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Götte J, Zittermann A, Deutsch MA, Schramm R, Bleiziffer S, Renner A, Gummert JF. Early and Late Results after Surgical Mitral Valve Repair: A High-Volume Center Experience. Thorac Cardiovasc Surg 2024. [PMID: 38346705 DOI: 10.1055/a-2266-7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Surgical mitral valve repair is the gold standard treatment of severe primary mitral regurgitation (MR). In the light of rapidly evolving percutaneous technologies, current surgical outcome data are essential to support heart-team-based decision-making. METHODS This retrospective, high-volume, single-center study analyzed in 1779 patients with primary MR early morbidity and mortality, postoperative valve function, and long-term survival after mitral valve (MV) repair. Surgeries were performed between 2009 and 2022. Surgical approaches included full sternotomy (FS) and right-sided minithoracotomy (minimally invasive cardiac [MIC] surgery). RESULTS Of the surgeries (mean age: 59.9 [standard deviation:11.4] years; 71.5% males), 85.6% (n = 1,527) were minithoracotomies. Concomitant procedures were performed in 849 patients (47.7%), including tricuspid valve and/or atrial septal defect repair, cryoablation, and atrial appendage closure. The majority of patients did not need erythrocyte concentrates. Mediastinitis and rethoracotomy for bleeding rates were 0.1 and 4.3%, respectively. Reoperation before discharge for failed repair was necessary in 12 patients (0.7%). Freedom from more than moderate MR was > 99%. Thirty-day mortality was 0.2% and did not differ significantly between groups (p = 0.37). Median follow-up was 48.2 months with a completeness of 95.9%. Long-term survival was similar between groups (p = 0.21). In the FS and MIC groups, 1-, 5-, and 10-year survival rates were 98.8 and 98.8%, 92.9 and 94.4%, and 87.4 and 83.1%, respectively. CONCLUSION MV surgery, both minimally invasive and via sternotomy, is associated with high repair rates, excellent perioperative outcomes, and long-term survival. Data underscore the effectiveness of surgical repair in managing MR, even in the era of advancing interventional techniques.
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Affiliation(s)
- Julia Götte
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Armin Zittermann
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Marcus-Andre Deutsch
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Rene Schramm
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Sabine Bleiziffer
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Andre Renner
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Jan F Gummert
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
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2
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Malvindi PG, Luthra S, Zingale A, Bifulco O, Berretta P, Pierri MD, Ohri SK, Di Eusanio M. Surgical repair and replacement for native mitral valve infective endocarditis. J Cardiovasc Med (Hagerstown) 2024; 25:334-341. [PMID: 38407841 DOI: 10.2459/jcm.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
AIMS The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. METHODS Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001-2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients' profile between the repair and replacement subgroups. RESULTS Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). CONCLUSIONS Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Anna Zingale
- Wessex Cardiothoracic Centre, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Michele Danilo Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, University of Southampton, Southampton, UK
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
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3
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Bifulco O, Malvindi PG, Berretta P, Brugiatelli L, Cefarelli M, Alfonsi J, D’Alfonso A, Zingaro C, Di Eusanio M. Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:29. [PMID: 38256290 PMCID: PMC10821199 DOI: 10.3390/medicina60010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Minimally invasive cardiac surgery is an established approach for the treatment of heart valve pathologies and is associated with excellent technical and early postoperative outcomes. Data from medium- and long-term longitudinal evaluation of patients who underwent mitral valve repair (MVr) through transaxillary approach (TAxA) are still lacking. The aim of this study is to investigate mid-term results in patients who underwent TAxA MVr. Materials and Methods: Prospectively collected data of patients who underwent first-time MVr for MV regurgitation between 2017 and 2022, were reviewed. A total of 308 patients received TAxA, while in 220 cases, traditional full sternotomy (FS) was performed. Concomitant aortic and coronary artery bypass grafting (CABG) procedures, infective endocarditis or urgent operations were excluded. A propensity match (PS) analysis was used to overcome preoperative differences between the populations. Follow-up data were retrieved from outpatients' clinic, telephone calls and municipal administration records. Results: After PS-matching, two well-balanced cohorts of 171 patients were analysed. The overall 30-day mortality rate was 0.6% in both cohorts. No statistical difference in postoperative complications was reported. TAxA cohort experienced earlier postoperative extubation (p < 0.001) with a higher rate of extubation performed in the operating theatre (p < 0.001), shorter intensive care unit (ICU) stay (p < 0.001), and reduced hospitalization with 51% of patients discharged home (p < 0.001). Estimated survival at 5 years was 98.8% in TAxA vs. 93.6% in FS cohort (Log rank p = 0.15). The cumulative incidence of reoperation was 2.6% and 4.4% at 5 years, respectively, in TAxA and FS cohorts (Gray test p = 0.49). Conclusions: TAxA approach for MVr was associated with low rates of in-hospital mortality and major postoperative complications being furthermore associated with shorter mechanical ventilation time, shorter ICU stay and reduced hospitalization with a higher rate of patients able to be discharged home. At mid-term, TAxA was associated with excellent survival and low rate of MV reoperation.
