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Wisniewski AM, Sutherland GN, Strobel RJ, Young A, Norman AV, Quader M, Yount KW, Teman NR. Mitral valve repair in a regional quality collaborative: Respect or resect? JTCVS Tech 2024; 24:66-75. [PMID: 38835591 PMCID: PMC11145075 DOI: 10.1016/j.xjtc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/11/2023] [Accepted: 01/01/2024] [Indexed: 06/06/2024] Open
Abstract
Objective Mitral valve repair is the gold standard for treatment of mitral regurgitation, but the optimal technique remains debated. By using a regional collaborative, we sought to determine the change in repair technique over time. Methods We identified all patients undergoing isolated mitral valve repair from 2012 to 2022 for degenerative mitral disease. Those with endocarditis, transcatheter repair, or tricuspid intervention were excluded. Continuous variables were analyzed via Wilcoxon rank sum, and categorical variables were analyzed via chi-square testing. Results We identified 1653 patients who underwent mitral valve repair, with 875 (59.2%) undergoing a no resection repair. Over the last decade, there was no significant trend in the proportion of repair techniques across the region (P = .96). Those undergoing no resection repairs were more likely to have undergone prior cardiac surgery (5.0% vs 2.2%, P = .002) or minimally invasive approaches (61.4% vs 24.7%, P < .001) with similar predicted risk of mortality (median 0.6% vs 0.6%, P = .75). Intraoperatively, no resection repairs were associated with longer bypass times (140 [117-167] minutes vs 122 [91-159] minutes, P < .001). Operative mortality was similar between both groups (1.1% vs 1.0%, P = .82), as were other postoperative outcomes. Anterior leaflet prolapse (odds ratio, 11.16 [6.34-19.65], P < .001) and minimally invasive approach (odds ratio, 6.40 [5.06-8.10], P < .001) were most predictive of no resection repair. Conclusions Despite minor differences in operative times, statewide over the past decade there remains a diverse mix of both classic "resect" and newer "respect" strategies with comparable short-term outcomes and no major timewise trends. These data may suggest that both approaches are equivocal.
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Affiliation(s)
- Alex M. Wisniewski
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | | | - Raymond J. Strobel
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Andrew Young
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Anthony V. Norman
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Mohammed Quader
- Division of Thoracic and Cardiovascular Surgery, Virginia Commonwealth University, Richmond, Va
| | - Kenan W. Yount
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Nicholas R. Teman
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
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Saitto G, Mariangela D, De Luca L, Lio A, Ranocchi F, Davoli M, Musumeci F. Long-term mitral valve repair outcomes and hospital volume: 15 years' analysis of an administrative dataset. J Cardiovasc Med (Hagerstown) 2024; 25:23-29. [PMID: 38051649 DOI: 10.2459/jcm.0000000000001567] [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: 12/07/2023]
Abstract
BACKGROUND Procedural volume has been documented as an important contributor to operative outcomes for most complex surgical procedures. Mitral valve repair (MVRep) has been associated with excellent results, and it is increasingly adopted in many cardiac surgical centers. We sought to investigate if procedural volume is associated with better clinical long-term outcomes after MVRep. METHODS We analyzed the 10-year outcomes after MVRep by procedural volume for each cardiac surgery center in an Italian Region, Lazio, during the last 15 years, using a regional administrative dataset. RESULTS Between 2006 and 2020, 4961 patients were treated in seven cardiac surgery centers for an isolated mitral valve surgery (2677 underwent MVRep). At multivariate analysis, mitral valve replacement (MVR) (vs. MVRep) resulted one of the independent predictors of 30-day mortality [adjusted odds ratio (OR) 3.40; 95% confidence interval (CI) 1.96-5.90; P < 0.0001]. Notably, a clear association between hospital volume of mitral valve surgery (>40 per year) and high rate of MVRep (>50%) was found. At 10 years, the incidence of mortality and the rate of death and rehospitalization for heart failure after MVRep were significantly lower in high-volume vs. low-volume hospitals. CONCLUSION Our data suggest that hospital volume is associated with a high rate of MVRep and long-term benefits in terms of mortality and recurrence of heart failure.
