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Salman J, Franz M, Aburahma K, de Manna ND, Tavil S, Ali-Hasan-Al-Saegh S, Ius F, Boethig D, Zubarevich A, Schmack B, Kaufeld T, Popov AF, Ruhparwar A, Weymann A. Hypothermic Ventricular Fibrillation in Redo Minimally Invasive Mitral Valve Surgery: A Promising Solution for a Surgical Challenge. J Clin Med 2024; 13:4269. [PMID: 39064309 PMCID: PMC11277611 DOI: 10.3390/jcm13144269] [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: 06/06/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Minimally invasive mitral valve surgery (MIMVS) is a treatment for severe mitral valve pathologies. In redo cases, especially after coronary artery bypass grafting (CABG) surgery with patent mammary bypass grafts, establishing aortic clamping followed by antegrade cardioplegia application might be challenging. Here, we present the outcome of hypothermic ventricular fibrillation as an alternative to conventional cardioprotection. Methods: Patients who underwent MIMVS either received hypothermic ventricular fibrillation (study group, n = 48) or antegrade cardioprotection (control group, n = 840) and were observed for 30 postoperative days. Data were retrospectively analyzed and collected from January 2011 until December 2022. Results: Patients in the study group had a higher preoperative prevalence of renal insufficiency (p = 0.001), extracardiac arteriopathy (p = 0.001), insulin-dependent diabetes mellitus (p = 0.001) and chronic lung disease (p = 0.036). Furthermore, they had a longer surgery time and a lower repair rate (p < 0.001). No difference, however, was seen in postoperative incidences of stroke (p = 0.26), myocardial infarction (p = 1) and mitral valve re-operation (p = 1) as well as 30-day mortality (p = 0.1) and postoperative mitral valve insufficiency or stenosis. Conclusions: The patients who underwent redo MIMVS with hypothermic ventricular fibrillation did not have worse outcomes or more serious adverse events compared to the patients who received routine conventional cardioprotection. Therefore, the use of hypothermic ventricular fibrillation appears to be a promising cardioprotective technique in this challenging patient population requiring redo MIMVS.
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Affiliation(s)
| | | | | | | | | | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany; (J.S.); (B.S.); (A.W.)
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Ali A, Gray Z, Loor G, Shafii AE, Rosengart TK, Liao KK. Minimally Invasive Mitral Valve Surgery Using a Cold Fibrillatory Cardiac Arrest Technique in Patients With Prior Cardiac Surgery. Tex Heart Inst J 2024; 51:e238167. [PMID: 39028800 PMCID: PMC11258755 DOI: 10.14503/thij-23-8167] [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: 07/21/2024]
Abstract
OBJECTIVE Minimally invasive mitral valve surgery (mini-MVS) is typically reserved for patients who have not undergone open cardiac surgery. In the reoperative setting, using intrapericardial dissection for crossclamping the aorta through a minimally invasive approach can be difficult and, at times, risky. Cold fibrillatory cardiac arrest (CFCA) with systemic cardiopulmonary bypass without cross-clamping is a well-described technique; however, data about its safety for patients who undergo reoperative mini-MVS are limited. METHODS Data for 34 patients who underwent reoperative mini-MVS with CFCA from March 2017 to March 2022 were reviewed retrospectively. A mini right thoracotomy (n = 30) or robotic (n = 4) approach was used. Systemic hypothermia was induced to a target temperature of 25 °C. RESULTS Patient mean (SD) age was 64.5 (9.6) years, and 15 of 34 (44.1%) patients were women. Of those 34 patients, 23 (67.6%) had severe regurgitation, and 11 (32.4%) had severe stenosis. Before mini-MVS, 28 patients had undergone valve surgery, and 8 had undergone coronary artery bypass graft surgery. The mitral valve was repaired in 5 of 34 (14.7%) and replaced in 29 of 34 (85.3%) patients. No difference was observed in preoperative and postoperative left ventricular function (P = .82). In 1 patient, kidney failure developed that necessitated dialysis. No postoperative stroke or mortality at 30 days occurred. CONCLUSION Mini-MVS with CFCA is well tolerated in patients with prior cardiac surgery. Myocardial function was not impaired, nor was the risk of stroke increased in this cohort, indicating that CFCA is a safe alternative in this high-risk population.
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Affiliation(s)
- Ahmed Ali
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor St Luke's Hospital, Baylor College of Medicine, Houston, Texas
- Division of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Zachary Gray
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor St Luke's Hospital, Baylor College of Medicine, Houston, Texas
| | - Gabriel Loor
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor St Luke's Hospital, Baylor College of Medicine, Houston, Texas
- Division of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Alexis E. Shafii
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor St Luke's Hospital, Baylor College of Medicine, Houston, Texas
- Division of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Todd K. Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor St Luke's Hospital, Baylor College of Medicine, Houston, Texas
- Division of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Kenneth K. Liao
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor St Luke's Hospital, Baylor College of Medicine, Houston, Texas
- Division of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
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Bhasin R, Erwin P, Kitahara H, Grady K, Balkhy HH. Mitral Valve Surgery With Previous Aortic Valve Replacement: A Robotic Endoscopic Approach Provides Excellent Visualization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:315-317. [PMID: 38721833 DOI: 10.1177/15569845241248620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Affiliation(s)
- Riya Bhasin
- Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Philip Erwin
- Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Hiroto Kitahara
- Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Kaitlin Grady
- Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
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Guerrero ME, Bapat VN, Mahoney P, Krishnaswamy A, Eleid MF, Eng MH, Yadav P, Coylewright M, Makkar R, Szerlip M, Nazif T, Kodali S, George I, Greenbaum A, Babaliaros V, Kapadia S, Rihal CS, Whisenant B, Thourani VH, McCabe JM. Contemporary 1-Year Outcomes of Mitral Valve-in-Ring With Balloon-Expandable Aortic Transcatheter Valves in the U.S. JACC Cardiovasc Interv 2024; 17:874-886. [PMID: 38599690 DOI: 10.1016/j.jcin.2024.02.012] [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: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Adequate valve performance after surgical mitral valve repair with an annuloplasty ring is not always sustained over time. The risk of repeat mitral valve surgery may be high in these patients. Transcatheter mitral valve-in-ring (MViR) is emerging as an alternative for high-risk patients. OBJECTIVES The authors sought to assess contemporary outcomes of MViR using third-generation balloon-expandable aortic transcatheter heart valves. METHODS Patients who underwent MViR and were enrolled in the STDS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between August 2015 and December 2022 were analyzed. RESULTS A total of 820 patients underwent MViR at 236 sites, mean age was 72.2 ± 10.4 years, 50.9% were female, mean STS score was 8.2% ± 6.9%, and most (78%) were in NYHA functional class III to IV. Mean left ventricular ejection fraction was 47.8% ± 14.2%, mean mitral gradient was 8.9 ± 7.0 mm Hg, and 75.5% had ≥ moderate mitral regurgitation. Access was transseptal in 93.9% with 88% technical success. All-cause mortality at 30 days was 8.3%, and at 1 year, 22.4%, with a reintervention rate of 9.1%. At 1-year follow-up, 75.6% were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire score increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg, and 91.7% had ≤ mild mitral regurgitation. CONCLUSIONS MViR with third-generation balloon-expandable aortic transcatheter heart valves is associated with a significant reduction in mitral regurgitation and improvement in symptoms at 1 year, but with elevated valvular gradients and a high reintervention rate. MViR is a reasonable alternative for high-risk patients unable undergo surgery who have appropriate anatomy for the procedure. (STS/ACC TVT Registry Mitral Module [TMVR]; NCT02245763).
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Affiliation(s)
- Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Vinayak N Bapat
- Department of Cardiothoracic Surgery, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Mahoney
- Division of Cardiology, Department of Cardiovascular Services, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marvin H Eng
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Pradeep Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Megan Coylewright
- Division of Cardiology Erlanger Health System, Chattanooga, Tennessee, USA
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Molly Szerlip
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Adam Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Ogami T, Serna-Gallegos D, Arnaoutakis GJ, Chu D, Ferdinand FD, Sezer A, Szeto WY, Grimm JC, Sultan I. The impact of reoperative surgery on aortic root replacement in the United States. J Thorac Cardiovasc Surg 2024; 167:1185-1193.e1. [PMID: 37156365 DOI: 10.1016/j.jtcvs.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/26/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Reoperative sternotomy is associated with poor outcomes after cardiac surgery. We aimed to investigate the impact of reoperative sternotomy on the outcomes after aortic root replacement. METHODS All patients who underwent aortic root replacement from January 2011 to June 2020 were identified using the Society of Thoracic Surgeons Adult Cardiac Surgery Database. We compared outcomes between patients who underwent first-time aortic root replacement with those with a history of sternotomy undergoing reoperative sternotomy aortic root replacement using propensity score matching. Subgroup analysis was performed among the reoperative sternotomy aortic root replacement group. RESULTS A total of 56,447 patients underwent aortic root replacement. Among them, 14,935 (26.5%) underwent reoperative sternotomy aortic root replacement. The annual incidence of reoperative sternotomy aortic root replacement increased from 542 in 2011 to 2300 in 2019. Aneurysm and dissection were more frequently observed in the first-time aortic root replacement group, whereas infective endocarditis was more common in the reoperative sternotomy aortic root replacement group. Propensity score matching yielded 9568 pairs in each group. Cardiopulmonary bypass time was longer in the reoperative sternotomy aortic root replacement group (215 vs 179 minutes, standardized mean difference = 0.43). Operative mortality was higher in the reoperative sternotomy aortic root replacement group (10.8% vs 6.2%, standardized mean difference = 0.17). In the subgroup analysis, logistic regression demonstrated that individual patient repetition of (second or more resternotomy) surgery and annual institutional volume of aortic root replacement were independently associated with operative mortality. CONCLUSIONS The incidence of reoperative sternotomy aortic root replacement might have increased over time. Reoperative sternotomy is a significant risk factor for morbidity and mortality in aortic root replacement. Referral to high-volume aortic centers should be considered in patients undergoing reoperative sternotomy aortic root replacement.
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Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - George J Arnaoutakis
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Francis D Ferdinand
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ahmet Sezer
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Joshua C Grimm
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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Szlapka M, Hausmann H, Timm J, Bauer A, Metz D, Pohling D, Fritzsche D, Gyoten T, Kuntze T, Dörge H, Feyrer R, Brambate A, Sodian R, Buchholz S, Sack FU, Höhn M, Fischlein T, Eichinger W, Franke U, Nagib R. Transcatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry. J Thorac Cardiovasc Surg 2024; 167:957-964. [PMID: 36088142 DOI: 10.1016/j.jtcvs.2022.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration. METHODS Data provided by 10 German heart centers underwent propensity score-matched retrospective analysis. The primary endpoint was 30-day/midterm mortality. Perioperative outcome was assessed according to the Mitral Valve Academic Research Consortium criteria. Further, the influence of moderate or greater tricuspid regurgitation (TR) on 30-day/midterm mortality was analyzed. RESULTS Between 2014 and 2019, 273 patients (79 transcatheter mitral valve-in-valve [TM-ViV] and 194 redo mitral valve replacement [Re-MVR]) underwent repeat procedure for mitral prosthesis/ring degeneration. Propensity score matching distinguished 79 patient pairs. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II-predicted risk was 15.7 ± 13.7% in the TM-ViV group and 15.0% ± 12.7% in the Re-MVR group (P = .5336). TM-ViV patients were older (74.73 vs 72.2 years; P = .0030) and had higher incidence of atrial fibrillation (54 vs 40 patients; P = .0233). Severe TR incidence was similar (17.95% in TM-ViV vs 14.10%; P = .1741). Sixty-eight TM-ViV patients previously underwent mitral valve replacement, whereas 41 Re-MVR patients underwent valve repair (P < .0001). Stenosis was the leading degeneration mechanism in 42 TM-ViV versus 22 Re-MVR patients (P < .0005). The 30-day/midterm mortality did not differ between groups. Moderate or greater TR was a predictor of total (odds ratio [OR], 4.36; P = .0011), 30-day (OR, 3.76; P = .0180), and midterm mortality (OR, 4.30; P = .0378), irrespective of group. CONCLUSIONS In both groups, observed mortality was less than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day, and midterm mortality in both groups.