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Affiliation(s)
| | - Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, 60126 Ancona, Italy (M.D.E.)
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4
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Mick SL, Gaudino M. Commentary: Repair of the tricuspid aortic valve: Simplicity is the ultimate sophistication. J Thorac Cardiovasc Surg 2023; 165:1008-1009. [PMID: 34020801 DOI: 10.1016/j.jtcvs.2021.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
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5
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Longitudinal Outcomes Following Surgical Repair of Primary Mitral Regurgitation. J Cardiovasc Dev Dis 2023; 10:jcdd10030095. [PMID: 36975860 PMCID: PMC10051838 DOI: 10.3390/jcdd10030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Degenerative mitral valve (MV) disease is the most common cause of organic mitral regurgitation (MR) in developed countries. Surgical mitral valve repair is the gold standard treatment for primary MR. Surgical mitral valve repair is associated with excellent outcomes in terms of survival and freedom from recurrent MR. As well, innovations in surgical repair techniques, including thoracoscopically and robotically assisted approaches, further reduce morbidity. Emerging catheter-based therapies may also provide advantages in select patient groups. Although the outcomes following surgical mitral valve repair are well described in the literature, longitudinal follow-up is heterogenous. Indeed, longitudinal follow-up and long-term data are vital to better advise treatment and counsel patients.
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6
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Khairallah S, Rahouma M, Dabsha A, Demetres M, Gaudino MF, Mick SL. Comparison of meta-analytical estimates of outcomes after Alfieri or neochordal repair in isolated anterior mitral prolapse. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2023; 63:6984718. [PMID: 36629477 DOI: 10.1093/ejcts/ezac587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Repair of the isolated degenerative anterior mitral leaflet has been considered more challenging and associated with compromised durability compared with isolated posterior leaflet in major series. Implantation of neochordae or Alfieri edge-to-edge is the most employed repair technique for isolated anterior repair currently, but little data exist comparing their relative durability. We sought to investigate this issue with this meta-analysis. METHODS A literature search was performed (Ovid MEDLINE, Ovid Embase and The Cochrane Library). The primary outcome was the incidence rate (IR) of reoperation, the secondary outcomes were recurrent moderately severe/severe mitral regurgitation (MR), in-hospital/30-day reoperation and mortality and follow-up mortality. A random-effect model was used. Leave-one-out, subgroup analysis (Alfieri versus neochordae) and meta-regression were done. RESULTS Seventeen studies (including 1358 patients) were included. At a weighted mean follow-up of 5.56 ± 3.31 years, the IR for reoperation was 14.45 event per 1000 person-year and significantly lower in Alfieri than neochordae repair (9.40 vs 18.61, P = 0.04) on subgroup analysis. The IR of follow-up moderately severe/severe MR was 19.89 event per 1000 person-year and significantly lower in Alfieri than neochordae repair (10.68 and 28.63, P = 0.01). In a sensitivity analysis comparing homogenous studies, a significant difference in the recurrence of regurgitation in favour of the Alfieri approach remained. There were no differences in operative outcomes or survival. There were significant associations between increased incidence of late reoperation and New York Heart Association class III/IV and associated coronary artery bypass graft procedure for whole cohort. CONCLUSIONS Alfieri repair may be associated with a lower incidence of recurrent MR compared with neochordae-based repair in the setting of isolated degenerative anterior mitral pathology. This is the first such meta-analysis and further inquiry into this area is needed.