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Affiliation(s)
- Guglielmo Saitto
- Cardiac Surgery and Heart Transplantation Unit, San Camillo Hospital
| | | | - Leonardo De Luca
- Department of Cardiosciences, Division of Cardiology, San Camillo Hospital, Rome, Italy
| | - Antonio Lio
- Cardiac Surgery and Heart Transplantation Unit, San Camillo Hospital
| | - Federico Ranocchi
- Cardiac Surgery and Heart Transplantation Unit, San Camillo Hospital
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1
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Burns DJ, Rajeswaran J, Desai MY, Gillinov AM, Hodges K, Roselli EE, Vargo PR, Svensson LG. Survival and repair durability in patients undergoing concomitant aortic valve reimplantation and mitral valve repair. JTCVS Tech 2023; 22:159-168. [PMID: 38152191 PMCID: PMC10750876 DOI: 10.1016/j.xjtc.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 12/29/2023] Open
Abstract
Objective The study objective was to determine repair durability and survival in patients with and without connective tissue disorders undergoing concomitant aortic valve reimplantation and mitral valve repair. Methods From 2002 to 2019, 68 patients underwent concomitant aortic valve reimplantation and mitral valve repair, including 27 patients with Marfan syndrome (39.7%). Follow-up echocardiograms were analyzed using nonlinear multiphase mixed-effects cumulative logistic regression. The regurgitation grade over time was estimated by averaging patient-specific profiles. Survival and freedom from reoperation were estimated by the Kaplan-Meier method. Results At 7 years, 11% of patients had aortic insufficiency greater than mild (severe in 2 patients). There was no difference in greater than mild aortic insufficiency between patients with or without Marfan syndrome (P = .37). Twenty percent of patients had progressed to mitral regurgitation greater than mild (severe in only 1 patient). The prevalence of recurrent mitral regurgitation was higher in those without Marfan syndrome, with greater than mild regurgitation increasing to 24% by 2 years and remaining constant thereafter (P = .04). Freedom from reoperation on the aortic valve or mitral valve was 83% at 10 years and did not differ between Marfan syndrome groups. There were no cases of perioperative mortality. Survival at 5 and 10 years was 94% and 87%, respectively, without a difference between those with and without Marfan syndrome. Conclusions Patients can undergo a total repair strategy using combined aortic valve reimplantation and mitral valve repair procedures with a low risk of mortality and complications, with favorable freedom from both residual valve regurgitation and reoperation.
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Affiliation(s)
- Daniel J.P. Burns
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | | | - A. Marc Gillinov
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Hodges
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Eric E. Roselli
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Patrick R. Vargo
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Lars G. Svensson
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Del Forno B, Tavana K, Ruffo C, Carino D, Lapenna E, Ascione G, Bisogno A, Belluschi I, Scarale MG, Nonis A, Monaco F, Alfieri O, Castiglioni A, Maisano F, De Bonis M. Neochordae implantation versus leaflet resection in mitral valve posterior leaflet prolapse and dilated left ventricle: a propensity score matching comparison with long-term follow-up. Eur J Cardiothorac Surg 2023; 64:ezad274. [PMID: 37551944 PMCID: PMC10693437 DOI: 10.1093/ejcts/ezad274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 07/22/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Uncorrected severe mitral regurgitation (MR) due to posterior prolapse leads to left ventricular dilatation. At this stage, mitral valve repair becomes mandatory to avoid permanent myocardial injury. However, which technique among neochoardae implantation and leaflet resection provides the best results in this scenario remains unknown. METHODS We selected 332 patients with left ventricular dilatation and severe degenerative MR due to posterior leaflet (PL) prolapse who underwent neochoardae implantation (85 patients) or PL resection (247 patients) at our institution between 2008 and 2020. A propensity score matching analysis was carried on to decrease the differences at baseline. RESULTS Matching yielded 85 neochordae implantations and 85 PL resections. At 10 years, freedom from cardiac death and freedom from mitral valve reoperation were 92.6 ± 6.1% vs 97.8 ± 2.1% and 97.7 ± 2.2% vs 95 ± 3% in the neochordae group and in the PL resection group, respectively. The MR ≥2+ recurrence rate was 23.9 ± 10% in the neochordae group and 20.8 ± 5.8% in the PL resection group (P = 0.834) at 10 years. At the last follow-up, the neochordae group showed a higher reduction of left ventricular end-diastolic diameter (44 vs 48 mm; P = 0.001) and a better ejection fraction (60% vs 55%; P < 0.001) compared to PL resection group. CONCLUSIONS In this subgroup of patients, both neochordae implantation and leaflet resection provide excellent durability of the repair in the long term. Neochordae implantation might have a better effect on dilated left ventricle.