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Affiliation(s)
- Michal Szlapka
- Clinic for Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, Germany.
| | - Harald Hausmann
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Jürgen Timm
- Competence Center for Clinical Trials Bremen, Bremen, Germany
| | - Adrian Bauer
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Dietrich Metz
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Daniel Pohling
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Dirk Fritzsche
- Clinic for Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Takayuki Gyoten
- Clinic for Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Thomas Kuntze
- Clinic for Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Hilmar Dörge
- Clinic for Cardiac and Thoracic Surgery, Clinic Fulda, Fulda, Germany
| | - Richard Feyrer
- Clinic for Cardiovascular Surgery, Central Military Hospital, Koblenz, Germany
| | - Agrita Brambate
- Clinic for Cardiovascular Surgery, Central Military Hospital, Koblenz, Germany
| | - Ralf Sodian
- Clinic for Cardiac Surgery, MediClin Heart Center Lahr, Lahr/Schwarzwald, Germany
| | - Stefan Buchholz
- Clinic for Cardiac Surgery, MediClin Heart Center Lahr, Lahr/Schwarzwald, Germany
| | - Falk Udo Sack
- Clinic for Cardiac Surgery, Heart Center Ludwigshafen
| | - Martina Höhn
- Clinic for Cardiac Surgery, Heart Center Ludwigshafen
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Walter Eichinger
- Clinic for Cardiac Surgery, München Klinik Bogenhausen, München, Germany
| | - Ulrich Franke
- Clinic for Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ragi Nagib
- Clinic for Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
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7
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Zwischenberger BA, Gaca JG, Milano C, Carr K, Glower DD. Late Survival After Redo Mitral Operation With Minithoracotomy Compared With Sternotomy. Ann Thorac Surg 2024; 117:353-359. [PMID: 37930297 DOI: 10.1016/j.athoracsur.2023.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The long-term effectiveness of minithoracotomy over redo median sternotomy for reoperative mitral operation is not well described. Here we present long-term survival after reoperative mitral operation based on operative approach. METHODS Adults undergoing mitral valve operation with previous sternotomy by redo sternotomy and minithoracotomy were reviewed from our prospectively maintained institutional database from 1997 to 2022. Propensity score matching was performed to compare short- and long-term outcomes. RESULTS Of 750 consecutive patients, thoracotomy was performed in 503 (67%). Median follow-up was 5.0 years (interquartile range, 0-23 years). Intraoperatively, sternotomy patients were more likely to have central aortic cannulation (205 of 223 [93%] vs 265 of 481 [56%]), cardioplegic arrest (220 of 223 [99%] vs 124 of 481 [26%]), and mitral valve replacement (190 of 223 [85%] vs 358 of 481 [74%]). Thoracotomy patients were older (63 ± 13 vs 58 ± 14 years) with elective presentation (387 of 503 [77%] vs 128 of 247 [52%]). Sternotomy patients were more likely to have endocarditis (52 of 247 [21%] vs 45 of 503 [9%], P < .001). At 10 years, thoracotomy patients experienced improved survival (52% ± 3% vs 46% ± 4%, P = .004). After propensity matching, 10-year survival was significantly higher for thoracotomy patients compared with sternotomy patients (60% ± 5% vs 42% ± 5%, P = .0006). The greatest difference in survival was at the first 6 months after operation (96% ± 1% vs 81% ± 3%, P < .001). CONCLUSIONS For patients undergoing reoperative mitral valve operation, minimally invasive right anterior thoracotomy can significantly decrease risk of death in the first 6 months, with durable survival benefit out to 10 years. We present a large single-center series to suggest an important opportunity to durably improve outcomes after reoperative mitral operation through wider use of right minithoracotomy.
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Affiliation(s)
| | - Jeffrey G Gaca
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Carmelo Milano
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Keith Carr
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Donald D Glower
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, North Carolina
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Tariq MA, Malik MK, Uddin QS, Altaf Z, Zafar M. Minimally Invasive Procedure versus Conventional Redo Sternotomy for Mitral Valve Surgery in Patients with Previous Cardiac Surgery: A Systematic Review and Meta-Analysis. J Chest Surg 2023; 56:374-386. [PMID: 37817430 PMCID: PMC10625962 DOI: 10.5090/jcs.23.038] [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: 03/20/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 10/12/2023] Open
Abstract
Background The heightened morbidity and mortality associated with repeat cardiac surgery are well documented. Redo median sternotomy (MS) and minimally invasive valve surgery are options for patients with prior cardiac surgery who require mitral valve surgery (MVS). We conducted a systematic review and meta-analysis comparing the outcomes of redo MS and minimally invasive MVS (MIMVS) in this population. Methods We searched PubMed, EMBASE, and Scopus for studies comparing outcomes of redo MS and MIMVS for MVS. To calculate risk ratios (RRs) for binary outcomes and weighted mean differences (MDs) for continuous data, we employed a random-effects model. Results We included 12 retrospective observational studies, comprising 4157 participants (675 for MIMVS; 3482 for redo MS). Reductions in mortality (RR, 0.54; 95% confidence interval [CI], 0.37-0.80), length of hospital stay (MD, -4.23; 95% CI, -5.77 to -2.68), length of intensive care unit (ICU) stay (MD, -2.02; 95% CI, -3.17 to -0.88), and new-onset acute kidney injury (AKI) risk (odds ratio, 0.34; 95% CI, 0.19 to 0.61) were statistically significant and favored MIMVS (p<0.05). No significant differences were observed in aortic cross-clamp time, cardiopulmonary bypass time, or risk of perioperative stroke, new-onset atrial fibrillation, surgical site infection, or reoperation for bleeding (p>0.05). Conclusion The current literature, which primarily consists of retrospective comparisons, underscores certain benefits of MIMVS over redo MS. These include decreased mortality, shorter hospital and ICU stays, and reduced AKI risk. Given the lack of high-quality evidence, prospective randomized control trials with adequate power are necessary to investigate long-term outcomes.
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Affiliation(s)
- Muhammad Ali Tariq
- Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Minhail Khalid Malik
- Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Qazi Shurjeel Uddin
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Zahabia Altaf
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mariam Zafar
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Lin HC, Lee YT, Tsao TP, Yin WH. A valve embolized twice: a case report of Sapien 3 embolization in left ventricle and left atrium during transcatheter transapical mitral valve-in-valve implantations for a failed bioprosthesis. Eur Heart J Case Rep 2023; 7:ytad357. [PMID: 37637099 PMCID: PMC10456212 DOI: 10.1093/ehjcr/ytad357] [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: 12/12/2022] [Revised: 03/26/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
Background Transcatheter mitral valve-in-valve (TMVIV) using the Sapien 3 (Edwards Lifesciences, Irvine, CA, USA) transcatheter heart valve is associated with high technical success and sustained valve performance. However, complications may occur or be detected during or after the procedure. Case summary We herein describe a rare case of a 59-year-old female who underwent TMVIV for a failed surgical mitral bioprosthesis. During the procedure, the device was embolized twice into the left ventricle and left atrium, respectively, resulting from the crimped transcatheter valve partially detaching from the balloon of the Certitude delivery system during passage through a tight transapical sheath. Fortunately, we were able to catch the dislodged valve and anchor it by the partially inflated device balloon, followed by successful repositioning and deployment. Discussion In cases where the valve has already detached, as in the present case, the sheath may be advanced against the proximal end of the valve as a pusher, providing good support to push the entire system to cross the bioprosthesis. Then, the delivery catheter should be withdrawn with the counteraction of the sheath in order to correct the interrelated positions of the valve and the balloon. Finally, the valve can be positioned and deployed after the sheath is withdrawn.
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Affiliation(s)
- Huan-Chiu Lin
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
- Institute of Microbiology and Immunology, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
- Faculty of Medicine, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City 112, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, No. 45, Cheng Hsin St, Beitou, Taipei 112, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City 112, Taiwan
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10
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Zogg CK, Hirji SA, Percy ED, Newell PC, Shah PB, Kaneko T. Comparison of Postdischarge Outcomes Between Valve-in-Valve Transcatheter Mitral Valve Replacement and Reoperative Surgical Mitral Valve Replacement. Am J Cardiol 2023; 201:200-210. [PMID: 37385175 DOI: 10.1016/j.amjcard.2023.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 07/01/2023]
Abstract
Limited data are available comparing the postdischarge perioperative outcomes of isolated valve-in-valve transcatheter mitral valve replacement (VIV-TMVR) versus surgical reoperative mitral valve replacement (re-SMVR) on a nationwide scale. The objective of this study was to perform a robust head-to-head assessment of contemporary postdischarge outcomes between isolated VIV-TMVR and re-SMVR using a large national multicenter longitudinal database. Adult patients aged ≥18 years with failed/degenerated bioprosthetic mitral valves who underwent either isolated VIV-TMVR or re-SMVR were identified in the 2015 to 2019 Nationwide Readmissions Database. The risk-adjusted differences in 30-, 90-, and 180-day outcomes were compared using propensity score weighting with overlap weights to mimic the results of a randomized controlled trial. The differences between a transeptal and transapical VIV-TMVR approach were also compared. A total of 687 patients with VIV-TMVR and 2,047 patients with re-SMVR were included. After the overlap weighting to attain balance between treatment groups, VIV-TMVR was associated with significantly lower major morbidity within 30 (odds ratio [95% confidence interval (CI)] 0.0.31 [0.22 to 0.46]), 90 (0.34 [0.23 to 0.50]), and 180 (0.35 [0.24 to 0.51]) days. The differences in major morbidity were primarily driven by less major bleeding (0.20 [0.14 to 0.30]), new onset complete heart block (0.48 [0.28 to 0.84]) and need for permanent pacemaker placement (0.26 [0.12 to 0.55]). The differences in renal failure and stroke were not significant. VIV-TMVR was also associated with shorter index hospital stays (median difference [95% CI] -7.0 [4.9 to 9.1] days) and an increased ability for patients to be discharged home (odds ratio [95% CI] 3.35 [2.37 to 4.72]). There were no significant differences in total hospital costs; in-hospital or 30-, 90-, and 180-day mortality; or readmission. The findings remained similar when stratifying the VIV-TMVR access using a transeptal versus a transapical approach. The changes in outcomes over time suggest marked improvements for patients with VIV-TMVR relative to stagnant results for patients with re-SMVR from 2015 to 2019. In this large nationally representative cohort of patients with failed/degenerated bioprosthetic mitral valves, VIV-TMVR appears to confer a short-term advantage over re-SMVR in terms of morbidity, discharge home, and length of stay. It yielded equivalent outcomes for mortality and readmission. Longer-term studies are needed to assess further follow-up beyond 180 days.
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Affiliation(s)
- Cheryl K Zogg
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Yale School of Medicine, New Haven, Connecticut
| | - Sameer A Hirji
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Edward D Percy
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Paige C Newell
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Pinak B Shah
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts; Cardiovascular Division, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri.
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Li Y, Lei R, Zhou J, Wu K, Shen J, Zhu Z, Wang J, Zhang H. Innovative use of a self-expanding valve for valve-in-valve transcatheter mitral valve replacement: experience from a four-year single-center study. Front Cardiovasc Med 2023; 10:1137663. [PMID: 37378395 PMCID: PMC10292798 DOI: 10.3389/fcvm.2023.1137663] [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: 01/04/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Background Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) is a minimally invasive option for patients with bioprosthetic mitral valve failure. Since January 2019, our center has been using a new innovative option, J-Valve, to treat patients with bioprosthetic mitral valve failure who were at high risk for open heart surgery. The aim of this study is to explore the effectiveness and safety of J-Valve and report the results from the four-year follow-up period of the innovative application of the transcatheter valve. Methods Patients who underwent the ViV-TMVR procedure between January 2019 and September 2022 in our center were included in the study. J-Valve™ system (JC Medical Inc., Suzhou, China) with three U-shape grippers was used for ViV-TMVR via transapical approach. Data on survival, complications, transthoracic echocardiographic results, New York Heart Association functional class in heart failure, and patient-reported health-related quality of life according to the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were collected during the four-year follow up. Results Thirty-three patients (mean age 70.1 ± 1.1 years, 13 men) were included and received ViV-TMVR. The surgery success rate was 97%: only one patient was converted to open-heart surgery due to intraoperative valve embolization to the left ventricle. During the first 30 days all-cause mortality was 0%, risk of stroke 2.5% and risk of mild paravalvular leak 15.2%; mitral valve hemodynamics improved (179.7 ± 8.9 at 30 days vs. 269 ± 49 cm/s at baseline, p < 0.0001). Median time from operation to discharge was six days, and there were no readmissions within 30 days from operation. The median and maximum follow-up durations were 28 and 47 months, respectively; during the entire follow-up, all-cause mortality was 6.1%, and the risk of cerebral infarction 6.1%. Cox regression analysis did not identify any variables significantly associated with survival. The New York Heart Association functional class and the KCCQ-12 score improved significantly compared with their preoperative values. Conclusion The use of J-Valve for ViV-TMVR is safe and effective with a high success rate, low mortality and very few associated complications, representing an alternative surgical strategy for the elderly, high-risk patients with bioprosthetic mitral valve failure.