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Affiliation(s)
- Sherif Khairallah
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Anas Dabsha
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Michelle Demetres
- Scholarly Communications Librarian, Weill Cornell Medicine (WCM), Samuel J. Wood Library & C.V. Starr Biomedical Information Center, New York, NY, USA
| | - Mario Fl Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Stephanie L Mick
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
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Campos-Arjona R, Rodríguez-Capitán J, Martínez-Carmona JD, Lavreshin A, Fernández-Romero L, Melero-Tejedor JM, Jiménez-Navarro M. Prognosis for Mitral Valve Repair Surgery in Functional Mitral Regurgitation. Ann Thorac Cardiovasc Surg 2022; 28:342-348. [PMID: 35851568 PMCID: PMC9585337 DOI: 10.5761/atcs.oa.22-00051] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose: Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation. Methods: A retrospective observational analysis of the recurrence of functional mitral regurgitation (ischemic and nonischemic) and global mortality during follow-up of 176 patients who underwent mitral repair surgery between 1999 and 2018 in our center was conducted. Results: The etiology of functional mitral regurgitation was ischemic in 55.7% of cases. After surgery, mitral regurgitation was 0-I in 92.3% of cases. We conducted a long-term clinical follow-up of a mean 42.2 months and an echocardiographic follow-up of a mean 41.8 months. We observed mitral regurgitation of at least grade II in 52 patients (36.9%). Survival at 1, 3, and 5 years was 78.8%, 66.7%, and 52.3%, respectively. Predictive factors for global mortality were age (hazard ratio = 1.038, p = 0.01) and a depressed preoperative ejection fraction. After a competing risk analysis, we found the only predictive factor for the recurrence of mitral regurgitation in our series to be age (sub-hazard ratio = 1.03, 95% confidence interval = 1.01–1.06, p = 0.016). Conclusion: Repair surgery for functional mitral regurgitation shows age as the only independent predictor of recurrence. Age and depressed ejection fraction were predictors of mortality.
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Affiliation(s)
- Rafael Campos-Arjona
- Department of Heart and Cardiovascular Pathology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Medicine and Dermatology, University of Malaga, Malaga, Spain.,Malaga Biomedical Research Institute (IBIMA), Malaga, Spain.,CIBERCV Cardiovascular Diseases. Carlos III Health Institute, Madrid, Spain
| | - Jorge Rodríguez-Capitán
- Department of Heart and Cardiovascular Pathology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Medicine and Dermatology, University of Malaga, Malaga, Spain.,Malaga Biomedical Research Institute (IBIMA), Malaga, Spain.,CIBERCV Cardiovascular Diseases. Carlos III Health Institute, Madrid, Spain
| | - José D Martínez-Carmona
- Department of Heart and Cardiovascular Pathology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Medicine and Dermatology, University of Malaga, Malaga, Spain.,Malaga Biomedical Research Institute (IBIMA), Malaga, Spain.,CIBERCV Cardiovascular Diseases. Carlos III Health Institute, Madrid, Spain
| | - Alexey Lavreshin
- Department of Heart and Cardiovascular Pathology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Medicine and Dermatology, University of Malaga, Malaga, Spain.,Malaga Biomedical Research Institute (IBIMA), Malaga, Spain.,CIBERCV Cardiovascular Diseases. Carlos III Health Institute, Madrid, Spain
| | - Loudes Fernández-Romero
- Department of Heart and Cardiovascular Pathology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Medicine and Dermatology, University of Malaga, Malaga, Spain.,Malaga Biomedical Research Institute (IBIMA), Malaga, Spain.,CIBERCV Cardiovascular Diseases. Carlos III Health Institute, Madrid, Spain
| | - José M Melero-Tejedor
- Department of Heart and Cardiovascular Pathology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Medicine and Dermatology, University of Malaga, Malaga, Spain.,Malaga Biomedical Research Institute (IBIMA), Malaga, Spain.,CIBERCV Cardiovascular Diseases. Carlos III Health Institute, Madrid, Spain
| | - Manuel Jiménez-Navarro
- Department of Heart and Cardiovascular Pathology, Virgen de la Victoria University Hospital, Malaga, Spain.,Department of Medicine and Dermatology, University of Malaga, Malaga, Spain.,Malaga Biomedical Research Institute (IBIMA), Malaga, Spain.,CIBERCV Cardiovascular Diseases. Carlos III Health Institute, Madrid, Spain
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8
