1
|
Shin JH, Lee SH, Joo HC, Youn YN, Kim JH, Lee S. Long-term Outcomes of Mitral Valve Repair for Atrial Functional Mitral Regurgitation. Ann Thorac Surg 2024:S0003-4975(24)00764-1. [PMID: 39277158 DOI: 10.1016/j.athoracsur.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Atrial functional mitral regurgitation (AFMR), defined by normal left ventricular function, enlarged left atrium, and a dilated mitral valve annulus, has been a concept discussed for >10 years. However, there are still no established guidelines for its treatment in the American College of Cardiology/American Heart Association recommendations. This study aimed to determine the long-term outcomes of mitral annuloplasty as a treatment for AFMR. METHODS We analyzed 1435 patients who underwent mitral valve repair at our institution between 2005 and 2020, with 162 classified as having AFMR. Exclusion criteria for AFMR were established based on preoperative echocardiography and operative notes. The primary outcome was overall mortality, and the secondary outcome was MR recurrence, which was defined as moderate or greater mitral regurgitation observed on echocardiography during the follow-up period, analyzed using our hospital's medical records and data from the National Statistical Office. RESULTS The median follow-up duration for the entire patient cohort was 6.1 years (interquartile range, 3.2-11.2 years). Patients had a 5-year survival rate of 86% and a 10-year survival rate of 73%, with freedom from MR recurrence rates of 89% and 80% at 5 and 10 years, respectively. Although all 162 patients had moderate or greater MR before surgery, most experienced trivial or mild MR after mitral valve repair throughout the follow-up period. CONCLUSIONS In summary, mitral valve repair effectively treats patients with AFMR, addressing survival and mitigating MR recurrence.
Collapse
Affiliation(s)
- Jung-Hoon Shin
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hyun Lee
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Chul Joo
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Kim
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Takahashi Y, Morisaki A, Sakon Y, Nishiya K, Inno G, Kawase T, Nishimoto Y, Nagao M, Kishimoto N, Noda K, Shibata T. Three-dimensional computed tomography analysis of the mitral annulus for mitral annuloplasty in 100 cases of robotic mitral valve repair. Front Cardiovasc Med 2024; 11:1369801. [PMID: 39323752 PMCID: PMC11422080 DOI: 10.3389/fcvm.2024.1369801] [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: 01/13/2024] [Accepted: 08/21/2024] [Indexed: 09/27/2024] Open
Abstract
Objectives This study aimed to evaluate the efficacy of preoperative computed tomography in assessing mitral annulus anatomy and the posterior annular plication rate in mitral valve repair with annuloplasty. Methods From July 2018 to August 2023, we performed robotic mitral valve repair with ring annuloplasty using a semi-rigid ring in 100 patients. Preoperative anatomical assessment of the mitral annulus was conducted by three-dimensional computed tomography. The ring size was selected based on the perioperative commissure-to-commissure length or the anterior leaflet area. Results The mean commissure-to-commissure length, posterior mitral annular length, and minimum distance between the left circumflex artery and mitral annulus values were 31, 109, and 3.8 mm, respectively. No postoperative left circumflex artery injury or ring detachment was recorded. The mean plication rate (length of the posterior side of the prosthetic ring/posterior annular length) was 0.68, and it did not differ among each prosthetic ring size. The posterior plication rate (duplicate ring size 19.4) was a factor influencing the postoperative transmitral mean pressure gradient of 5 mmHg or higher. Freedom from moderate or severe mitral regurgitation was not different between the two groups above and below the posterior plication rate × ring size of 19.4 (p = 0.73), with an event-free rate of 97% vs. 96% in 3 years, respectively. Conclusions Preoperative evaluation of the mitral annular anatomy is useful for safe mitral valve repair with ring annuloplasty. Determining ring size by focusing on the posterior annular plication rate may be a new method for ring size selection.