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Affiliation(s)
- Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruobing Lei
- Chevidence Lab of Child & Adolescent Health, Department of Pediatric Research Institute, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jiawei Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kaisheng Wu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinglun Shen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhihui Zhu
- Department of Medicine IV, LMU University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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12
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Zhou J, Li Y, Chen Z, Zhang H. Transcatheter mitral valve replacement versus redo surgery for mitral prosthesis failure: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1058576. [PMID: 36741847 PMCID: PMC9889358 DOI: 10.3389/fcvm.2022.1058576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Background Transcatheter mitral valve replacement (TMVR) has emerged as an alternative to redo surgery. TMVR compared with redo surgical mitral valve replacement (SMVR) in patients with mitral prosthesis failure remains limited. In this study, we performed a meta-analysis to assess the outcomes of TMVR (including valve-in-valve and valve-in-ring) versus redo surgery for mitral prosthesis failure. Methods We comprehensively searched the PubMed, Embase, and Cochrane library databases according to predetermined inclusion and exclusion criteria, and then we extracted data. We compared the outcomes of TMVR and redo SMVR for mitral prosthesis failure in terms of the in-hospital mortality, stroke, renal dysfunction, vascular complication, pacemaker implantation, exploration for bleeding, paravalvular leak, mean mitral valve gradient, 30-day mortality, and 1-year mortality. Results Nine retrospective cohort studies and a total of 3,038 patients were included in this analysis. Compared with redo SMVR for mitral prosthesis failure, TMVR was associated with lower in-hospital mortality [odds ratios (OR): 0.44; 95% confidence interval (CI): 0.30-0.64; P < 0.001], stroke (OR: 0.44; 95% CI: 0.29-0.67; P = 0.0001), renal dysfunction (OR: 0.52; 95% CI: 0.37-0.75; P = 0.0003), vascular complication (OR: 0.58; 95% CI: 0.43-0.78; P = 0.004), pacemaker implantation (OR: 0.23; 95% CI: 0.15-0.36; P < 0.00001), and exploration for bleeding (OR: 0.24; 95% CI: 0.06-0.96; P = 0.04). Conversely, redo SMVR had lower paravalvular leak (OR: 22.12; 95% CI: 2.81-174.16; P = 0.003). There was no difference in mean mitral valve gradient (MD: 0.04; 95% CI: -0.47 to 0.55; P = 0.87), 30-day mortality (OR: 0.65; 95% CI: 0.36-1.17; P = 0.15), and 1-year mortality (OR: 0.96; 95% CI: 0.63-1.45; P = 0.84). Conclusion In patients with mitral prosthesis failure, TMVR is associated with lower in-hospital mortality and lower occurrence of postoperative complications, except for paravalvular leak. TMVR offers a viable alternative to the conventional redo surgery in selected patients.
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Snowdon JL, Scheufele EL, Pritts J, Le PT, Mensah GA, Zhang X, Dankwa-Mullan I. Evaluating Social Determinants of Health Variables in Advanced Analytic and Artificial Intelligence Models for Cardiovascular Disease Risk and Outcomes: A Targeted Review. Ethn Dis 2023; 33:33-43. [PMID: 38846264 PMCID: PMC11152155 DOI: 10.18865/1704] [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: 06/09/2024] Open
Abstract
Introduction/Purpose Predictive models incorporating relevant clinical and social features can provide meaningful insights into complex interrelated mechanisms of cardiovascular disease (CVD) risk and progression and the influence of environmental exposures on adverse outcomes. The purpose of this targeted review (2018-2019) was to examine the extent to which present-day advanced analytics, artificial intelligence, and machine learning models include relevant variables to address potential biases that inform care, treatment, resource allocation, and management of patients with CVD. Methods PubMed literature was searched using the prespecified inclusion and exclusion criteria to identify and critically evaluate primary studies published in English that reported on predictive models for CVD, associated risks, progression, and outcomes in the general adult population in North America. Studies were then assessed for inclusion of relevant social variables in the model construction. Two independent reviewers screened articles for eligibility. Primary and secondary independent reviewers extracted information from each full-text article for analysis. Disagreements were resolved with a third reviewer and iterative screening rounds to establish consensus. Cohen's kappa was used to determine interrater reliability. Results The review yielded 533 unique records where 35 met the inclusion criteria. Studies used advanced statistical and machine learning methods to predict CVD risk (10, 29%), mortality (19, 54%), survival (7, 20%), complication (10, 29%), disease progression (6, 17%), functional outcomes (4, 11%), and disposition (2, 6%). Most studies incorporated age (34, 97%), sex (34, 97%), comorbid conditions (32, 91%), and behavioral risk factor (28, 80%) variables. Race or ethnicity (23, 66%) and social variables, such as education (3, 9%) were less frequently observed. Conclusions Predictive models should adjust for race and social predictor variables, where relevant, to improve model accuracy and to inform more equitable interventions and decision making.
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Affiliation(s)
- Jane L. Snowdon
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
| | - Elisabeth L. Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
| | - Jill Pritts
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
| | - Phuong-Tu Le
- Division of Integrative Biological and Behavioral Sciences, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892
| | - George A. Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Xinzhi Zhang
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Irene Dankwa-Mullan
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
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Bojko M, Hershenhouse KS, Elsayed RS, Abt B, Cohen RG, Lee R, Bowdish ME, Starnes VA. Surgical Outcomes After Reconstruction of the Aortomitral Curtain. Semin Thorac Cardiovasc Surg 2022; 36:158-166. [PMID: 36481412 DOI: 10.1053/j.semtcvs.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Repair of concomitant aortic and mitral valvular disease with involvement of the aortomitral curtain requires a technically complex operation colloquially termed the commando procedure. Surgical outcomes of this procedure are not well described. The objective of this study was to examine outcomes of the commando procedure at our center. We identified all patients undergoing concomitant aortic and mitral valve replacements from 2004-2021. Of 363 patients, 41 underwent reconstruction of the aortomitral curtain. Survival analysis and multivariable modeling were used to examine outcomes and risk factors for mortality. The median age was 52 (IQR 44-71) years. Preoperatively, 4 of 41 (9.8%) patients had renal failure, and 10 of 41 (24.4%) had a stroke. The most common surgical indication was endocarditis in 25 of 41 (61.0%) patients. 25 of 41 (61.0%) patients underwent redo sternotomy, and 23 of 41 (56.1%) had previous prosthetic valves. Operative mortality was 14 of 41 (34.1%), and 8 of 41 (9.5%) patients received a permanent pacemaker. Survival at 1, 3, and 5 years was 55.4% (95% confidence interval (CI), 40.6-75.5%), 50.3% (35.0-72.3%), and 37.7% (19.3-73.9%) respectively. Cox proportional hazards regression identified previous sternotomy (HR 4.76, 95% CI 1.21-18.73), and female gender (HR 1.39, 95% CI 1.17-13.82) as risk factors for mortality. Patients undergoing reconstruction of the aortomitral curtain represent a high-risk population with complex surgical indications. Due to high perioperative morbidity and mortality, this procedure should be performed only when necessary. Despite a high up front morbidity burden, outcomes remain favorable for patients who survive the initial hospitalization.
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Affiliation(s)
- Markian Bojko
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Korri S Hershenhouse
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Ramsey S Elsayed
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Brittany Abt
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Robbin G Cohen
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Raymond Lee
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Michael E Bowdish
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vaughn A Starnes
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California..
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15
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Glance LG, Joynt Maddox KE, Mazzefi M, Knight PW, Eaton MP, Feng C, Kertai MD, Albernathy J, Wu IY, Wyrobek JA, Cevasco M, Desai N, Dick AW. Racial and Ethnic Disparities in Access to Minimally Invasive Mitral Valve Surgery. JAMA Netw Open 2022; 5:e2247968. [PMID: 36542380 PMCID: PMC9857175 DOI: 10.1001/jamanetworkopen.2022.47968] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Whether people from racial and ethnic minority groups experience disparities in access to minimally invasive mitral valve surgery (MIMVS) is not known. OBJECTIVE To investigate racial and ethnic disparities in the utilization of MIMVS. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Society of Thoracic Surgeons Database for patients who underwent mitral valve surgery between 2014 and 2019. Statistical analysis was performed from January 24 to August 11, 2022. EXPOSURES Patients were categorized as non-Hispanic White, non-Hispanic Black, and Hispanic individuals. MAIN OUTCOMES AND MEASURES The association between MIMVS (vs full sternotomy) and race and ethnicity were evaluated using logistic regression. RESULTS Among the 103 753 patients undergoing mitral valve surgery (mean [SD] age, 62 [13] years; 47 886 female individuals [46.2%]), 10 404 (10.0%) were non-Hispanic Black individuals, 89 013 (85.8%) were non-Hispanic White individuals, and 4336 (4.2%) were Hispanic individuals. Non-Hispanic Black individuals were more likely to have Medicaid insurance (odds ratio [OR], 2.21; 95% CI, 1.64-2.98; P < .001) and to receive care from a low-volume surgeon (OR, 4.45; 95% CI, 4.01-4.93; P < .001) compared with non-Hispanic White individuals. Non-Hispanic Black individuals were less likely to undergo MIMVS (OR, 0.65; 95% CI, 0.58-0.73; P < .001), whereas Hispanic individuals were not less likely to undergo MIMVS compared with non-Hispanic White individuals (OR, 1.08; 95% CI, 0.67-1.75; P = .74). Patients with commercial insurance had 2.35-fold higher odds of undergoing MIMVS (OR, 2.35; 95% CI, 2.06-2.68; P < .001) than those with Medicaid insurance. Patients operated by very-high volume surgeons (300 or more cases) had 20.7-fold higher odds (OR, 20.70; 95% CI, 12.7-33.9; P < .001) of undergoing MIMVS compared with patients treated by low-volume surgeons (less than 20 cases). After adjusting for patient risk, non-Hispanic Black individuals were still less likely to undergo MIMVS (adjusted OR [aOR], 0.88; 95% CI, 0.78-0.99; P = .04) and were more likely to die or experience a major complication (aOR, 1.25; 95% CI, 1.16-1.35; P < .001) compared with non-Hispanic White individuals. CONCLUSIONS AND RELEVANCE In this cross-sectional study, non-Hispanic Black patients were less likely to undergo MIMVS and more likely to die or experience a major complication than non-Hispanic White patients. These findings suggest that efforts to reduce inequity in cardiovascular medicine may need to include increasing access to private insurance and high-volume surgeons.