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Morisaki A, Takahashi Y, Fujii H, Sakon Y, Murakami T, Shibata T. Outcomes of loop technique with ring annuloplasty: a > 10-year experience. Gan To Kagaku Ryoho 2022; 70:793-803. [PMID: 35349037 DOI: 10.1007/s11748-022-01804-8] [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: 12/19/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We assessed the long-term outcomes of the loop technique with ring annuloplasty for mitral regurgitation from our > 10-year experience. METHODS We retrospectively reviewed 362 patients who underwent the loop technique with ring annuloplasty via median sternotomy or right mini-thoracotomy for mitral regurgitation. The median follow-up duration was 4.1 years (interquartile range 2.3-5.8 years). RESULTS This study involved 147 women and 215 men (median age, 66.5 years). Mitral regurgitation was caused by Barlow's disease in 27 patients. Seven patients required reoperations (recurrent regurgitation caused by technical issues, n = 3; progression of degenerative disease, n = 4). The 5- and 10-year cumulative incidences of reoperation considering death as the competing event were 1.4% and 5.4%, respectively. The 5- and 10-year postoperative cumulative incidences of moderate-to-severe recurrent mitral regurgitation were 4.7% and 13.0%, respectively. Residual regurgitation ≥ mild (hazard ratio, 6.99; 95% confidence interval, 1.520-32.12; P = .012) was an independent risk factor for reoperation. The independent risk factors for moderate-to-severe recurrent regurgitation were residual regurgitation ≥ mild (hazard ratio, 9.60; 95% confidence interval, 3.042-30.31; P < .001) and the loop-in-loop technique (hazard ratio, 3.40; 95% confidence interval, 1.058-10.90; P = .040). The median mean pressure gradient was sustained at almost 3.5 mmHg for > 7 years. CONCLUSIONS The loop technique with ring annuloplasty provided excellent results with good hemodynamics beyond the mid-term. Residual regurgitation ≥ mild and the loop-in-loop technique may not be preferable for durable outcomes.
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Affiliation(s)
- Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Elsayed RS, Abt BG, Bowdish ME. Response to Letter to Editor Regarding: Equivalent outcomes with minimally invasive and sternotomy mitral valve repair for degenerative mitral valve disease. J Card Surg. 2021; 36:2636-43. J Card Surg 2021; 37:475-476. [PMID: 34862666 DOI: 10.1111/jocs.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ramsey S Elsayed
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Brittany G Abt
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Michael E Bowdish
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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10
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Bishawi M, Milano C, Gaca J, Carr K, Wang A, Glower DD. The outcome of mitral repair for degenerative versus ischemic mitral regurgitation using a single complete ring. J Card Surg 2021; 37:290-296. [PMID: 34665478 DOI: 10.1111/jocs.16094] [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: 07/13/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The durability of surgical repair for degenerative versus ischemic mitral regurgitation (MR) is thought to be markedly different. We, therefore, examined late outcomes and durability for mitral repair in a large cohort of patients receiving a single annuloplasty device. METHODS A total of 749 consecutive patients receiving mitral repair for degenerative mitral regurgitation (DMR) or ischemic mitral regurgitation (IMR) were evaluated from a prospective database. Patients with tricuspid or maze surgery were included. Papillary muscle rupture and mixed valve etiologies were excluded. Outcomes were compared for IMR versus DMR. RESULTS Patients with DMR were younger and less urgent. Patients with IMR had mean end-systolic diameter 4.5 ± 1.1 cm. All patients received the same complete semirigid annuloplasty device with median ring size 32 mm for DMR and 24 mm for IMR. New York Heart Association failure class improved from 2.8 to 1.5 (p < .001). Patients with DMR had lower operative mortality (1/384 [0.3%] vs. 26/365 [7%], p < .0001) and shorter length of stay. A 15-year survival was better with DMR (63% ± 3% vs. 13% ± 2%, p < .001). At 10 years, the incidence of recurrent ≥2+ MR (10% ± 2% vs. 16% ± 2%, p = .16) was not significantly different. Predictors of recurrent ≥2+ MR were female gender (odds ratio [OR]: 3.0 (1.9-4.8, p < .0001), and prior operation (OR: 2.4 [1.3-4.5], p = .02) but not IMR (OR: 1.4 [0.9-2.3], p = .15). CONCLUSIONS In this series, where patients with IMR had relatively preserved ventricular dimensions, the primary determinants of late recurrent MR were female gender and prior operation but not IMR versus DMR. Selected patients with IMR can obtain relatively durable mitral repair despite higher operative risk and lower survival compared to DMR.