Collapse
Affiliation(s)
- Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Kenta Nishiya
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Goki Inno
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Takumi Kawase
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Yukihiro Nishimoto
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Munehide Nagao
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Noriaki Kishimoto
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Kazuki Noda
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan
| |
Collapse
|
3
|
Kwon Y, Kim HJ, Kim JB, Kim HR, Yoo JS, Jung SH, Lee JW. Mitral valve repair with leaflet resection versus preservation for degenerative posterior leaflet prolapse. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00549-X. [PMID: 38964494 DOI: 10.1016/j.jtcvs.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/31/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES The optimal technique for repairing posterior mitral valve leaflet prolapse remains undetermined. We aimed to compare leaflet resection and neochordae implantation in patients undergoing mitral valve repair for posterior leaflet prolapse, focusing on transmitral pressure gradient and recurrence of mitral regurgitation. METHODS We enrolled patients undergoing mitral valve repair using either leaflet resection or neochordae implantation for single-segment prolapse of posterior mitral valve leaflet between 2000 and 2021 at our institution. Longitudinal outcomes were evaluated after adjustments with inverse-probability-of-treatment weighting. Repeat echocardiographic measurements (n = 3473, 5.4/patient) of transmitral pressure gradient and significant (moderate or severe) mitral regurgitation recurrence were estimated using nonlinear mixed-effect models. Subgroup analyses were conducted based on the size and type of prosthesis. RESULTS Among 639 patients, leaflet resection was used in 479 (75.0%) and neochordae implantation was used in 160 (25.0%). In the inverse-probability-of-treatment weighting adjusted cohort, the risk of death (P = .623) and mitral valve reoperation (P = .340) did not significantly differ between the 2 groups during a median follow-up of 97.3 months. Echocardiographic data showed comparable mean (at 5 years, 3.8 vs 4.0 mm Hg; P = .442) and peak (9.6 vs 10.4 mm Hg; P = .131) pressure gradients between groups, which persisted in most subgroup analyses. However, neochordae implantation was associated with a higher probability of significant mitral regurgitation recurrence compared with leaflet resection (at 5 years, 16.1% vs 7.0%; P < .001). CONCLUSIONS Leaflet resection yielded similar clinical outcomes and transmitral pressure gradients compared with neochordae implantation after mitral valve repair, with a lower mitral regurgitation recurrence rate. These findings underscore the need to reassess the efficacy of neochordae implantation relative to leaflet resection.
Collapse
Affiliation(s)
- Youngkern Kwon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Buchoen, Gyeonggi-do, Republic of Korea
| |
Collapse
|
4
|
Shimokawa T, Kasegawa H, Tabata M, Fukui T, Kin H, Shimizu A, Uchimuro T, Zaikokuji K, Takanashi S. Long-term follow-up of repair-like replacement of mitral valve using autologous pericardium. JTCVS Tech 2024; 25:55-62. [PMID: 38899115 PMCID: PMC11184484 DOI: 10.1016/j.xjtc.2024.02.020] [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: 08/15/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives The present study assessed the late results of the operation, which consisted of the construction of a stentless mitral valve using autologous pericardium and valve implantation. Methods Between 2011 and 2018, among 1617 consecutive patients who underwent mitral valve operation at our institution, 15 adult patients (0.9%) with unrepairable mitral valves who wished to avoid conventional mitral valve replacement underwent this operation. Ten patients (67%) had a history of valve repair. After discharge, patients were prospectively followed-up with a echocardiographic evaluation up to the end point. The mean follow-up term was 70.8 ± 42.5 months. Results There were no hospital deaths or thromboembolic events and only 1 late noncardiac death. Intraoperative transesophageal echocardiography of all patients revealed no or trivial mitral regurgitation. Eight patients (53.3%) underwent redo valve replacement within 12 years. Except 1 late death, the postoperative course was divided into 3 groups depending on the occurrence of redo surgery, as follows: an early reoperation group (reoperation within 4 years; n = 4), a late reoperation group (reoperation after 4 years; n = 4), and a free from reoperation group (n = 6). The latest transthoracic echocardiographic examination performed 7.2 ± 2.9 years after the operation revealed the grade of mitral regurgitation to be none in 2 patients, mild in 2 patients, mild to moderate in 1 patients, and moderate in 1 patient in the free from reoperation group. Conclusions Despite the high incidence of reoperation, Normo operation can be a viable option during valve replacement, especially for young patients.