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Affiliation(s)
- Laurent G. Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York
- RAND Health, RAND, Boston, Massachusetts
| | - Karen E. Joynt Maddox
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Center for Health Economics and Policy at the Institute for Public Health, Washington University in St Louis, St Louis, Missouri
| | - Michael Mazzefi
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville
| | - Peter W. Knight
- Department of Surgery, University of Rochester School of Medicine, Rochester, New York
| | - Michael P. Eaton
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, New York
| | - Miklos D. Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James Albernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins, Baltimore, Maryland
| | - Isaac Y. Wu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Julie A. Wyrobek
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Marisa Cevasco
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia
| | - Nimesh Desai
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia
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Zahid S, Ullah W, Hashem AM, Khan MZ, Gowda S, Vishnevsky A, Fischman DL. Transcatheter valve-in-valve implantation versus redo surgical mitral valve replacement in patients with failed mitral bioprostheses. EUROINTERVENTION 2022; 18:824-835. [PMID: 36106346 PMCID: PMC9724889 DOI: 10.4244/eij-d-22-00437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Data on the safety of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) compared with redo surgical mitral valve replacement (SMVR) in patients with a history of bioprosthetic mitral valve (MV) remain limited. AIMS We aimed to evaluate the in-hospital, 30-day and 6-month readmission outcomes of ViV-TMVR compared with redo-SMVR in a real-world cohort. METHODS The Nationwide Readmission Database was utilised, analysing data from 2015 to 2019. To determine the adjusted odds ratio (aOR), we used the propensity-matched analysis for major outcomes at index hospitalisation, 30 days, and 6 months during the episode of readmission. RESULTS A total of 3,691 patients were included, of these, 24.2% underwent ViV-TMVR and 75.8% underwent redo-SMVR. Patients undergoing ViV-TMVR were older with higher rates of comorbidities. The mean length of stay (15 days vs 4 days) and cost of hospitalisation ($76,558 vs $46,743) were significantly higher for redo-SMVR. The rate of in-hospital all-cause mortality was also significantly lower in ViV-TMVR (2.6% vs 7.3%). By contrast, 30-day all-cause mortality during the episode of readmission (aOR 1.01, 95% confidence interval [CI]: 0.40-2.55) and all-cause readmission rates (aOR 0.82, 95% CI: 0.66-1.02) were similar between both groups. The incidence of all-cause readmissions at 6 months (aOR 0.83, 95% CI: 0.65-1.05) and all-cause mortality during the episode of readmission at 6 months (aOR 1.84, 95% CI: 0.54-6.36) were also comparable. The utilisation of the ViV-TMVR procedure increased significantly during our study duration, from 5.2% to 36.8%, (ptrend<0.01). CONCLUSIONS ViV-TMVR is associated with lower odds of in-hospital mortality, complications, and resource utilisation. The all-cause readmissions and 30-day and 6-month mortality during the episode of readmissions were comparable between both groups.
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Affiliation(s)
- Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Anas M Hashem
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Smitha Gowda
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Alec Vishnevsky
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - David L Fischman
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Risk Factors for Postoperative Acute Kidney Injury in Patients Undergoing Redo Cardiac Surgery Using Cardiopulmonary Bypass. J Cardiovasc Dev Dis 2022; 9:jcdd9080244. [PMID: 36005408 PMCID: PMC9409715 DOI: 10.3390/jcdd9080244] [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: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: This paper aimed to investigate the incidence and risk factors of postoperative acute kidney injury (AKI) in adult patients undergoing redo cardiac surgery with cardiopulmonary bypass (CPB), and explore the impact of AKI on early outcomes. Methods: A total of 116 patients undergoing redo cardiac surgery with CPB between November 2017 and May 2021 were included. Patients were divided into two groups, AKI group and non-AKI group, according to the Kidney Disease Improving Global Outcomes criteria. Perioperative variables were retrospectively collected and analyzed. Risk factors for the development of AKI were investigated by univariate and multiple logistic regression models. Clinical outcomes were also compared between the groups. Results: Postoperative AKI occurred in 63 patients (54.3%), among whom renal replacement therapy was required in 12 patients (19.0%). The mechanical ventilation time (AKI: 43.00 (19.00, 72.00) hours; non-AKI: 18.00 (15.00, 20.00) hours; p < 0.001), ICU length of stay (AKI: 4.00 (2.00, 6.00) days; non-AKI: 3.00 (2.00, 4.00) days; p = 0.010), hospital length of stay since operation (AKI: 12.00 (8.00, 18.00) days; non-AKI: 9.00 (7.00, 12.50) days; p = 0.024), dialysis (AKI: 12.00 (19.05%); non-AKI: 0 (0%); p = 0.001), reintubation (AKI: 7.00 (11.11%); non-AKI: 0 (0%); p = 0.035), and hospital mortality (AKI: 8.00 (12.70%); non-AKI: 0 (0%); p = 0.020) were all higher in the AKI group than in the non-AKI group. Multivariate analysis revealed that high aspartate aminotransferase (OR, 1.028, 95% CI, 1.003 to 1.053, p = 0.025), coronary angiogram within 2 weeks before surgery (OR, 3.209, 95% CI, 1.307 to 7.878, p = 0.011) and CPB time (OR, 1.012, 95% CI, 1.005 to 1.019, p = 0.001) were independent risk factors for postoperative AKI. Conclusions: High aspartate aminotransferase, coronary angiogram within 2 weeks before surgery and CPB time seem to be associated with an increased incidence of postoperative AKI in patients with redo cardiac surgery.
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Murphy DA, Jonsson AA, Halkos ME. Endoscopic Robotic Mitral Valve Surgery in Patients With Previous Sternotomy Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:297-303. [PMID: 35770592 DOI: 10.1177/15569845221106791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Mitral surgery is higher risk in patients with a previous median sternotomy. We describe an endoscopic robotic approach in this higher-risk cohort by an experienced robotic team. Methods: From January 2006 through June 2021, 152 consecutive patients with previous sternotomy cardiac surgery underwent mitral surgery using endoscopic robotics. Peripheral perfusion with endoaortic balloon occlusion was used in 148 patients (97.4%) and ventricular fibrillation in 4 patients (2.6%). Results: Mitral repair was performed in 73 patients (48%) including primary repair in 57 patients and re-repair in 16 patients, mitral replacement in 78 patients (51.3%) including primary replacement in 26 patients, conversion of a previous repair to replacement in 28 patients, and re-replacement in 24 patients. A paravalvular leak was primarily repaired in 1 patient (0.7%). Concomitant procedures included tricuspid repair in 28 patients (18.4%) and cryoablation in 8 patients (5.3%). Postoperative echocardiography in the mitral repair patients demonstrated none to mild regurgitation in 72 patients (98.6%). One repair patient (1.4%) had severe regurgitation and required robotic mitral replacement 5 days postoperatively. There were no paravalvular leaks in the mitral replacement patients. Operative mortality occurred in 3 patients (1.97%). Stroke occurred in 1 patient (0.7%), prolonged ventilation in 18 patients (11.8%), renal failure in 2 patients (1.4%), and re-exploration for bleeding in 10 patients (6.6%). Mean length of stay for the entire cohort was 5 ± 5.4 days. Conclusions: Robotic mitral valve surgery can be extended to patients with previous sternotomy with satisfactory efficacy and low operative mortality and morbidity.
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Affiliation(s)
- Douglas A Murphy
- 22646Division of Cardiothoracic Surgery, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Amalia A Jonsson
- 22646Division of Cardiothoracic Surgery, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Michael E Halkos
- 22646Division of Cardiothoracic Surgery, 1371Emory University School of Medicine, Atlanta, GA, USA
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19
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Liu L, Xiao B, Wu B, Guo Y. Transcatheter Mitral Valve-in-Valve Implantations Using Inverted J-Valve. Front Cardiovasc Med 2022; 9:896639. [PMID: 35811703 PMCID: PMC9260111 DOI: 10.3389/fcvm.2022.896639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAs bioprosthetic valves are being widely used, the incidence of structural valve deterioration increases, as well as the need for reoperation. Transcatheter mitral valve-in-valve implantations are being increasingly adopted as an alternative to redo-surgical mitral replacement for patients with high surgical risks. This study reports a series of transcatheter mitral valve-in-valve implantations using inverted J-valves.MethodsFrom April 2019 to September 2021, 17 symptomatic high-risk patients with mitral bioprosthetic valve dysfunction underwent transapical transcatheter mitral valve-in-valve implantations using inverted J-valves at our institution.ResultsThe median age was 70 years, with 76.5% being female. The median Society of Thoracic Surgeons predicted risk of mortality (STS PROM) was 17.2% (8.7–82.24%). All patients had successful transapical transcatheter mitral valve-in-valve implantations except for one intraoperative death due to left ventricle rupture. Four patients underwent simultaneous transcatheter aortic valve implantation, two of which had valve-in-valve transcatheter aortic valve implantation. There was no major complication except one case of bleeding. Thirty-day mortality was 11.8% (2/17), and 90-days mortality was 23.5% (4/17). Percentages of patients with New York Heart Association class III/IV symptoms decreased from 100 (17/17) to 20% (3/15) at 30-days. Median mitral inflow velocity was 1.95 mm/s at 30 days, compared to 2.7 mm/s at baseline. Median mitral valve effective orifice area increases from 1.5 mm at baseline to 1.85 mm at 30 days.ConclusionTranscatheter transapical valve-in-valve implantations with J-valve can be a plausible solution to failed mitral bioprosthesis with acceptable results for high-risk patients.
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20
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Sá MP, Ramlawi B, Gray WA, Malin JH, Van den Eynde J, Sicouri S, Torregrossa G, Klein C, Heil E, Sündermann SH, Emmerich A, Kempfert J, Kofler M, Falk V, Unbehaun A, Van Praet KM. Transcatheter mitral valve implantation in the ongoing structural heart revolution. J Card Surg 2022; 37:1691-1704. [PMID: 35340080 DOI: 10.1111/jocs.16431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Transcatheter mitral valve implantation (TMVI) has emerged as a less invasive approach potentially surmounting some of the current hurdles associated with transcatheter edge-to-edge repair and high-risk mitral valve surgery. In this review, we aimed to outline the main scenarios in the TMVI field, highlight current and upcoming devices, and describe challenges and clinical results. Finally, we briefly discuss the future perspectives for this emerging field and how TMVI might further advance the field of transcatheter treatments of mitral valve disease.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - William A Gray
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - John H Malin
- Philadelphia College of Osteopathic Medicine, Bala Cynwyd, Pennsylvania, USA
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Christoph Klein
- Department of Internal Medicine-Cardiology, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Emanuel Heil
- Department of Internal Medicine-Cardiology, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Simon H Sündermann
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Emmerich
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Jörg Kempfert
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Markus Kofler
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Health Sciences and Technology, Institute of Translational Medicine, Swiss Federal Institute of Technology, Translational Cardiovascular Technologies, Zurich, Switzerland
| | - Axel Unbehaun
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Karel M Van Praet
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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21
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Meidan TG, Lanfear AT, Squiers JJ, Hamandi M, Lytle BW, DiMaio JM, Smith RL. Robotic Mitral Valve Surgery After Prior Sternotomy. JTCVS Tech 2022; 13:46-51. [PMID: 35711230 PMCID: PMC9196136 DOI: 10.1016/j.xjtc.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Despite the recent increase in the use of minimally invasive approaches to mitral valve surgery in patients with a prior sternotomy, the outcomes of the robotic approach to mitral valve surgery in this patient population have not been examined. Methods We retrospectively reviewed 342 consecutive patients who underwent mitral valve surgery after a prior sternotomy between 2013 and 2020, in which the robotic approach was used in 21 patients (6.1%). We reviewed the clinical details of these 21 patients. Results The median age was 71 years [interquartile range 64.00, 74.00 years], and mean Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% ± 3.8%. The indication for mitral valve surgery was degenerative mitral valve disease in 33.3% (7/21), functional disease in 28.6% (6/21), mixed disease in 4.8% (1/21), rheumatic disease in 9.5% (2/21), and failed repair for degenerative disease in 23.8% (5/21). No cases required conversion from robotic assistance to alternative approaches, there were no intraoperative deaths, and intraoperative transesophageal echocardiogram confirmed complete elimination of mitral regurgitation in 90.5% (19/21) of cases. Thirty-day mortality was 0.0% (0/21), and 1-year mortality was 4.8% (1/21). There were no strokes or wound infections at 30 days, and 14.3% (3/21) of patients received intraoperative blood product transfusions. Conclusions The results of this retrospective review suggest that the robotic approach to mitral valve surgery in patients with a prior sternotomy is safe in experienced hands. Although some centers have considered prior sternotomy a relative contraindication to robotic mitral valve surgery, this approach is feasible and can be considered an option for experienced surgeons.