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Affiliation(s)
- Muath Bishawi
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Carmelo Milano
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey Gaca
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Keith Carr
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Donald D Glower
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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11
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Bowdish ME, Elsayed RS, Tatum JM, Cohen RG, Mack WJ, Abt B, Yin V, Barr ML, Starnes VA. Equivalent outcomes with minimally invasive and sternotomy mitral valve repair for degenerative mitral valve disease. J Card Surg 2021; 36:2636-2643. [PMID: 33908645 DOI: 10.1111/jocs.15586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Debate continues in regard to the optimal surgical approach to the mitral valve for degenerative disease. METHODS Between February 2004 and July 2015, 363 patients underwent mitral valve repair for degenerative mitral valve disease via either sternotomy (sternotomy, n = 109) or small right anterior thoracotomy (minimally invasive, n = 259). Survival, need for mitral valve reoperation, and progression of mitral regurgitation more than two grades were compared between cohorts using time-based statistical methods and inverse probability weighting. RESULTS Survival at 1, 5, and 10 years were 99.2, 98.3, and 96.8 for the sternotomy group and 98.1, 94.9, and 94.9 for the minimally invasive group (hazard ratio: 0.39, 95% confidence interval [CI] 0.11-1.30, p = .14). The cumulative incidence of need for mitral valve reoperation with death as a competing outcome at 1, 3, and 5 years were 2.7%, 2.7%, and 2.7% in the sternotomy cohort and 1.5%, 3.3%, and 4.1% for the minimally invasive group (subhazard ratio (SHR) 1.17, 95% CI: 0.33-4.20, p = .81). Cumulative incidence of progression of mitral regurgitation more than two grades with death as a competing outcome at 1, 3, and 5 years were 5.5%, 14.4%, and 44.5% for the sternotomy cohort and 4.2%, 9.7%, and 20.5% for the minimally invasive cohort (SHR: 0.67, 95% CI: 0.28-1.63, p = .38). Inverse probability weighted time-based analyses based on preoperative cohort assignment also demonstrated equivalent outcomes between surgical approaches. CONCLUSIONS Minimally invasive and sternotomy mitral valve repair in patients with degenerative mitral valve disease is associated with equivalent survival and repair durability.
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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, USA.,Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Ramsey S Elsayed
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - James M Tatum
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Robbin G Cohen
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Brittany Abt
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Victoria Yin
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Mark L Barr
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Vaughn A Starnes
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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12
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Barac YD, Loungani RS, Sabulsky R, Zwischenberger B, Gaca J, Carr K, Glower DD. Robotic versus port-access mitral repair: A propensity score analysis. J Card Surg 2021; 36:1219-1225. [PMID: 33462900 DOI: 10.1111/jocs.15342] [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: 10/08/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Port-access (PORT) and robotic (ROBO) mitral repair are well established, but differences in patient selection and outcomes are not well documented. METHODS A retrospective analysis was performed on 129 ROBO and 628 PORT mitral repairs at one institution. ROBO patients had 4 cm nonrib spreading incisions with robotic assistance, while PORT patients had 6-8 cm rib spreading incisions with thoracoscopic assistance. Propensity score analysis matched patients for differences in baseline characteristics. RESULTS Unmatched ROBO patients were younger (58 ± 11 vs. 61 ± 13, p = .05), had a higher percentage of males (77% vs. 63%, p = .003) and had less NYHA Class 3-4 symptoms (11% vs. 21%, p < .01), less atrial fibrillation (19% vs. 29%, p = .02) and less tricuspid regurgitation (14% vs. 24%, p = .01). Propensity score analysis of matched patients showed that pump time (275 ± 57 vs. 207 ± 55, p < .0001) and clamp time (152 ± 38 vs. 130 ± 34, p < .0001) were longer for ROBO patients. However, length of stay, postoperative morbidity, and 5-year survival (97 ± 1% vs. 96 ± 3%, p = .7) were not different. For matched patients with degenerative valve disease, 5-year incidence of mitral reoperation (3 ± 2% vs. 1 ± 1%), severe mitral regurgitation (MR) (6 ± 4% vs. 1 ± 1%), or ≥2 + MR (12 ± 5% vs. 12 ± 4%), were not significantly different between ROBO versus PORT approaches. Predictors of recurrent moderate MR were connective tissue disease, functional etiology, and non-White race, but not surgical approach. CONCLUSIONS In this first comparison out to 5 years, robotic versus port-access approach to mitral repair had longer pump and clamp times. Perioperative morbidity, 5-year survival, and 5-year repair durability were otherwise similar.
