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Haidari Z, Wendt D, Thielmann M, Jakob H, Ruhparwar A, El-Gabry M. Limited Versus Radical Resection in Mitral Valve Infective Endocarditis Surgery. J Cardiovasc Dev Dis 2023; 10:jcdd10040146. [PMID: 37103026 PMCID: PMC10144351 DOI: 10.3390/jcdd10040146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compare a limited-resection and non-patch technique with the classic radical-resection technique. Methods: Eligible candidates were patients with definitive IE of the native mitral valve undergoing surgery between January 2013 and December 2018. Patients were classified according to the surgical strategy into two groups: limited- versus radical-resection strategy. Propensity score matching was used. Endpoints were repair rate, all-cause mortality (30-day and 2-year), re-endocarditis and reoperation at q-year follow-up. Results: After propensity score matching, 90 patients were included. Follow-up was 100% complete. Mitral valve repair rate was 84% in the limited-resection versus 18% in the radical-resection strategy, p < 0.001. The 30-day and 2-year mortality were 20% versus 13% (p = 0.396) and 33% versus 27% (p = 0.490) in the limited-resection versus radical-resection strategy, respectively. The incidence of re-endocarditis during the 2-year follow-up was 4% in the limited-resection strategy versus 9% in the radical-resection strategy, p = 0.677. Three patients in the limited-resection strategy underwent reoperation of the mitral valve, while there were none in the radical-resection strategy (p = 0.242). Conclusions: Although mortality in patients with IE of the native mitral valve remains high, the limited-resection and non-patch surgical strategy is associated with a significantly higher repair rates with comparable 30-day and mid-term mortality, risk of re-endocarditis and re-operation compared to the radical-resection strategy.
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Affiliation(s)
- Zaki Haidari
- Correspondence: ; Tel.: +49-(0)201-723-84851; Fax: +49-(0)201-723-5451
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Lin X, Chen L, Zhang D, Luo S, Sheng Y, Liu X, Liu Q, Li J, Shi B, Peng G, Zhong X, Huang Y, Li D, Qin G, Yin Z, Xu J, Meng C, Liu Y. Prediction of Surgical Approach in Mitral Valve Disease by XGBoost Algorithm Based on Echocardiographic Features. J Clin Med 2023; 12:jcm12031193. [PMID: 36769840 PMCID: PMC9917697 DOI: 10.3390/jcm12031193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
In this study, we aimed to develop a prediction model to assist surgeons in choosing an appropriate surgical approach for mitral valve disease patients. We retrospectively analyzed a total of 143 patients who underwent surgery for mitral valve disease. The XGBoost algorithm was used to establish a predictive model to decide a surgical approach (mitral valve repair or replacement) based on the echocardiographic features of the mitral valve apparatus, such as leaflets, the annulus, and sub-valvular structures. The results showed that the accuracy of the predictive model was 81.09% in predicting the appropriate surgical approach based on the patient's preoperative echocardiography. The result of the predictive model was superior to the traditional complexity score (81.09% vs. 75%). Additionally, the predictive model showed that the three main factors affecting the choice of surgical approach were leaflet restriction, calcification of the leaflet, and perforation or cleft of the leaflet. We developed a novel predictive model using the XGBoost algorithm based on echocardiographic features to assist surgeons in choosing an appropriate surgical approach for patients with mitral valve disease.
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Affiliation(s)
- Xiaoxuan Lin
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Lixin Chen
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Defu Zhang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Shuyu Luo
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Yuanyuan Sheng
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Xiaohua Liu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Qian Liu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Jian Li
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Bobo Shi
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Guijuan Peng
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Xiaofang Zhong
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Yuxiang Huang
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
| | - Dagang Li
- Department of Cardiovascular Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
| | - Gengliang Qin
- Department of Cardiovascular Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
| | - Zhiqiang Yin
- Department of Cardiovascular Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
| | - Jinfeng Xu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
- Correspondence: (J.X.); (C.M.); (Y.L.)
| | - Chunying Meng
- Department of Cardiovascular Surgery, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
- Correspondence: (J.X.); (C.M.); (Y.L.)
| | - Yingying Liu
- Department of Ultrasound, The Second Clinical Medical College, Jinan University (Shenzhen People’s Hospital), Shenzhen 518020, China
- Correspondence: (J.X.); (C.M.); (Y.L.)
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Surgical mitral valve repair technique considerations based on the available evidence. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:302-316. [PMID: 36168574 PMCID: PMC9473589 DOI: 10.5606/tgkdc.dergisi.2022.23340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022]
Abstract
Mitral valve regurgitation is the second most common valve disease in the western world. Surgery is currently the best tool for generating a long-lasting elimination of mitral valve regurgitation. However, the mitral valve apparatus is a complex anatomical and functional structure, and repair results and durability show substantial heterogeneity. This is not only due to differences in the underlying mitral valve regurgitation pathophysiology but also due to differences in repair techniques. Repair philosophies differ substantially from one surgeon to the other, and consensus for the technically best repair strategy has not been reached yet. We had previously addressed this topic by suggesting that ring sizing is "voodoo". We now review the available evidence regarding the various repair techniques described for structural and functional mitral valve regurgitation. Herein, we illustrate that for structural mitral valve regurgitation, resuspension of prolapsing valve segments or torn chordae with polytetrafluoroethylene sutures and annuloplasty can generate the most durable results paired with the best achievable hemodynamics. For functional mitral valve regurgitation, the evidence suggests that annuloplasty alone is insufficient in most cases to generate durable results, and additional subvalvular strategies are associated with improved durability and possibly improved clinical outcomes. This review addresses current strategies but also implausibilities in mitral valve repair and informs the mitral valve surgeon about the current evidence. We believe that this information may help improve outcomes in mitral valve repair as the heterogeneity of mitral valve regurgitation pathophysiology does not allow a one-size-fits-all concept.
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Amabile A, Mori M, Geirsson A. Commentary: Isolated Native Mitral Valve Infective Endocarditis: 'Repair When Feasible' as the Miracle Cure? Semin Thorac Cardiovasc Surg 2021; 34:500-501. [PMID: 34133946 DOI: 10.1053/j.semtcvs.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Makoto Mori
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
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