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Barta LE, Holland HK, Costa HA, Rzepka JW, Almassi GH, Schena S, Pagel PS. Two Posterior Mitral Leaflets or a Feature of Degenerative Valve Disease That Contributes to Mitral Regurgitation? J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00320-8. [PMID: 37225549 DOI: 10.1053/j.jvca.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Lauren E Barta
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Hannah K Holland
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Costa
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jason W Rzepka
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Stefano Schena
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Kawano Y, Newell P, Harloff M, Hirji S, Percy E, Shah P, Kaneko T. Early outcomes of transatrial mitral valve replacement in severe mitral annular calcification. JTCVS Tech 2021; 9:49-56. [PMID: 34647059 PMCID: PMC8501192 DOI: 10.1016/j.xjtc.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Mitral valve replacement (MVR) in the setting of severe mitral annular calcification is a technically challenging operation with increased morbidity and mortality. Transseptal/apical transcatheter MVR (TMVR) in mitral annular calcification has emerged as an option for these cases, although may not be feasible due to anatomical reasons. Transatrial TMVR is a potential treatment option for this subgroup of patients. Methods Patients who underwent transatrial TMVR between June 2018 and November 2020 at a single institution were included. Patients were selected by a structural heart team based on their surgical risk, pattern of mitral annular calcification, risk of valve migration, left ventricular outflow obstruction, and paravalvular leak. Results A total of 11 patients underwent transatrial TMVR. Mean patient age was 74.2 years and mean Society of Thoracic Surgeons predicted risk of mortality score was 9.1%. All patients had the presence of both mitral stenosis and regurgitation—dominant etiology—was mitral stenosis in 81.2%, and mitral regurgitation in 18.8%. Among patients, 54.5% had a concomitant cardiac procedure. There was no in-hospital or 30-day mortality. Technical success defined by the Mitral Valve Academic Research Consortium was achieved in 90.9% of patients. Postoperative paravalvular leak was mild or less in all patients. Conclusions In this series, transatrial TMVR was shown to be a safe and effective treatment option for patients who are high risk for surgical MVR and should be in surgeons' armamentarium in the treatment of this high-risk patient population. Dissemination of safe technique will be critical in the successful conduct of this surgery.
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Affiliation(s)
- Yuji Kawano
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.,Division of Cardiac Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Edward Percy
- Division of Cardiac Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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Badhwar V. Commentary: Robotic approach to mitral annular calcification-Are we doing more with less, or is less still more? J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30443-8. [PMID: 32147206 DOI: 10.1016/j.jtcvs.2020.01.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
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Kassar M, Khalique OK, Pilgrim T, Reineke D, Carrel T, Windecker S, George I, Praz F. Surgical Transatrial Implantation of Transcatheter Heart Valves in Severe Mitral Annular Calcification. Interv Cardiol Clin 2019; 8:313-319. [PMID: 31078187 DOI: 10.1016/j.iccl.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Surgical mitral valve replacement in patients with severe annular calcification is a challenge for the cardiac surgeon. Surgical transatrial implantation of a transcatheter heart valve is an alternative for selected patients, in particular those at risk for obstruction of the left ventricular outflow tract or valve embolization. Herein, we review patient selection, surgical technique, and early outcomes after this novel hybrid procedure.
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Affiliation(s)
- Mohammad Kassar
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Omar K Khalique
- Structural Heart and Valve Center, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Medical Center, 630 West 168th Street, New York City, NY 10032, USA
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland
| | - Isaac George
- Department of Cardiothoracic Surgery, New York-Presbyterian Hospital-Columbia University Medical Center, 630 West 168th Street, New York City, NY 10032, USA
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Freiburgstrasse 4, Bern 3011, Switzerland.
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Transatrial implantation of a transcatheter heart valve for severe mitral annular calcification. J Thorac Cardiovasc Surg 2018; 156:132-142. [DOI: 10.1016/j.jtcvs.2018.03.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/09/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
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Ben-Avi R, Orlov B, Sternik L, Kogan A, Kuperstien R, Shalabi A, Ram E, Lipey A, Raanani E. Short- and long-term results after prosthetic mitral valve implantation in patients with severe mitral annulus calcification†. Interact Cardiovasc Thorac Surg 2017; 24:876-881. [PMID: 28329271 DOI: 10.1093/icvts/ivx043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate short- and long-term outcomes of a conservative decalcification approach in mitral valve replacement (MVR) surgery in the presence of mitral annulus calcification (MAC). METHODS Of the 1038 patients who underwent MVR, 133 (13%) had significant MAC with at least 30% of the annular circumference heavily calcified. In most patients, the surgical approach to MAC included conservative decalcification, supra-annular prosthesis implantation and insertion of a pericardial patch between the MV annulus and the prosthesis. These patients were matched by a propensity score to a group of patients who underwent MVR without MAC ( n = 118 in each group) and served as a control group. RESULTS There were 6 early deaths in each group with an overall mortality of 5% ( P = 0.90). Early complications included one major stroke in the non-MAC group and acute renal failure needing dialysis in 2 and 3 patients in the MAC and non-MAC groups, respectively. Mean follow-up was 55 ± 37 months and 99.1% complete. There were 38 (33%) and 33 (29%) late deaths with an estimated survival of 61% and 69% at 6 years in the MAC and non-MAC groups, respectively ( P = 0.55). At follow-up, functional class did not differ between groups ( P = 0.096). Mean echo follow-up time was 40 ± 35 months and was 83% complete. Freedom from moderate or severe mitral regurgitation was 95% and 98%, with an estimated freedom of 95% and 96% at 6 years ( P = 0.20), and mean gradient was 4.9 ± 2.3 mmHg and 5.2 ± 2.0 mmHg for MAC and non-MAC groups, respectively ( P = 0.58). CONCLUSIONS A conservative approach for dealing with MAC is suitable for the majority of patients. Early and late clinical and echocardiographic outcomes did not differ between the MAC and non-MAC patients, including freedom from early and late occurrence of MV prosthesis paravalvular leak.
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Affiliation(s)
- Ronny Ben-Avi
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Boris Orlov
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Alexander Kogan
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Rafael Kuperstien
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Amjad Shalabi
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Alexander Lipey
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
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Okamoto K, Tazume H, Koga A, Fukui T. Repair of left ventricular rupture in a patient with mitral annular calcification. Interact Cardiovasc Thorac Surg 2017; 24:972-973. [PMID: 28329152 DOI: 10.1093/icvts/ivx040] [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: 11/04/2016] [Accepted: 01/23/2017] [Indexed: 11/14/2022] Open
Abstract
Left ventricular free wall rupture is a complication following acute myocardial infarction or mitral valve replacement. We report the case of a 56-year-old female patient with idiopathic left ventricular rupture confirmed by contrast-enhanced computed tomography (CT). CT also showed no coronary artery obstruction and severe mitral annular calcification. Left ventricular rupture was successfully repaired internally with bovine pericardium. Mitral valve replacement with annular decalcification was also performed.
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Affiliation(s)
- Ken Okamoto
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Hirokazu Tazume
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ayumi Koga
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
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