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Affiliation(s)
- Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Kevin Tavana
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Ruffo
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Carino
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Arturo Bisogno
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Giovanna Scarale
- University Centre of Statistics in Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Nonis
- University Centre of Statistics in Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Baikoussis NG, Koumallos N, Aggeli Κ. Mitral valve repair with the use of the "Memo 3D ReChord" ring. J Cardiothorac Surg 2023; 18:151. [PMID: 37069590 PMCID: PMC10111840 DOI: 10.1186/s13019-023-02200-w] [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: 11/16/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND From a variety of ring types, semirigid ring is more preferred for mitral annuloplasty during mitral valve repair particularly in patients whose native mitral saddle shape annulus is well maintained. During mitral annuloplasty artificial chord implantation with the appropriate neochord length is surgically challenging. We present our experience of using the Memo 3D ReChord, a semirigid ring with additional chordal guiding system for mitral valve repair. PATIENTS AND METHODS From September 2018 to February 2020, we successfully treated ten patients with severe (4+/4+) degenerative mitral valve regurgitation due to posterior leaflet prolapse with chordal rupture with the implantation Memo 3D ReChord and neo-chords. RESULTS We implanted from one to three neo-chords and always a ring in our patients. None of the patients had any residual mitral valve regurgitation at the end of the repair and on their discharge evaluated through transesophageal and transthoracic echocardiography respectively. There was no mortality at 30-days or on midterm follow-up. During the 3-month follow-up no regurgitation was noticed either. We included in our study only the patients successfully treated. We also used it in two patients, who underwent valve replacement during the same operation due to mild to moderate mitral valve regurgitation. CONCLUSIONS This, in our knowledge, is the first Greek series of the implantation of the Memo 3D Rechord. The initial excellent results give us the enthusiasm to continue while long-term results and the durability of this technique are necessary to establish this semirigid annuloplastic ring in our every-day practice.
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Affiliation(s)
- Nikolaos G Baikoussis
- Cardiac Surgery Department, Ippokrateio General Hospital of Athens, 114 Vasilissis Sofias Avenue, Athens, 11527, Greece.
| | - Nikolaos Koumallos
- Cardiac Surgery Department, Ippokrateio General Hospital of Athens, 114 Vasilissis Sofias Avenue, Athens, 11527, Greece
| | - Κonstantina Aggeli
- 1st Department of Cardiology, Ippokrateio General Hospital of Athens. Athens University, School of Medicine, Athens, Greece
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Brown CR, Sperry AE, Cohen WG, Han JJ, Khurshan F, Groeneveld P, Desai N. Risk of Stroke and Major Bleeding With Vitamin K Antagonist Use After Mitral Valve Repair. Ann Thorac Surg 2023; 115:957-964. [PMID: 36223805 DOI: 10.1016/j.athoracsur.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/22/2022] [Accepted: 09/26/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Guidelines are discordant on the use of a vitamin K antagonist (VKA) after mitral valve repair (MVr) to reduce the risk of cerebral embolic events. We performed an observational study among patients who underwent a MVr, without perioperative atrial fibrillation, to determine the risk of cerebral ischemic and major bleeding events with or without VKA. METHODS From 2004 to 2016, we included patients who underwent MVr, using a national administrative claims database. Those with preoperative atrial fibrillation and anticoagulant use were excluded. Patients were stratified based on the presence of a VKA. Inverse probability weighting with a Cox proportional hazard model was used. RESULTS After MVr, 754 patients were discharged on VKA and 1462 on no-VKA. We found no difference in the cumulative incidence for embolic stroke at 180 days (VKA: 2.21% vs no-VKA: 1.50%; hazard ratio, 1.35; P = .38). However, VKA patients had a significantly increased risk for any-cause major bleeding events at 180 days (VKA: 8.58% vs no-VKA: 4.21%; hazard ratio, 2.09; P < .001). VKA patients also had increased need for a pericardiocentesis/pericardial window at 30 days after discharge (VKA: 1.13% vs no-VKA: 0.37%; hazard ratio, 3.88; P = .025). CONCLUSIONS Our study suggests that VKA after MVr does not reduce the risk of cerebral embolic events but is associated with an increased risk of major bleeding events.
