC in MI-PAS included lung adhesions (n = 35, 1.2%), inadequate visualization (n = 2, 0.1%), ventricular bleeding (n = 3, 0.1%) and atrioventricular dehiscence (n = 5, 0.2%). Neurological deficit occurred in 1 (0.1%) and 3 (3.5%) MI-AVS and MI-PAS conversions, respectively. No operative or 30-day mortalities were observed in MI-AVS conversions (n = 28). The 30-day mortality associated with SC in MI-PAS (n = 86) was 10.5% (n = 9). CONCLUSIONS MIVS is increasingly being recognized as the 'gold-standard' for surgical valve interventions in the context of rapidly expanding catheter-based technology and increasing patient expectations. Surgeons need to be aware of factors that contribute to SC and adverse intraoperative outcomes to ensure that patients enjoy the maximum potential benefit of MIVS and to apply effective risk reduction strategies that encourage safer and sustainable MIVS programmes.
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Affiliation(s)
- Johan van der Merwe
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Bernard Stockman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Yvette Vermeulen
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
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39
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Tomšič A, Hiemstra YL, van Brakel TJ, Versteegh MI, Marsan NA, Klautz RJ, Palmen M. Outcomes of Valve Repair for Degenerative Disease in Patients With Mitral Annular Calcification. Ann Thorac Surg 2019; 107:1195-1201. [DOI: 10.1016/j.athoracsur.2018.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 11/26/2022]
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40
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Bertrand PB, Mihos CG, Yucel E. Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:19. [PMID: 30929092 DOI: 10.1007/s11936-019-0723-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Mitral annular calcification (MAC) and associated calcific mitral stenosis (MS) are frequent in the aging population, although optimal management remains debated and outcomes are poor. This article summarizes challenges in the diagnosis and therapy of calcific MS, the indications for valve intervention, procedural concerns, and emerging treatment options. RECENT FINDINGS Surgical mitral valve replacement is the procedure of choice in symptomatic patients at acceptable surgical risk, with transcatheter mitral valve replacement (TMVR) being evaluated in clinical trials as an alternative for patients at prohibitive surgical risk. Significant challenges exist with the currently available technology and outcomes have been suboptimal. Optimizing the patient-selection process by using multimodality imaging tools has proven to be essential. MAC and calcific MS is an increasingly prevalent, challenging issue with poor outcomes. While surgical valve replacement can be performed in patients with acceptable surgical risk, TMVR can be considered for patients at higher risk. Clinical trials are underway to optimize outcomes. Dedicated device designs and techniques to minimize risk of left ventricular outflow tract obstruction, paravalvular leakage, and device embolization are to be awaited.
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Affiliation(s)
- Philippe B Bertrand
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA
| | - Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA.
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Chiche O, Rodés‐Cabau J, Campelo‐Parada F, Freitas‐Ferraz AB, Regueiro A, Chamandi C, Rodriguez‐Gabella T, Côté M, DeLarochellière R, Paradis J, Dumont E, Doyle D, Mohammadi S, Bergeron S, Pibarot P, Beaudoin J. Significant mitral regurgitation in patients undergoing
TAVR
: Mechanisms and imaging variables associated with improvement. Echocardiography 2019; 36:722-731. [DOI: 10.1111/echo.14303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/09/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
- Olivier Chiche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
- Centre Hospitalier Universitaire de Nice – Département de Cardiologie Nice France
| | - Josep Rodés‐Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Francisco Campelo‐Parada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Afonso B. Freitas‐Ferraz
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Ander Regueiro
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Chekrallah Chamandi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Tania Rodriguez‐Gabella
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Mélanie Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Robert DeLarochellière
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Jean‐Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Eric Dumont
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Daniel Doyle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Siamak Mohammadi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Sébastien Bergeron
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval Québec City Québec Canada
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Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification. J Thorac Cardiovasc Surg 2019; 157:907-916. [DOI: 10.1016/j.jtcvs.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/02/2018] [Indexed: 11/15/2022]
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43
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Does Mitral Valve Calcium in Patients Undergoing Mitral Valve Replacement Portend Worse Survival? Ann Thorac Surg 2019; 107:444-452. [DOI: 10.1016/j.athoracsur.2018.07.098] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 11/20/2022]
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44