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Affiliation(s)
- Yaron D Barac
- Rabin Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Jeffrey Gaca
- Duke University Medical Center, Durham, North Carolina, USA
| | - Keith Carr
- Duke University Medical Center, Durham, North Carolina, USA
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13
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Tarasoutchi F, Montera MW, Ramos AIDO, Sampaio RO, Rosa VEE, Accorsi TAD, Santis AD, Fernandes JRC, Pires LJT, Spina GS, Vieira MLC, Lavitola PDL, Ávila WS, Paixão MR, Bignoto T, Togna DJD, Mesquita ET, Esteves WADM, Atik F, Colafranceschi AS, Moises VA, Kiyose AT, Pomerantzeff PMA, Lemos PA, Brito Junior FSD, Weksler C, Brandão CMDA, Poffo R, Simões R, Rassi S, Leães PE, Mourilhe-Rocha R, Pena JLB, Jatene FB, Barbosa MDM, Abizaid A, Ribeiro HB, Bacal F, Rochitte CE, Fonseca JHDAPD, Ghorayeb SKN, Lopes MACQ, Spina SV, Pignatelli RH, Saraiva JFK. Update of the Brazilian Guidelines for Valvular Heart Disease - 2020. Arq Bras Cardiol 2020; 115:720-775. [PMID: 33111877 PMCID: PMC8386977 DOI: 10.36660/abc.20201047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Roney Orismar Sampaio
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Vitor Emer Egypto Rosa
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Antonio de Santis
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - João Ricardo Cordeiro Fernandes
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Lucas José Tachotti Pires
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Guilherme S Spina
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Paulo de Lara Lavitola
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Walkiria Samuel Ávila
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Milena Ribeiro Paixão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tiago Bignoto
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | | | - Fernando Atik
- Fundação Universitária de Cardiologia (FUC), São Paulo, SP - Brasil
| | | | | | | | | | - Pedro A Lemos
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Carlos Manuel de Almeida Brandão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Robinson Poffo
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Ricardo Simões
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | | | - Ricardo Mourilhe-Rocha
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Alexandre Abizaid
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Henrique Barbosa Ribeiro
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - José Francisco Kerr Saraiva
- Sociedade Campineira de Educação e Instrução Mantenedora da Pontifícia Universidade Católica de Campinas, Campinas, SP - Brasil
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14
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Chen SW, Chen CY, Chien-Chia Wu V, Chou AH, Cheng YT, Chang SH, Chu PH. Mitral valve repair versus replacement in patients with rheumatic heart disease. J Thorac Cardiovasc Surg 2020; 164:57-67.e11. [PMID: 32994098 DOI: 10.1016/j.jtcvs.2020.07.117] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/31/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Rheumatic heart disease remains a major cause of cardiovascular death worldwide. Limited real-world nationwide data are available to compare the long-term outcomes between mitral valve repair and replacement in rheumatic heart disease. METHODS We identified adult patients with rheumatic heart disease who underwent mitral valve repair or replacement surgery between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Outcomes of interest included operation-related complications, all-cause mortality, and mitral valve reoperation rate. Propensity score matching at a 1:1 ratio was conducted to mitigate possible confounding factors. RESULTS A total of 5086 patients with rheumatic heart disease who underwent mitral valve surgery were identified. Of those, 489 (9.6%) and 4597 (90.4%) underwent mitral valve repair and mitral valve replacement, respectively. After propensity score matching was applied, each group had 467 patients. No difference in risk of in-hospital mortality was observed between groups. With a mean follow-up of 6 years, the mitral valve repair group had comparable risks of all-cause mortality with the mitral valve replacement group (33.4% vs 32.5%; hazard ratio, 1.01; 95% confidence interval, 0.81-1.25). However, higher risks of mitral valve reoperation were observed in the mitral valve repair group (subdistribution hazard ratio, 4.32; 95% confidence interval, 2.02-9.23). Previous percutaneous transvenous mitral commissurotomy was identified as a risk factor of mitral valve reoperation in the repair group. CONCLUSIONS Among patients with rheumatic heart disease, mitral valve repair is not associated with superior long-term outcomes. Patients should be carefully selected for mitral valve repair because of its higher reoperation rate, particularly those with previous percutaneous transvenous mitral commissurotomy.