Collapse
Affiliation(s)
- Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
- Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan
| | - Hitoshi Kasegawa
- Department of Cardiac Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University, Kumamoto, Japan
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate University, Iwate, Japan
| | - Atsushi Shimizu
- Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Tomoya Uchimuro
- Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Kenta Zaikokuji
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Schuichiro Takanashi
- Department of Cardiac Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| |
Collapse
|
5
|
Hu YN, Lee WH, Tsai MT, Wang YC, Shih CJ, Huang YC, Roan JN. The Predictors and Outcomes of Functional Mitral Stenosis following Surgical Mitral Valve Repair: A Retrospective Analysis. J Cardiovasc Dev Dis 2023; 10:470. [PMID: 37998528 PMCID: PMC10672255 DOI: 10.3390/jcdd10110470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
To optimize mitral valve repair outcomes, it is crucial to comprehend the predictors of functional mitral valve stenosis (FMS), to enhance preoperative assessments, and to adapt intraoperative treatment strategies. This study aimed to identify FMS risk factors, contributing valuable insights for refining surgical techniques. Among 228 selected patients, 215 underwent postoperative echocardiography follow-ups, and 36 met the FMS criteria based on a mean trans-mitral pressure gradient of >5 mmHg. Patients with FMS exhibited higher pulmonary systolic arterial pressure and increased late mortality during the follow-up. Univariable logistic regression analysis identified several risk factors for FMS, including end-stage renal disease, anterior leaflet lesion, concomitant aortic valve replacement, smaller ring size, ring type, and neochordae implantation. Conversely, resection alone and resection combined with neochordae implantation had protective effects against FMS. Multivariable logistic regression analysis revealed that smaller ring sizes and patch repair independently predicted FMS. When focusing on degenerative mitral regurgitation, the neochordae implantation without resection in leaflet repair, emerged as an independent predictor of FMS. Surgeons should weigh the substantial impact of surgical procedures on postoperative trans-mitral pressure gradients, emphasizing preoperative evaluation and techniques such as precise ring size assessment and effective leaflet management.
Collapse
Affiliation(s)
- Yu-Ning Hu
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Wen-Huang Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Meng-Ta Tsai
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Yi-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Chao-Jung Shih
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Yu-Ching Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| |
Collapse
|
6
|
Chen S, Grossi EA. Commentary: Postrepair mitral stenosis: A pyrrhic victory. J Thorac Cardiovasc Surg 2023; 165:e150-e151. [PMID: 33526275 DOI: 10.1016/j.jtcvs.2020.12.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Stacey Chen
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY.
| |
Collapse
|
7
|
Hibino M, Pandey AK, Chan V, Mazer CD, Rumman R, Dhingra NK, Bonneau C, Verma R, Yokoyama Y, Quan A, Teoh H, Cheema A, de Varennes BE, Yanagawa B, Leong-Poi H, Connelly KA, Bisleri G, Verma S. Risk Factors for Postrepair Elevated Mitral Gradient: A Post-hoc Analysis of a Randomized Trial. Ann Thorac Surg 2023; 115:437-443. [PMID: 35779599 DOI: 10.1016/j.athoracsur.2022.05.053] [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: 02/19/2022] [Revised: 04/21/2022] [Accepted: 05/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Predischarge elevated mean mitral gradients (>5 mm Hg) may occur after repair for degenerative mitral regurgitation. We sought to identify risk factors associated with elevated gradients and to evaluate its impact on functional outcomes at 12 months in this subanalysis of the Canadian Mitral Research Alliance CardioLink-2 trial. METHODS One hundred four patients with degenerative mitral regurgitation undergoing mitral repair were randomized to either a leaflet resection or preservation strategy. Logistic regression was used to identify risk factors associated with an elevated gradient. Functional outcomes at 12 months were compared between participants with and without elevated gradients. RESULTS Elevated gradients was identified in 15 participants (14.4%), which was not significantly different based on allocation to each repair strategy (P = .10). Patients with elevated gradients were more likely to be women (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.29-14.19; P = .02) and to have a lower preoperative hemoglobin level (OR, 0.93; 95% CI, 0.89-0.98; P = .01) and smaller intercommissural diameter (OR, 0.86; 95% CI, 0.76-0.97; P = .02) and mitral annuloplasty size (OR, 0.71; 95% CI, 0.57-0.87; P = .001). The ratio of intercommissural diameter-to-annuloplasty size was similar between those with and without elevated gradients (both 0.8 ± 0.1, P = .69). At 12 months those with elevated gradients had a worse New York Heart Association functional status (P = .0001), lower peak oxygen saturation in exercise test (P = .01), smaller body weight-walk distance product (P = .02), and higher Borg scale (P = .01) in the 6-minute walk test. CONCLUSIONS Female gender, smaller mitral anatomy sizes, and lower preoperative hemoglobin levels were associated with postoperative elevated mitral gradients, which was in turn were associated with reduced functional status. Further research is warranted to investigate these potential risk factors.