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Smith CR. Creative use of a sutureless valve. J Thorac Cardiovasc Surg 2019; 157:229-230. [DOI: 10.1016/j.jtcvs.2018.07.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
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45
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López-Rodríguez FJ, Arnáiz-García ME, Barreiro-Pérez M, González-Santos JM. Left atrial to left ventricular valved conduit for a calcified mitral annulus and ascending aorta. J Thorac Cardiovasc Surg 2018; 157:e143-e145. [PMID: 30401526 DOI: 10.1016/j.jtcvs.2018.09.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - María Elena Arnáiz-García
- Cardiovascular Surgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Manuel Barreiro-Pérez
- Cardiac Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Bedeir K, Kaneko T, Aranki S. Current and evolving strategies in the management of severe mitral annular calcification. J Thorac Cardiovasc Surg 2018; 157:555-566. [PMID: 30385026 DOI: 10.1016/j.jtcvs.2018.05.099] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/15/2018] [Accepted: 05/28/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Kareem Bedeir
- Department of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Department of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sary Aranki
- Department of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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Tjørnild MJ, Skov SN, Poulsen KB, Sharghbin M, Benhassen LL, Carlson Hanse L, Waziri F, Røpcke DM, Nielsen SL, Hasenkam JM. Mitral valve posterior leaflet reconstruction using extracellular matrix: an acute porcine study†. Eur J Cardiothorac Surg 2018; 54:832-840. [DOI: 10.1093/ejcts/ezy152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Karen B Poulsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mona Sharghbin
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Leila L Benhassen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Farhad Waziri
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Diana M Røpcke
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sten L Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Kim SW, Jeong DS, Sung K, Kim WS, Lee YT, Park PW. Surgical outcomes of mitral valve replacement with concomitant mitral annular reconstruction. J Card Surg 2018; 33:69-75. [PMID: 29464789 DOI: 10.1111/jocs.13542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY We evaluated the early and long-term outcomes of mitral annular reconstruction (MAR) with pericardium during mitral valve replacement (MVR), and analyzed the risk factors associated with post-operative mortality. METHODS Between May 1997 and April 2013, 78 consecutive patients underwent MVR with MAR. The indications for MAR were treatment for annular infection in native valve endocarditis (n = 23, 29.5%) or prosthetic valve endocarditis (n = 26, 33.3%), reinforcement of damaged annulus resulting from a previous operation (n = 17, 21.8%), complete excision of extensive calcification (n = 9, 11.5%), and left ventricular or left atrial rupture (n = 3, 3.8%). Patients were classified into infective endocarditis (n = 49) and non-endocarditis groups (n = 29). The mean follow-up period was 59.4 ± 47.3 months. RESULTS There were two operative deaths and 11 cases of late mortality in the endocarditis group and five cases in the non-endocarditis group. Late prosthetic valve endocarditis occurred in four patients. The overall survival rate at 1 and 10 years was 94.8% and 65.1%, respectively. There was no statistical difference in the overall survival, freedom from reoperation, and freedom from endocarditis rates between the groups (P = 0.565, P = 0.635, and P = 0.449, respectively). Univariable and multivariable analyses revealed that pre-operative left ventricular dysfunction (ejection fraction <40%) was an independent predictor of overall mortality. CONCLUSIONS The early and long-term results of MAR with pericardium during MVR are acceptable in both endocarditis and non-endocarditis patients.
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Affiliation(s)
- Su Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Waldron NH, Haney JC, Suarez A, Swaminathan M. The Value of Echocardiography in Unexpected Valve Disease in a Patient With Ischemic Cardiomyopathy: Less Is Not Always the Right Answer. J Cardiothorac Vasc Anesth 2018; 32:389-392. [DOI: 10.1053/j.jvca.2017.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 11/11/2022]
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50
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Dingli P, Felice H, Mizzi A, Montefort S. Caseous mitral annular calcification mimicking a lung tumor on chest X-ray. J Family Med Prim Care 2018; 6:442-444. [PMID: 29302564 PMCID: PMC5749103 DOI: 10.4103/jfmpc.jfmpc_416_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mitral annular calcification (MAC) is a common condition of the mitral valve apparatus. A case involving caseous calcification, a rare variant of MAC is presented. This variant which has a benign course can present as an intracardiac mass and needs to be differentiated from more sinister causes of calcified cardiac masses such as tumor, abscess, and infective vegetation. Often, this requires multimodality imaging with echocardiography, computed tomography, and magnetic resonance imaging. Features of caseous calcification of the mitral valve on these imaging modalities are reviewed as the associations and clinical features.
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Affiliation(s)
- Philip Dingli
- Department of Cardiology, Mater Dei Hospital, Msida, Malta
| | - Herbert Felice
- Department of Cardiology, Mater Dei Hospital, Msida, Malta
| | - Adrian Mizzi
- Department of Radiology, Mater Dei Hospital, Msida, Malta
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