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Affiliation(s)
- Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
| | - Cheng-Yu Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Hung Chang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
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15
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Trumello C, Giambuzzi I, Del Forno B, Bargagna M, Blasio A, Ruggeri S, Meneghin R, Schiavi D, Nascimbene S, Castiglioni A, Alfieri O, De Bonis M. Re-repair after previous mitral valve reconstruction: handle with care! Interact Cardiovasc Thorac Surg 2020; 31:35-41. [DOI: 10.1093/icvts/ivaa057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/23/2020] [Accepted: 02/26/2020] [Indexed: 11/15/2022] Open
Abstract
Abstract
OBJECTIVES
Patients with recurrent mitral regurgitation after surgical repair are currently treated with a re-repair procedure or valve replacement. The aim of this study was to compare outcomes of our series of patients who underwent re-repair versus replacement in this setting.
METHODS
From 2003 to 2017, a total of 79 patients with recurrent mitral regurgitation underwent re-repair, group A (39), or replacement, group B (40). Mean follow-up was 7.4 ± 3.27 years (max 14.4). Inverse Probability of Treatment Weighting was used to create comparable distributions of the covariates; the Kaplan–Meier method was used for survival and competing risk analysis for time to cardiac death, time to recurrence of MR ≥3+ and MR ≥2+.
RESULTS
A re-repair was possible in 49.4% of patients (39/79). At hospital discharge, residual MR ≥2+ was present in 5 patients in group A, and none in group B (P < 0.001). The paired overall survival at 8 years was 100% in the re-repair group and 96.5 ± 2.34% in the replacement group (P = 0.069). The cumulative incidence function of cardiac death, with non-cardiac death as competitive event, at 8 years was 0% in group A and 3.5 ± 2.34% in group B (P = 0.077). The cumulative incidence function of MR ≥3+ at 8 years was 29.2 ± 8.81% in group A and 0% in group B (P < 0.001).
CONCLUSIONS
Recurrent significant mitral regurgitation after re-repair is not rare already at 8 years, but the survival tends to be worse after replacement. This finding calls for a very selective approach in pursuing a re-repair only when the intraoperative findings and the immediate results are very reassuring as far as long-term durability is concerned.
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Affiliation(s)
- Cinzia Trumello
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Giambuzzi
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedetto Del Forno
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bargagna
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Blasio
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Ruggeri
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Meneghin
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Schiavi
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Nascimbene
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Castiglioni
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Division of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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16
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Very long-term outcomes of twisted auto-pericardial mitral annuloplasty. Gen Thorac Cardiovasc Surg 2020; 68:1113-1118. [DOI: 10.1007/s11748-020-01324-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/18/2020] [Indexed: 01/22/2023]
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17
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Can We Predict Failure of Mitral Valve Repair? J Clin Med 2019; 8:jcm8040526. [PMID: 30999593 PMCID: PMC6517919 DOI: 10.3390/jcm8040526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/05/2022] Open
Abstract
Objective: To identify echocardiographic and surgical risk factors for failure after mitral valve repair. Methods: We identified a total of 77 consecutive patients from our institutional mitral valve surgery database who required redo mitral valve surgery due to recurrence of mitral regurgitation after primary mitral valve repair. A control group of 138 patients who had a stable echocardiographic long-term result was included based on propensity score matching. Systematic analysis of echocardiographic parameters was performed before primary surgery; after mitral valve repair and prior to redo surgery. Risk factor analysis was performed using multivariate Cox regression model. Results: Redo surgery was associated with the presence of pulmonary hypertension ≥ 50 mmHg (p = 0.02), a mean transmitral gradient > 5 mmHg (p = 0.001), left ventricular ejection fraction ≤ 45% (p = 0.05) before surgery and mitral regurgitation ≥moderate at time of discharge (p = 0.002) in the whole cohort. Patients with functional mitral valve regurgitation had a higher tendency to undergo redo surgery if preoperative left ventricular end-diastolic diameter exceeded 65 mm (p = 0.043) and if postoperative tenting height exceeded 6 mm (p = 0.018). Low ejection fraction was not significantly associated with the need for redo mitral valve surgery in the functional subgroup. Conclusions: Recurrent mitral regurgitation is still a valuable problem and is associated with relevant perioperative mortality. Patients with severe mitral regurgitation should undergo early mitral valve repair surgery as long as systolic pulmonary artery pressure is low, left ventricular ejection fraction is preserved, and LVEED is deceeds 65 mm.