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Affiliation(s)
- Talia G. Meidan
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
- Address for reprints: Talia G. Meidan, BS, Baylor Scott & White The Heart Hospital – Plano, 1100 Allied Dr, Plano, TX 75093.
| | - Allison T. Lanfear
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - John J. Squiers
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Mohanad Hamandi
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Bruce W. Lytle
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - J. Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Robert L. Smith
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
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22
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Li J, Wang S, Sun H, Xu J, Dong C, Song M, Yu Q. Clinical and Surgical Evaluations of Reoperation After Mechanical Mitral Valve Replacement Due to Different Etiologies. Front Cardiovasc Med 2022; 8:778750. [PMID: 35111824 PMCID: PMC8801603 DOI: 10.3389/fcvm.2021.778750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background:This study aimed to evaluate the clinical and surgical characteristics of patients who required reoperation after mechanical mitral valve replacement (MVR).Methods:We retrospectively identified 204 consecutive patients who underwent reoperation after mechanical MVR between 2009 and 2018. Patients were categorized according the reason for reoperation (perivalvular leakage, thrombus formation, or pannus formation). The patients' medical and surgical records were studied carefully and the rates of in-hospital complications were calculated.Results:The mean age was 51±12 years and 44% of the patients were male. The reasons for reoperation were perivalvular leakage (117 patients), thrombus formation (35 patients), and pannus formation (52 patients). The most common positions for perivalvular leakage were at the 6–10 o'clock positions (proportions of ≥25% for each hour position). Most patients had an interval of >10 years between the original MVR and reoperation. The most common reoperation procedure was re-do MVR (157 patients), and 155 of these patients underwent concomitant cardiac procedures. There were 10 in-hospital deaths and 32 patients experienced complications. The 10-year survival rate was 82.2 ± 3.9% in general, and the group of lowest rate was patients with PVL (77.5 ± 5.2%). The independent risk factors were “male” (4.62, 95% CI 1.57–13.58, P = 0.005) and “Hb <9g/dL before redo MV operation” (3.45, 95% CI 1.13–10.49, P = 0.029).Conclusion:Perivalvular leakage was the most common reason for reoperation after mechanical MVR, with a low survival rate in long term follow-up relatively.
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23
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Simonato M, Forrest JK, Dvir D. The Dos and Don'ts of Mitral Valve-in-Valve and Valve-in-Ring. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:402-408. [PMID: 34839722 DOI: 10.1177/15569845211048940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Danny Dvir
- Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
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24
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Ogami T, Sanon S, Sultan I. Paravalvular leak after heart valve replacement: Transcatheter or surgical management? J Card Surg 2021; 37:431-432. [PMID: 34811793 DOI: 10.1111/jocs.16155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Saurabh Sanon
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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25
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Zubarevich A, Szczechowicz M, Zhigalov K, Marx P, Lind A, Jánosi RA, Rassaf T, Shehada SE, Malik R, Kamler M, Thielmann M, Schmack B, Ruhparwar A, Weymann A, Wendt D. Transapical transcatheter mitral valve implantation in patients with degenerated mitral bioprostheses or failed ring annuloplasty. Ann Cardiothorac Surg 2021; 10:674-682. [PMID: 34733695 DOI: 10.21037/acs-2021-tviv-fs-67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background We sought to evaluate the outcomes of transapical transcatheter mitral valve replacement in patients with degenerated mitral bioprostheses or failed mitral ring annuloplasty and high surgical risk for redo mitral valve procedure. Methods Between August 2012 and December 2020, 41 consecutive high-risk patients underwent transcatheter mitral 'valve-in-valve' (TM-ViV, n=25) or 'valve-in-ring' (TM-ViR, n=16) implantation at our institution. All procedures were performed in a hybrid operating theater using the SAPIEN XT/3™ or the DIRECT FLOW MEDICAL™ prostheses. Data was collected prospectively according to MVARC criteria. Results The logistic EuroSCORE-I was 42.3%±20.5% (mean ± SD), the Society of Thoracic Surgeons (STS) score was 11.9%±10.8%, and the STS/ACC-score was 7.6%±4.2%. Transcatheter mitral valve implantations were successful in all patients (100%). Early echocardiographic examinations showed no obstruction of the left ventricular outflow tract (LVOT), no paravalvular leakage, and only trace transvalvular leakage in eight patients. There was no operative mortality; thirty-day mortality was 9.8%. Survival was 72% at one year and 63% at three years. At two-year follow-up, transvalvular mean pressure gradients were 4.6±1.4 mmHg. Conclusions Transapical transcatheter mitral valve-in-valve or valve-in-ring implantation represents a true minimally invasive alternative to surgical redo procedures, especially in high-risk patients with failed bioprosthetic mitral valves or annuloplasty and favorable anatomy.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Philipp Marx
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Lind
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Rizwan Malik
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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26
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Orfanoudaki A, Giannoutsou A, Hashim S, Bertsimas D, Hagberg RC. Machine learning models for mitral valve replacement: A comparative analysis with the Society of Thoracic Surgeons risk score. J Card Surg 2021; 37:18-28. [PMID: 34669218 DOI: 10.1111/jocs.16072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current Society of Thoracic Surgeons (STS) risk models for predicting outcomes of mitral valve surgery (MVS) assume a linear and cumulative impact of variables. We evaluated postoperative MVS outcomes and designed mortality and morbidity risk calculators to supplement the STS risk score. METHODS Data from the STS Adult Cardiac Surgery Database for MVS was used from 2008 to 2017. The data included 383,550 procedures and 89 variables. Machine learning (ML) algorithms were employed to train models to predict postoperative outcomes for MVS patients. Each model's discrimination and calibration performance were validated using unseen data against the STS risk score. RESULTS Comprehensive mortality and morbidity risk assessment scores were derived from a training set of 287,662 observations. The area under the curve (AUC) for mortality ranged from 0.77 to 0.83, leading to a 3% increase in predictive accuracy compared to the STS score. Logistic Regression and eXtreme Gradient Boosting achieved the highest AUC for prolonged ventilation (0.82) and deep sternal wound infection (0.78 and 0.77) respectively. EXtreme Gradient Boosting performed the best with an AUC of 0.815 for renal failure. For permanent stroke prediction all models performed similarly with an AUC around 0.67. The ML models led to improved calibration performance for mortality, prolonged ventilation, and renal failure, especially in cases of reconstruction/repair and replacement surgery. CONCLUSIONS The proposed risk models complement existing STS models in predicting mortality, prolonged ventilation, and renal failure, allowing healthcare providers to more accurately assess a patient's risk of morbidity and mortality when undergoing MVS.
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Affiliation(s)
| | - Aikaterini Giannoutsou
- USC Marshall School of Business, University of South California, Los Angeles, California, USA
| | - Sabet Hashim
- Hartford HealthCare Heart & Vascular Institute, Hartford, Connecticut, USA
| | - Dimitris Bertsimas
- Operations Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Robert C Hagberg
- Hartford HealthCare Heart & Vascular Institute, Hartford, Connecticut, USA
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27
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Belluschi I, Glauber M, Miceli A. Commentary: Is Minimally Invasive Mitral Approach After a Previous Sternotomy Still Competitive? Semin Thorac Cardiovasc Surg 2021; 34:1218-1219. [PMID: 34525390 DOI: 10.1053/j.semtcvs.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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28
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Zia Khan M, Zahid S, Khan MU, Kichloo A, Jamal S, Mannan Khan Minhas A, Ullah W, Sattar Y, Balla S. Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample. J Am Heart Assoc 2021; 10:e020948. [PMID: 34459226 PMCID: PMC8649266 DOI: 10.1161/jaha.121.020948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Redo mitral valve surgery is required in up to one-third of patients and is associated with significant mortality and morbidity. Valve-in-valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real-world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, P<0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, P<0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, P<0.01) and acute kidney injury (36.7% versus 13.9%, P<0.01). Cost of care was higher (USD$57 172 versus USD$52 579, P<0.01), length of stay was longer (10 versus 3 days, P<0.01), and discharge to home was lower (20.3% versus 64.6%, P<0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long-term outcomes and durability of ViV TMVR are needed. A patient-centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision-making about the choice of intervention for the individual patient.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Salman Zahid
- Department of Medicine Rochester General Hospital Rochester NY
| | - Muhammad U Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | | | | | | | | | - Yasar Sattar
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Sudarshan Balla
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
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29
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Zubarevich A, Szczechowicz M, Arjomandi Rad A, Vardanyan R, Marx P, Lind A, Jánosi RA, Roosta-Azad M, Malik R, Kamler M, Thielmann M, El Gabry M, Schmack B, Ruhparwar A, Weymann A, Wendt D. Mitral surgical redo versus transapical transcatheter mitral valve implantation. PLoS One 2021; 16:e0256569. [PMID: 34432834 PMCID: PMC8386843 DOI: 10.1371/journal.pone.0256569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background Transcatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly because redo patients often present with multiple comorbidities and high operative risk. We sought to evaluate and compare our experience with transapical transcatheter mitral valve replacement (TA-TMVR) to conventional redo mitral valve replacement in patients presenting with degenerated biological mitral valve prostheses or failed valve annuloplasty. Methods and material Between March 2012 and November 2020, 74 consecutive high-risk patients underwent surgical redo mitral valve replacement (n = 33) or TA-TMVR (n = 41) at our institution. All patients presented with a history of a surgical mitral valve procedure. All transcatheter procedures were performed using the SAPIEN XT/3™ prostheses. Data collection was prospectively according to MVARC criteria. Results The mean logistic EuroSCORE-II of the whole cohort was 19.9±16.7%, and the median STS-score was 11.1±12.5%. The mean age in the SMVR group was 63.7±12.8 years and in the TMVR group 73.6±9.7 years. Patients undergoing TA-TMVR presented with significantly higher risk scores. Echocardiography at follow up showed no obstruction of the left ventricular outflow tract, no paravalvular leakage and excellent transvalvular gradients in both groups (3.9±1.2 mmHg and 4.2±0.8 mmHg in the surgical and transcatheter arm respectively). There was no difference in postoperative major adverse events between the groups with no strokes in the whole cohort. Both methods showed similar survival rates at one year and a 30-day mortality of 15.2% and 9.8% in SAVR and TMVR group, respectively. Despite using contrast dye in the transcatheter group, the rate of postoperative acute kidney failure was similar between the groups. Conclusion Despite several contraindications for surgery, we showed the non-inferiority of TA-TMVR compared to conventional surgical redo procedures in high-risk patients. With its excellent hemodynamic and similar survival rate, TA-TMVR offers a feasible alternative to the conventional surgical redo procedure in selected patients.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Philipp Marx
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Lind
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Mehdy Roosta-Azad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Rizwan Malik
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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Ko K, de Kroon TL, Kelder JC, Saouti N, van Putte BP. Reoperative Mitral Valve Surgery Through Port Access. Semin Thorac Cardiovasc Surg 2021; 34:1208-1217. [PMID: 34425218 DOI: 10.1053/j.semtcvs.2021.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022]
Abstract
Minimally invasive mitral valve surgery (MIMVS) has become the standard approach for mitral valve pathology in many centres. The anterolateral mini thoracotomy access is beneficial in reoperative surgery by avoiding repeat sternotomy associated risks. The aim of this study is to analyse the safety of this technique. All patients undergoing reoperative MIMVS between 2008 and 2019 were studied retrospectively. Primary endpoint was 30-day major complications and mortality; secondary outcome was long term survival, reoperation rate and rate of more than moderate recurrent regurgitation. 146 Patients underwent reoperative MIMVS with a mean age of 68 ± 8 years. The composite outcome of 30-day major complication and mortality was 29.5%. 30-Day mortality was 6.2% and stroke rate 3.4%. Survival for the whole cohort was 89.7 ± 2.5% at 1-year, 71.6 ± 4.3% at 5 year and 50.9 ± 5.9% at 8-year follow up. Cox regression analysis revealed reduced left ventricular function (HR 2.8; 95%CI 1.5 - 5.0), GFR < 60 (HR 2.1; 95%CI 1.2 - 3.7) and active endocarditis (HR 6.4; 95%CI 2.7 - 15.4) as variables associated with reduced long-term survival. The cumulative incidence of re-operation after mitral valve replacement was 11.3 ± 3.2% at 5-year and for repair 16.2 ± 7.5% at 5-year. The cumulative incidence of more than moderate recurrent regurgitation after mitral valve repair was 25.4 ± 9.0% at 3-year. Minimally invasive access in reoperative mitral valve surgery in the current study showed similar 30-day mortality and stroke rate compared to repeat sternotomy results reported in literature.
