1
|
Cetinkaya A, Waheed M, Bramlage K, Liakopoulos OJ, Zeriouh M, Hein S, Bramlage P, Schönburg M, Choi YH, Richter M. Comparison of flexible, open with semi-rigid, closed annuloplasty-rings for mitral valve repair. J Cardiothorac Surg 2021; 16:35. [PMID: 33743744 PMCID: PMC7981851 DOI: 10.1186/s13019-021-01405-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mitral regurgitation is a frequent valvular disease, with an increasing prevalence. We analysed the long-term outcomes of mitral valve repair procedures conducted over the last 10 years in our clinic using almost exclusively two different annuloplasty ring types. Methods A single-centre, retrospective analysis of mitral valve surgeries conducted between January 2005 and December 2015 for patients undergoing first-line mitral valve repair with either open (Cosgrove) or closed (CE Physio / Physio II) annuloplasty (OA or CA, respectively) rings. Results In total, 1120 patient documentations were available of which 528 underwent OA and 592 patients CA. The median age of patients was 64.0 years and 41.1% were female. The majority of these patients underwent the procedure because of degenerative valve disease. Rates of successful repair were about 90%, 72 h procedural mortality was 0.6% and the rate of re-intervention was 0.6% within the first 30 days. Functional (mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and systolic diameter and New York Heart Association class) as well as hard outcomes were comparable. 77.7 and 74.4% of patients were alive at the 10-year follow-up in the OA and CA groups, respectively. Upon multivariable adjustment, the hazard ratio was 0.926 (95% CI: 0.642–1.3135; p = 0.681). Conclusions The functional outcome and survival rates up to 10 years after mitral valve repair were comparable using open and closed annuloplasty rings. Whether this means these rings are interchangeable or a carefully selection of the best-for-the-patient devices will be subject of future investigations.
Collapse
Affiliation(s)
- Ayse Cetinkaya
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Maryam Waheed
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Karin Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Oliver Johannes Liakopoulos
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Mohamed Zeriouh
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Stefan Hein
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany.
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Campus of the University Hospital Giessen, Justus-Liebig Universiy Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| |
Collapse
|
2
|
Moscarelli M, Di Bari N, Fattouch K, Brigiani MS, Bonifazi R, Nasso G, Speziale G. Minimally Invasive Mitral Valve Repair for Standalone Secondary Mitral Regurgitation. Heart Lung Circ 2020; 30:431-437. [PMID: 32896484 DOI: 10.1016/j.hlc.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic secondary mitral valve regurgitation is associated with a poor prognosis. Yet, in contrast to primary mitral regurgitation, there is no clear evidence that a reduction in regurgitation improves survival. The limited availability of data regarding secondary mitral regurgitation has resulted in a low level of evidence for treatment recommendations. We evaluated the influence of minimally invasive mitral valve annuloplasty on survival, freedom from recurrent regurgitation, and other echocardiographic parameters in patients with "standalone" secondary mitral valve regurgitation. METHODS The analysis included patients with severe secondary mitral regurgitation, left ventricular function <40%, and persistent symptoms, despite optimal medical therapy. We excluded patients who were eligible for coronary artery revascularisation or cardiac resynchronisation therapy (i.e., not standalone mitral regurgitation). After discharge, patients were scheduled for outpatient clinic follow-up at 1, 3, 6, and 12 months. RESULTS From 2012 to 2018, 54 consecutive patients underwent minimally invasive mitral valve annuloplasty for severe standalone secondary mitral regurgitation. All patients were discharged with no or trivial residual regurgitation. The mean duration of follow-up was 33.5±16.8 months. Overall survival was 90% at 4 years postprocedure. Freedom from moderate regurgitation or reintervention was 89% at the 4-year follow-up. There was a low incidence of readmission for heart failure and patients showed consistent improvements in left ventricular function and symptoms. CONCLUSIONS Mitral valve repair with reduction and stabilisation of the annulus may be beneficial for symptomatic patients with secondary stand-alone mitral regurgitation.
Collapse
Affiliation(s)
- Marco Moscarelli
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy; Imperial College, National Heart and Lung Institute, London, UK.