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18
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Agnino A, Antonazzo A, Albano G, Panisi P, Gerometta P, Piti A, Anselmi A. Strategy-specific durability of mitral valve repair through the video-assisted right minithoracotomy approach. J Cardiovasc Med (Hagerstown) 2019; 20:137-144. [PMID: 30601192 DOI: 10.2459/jcm.0000000000000753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We sought to analyze the early and follow-up results of minimally invasive video-assisted mitral valve repair. With particular focus on degenerative disease, results were stratified according to type of lesion, strategy of repair and surgical technique. METHODS We retrospectively built a database over 241 patients who received mitral repair for severe regurgitation through right minithoracotomy in the 2009-17 period. Cause was degenerative in 92.1%, restrictive in 5.8% and mixed in the remainders. Clinical and echocardiographic follow-up (98.7% complete, average duration 2.9 years ± 1.4) was obtained through contact of in-house and territorial cardiologists. Recurrent mitral regurgitation at follow-up was defined as being at least mild-to-moderate (2+). RESULTS Operative mortality was 1.7%, and related to the technique in one case. Five-year actuarial survival was 95% ± 2; there was no valve-related death and one reoperation. At follow-up, we observed eight cases of 2+ regurgitation and one instance of 4+ regurgitation (4-year actuarial freedom: 92% ± 4). Freedom from recurrent regurgitation was significantly lower in the 'restrictive' subgroup vs. the 'degenerative' subgroup (P = 0.02); no statistically significant difference in freedom from recurrence was observed among patients who received mitral repair using a 'resect' vs. 'nonresection' strategy (P = 0.46), and in those who received the Totally Endoscopic technique (endoaortic balloon occlusion, no costal spreading) vs. controls (external aortic clamp, costal spreading) (P = 0.98). CONCLUSION Durability of minimally invasive mitral repair is optimal. Nonresection repair techniques are at least noninferior to previous approaches based on leaflet resection.
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Affiliation(s)
- Alfonso Agnino
- Cardiovascular Department.,Division of Minimally Invasive Cardiac Surgery
| | - Andrea Antonazzo
- Cardiovascular Department.,Division of Minimally Invasive Cardiac Surgery
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | | | | | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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19
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Alreshidan M, Herron RD, Wei LM, Cook CC, Salman M, Roberts HG, Badhwar V. Surgical Techniques for Mitral Valve Repair: A Pathoanatomic Grading System. Semin Cardiothorac Vasc Anesth 2018; 23:20-25. [PMID: 30516443 PMCID: PMC6415492 DOI: 10.1177/1089253218815465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mitral valve surgery has evolved over 4 decades from one based on the principles of prosthetic replacement to a subspecialty with a foundation based on the principles of repair. This review will attempt to enumerate the contemporary techniques of mitral valve repair and a pathoanatomically directed approach with which to apply them by focusing on degenerative disease and associated complexities.
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Affiliation(s)
- Mohammed Alreshidan
- 1 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Robert D Herron
- 1 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Lawrence M Wei
- 1 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Chris C Cook
- 1 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Muhammad Salman
- 1 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Harold G Roberts
- 1 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Vinay Badhwar
- 1 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
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20
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Roberts HG, Rankin JS, Wei LM, Cook CC, Salman M, Badhwar V. Respectful resection to enhance the armamentarium of mitral valve repair: Is less really more? J Thorac Cardiovasc Surg 2018; 156:1854-1855. [PMID: 30107931 DOI: 10.1016/j.jtcvs.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Harold G Roberts
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Chris C Cook
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Muhammad Salman
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
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21
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Murphy DA, Moss E, Miller J, Halkos ME. Repeat Robotic Endoscopic Mitral Valve Operation: A Safe and Effective Strategy. Ann Thorac Surg 2018; 105:1704-1709. [DOI: 10.1016/j.athoracsur.2018.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/25/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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22
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Mick S, McCurry K, Navia J, Gillinov M. How long will my repair last, doctor? Additional data on the durability of mitral valve repair. J Thorac Cardiovasc Surg 2017. [DOI: 10.1016/j.jtcvs.2017.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Corrigan FE, Maini A, Reginauld S, Lerakis S. Contemporary evaluation of mitral regurgitation – 3D echocardiography, cardiac magnetic resonance, and procedural planning. Expert Rev Cardiovasc Ther 2017; 15:715-725. [DOI: 10.1080/14779072.2017.1362981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Frank E. Corrigan
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Aneel Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Shawn Reginauld
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Stamatios Lerakis
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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