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Affiliation(s)
- Kinsing Ko
- Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands; Cardiothoracic Surgery, Radboud UMC, Nijmegen, The Netherlands.
| | - Thom L de Kroon
- Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nabil Saouti
- Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands; Cardiothoracic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Bart P van Putte
- Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands; Cardiothoracic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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Zubarevich A, Szczechowicz M, Zhigalov K, Rad AA, Vardanyan R, Easo J, Roosta-Azad M, Kamler M, Schmack B, Ruhparwar A, Wendt D, Weymann A. Surgical redo mitral valve replacement in high-risk patients: The real-world experience. J Card Surg 2021; 36:3195-3204. [PMID: 34227147 DOI: 10.1111/jocs.15787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Redo surgical mitral valve replacement (SMVR) remains the gold standard treatment in patients with a history of mitral valve surgery presenting with recurrent mitral valve pathologies. Whilst this procedure is demanding, it is an inevitable intervention for some indications, such as infective endocarditis, thrombosis, or multivalve procedures. In this study, we aim to evaluate our institutional experience with SMVR on a real-life cohort, identifying the factors that contribute to poor surgical outcomes whilst avoiding selection bias. METHODS Between March 2012 and November 2020, 58 consecutive high-risk patients underwent a redo SMVR at our institution. The primary endpoints of this study were 30-day and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events. We analyzed and compared the survival in patients undergoing an isolated SMVR and in those that required at least one concomitant procedure. RESULTS The overall operative, 30-day, and 1-year mortality were 3.4%, 22.4%, and 25.9%, respectively. The mortality in patients undergoing isolated SMVR was significantly lower than in patients requiring concomitant procedures. The multivariable regression model showed that NYHA Class IV, infective endocarditis, and postoperative dialysis were significantly associated with 30-day mortality. Society of Thoracic Surgeons Score, infective endocarditis, concomitant procedures, and mechanical valve implantation appeared to predict long-term mortality. CONCLUSION This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.
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Affiliation(s)
- Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Marcin Szczechowicz
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arian A Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Jerry Easo
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Mehdy Roosta-Azad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
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32
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Glower DD. Is redo mitral mortality getting better or getting worse? J Card Surg 2021; 36:3205-3206. [PMID: 34218461 DOI: 10.1111/jocs.15789] [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: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
Zubarevich et al. present the 30 day and 1-year outcomes of redo mitral valve replacement in 58 high-risk patients. The authors conclude that careful patient selection and risk stratification provides acceptable surgical results in this cohort. This series reminds us that increased use of bioprostheses, increased use of mitral replacement instead of repair, and an aging population drive the volume of high-risk redo mitral replacement. It remains to be seen whether redo mitral mortality is getting better or worse, but the risk and the patients will be with us for some time.
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Affiliation(s)
- Donald D Glower
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Eng MH, Kargoli F, Wang DD, Frisoli TM, Lee JC, Villablanca PS, Nemeh H, Greenbaum AB, Guerrero M, O'Neill BP, Wyman J, O'Neill W. Short- and mid-term outcomes in percutaneous mitral valve replacement using balloon expandable valves. Catheter Cardiovasc Interv 2021; 98:1193-1203. [PMID: 34106514 DOI: 10.1002/ccd.29783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Due to elevated surgical risk, transcatheter mitral valve replacement (TMVR) is used as an alternative for treating failed bioprosthetic valves, annuloplasty repairs and mitral annular calcification (MAC). We report the procedural and longitudinal outcomes for each subtype: Mitral valve-in-valve (MVIV), mitral valve-in-ring (MViR), and valve-in-MAC (ViMAC). METHODS Consecutive patients undergoing TMVR from October 2013 to December 2019 were assessed. Patients at high risk for left ventricular outflow tract obstruction had either alcohol septal ablation or intentional laceration of the anterior leaflet (LAMPOON). RESULTS Eight-eight patients underwent TMVR; 38 MViV, 31 MViR, and 19 ViMAC procedures were performed. The median Society of Thoracic Surgery 30-day predicted risk of mortality was 8.2% (IQR 5.2, 19.9) for all. Sapien 3 (78%) and transseptal access (98%) were utilized in most cases. All-cause in-hospital mortality, technical, and procedural success were 8%, 83%, and 66% respectively. Median follow up was 1.4 years (IQR 0.5-2.9 years) and overall survival was 40% at 4 years. Differential survival rates were observed with MViV doing the best, followed by MViR and ViMAC having a <20% survival at 4 years. After adjusting for co-variates, MViV procedure was the strongest predictor of survival (HR 0.24 [95% CI 0.079-0.7]). CONCLUSION TMVR is performed in at high-risk patients with attenuated long-term survival. MViV has the best success and survival rate, but long-term survival in MViR and ViMAC is guarded.
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Affiliation(s)
- Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Faraj Kargoli
- Division of Cardiology, Montiefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Tiberio M Frisoli
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - James C Lee
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Pedro S Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Hassan Nemeh
- Division of Cardiothoracic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Mayra Guerrero
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian P O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Janet Wyman
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
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Hamandi M, Squiers JJ, Lanfear AT, Banwait JK, Meidan TG, Smith RL, Hutcheson K, DiMaio JM, Mack MJ, George TJ, Ryan WH. Minimally invasive mitral valve surgery after previous sternotomy: A propensity-matched analysis. J Card Surg 2021; 36:3177-3183. [PMID: 34091951 DOI: 10.1111/jocs.15711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the incidence of mitral valve (MV) surgery after previous open-heart surgery is increasing, there is no consensus regarding the optimal surgical approach. Reoperative MV surgery is most commonly performed via sternotomy (ST). We sought to determine whether minimally-invasive (MIS) reoperative MV surgery is safe and feasible. METHODS All patients with a history of ST undergoing MV surgery with or without concomitant tricuspid or atrial fibrillation surgery at a single institution from 2007 to 2018 were retrospectively reviewed. ST and MIS approaches were compared using propensity-matched analysis. The coprimary endpoints were operative mortality and 1-year survival, and secondary endpoints were operative complications and length of stay. RESULTS A total of 305 isolated MV reoperations were performed: 199 (65%) MIS and 106 (35%) ST. MIS patients were older than ST patients (71 [63, 76.5] vs. 66 [56, 72] years, p < .01), more likely to have undergone prior coronary artery bypass grafting (57% vs. 27%, p < .01), and less likely to have had prior valve surgery (55% vs. 78%, p < .01). In unmatched comparisons, operative mortality was significantly lower among MIS patients (3.0% vs. 8.5%, p = .04), but 1-year mortality was similar (14.4% vs. 15.6%, p = .8). After propensity matching, 88 pairs had excellent balance across baseline characteristics. Mortality was similar among MIS and ST patients at 30 days (3.4% vs. 8%, p = .19) and 1 year (15.9% vs. 16.5%, p = .9). RBC and fresh frozen plasma transfusions were significantly lower in the MIS group (p < .01). CONCLUSIONS A minimally invasive approach is a safe alternative in patients with prior ST undergoing MV surgery.
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Affiliation(s)
- Mohanad Hamandi
- Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - John J Squiers
- Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - Allison T Lanfear
- Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - Jasjit K Banwait
- Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - Talia G Meidan
- Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - Robert L Smith
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - Kelley Hutcheson
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - John Michael DiMaio
- Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA.,Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - Michael J Mack
- Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA.,Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - Timothy J George
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
| | - William H Ryan
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas, USA
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Guerrero M, Pursnani A, Narang A, Salinger M, Wang DD, Eleid M, Kodali SK, George I, Satler L, Waksman R, Meduri CU, Rajagopal V, Inglessis I, Palacios I, Reisman M, Eng MH, Russell HM, Pershad A, Fang K, Kar S, Makkar R, Saucedo J, Pearson P, Bokhary U, Kaptzan T, Lewis B, Tommaso C, Krause P, Thaden J, Oh J, Lang RM, Hahn RT, Leon MB, O'Neill WW, Feldman T, Rihal C. Prospective Evaluation of Transseptal TMVR for Failed Surgical Bioprostheses: MITRAL Trial Valve-in-Valve Arm 1-Year Outcomes. JACC Cardiovasc Interv 2021; 14:859-872. [PMID: 33888231 DOI: 10.1016/j.jcin.2021.02.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study was to assess 1-year clinical outcomes among high-risk patients with failed surgical mitral bioprostheses who underwent transseptal mitral valve-in-valve (MViV) with the SAPIEN 3 aortic transcatheter heart valve (THV) in the MITRAL (Mitral Implantation of Transcatheter Valves) trial. BACKGROUND The MITRAL trial is the first prospective study evaluating transseptal MViV with the SAPIEN 3 aortic THV in high-risk patients with failed surgical mitral bioprostheses. METHODS High-risk patients with symptomatic moderate to severe or severe mitral regurgitation (MR) or severe mitral stenosis due to failed surgical mitral bioprostheses were prospectively enrolled. The primary safety endpoint was technical success. The primary THV performance endpoint was absence of MR grade ≥2+ or mean mitral valve gradient ≥10 mm Hg (30 days and 1 year). Secondary endpoints included procedural success and all-cause mortality (30 days and 1 year). RESULTS Thirty patients were enrolled between July 2016 and October 2017 (median age 77.5 years [interquartile range (IQR): 70.3 to 82.8 years], 63.3% women, median Society of Thoracic Surgeons score 9.4% [IQR: 5.8% to 12.0%], 80% in New York Heart Association functional class III or IV). The technical success rate was 100%. The primary performance endpoint in survivors was achieved in 96.6% (28 of 29) at 30 days and 82.8% (24 of 29) at 1 year. Thirty-day all-cause mortality was 3.3% and was unchanged at 1 year. The only death was due to airway obstruction after swallowing several pills simultaneously 29 days post-MViV. At 1-year follow-up, 89.3% of patients were in New York Heart Association functional class I or II, the median mean mitral valve gradient was 6.6 mm Hg (interquartile range: 5.5 to 8.9 mm Hg), and all patients had MR grade ≤1+. CONCLUSIONS Transseptal MViV in high-risk patients was associated with 100% technical success, low procedural complication rates, and very low mortality at 1 year. The vast majority of patients experienced significant symptom alleviation, and THV performance remained stable at 1 year.
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Affiliation(s)
- Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Amit Pursnani
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Akhil Narang
- Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Michael Salinger
- Division of Cardiology, Froedtert Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Lowell Satler
- Division of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Division of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | | | - Vivek Rajagopal
- Division of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA
| | - Ignacio Inglessis
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Igor Palacios
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark Reisman
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hyde M Russell
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Kenith Fang
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Saibal Kar
- Division of Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Rajj Makkar
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Jorge Saucedo
- Division of Cardiology, Froedtert Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paul Pearson
- Division of Cardiovascular Surgery, Froedtert Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ujala Bokhary
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Tatiana Kaptzan
- Cardiovascular Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Brad Lewis
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Carl Tommaso
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Philip Krause
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Jeremy Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Roberto M Lang
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Bowdish ME, D'Agostino RS, Thourani VH, Schwann TA, Krohn C, Desai N, Shahian DM, Fernandez FG, Badhwar V. STS Adult Cardiac Surgery Database: 2021 Update on Outcomes, Quality, and Research. Ann Thorac Surg 2021; 111:1770-1780. [PMID: 33794156 DOI: 10.1016/j.athoracsur.2021.03.043] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/27/2022]
Abstract
The Society of Thoracic Surgeons Adult Cardiac Surgery Database is the most mature and comprehensive cardiac surgery database. It has been the foundation for quality measurement and improvement activities in cardiac surgery, facilitated the generation of accurate risk adjusted performance benchmarks and serves as a platform for novel research. Recent enhancements have added to the database's functionality, ease of use, and value to multiple stakeholders. This report is the sixth in a series of annual reports that provide updated volumes, outcomes, database-related developments, quality improvement initiatives, and research summaries using the Adult Cardiac Surgery Database in the past year.