Collapse
Affiliation(s)
- Makoto Hibino
- Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arjun K Pandey
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Rawan Rumman
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Nitish K Dhingra
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Raj Verma
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yujiro Yokoyama
- Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Asim Cheema
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Benoit E de Varennes
- Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Howard Leong-Poi
- Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
8
|
Leaflet Resection vs Preservation for Degenerative Mitral Regurgitation: Functional Outcomes and Mitral Stenosis at 12 months in a Randomized Trial. Can J Cardiol 2022; 38:808-814. [DOI: 10.1016/j.cjca.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 12/16/2022] Open
|
9
|
James L, Grossi EA, Loulmet DF, Galloway AC. Semirigid posterior annuloplasty band: Reshaping the mitral orifice while preserving its physiology. JTCVS Tech 2021; 10:37-42. [PMID: 34977703 PMCID: PMC8691863 DOI: 10.1016/j.xjtc.2021.10.001] [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] [Received: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/01/2022] Open
|
10
|
Hinduja M. ROVING PEN. Indian J Thorac Cardiovasc Surg 2021; 37:712-715. [PMID: 34776673 PMCID: PMC8545971 DOI: 10.1007/s12055-021-01250-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022] Open
Abstract
Cardiac surgeons wish to spare most of their time in the operating rooms with their patients. However, in their busy schedule, sparing few minutes to update with the important global research is quite essential. These are summaries of few recent articles in cardiac surgery from important journals which might help in better patient care.
Collapse
Affiliation(s)
- Manish Hinduja
- Fortis Hospital Mulund, Mulund Goregaon Link Road, Mulund West, Mumbai, 400078 India
| |
Collapse
|
11
|
What Can We Learn from the Past by Means of Very Long-Term Follow-Up after Aortic Valve Replacement? J Clin Med 2021; 10:jcm10173925. [PMID: 34501375 PMCID: PMC8432120 DOI: 10.3390/jcm10173925] [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: 07/28/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Studies on very long-term outcomes after aortic valve replacement are sparse. Methods: In this retrospective cohort study, long-term outcomes during 25.1 ± 2.8 years of follow-up were determined in 673 patients who underwent aortic valve replacement with or without concomitant coronary artery bypass surgery for severe aortic stenosis and/or regurgitation. Independent predictors of decreased long-term survival were determined. Cumulative incidence rates of major adverse events in patients with a mechanical versus those with a biologic prosthesis were assessed, as well as of major bleeding events in patients with a mechanical prosthesis under the age of 60 versus those above the age of 60. Results: Impaired left ventricular function, severe prosthesis–patient mismatch, and increased aortic cross-clamp time were independent predictors of decreased long-term survival. Left ventricular hypertrophy, a mechanical or biologic prosthesis, increased cardiopulmonary bypass time, new-onset postoperative atrial fibrillation, and the presence of symptoms did not independently predict decreased long-term survival. The risk of major bleeding events was higher in patients with a mechanical in comparison with those with a biologic prosthesis. Younger age (under 60 years) did not protect patients with a mechanical prosthesis against major bleeding events. Conclusions: Very long-term outcome data are invaluable for careful decision-making on aortic valve replacement.
Collapse
|
12
|
Joseph KM, Nyman C. Mitral Valve Annuloplasty Failure and Percutaneous Treatment Options. Curr Cardiol Rep 2021; 23:140. [PMID: 34410525 DOI: 10.1007/s11886-021-01574-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Mitral valve repair is a common surgical procedure for both primary and secondary mitral regurgitation. With operations performed earlier in disease progression and increased patient longevity, the need for a repeat intervention is not infrequent. With the associated risks of reoperation and patient comorbidities, percutaneous techniques for acute or delayed failure after ring annuloplasty are emerging. RECENT FINDINGS Current commercially available devices, used in "off-label" ways, such as the MitraClip, may be effective in repairing recurrent mitral regurgitation after annuloplasty. Similarly, a valve-in-ring transcatheter mitral valve replacement can be considered in patients at high risk for surgical reoperation. These procedures are not without risk, for example, resultant mitral stenosis in the setting of edge-to-edge repair or left ventricular outflow tract (LVOT) obstruction with valve-in-ring transcatheter mitral valve replacement. Newer devices are emerging to permit more options for this subset of patients, which include transcatheter valves that are specifically designed for the mitral position. Undoubtedly, surgical reoperation has increased risk as compared to primary operation. Though percutaneous options are evolving, use in this patient population is currently limited to "off-label" use and is also associated with procedural complexities and risk. It is prudent for cardiologists, surgeons, and anesthesiologists to weigh risks, benefits, and limitations when considering patients for surgical reoperation, percutaneous repair, or transcatheter replacement after failed mitral annuloplasty.
Collapse
Affiliation(s)
- Kara M Joseph
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Charles Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| |
Collapse
|
13
|
Galloway AC. Mitral Valve Repair: The Goal Is a Durable, Physiologically Normal Valve. Ann Thorac Surg 2020; 111:1215. [PMID: 33189673 DOI: 10.1016/j.athoracsur.2020.08.077] [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: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Aubrey C Galloway
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, 530 First Ave, Ste 9V, New York, NY 10016.
| |
Collapse
|