| | - Nicola Di Bari
- Cardiothoracic and Vascular Department, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Khalil Fattouch
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Mario Siro Brigiani
- Cardiothoracic and Vascular Department, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Raffaele Bonifazi
- Cardiothoracic and Vascular Department, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Nasso
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Speziale
- Cardiothoracic and Vascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| |
Collapse
|
3
|
Micali LR, Parise G, Moula AI, Alayed Y, Parise O, Matteucci F, de Jong M, Tetta C, Gelsomino S. Are recurrence of ischemic mitral regurgitation and left ventricular reverse remodeling after restrictive annuloplasty ring dependent? Int J Cardiol 2020; 309:55-62. [PMID: 32178901 DOI: 10.1016/j.ijcard.2020.02.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/27/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This meta-analysis investigates MR recurrence and degree of left ventricular reverse remodeling (LVRR) in CIMR patients in mitral annuloplasty employing different ring designs. BACKGROUND The deeper understanding of complex changes caused by chronic ischemic mitral regurgitation (CIMR) have led to new generations of rings that, by maintaining normal 3D annular geometry are supposed to enhance long-term repair durability. METHODS A meta-analysis of all available reports in literature of MV repair through different ring design was conducted. Meta-regression was performed to investigate the impact of mitral ring characteristics related to flexibility, planarity, symmetry and single type utilized. Twenty studies encompassing a total of 1876 patients were included at the end of the selection process. RESULTS At meta-regression recurrence of MR was not influenced by the ring employed. Nonetheless, the event rate of MR recurrence in planar rings was 19%. Vs. 11% observed with non-planar rings. Recurrence rate in patients implanted with symmetric rings was 14% whereas it was 7% in asymmetric rings. The non-planar asymmetric IMR-ETlogix showed the lowest recurrence rate (6%). Furthermore, in planar group the reduction of pre- and post-operative LVEDD was - 4%. In the non-planar group, the LVEDD was reduced by 8.6%. In patients implanted with symmetric rings LVEDD reduction was 10.8%. LVRR in the asymmetric group was -5.8%. CONCLUSION MR recurrence occurred the least with asymmetric rings with less disproportionate asymmetry. In contrast, LVRR occurred at a greater extent in symmetric rings.
Collapse
Affiliation(s)
- Linda Renata Micali
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Gianmarco Parise
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Amalia Ioanna Moula
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Yazeed Alayed
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Orlando Parise
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Francesco Matteucci
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Monique de Jong
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Cecilia Tetta
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, the Netherlands.
| |
Collapse
|
4
|
Micali LR, Qadrouh MN, Parise O, Parise G, Matteucci F, de Jong M, Tetta C, Moula AI, Johnson DM, Gelsomino S. Papillary muscle intervention vs mitral ring annuloplasty in ischemic mitral regurgitation. J Card Surg 2020; 35:645-653. [PMID: 31951676 PMCID: PMC7078820 DOI: 10.1111/jocs.14407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Aims The main pathophysiological factor of chronic ischemic mitral regurgitation (MR) is the outward displacement of the papillary muscles (PMs) leading to leaflet tethering. For this reason, papillary muscle intervention (PMI) in combination with mitral ring annuloplasty (MRA) has recently been introduced into clinical practice to correct this displacement, and to reduce the recurrence of regurgitation. Methods A meta‐analysis was conducted comparing the outcomes of PMI and MRA performed in combination vs MRA performed alone, in terms of MR recurrence and left ventricular reverse remodeling (LVRR). A meta‐regression was carried out to investigate the impact of the type of PMI procedure on the outcomes. Results MR recurrence in patients undergoing both PMI and MRA was lower than in those who only had MRA (log incidence rate ratio, −0.66; lower‐upper limits, −1.13 to 0.20; I2 = 0.0%; p = .44; Egger's test: intercept 0.35 [−0.78 to 1.51]; p = .42). The group with both PMI and MRA and that with only MRA showed a slightly higher reduction in left ventricular diameters (−5.94%; −8.75% to 3.13%,). However, in both groups, LVRR was <10%. No difference was detected between PM relocation/repositioning and papillary muscle approximation in terms of LVRR (p = .33). Conclusions Using PMI and MRA together has a lower MR recurrence than using MRA alone. No significant LVRR was observed between the two groups nor between the PMI techniques employed.
Collapse
Affiliation(s)
- Linda R Micali
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Mohammad N Qadrouh
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Orlando Parise
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Gianmarco Parise
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Francesco Matteucci
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Monique de Jong
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Cecilia Tetta
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Amalia I Moula
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Daniel M Johnson
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| |
Collapse
|
5
|
Abdul Khayum P, Sudheer Babu RP. Mitral Regurgitation Severity Analysis Based on Features and Optimal HE (OHE) with Quantification using PISA Method. JOURNAL OF INTELLIGENT SYSTEMS 2019. [DOI: 10.1515/jisys-2017-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Heart disease is the foremost reason for death and also the main source of incapability in the developed nations. Mitral regurgitation (MR) is a typical heart disease that does not bring about manifestations until its end position. In view of the hidden etiologies of heart distress, functional MR can be partitioned into two subgroups, ischemic and no ischemic MR. A procedure is progressed for jet area separation and quantification in MR evaluation in arithmetical expressions. Thus, a strategy that depends on echocardiography recordings, image processing methods, and artificial intelligence could be useful for clinicians, particularly in marginal cases. In this research paper, MR segmentation is analyzed by the optimal histogram equalization (OHE) system used to segment the jet area. For a better execution of the work, threshold in HE was improved with the help of the krill herd optimization (KHO) strategy. With the MR quantification procedure, this segmented jet area was supported by the proximal isovelocity surface area (PISA); in this procedure, a few parameters in the segmentation were evaluated. From the results, this proposed methodology accomplishes better accuracy in the segmented and quantification method in contrast with the existing examination.
Collapse
|