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Affiliation(s)
- Michael E Bowdish
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
| | - Richard S D'Agostino
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Surgery, Division of Cardiothoracic Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Thomas A Schwann
- Division of Cardiac Surgery, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts
| | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Nimesh Desai
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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Sengupta A, Yazdchi F, Alexis SL, Percy E, Premkumar A, Hirji S, Bapat VN, Bhatt DL, Kaneko T, Tang GHL. Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement: A Systematic Review. J Am Heart Assoc 2021; 10:e019854. [PMID: 33686870 PMCID: PMC8174229 DOI: 10.1161/jaha.120.019854] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve-in-valve (MVIV) and valve-in-ring (MVIR) replacement are now feasible, but data comparing these approaches are lacking. We sought to compare the outcomes of (1) reoperative mitral valve replacement (redo-MVR) and MVIV for structural valve degeneration, and (2) reoperative mitral valve repair (redo-MVr) or MVR and MVIR for failed MVr. A literature search of PubMed, Embase, and the Cochrane Library was conducted up to July 31, 2020. Thirty-two studies involving 25 832 patients were included. Redo-MVR was required in ≈35% of patients after index surgery at 10 years, with 5% to 15% 30-day mortality. MVIV resulted in >95% procedural success with 30-day and 1-year mortality of 0% to 8% and 11% to 16%, respectively. Recognized complications included left ventricular outflow tract obstruction (0%-6%), valve migration (0%-9%), and residual regurgitation (0%-6%). Comparisons of redo-MVR and MVIV showed no statistically significant differences in mortality (11.3% versus 11.9% at 1 year, P=0.92), albeit higher rates of major bleeding and arrhythmias with redo-MVR. MVIR resulted in 0% to 34% mortality at 1 year, whereas both redo-MVr and MVR for failed repairs were performed with minimal mortality and durable long-term results. MVIV is therefore a viable alternative to redo-MVR for structural valve degeneration, whereas redo-MVr or redo-MVR is preferred for failed MVr given the suboptimal results with MVIR. However, not all patients will be candidates for MVIV/MVIR because anatomical restrictions may preclude transcatheter options from adequately addressing the underlying pathology.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| | - Farhang Yazdchi
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Sophia L Alexis
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| | - Edward Percy
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Akash Premkumar
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Sameer Hirji
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | | | - Deepak L Bhatt
- Brigham and Women's Heart & Vascular CenterHarvard Medical School Boston MA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
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Whisenant B, Kapadia SR, Eleid MF, Kodali SK, McCabe JM, Krishnaswamy A, Morse M, Smalling RW, Reisman M, Mack M, O'Neill WW, Bapat VN, Leon MB, Rihal CS, Makkar RR, Guerrero M. One-Year Outcomes of Mitral Valve-in-Valve Using the SAPIEN 3 Transcatheter Heart Valve. JAMA Cardiol 2021; 5:1245-1252. [PMID: 32745164 DOI: 10.1001/jamacardio.2020.2974] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Bioprosthetic mitral valves are implanted with increasing frequency but inevitably degenerate, leading to heart failure. Reoperation is associated with high morbidity and mortality. Transcatheter mitral valve-in-valve (MViV) using balloon-expandable transcatheter valves has emerged as an alternative for high-surgical risk patients. Objective To assess contemporary outcomes of SAPIEN 3 (Edwards Lifesciences) MViV replacement. Design, Setting, and Participants In this registry-based prospective cohort study of SAPIEN 3 MViV, patients entered in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from June 2015 to July 2019 were analyzed. US Centers for Medicare and Medicaid linkage ensured comprehensive collection of death and stroke data. Exposures Mitral valve-in-valve for degenerated bioprosthetic mitral valves. Main Outcomes and Measures The primary efficacy end point was 1-year mortality. The primary safety end point was procedural technical success as defined by the Mitral Valve Academic Research Consortium criteria. Secondary end points included 30-day mortality, New York Heart Association-defined heart failure, and mitral valve performance. Results A total of 1529 patients (mean [SD] age, 73.3 [11.84] years; 904 women [59.1%]) underwent transseptal or transapical MViV implant at 295 hospitals between June 2015 and July 2019. The mean (SD) Society of Thoracic Surgeons predicted risk of mortality was 11.1% (8.7%). Procedural technical success was achieved for 1480 of 1529 patients (96.8%). All-cause mortality was 5.4% at 30 days and 16.7% at 1 year. Transseptal access was associated with lower 1-year all-cause mortality than transapical access (15.8% vs 21.7%; P = .03). Transcatheter MViV led to early, sustained, and clinically meaningful improvements in heart failure (class III/IV New York Heart Association heart failure of 87.1% at baseline vs 9.7% at 1 year). The mean (SD) mitral valve gradient at 1 year was 7 (2.89) mm Hg. Conclusions and Relevance Transcatheter MViV using the SAPIEN 3 transcatheter heart valve is associated with high technical success, low 30-day and 1-year mortality, significant improvement of heart failure symptoms, and sustained valve performance. Transseptal MViV should be considered an option for most patients with failed surgical bioprosthetic valves and favorable anatomy.
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Affiliation(s)
| | | | | | | | | | | | | | - Richard W Smalling
- Memorial Hermann Heart and Vascular Institute, University of Texas/McGovern Medical School, Houston
| | - Mark Reisman
- University of Washington Medical Center, Seattle
| | | | | | | | | | | | - Raj R Makkar
- Cedar Sinai Medical Center, Los Angeles, California
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39
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Kindzelski BA, Bakaeen FG, Tong MZ, Roselli EE, Soltesz EG, Johnston DR, Wierup P, Pettersson GB, Houghtaling PL, Blackstone EH, Gillinov AM, Svensson LG. Modern practice and outcomes of reoperative cardiac surgery. J Thorac Cardiovasc Surg 2021; 164:1755-1766.e16. [PMID: 33757681 DOI: 10.1016/j.jtcvs.2021.01.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate recent practice and outcomes of reoperative cardiac surgery via re-sternotomy. Use of early versus late institution of cardiopulmonary bypass (CPB) before sternal re-entry was of particular interest. METHODS From January 2008 to July 2017, 7640 patients underwent reoperative cardiac surgery at Cleveland Clinic. The study group consisted of 6627 who had a re-sternotomy and preoperative computed tomography scans; 755 and 5872 were in the early and late institution of CPB groups, respectively. Patients were stratified into high (n = 563) or low (n = 6064) anatomic risk of re-entry on the basis of computed tomography criteria. Weighted propensity-balanced operative mortality and morbidity were compared with surgeon as a random effect. RESULTS Reoperative procedures most commonly incorporated aortic valve replacement (n = 3611) and coronary artery bypass grafting (n = 2029), but also aortic root (n = 1061) and arch procedures (n = 527). Unadjusted operative mortality was 3.5% (235/6627), and major sternal re-entry and mediastinal dissection injuries were uncommon (2.8%). In the propensity-weighted analysis, similar mortality (3.1% vs 4.5%; P = .6) and major morbidity, including stroke (1.8% vs 3.2%) and dialysis (0 vs 2.6%), were noted in the high anatomic risk cohort between early and late CPB groups. Similar trends were observed in the low anatomic risk cohort (mortality 3.5% vs 2.1%; P = .2). CONCLUSIONS Reoperative cardiac surgery is associated with low operative morbidity and mortality at an experienced center. Early and late CPB strategies have comparable outcomes in the context of an image-guided, team-based strategy.
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Affiliation(s)
- Bogdan A Kindzelski
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Michael Z Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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40
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Brown JA, Sultan I. Commentary: Reoperative cardiac surgery: The importance of surgeon judgment. J Thorac Cardiovasc Surg 2021; 164:1769-1771. [PMID: 33610361 DOI: 10.1016/j.jtcvs.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
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41
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Simonato M, Whisenant B, Ribeiro HB, Webb JG, Kornowski R, Guerrero M, Wijeysundera H, Søndergaard L, De Backer O, Villablanca P, Rihal C, Eleid M, Kempfert J, Unbehaun A, Erlebach M, Casselman F, Adam M, Montorfano M, Ancona M, Saia F, Ubben T, Meincke F, Napodano M, Codner P, Schofer J, Pelletier M, Cheung A, Shuvy M, Palma JH, Gaia DF, Duncan A, Hildick-Smith D, Veulemans V, Sinning JM, Arbel Y, Testa L, de Weger A, Eltchaninoff H, Hemery T, Landes U, Tchetche D, Dumonteil N, Rodés-Cabau J, Kim WK, Spargias K, Kourkoveli P, Ben-Yehuda O, Teles RC, Barbanti M, Fiorina C, Thukkani A, Mackensen GB, Jones N, Presbitero P, Petronio AS, Allali A, Champagnac D, Bleiziffer S, Rudolph T, Iadanza A, Salizzoni S, Agrifoglio M, Nombela-Franco L, Bonaros N, Kass M, Bruschi G, Amabile N, Chhatriwalla A, Messina A, Hirji SA, Andreas M, Welsh R, Schoels W, Hellig F, Windecker S, Stortecky S, Maisano F, Stone GW, Dvir D. Transcatheter Mitral Valve Replacement After Surgical Repair or Replacement. Circulation 2021; 143:104-116. [DOI: 10.1161/circulationaha.120.049088] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mitral valve-in-valve (ViV) and valve-in-ring (ViR) are alternatives to surgical reoperation in patients with recurrent mitral valve failure after previous surgical valve repair or replacement. Our aim was to perform a large-scale analysis examining midterm outcomes after mitral ViV and ViR.
Methods:
Patients undergoing mitral ViV and ViR were enrolled in the Valve-in-Valve International Data Registry. Cases were performed between March 2006 and March 2020. Clinical endpoints are reported according to the Mitral Valve Academic Research Consortium (MVARC) definitions. Significant residual mitral stenosis (MS) was defined as mean gradient ≥10 mm Hg and significant residual mitral regurgitation (MR) as ≥ moderate.
Results:
A total of 1079 patients (857 ViV, 222 ViR; mean age 73.5±12.5 years; 40.8% male) from 90 centers were included. Median STS-PROM score 8.6%; median clinical follow-up 492 days (interquartile range, 76–996); median echocardiographic follow-up for patients that survived 1 year was 772.5 days (interquartile range, 510–1211.75). Four-year Kaplan-Meier survival rate was 62.5% in ViV versus 49.5% for ViR (
P
<0.001). Mean gradient across the mitral valve postprocedure was 5.7±2.8 mm Hg (≥5 mm Hg; 61.4% of patients). Significant residual MS occurred in 8.2% of the ViV and 12.0% of the ViR patients (
P
=0.09). Significant residual MR was more common in ViR patients (16.6% versus 3.1%;
P
<0.001) and was associated with lower survival at 4 years (35.1% versus 61.6%;
P
=0.02). The rates of Mitral Valve Academic Research Consortium–defined device success were low for both procedures (39.4% total; 32.0% ViR versus 41.3% ViV;
P
=0.01), mostly related to having postprocedural mean gradient ≥5 mm Hg. Correlates for residual MS were smaller true internal diameter, younger age, and larger body mass index. The only correlate for residual MR was ViR. Significant residual MS (subhazard ratio, 4.67; 95% CI, 1.74–12.56;
P
=0.002) and significant residual MR (subhazard ratio, 7.88; 95% CI, 2.88–21.53;
P
<0.001) were both independently associated with repeat mitral valve replacement.
Conclusions:
Significant residual MS and/or MR were not infrequent after mitral ViV and ViR procedures and were both associated with a need for repeat valve replacement. Strategies to improve postprocedural hemodynamics in mitral ViV and ViR should be further explored.
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Affiliation(s)
- Matheus Simonato
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | | | - Henrique Barbosa Ribeiro
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - John G. Webb
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Ran Kornowski
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | | | | | | | | | | | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | - Axel Unbehaun
- Deutsches Herzzentrum Berlin, Berlin, Germany (J.K., A.U.)
| | | | | | | | | | - Marco Ancona
- I.R.C.C.S. Ospedale San Raffaele, Milan, Italy (M.M., M.Ancona)
| | | | - Timm Ubben
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | - Felix Meincke
- Asklepios Klinik St. Georg, Hamburg, Germany (T.U., F.Meincke)
| | | | - Pablo Codner
- Rabin Medical Center, Petah Tikva, Israel (R.K., P.C.)
| | | | - Marc Pelletier
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.P.)
| | - Anson Cheung
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | - Mony Shuvy
- Hadassah Medical Center, Jerusalem, Israel (M.Shuvy)
| | - José Honório Palma
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (H.B.R., J.H.P.)
| | - Diego Felipe Gaia
- Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil (M.Simonato, J.H.P., D.F.G.)
| | - Alison Duncan
- The Royal Brompton Hospital, London, United Kingdom (A.D.)
| | | | | | | | - Yaron Arbel
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel (Y.A.)
| | - Luca Testa
- I.R.C.C.S. Policlinico San Donato, Milan, Italy (L.T.)
| | - Arend de Weger
- Leids Universitair Medisch Centrum, Leiden, the Netherlands (A.d.W.)
| | | | | | - Uri Landes
- St. Paul’s Hospital, Vancouver, Canada (J.G.W., A.Cheung, U.L.)
| | | | | | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada (J.R-C.)
| | | | | | | | - Ori Ben-Yehuda
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- University of California San Diego (O.B-Y.)
| | | | - Marco Barbanti
- Università degli Studi di Catania, Catania, Italy (M.B.)
| | | | | | | | - Noah Jones
- Mount Carmel Health System, Columbus, OH (N.J.)
| | | | | | | | | | - Sabine Bleiziffer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany (S.B.)
| | | | | | - Stefano Salizzoni
- Città della Salute e della Scienza - “Molinette” Hospital, Torino, Italy (S.Salizzoni)
| | | | | | | | - Malek Kass
- University of Manitoba, Winnipeg, Canada (M.K.)
| | | | | | - Adnan Chhatriwalla
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.Chhatriwalla)
| | - Antonio Messina
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy (A.M.)
| | | | - Martin Andreas
- Medizinische Universität Wien, Vienna, Austria (M.Andreas)
| | | | | | - Farrel Hellig
- Sunninghill Hospital, Johannesburg, South Africa (F.H.)
| | | | | | | | - Gregg W. Stone
- The Cardiovascular Research Foundation, New York (M.Simonato, G.W.S., O.B-Y.)
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.)
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Rupprecht L, Schopka S, Keyser A, Lunz D, Sossalla S, Hilker M, Schmid C. 25 Years' Experience with Redo Operations in Cardiac Surgery-Third-Time Sternotomy Procedures. Thorac Cardiovasc Surg 2020; 70:377-383. [PMID: 33368107 DOI: 10.1055/s-0040-1719157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Over the years, open heart surgery has become more complex, and especially reoperative surgery, more demanding. The risk of third-time or more sternotomy procedures is unclear. METHODS We reviewed our institutional experience of 25 years based on two generations of cardiac surgeons in a German university medical center to document frequency, outcome, and complications of the various types of open heart procedures. RESULTS Overall, we included 104 patients with a mean age of 64 ± 13 years. The EuroSCORE II (European System for Cardiac Operative Risk Evaluation) calculated an average mortality risk of 15.7 ± 15.4%. Subgroup comparison of isolated coronary artery bypass grafting (CABG), aortic valve replacement, and mitral valve replacement procedures did not delineate significantly different risk profiles except for the incidence of acute myocardial infarction, which was present in every second patient (53.3%) scheduled for CABG surgery. The time interval to previous surgery was 4.7 ± 6.3 years on average. Most frequent surgical procedures were valve operations, which were accomplished in 72 patients (69.2%), whereas coronary bypass surgery was performed in 23 patients (22.1%) only. Combined procedures were performed in 27 patients. Complex aortic arch replacement with a frozen elephant trunk procedure was necessary in six patients. Overall, 30-day survival was 81.7%. CONCLUSION In conclusion, third-time and more sternotomy procedures offer acceptable outcome and should therefore be considered in appropriate patients.
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Affiliation(s)
- Leopold Rupprecht
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Dirk Lunz
- Department of Anesthesiology, University Medical Center, Regensburg, Germany
| | - Samuel Sossalla
- Department of Cardiology, University Medical Center, Regensburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
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Reoperative Cardiac Surgery Is a Risk Factor for Long-Term Mortality. Ann Thorac Surg 2020; 110:1235-1242. [DOI: 10.1016/j.athoracsur.2020.02.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/09/2020] [Accepted: 02/06/2020] [Indexed: 12/26/2022]
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44
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Tiwana J, Aldea G, Levin DB, Johnson K, Don CW, Dvir D, Mackensen GB, Reisman M, McCabe JM. Contemporary Transcatheter Mitral Valve Replacement for Mitral Annular Calcification or Ring. JACC Cardiovasc Interv 2020; 13:2388-2398. [DOI: 10.1016/j.jcin.2020.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
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45
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Timek TA. Commentary: Doing it and (re)doing it well. J Thorac Cardiovasc Surg 2020; 163:1814-1815. [PMID: 33160612 DOI: 10.1016/j.jtcvs.2020.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Mich.
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46
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Sekaran N, Horne BD, Doty JR, Reid BB, Miner EC, Harkness JR, Jones KW, Minder CM, Caine WT, Clayson SE, Whisenant BK. Transcatheter mitral valve in ring, hazards of long anterior mitral leaflet and 3-dimensional rings. Catheter Cardiovasc Interv 2020; 97:353-358. [PMID: 32865863 DOI: 10.1002/ccd.29232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/26/2020] [Accepted: 08/10/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this study was to define anterior mitral leaflet (AML) length and mitral ring characteristics associated with LVOT obstruction and PVL following MViR. BACKGROUND Transcatheter Mitral Valve in Ring (MViR) procedural complications including parvalvular leak (PVL) and left ventricular outflow tract (LVOT) obstruction are frequent. METHODS Clinical records, computer tomographic scans (CTs) and echocardiograms of consecutive MViR patients were retrospectively reviewed for anterior mitral leaflet length, CT-simulated neoLVOT, and aortomitral angle among patients with and without MViR-induced LVOT obstruction. Acute and 1-year outcomes are described. RESULTS Twenty-two patients underwent MViR. Technical success was achieved in 13/22 (57.1%) patients, limited by paravalvular regurgitation requiring second transcatheter heart valves (THVs) in seven patients. Second valves were needed in 6/11 (54.5%) patients with 3-dimensional rings but 1/11 (9.1%, p = .06) of patients with planar rings. Procedure success at 30 days was achieved in 20/22 (90.9%) patients. There were no procedural, in-hospital, or 30-day deaths. Two patients developed significant LVOT obstruction, one managed with urgent surgery and one with elective alcohol septal ablation. Anterior mitral leaflets were longer among the two patients with LVOT obstruction than the 20 patients who did not develop LVOT obstruction when measured by TEE (30 mm vs. 21 mm, p = .009) or by CT (29 mm vs. 22 mm, p = .026). CONCLUSIONS AML >25 mm increases the risk of MViR induced LVOT obstruction. PVL is common, particularly in 3-dimensional rings which can be managed with a second THV.
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Affiliation(s)
| | - Benjamin D Horne
- Intermountain Heart Institute, Salt Lake City, Utah.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - John R Doty
- Intermountain Heart Institute, Salt Lake City, Utah
| | - Bruce B Reid
- Intermountain Heart Institute, Salt Lake City, Utah
| | | | | | - Kent W Jones
- Intermountain Heart Institute, Salt Lake City, Utah
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47
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Outcomes of mitral valve re-replacement for bioprosthetic structural valve deterioration. J Thorac Cardiovasc Surg 2020; 163:1804-1812.e5. [PMID: 33059934 DOI: 10.1016/j.jtcvs.2020.08.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/25/2020] [Accepted: 08/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Reoperation for structural valve deterioration (SVD) of bioprosthetic mitral valves carries a presumed high operative risk, and transcatheter mitral valve-in-valve implantation has emerged as an alternative. However, surgical risk and long-term outcome following mitral valve re-replacement in these patients remain ill-defined. Hence, we sought to evaluate outcomes and long-term survival following surgical mitral valve re-replacement and to identify risk factors for mortality. METHODS From January 1990 to January 2017, 525 patients underwent surgical mitral valve re-replacement at Cleveland Clinic for bioprosthetic SVD: 133 (25%) isolated operations and 392 (75%) with concomitant procedures. Surgical complications and modes of death were compiled, long-term mortality assessed, and risk factors identified using a multivariable nonproportional hazards model and random forest analysis. RESULTS SVD was characterized by bioprosthetic regurgitation in 81% (425 out of 525) and stenosis in 44% (231 out of 525). One in-hospital death occurred after isolated valve re-replacement (0.75%) and 28 deaths occurred (7.1%; P = .003) after nonisolated re-replacement, 19 (68%) of which were from coagulopathy, vasoplegia, and multisystem organ failure. In the nonisolated group, incremental risk factors for time-related death after re-replacement included New York Heart Association functional class IV symptoms, concomitant coronary artery bypass grafting, prolonged cardiopulmonary bypass time, and transfusions. CONCLUSIONS Mitral valve re-replacement for bioprosthetic SVD was associated with low surgical risk and excellent long-term survival. Isolated mitral valve re-replacement for bioprosthetic SVD had near-zero surgical risk. Excessive cardiopulmonary bypass duration and multiple transfusions correlated with increased early mortality in nonisolated procedures, as did preoperative severe heart failure. Optimal surgical plan and timing of surgery are keys to success.
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Brown JA, Kilic A, Aranda‐Michel E, Serna‐Gallegos D, Habertheuer A, Bianco V, Thoma FW, Navid F, Sultan I. The long‐term impact of peripheral cannulation for redo cardiac surgery. J Card Surg 2020; 35:1920-1926. [DOI: 10.1111/jocs.14852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- James A. Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Edgar Aranda‐Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Derek Serna‐Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Andreas Habertheuer
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
| | - Floyd W. Thoma
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
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Mihos CG, Horvath SA, Fernandez R, Nappi F, Xydas S. Early failure of mitral valve repair with anterior leaflet pericardial patch augmentation in rheumatic and radiation-induced valvulitis. J Thorac Dis 2020; 12:2977-2982. [PMID: 32642211 PMCID: PMC7330283 DOI: 10.21037/jtd.2020.01.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Sofia A Horvath
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Rafle Fernandez
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Steve Xydas
- Columbia University Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
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Gerosa G, Besola L, Beiras-Fernandez A, Salizzoni S, Vairo A, D'Aleo S, von Bardeleben RS, De Paulis R, Yadav R, Duncan A, Albertini A, Rinaldi M, Colli A. The Neochord Procedure After Failed Surgical Mitral Valve Repair. Semin Thorac Cardiovasc Surg 2020; 33:35-44. [PMID: 32621965 DOI: 10.1053/j.semtcvs.2020.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 11/11/2022]
Abstract
Surgical mitral valve reintervention is associated with significant morbidity and mortality, and repeat repair is not always feasible. We examine the clinical outcomes of the NeoChord procedure after failed conventional mitral valve repair. A total of 312 patients were treated with the NeoChord repair procedure between January 2014 and December 2018 at 5 European centers. Clinical and echocardiographic data were reviewed to identify patients who had a prior surgical mitral valve repair procedure. The primary endpoint (Patient Success) was a composite of placement of at least 2 neochordae and end-procedure mitral valve regurgitation (MR) ≤ mild, freedom from death, stroke, structural or functional procedure failure (MR > moderate), procedure or device-related unplanned procedures, cardiac-related rehospitalization, or worsening NYHA functional class at 1 and 2-year FU. Fifteen (15) patients were identified who required reoperation for failed surgical mitral valve repair. Mean time-to-reoperation was 2.7 years (2.2-6.1). Median intensive care unit stay was 24 hours and median hospitalization time was 7 days (6-8). No in-hospital deaths were observed. At discharge, mitral regurgitation was ≤ mild in 13 patients (86.7%). Patient success and freedom from more than mild MR were 92.3 ± 7.4% and 83.9 ± 10.4% at 1 and 2-year follow-up respectively. One high-risk patient presented with severe recurrent MR and died during surgical reintervention due to an acute aortic dissection. Selected patients can be successfully treated with the NeoChord procedure after failed surgical mitral valve repair. These results support a wider adoption of the NeoChord procedure as a first-line minimally invasive, alternative therapy to treat failed mitral valve repair.
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Affiliation(s)
- Gino Gerosa
- Department of Cardio-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Laura Besola
- Department of Cardiovascular Surgery, Salus Hospital GVM Care and Research, Reggio Emilia, Italy
| | - Andres Beiras-Fernandez
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefano Salizzoni
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Alessandro Vairo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | | | | | | | - Rashmi Yadav
- Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Alison Duncan
- Department of Cardiothoracic Surgery, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Alberto Albertini
- Department of Cardiovascular Surgery, Maria Cecilia Hospital GVM care & research, Cotignola (RA) Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Andrea Colli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.
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