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Affiliation(s)
- Chase R Brown
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Alexandra E Sperry
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William G Cohen
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason J Han
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fabliha Khurshan
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Groeneveld
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Internal Medicine, Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Nimesh Desai
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Alfieri O, De Bonis M, Lapenna E, Maisano F. The great performance of the edge-to-edge repair in the anterior leaflet prolapse: a surprise? EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2023; 63:7009230. [PMID: 36715633 DOI: 10.1093/ejcts/ezad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Delgado-Ramis L, Llorens A, Berastegui E, Cediel G, Fernandez C, Muñoz C. Reparación de la insuficiencia mitral por prolapso del velo posterior. ¿Qué ha cambiado? CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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9
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Newell P, Percy E, Hirji S, Harloff M, McGurk S, Malarczyk A, Chowdhury M, Yazdchi F, Kaneko T. Outcomes of Mitral Valve Repair Among High- and Low-Volume Surgeons Within a High-Volume Institution. Ann Thorac Surg 2023; 115:412-419. [PMID: 35779603 DOI: 10.1016/j.athoracsur.2022.05.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/02/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Volume-outcome relationships have been described for mitral valve repair at the institution and surgeon level. We aimed to assess whether this relationship is mitigated at high-volume (HV) mitral repair centers between HV and low-volume (LV) surgeons. METHODS All mitral repair cases at an HV mitral center (mean, 192 annual repairs) from 1992 to 2018 were considered. Cases with concomitant procedures other than tricuspid and atrial fibrillation procedures were excluded. Surgeons who performed ≥25 repairs per year were considered HV. The primary outcome was operative mortality; secondary outcomes were operative complications, long-term mortality, and reoperation. RESULTS In total, 2653 mitral repairs from 19 surgeons were included. The mean age of the patients in the HV and LV groups was 59.6 years and 61.8 years, respectively (P = .005), with no difference in other baseline characteristics. HV surgeons had significantly shorter median aortic cross-clamp times (80 vs 87 minutes; P < .001) compared with LV surgeons; however, there was no significant difference in operative mortality (0.9% vs 1.6%; P = .19), reoperation, perioperative complications, or length of stay. LV surgeons had higher repair conversion to replacement than HV surgeons did (9.0% vs 3.4%; P < .001). In the risk-adjusted analyses, surgeon volume group did not have an impact on longitudinal survival or reoperation. CONCLUSIONS At an HV mitral repair institution, LV surgeons appear to have short- and long-term outcomes similar to those of HV surgeons despite increased conversion rates. These findings suggest that institutional volume may mitigate the surgeon volume outcome. However, complex repairs may benefit from referral to HV surgeons, given the lower conversion rate.
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Affiliation(s)
- Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward Percy
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Cardiac Surgery, University of British Columbia, Vancouver, British Columbia
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Farhang Yazdchi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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10
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Reparación valvular mitral por prolapso del velo posterior: resultados y seguimiento a 20 años. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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11
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Mastro F, Angelini A, D'Onofrio A, Gerosa G. A journey from resect to respect to restore: aiming at optimal physiological surgical mitral valve repair. J Cardiovasc Med (Hagerstown) 2023; 24:1-11. [PMID: 36484280 DOI: 10.2459/jcm.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The concept of 'repairing' a degenerated mitral valve in order to restore the native competence means achieving the best physiological result coupled with the least invasive approach: this represents an interesting challenge for cardiac surgeons. The evolution of cardiac surgery through the years has involved techniques and technologies in every field of interest. From 'resect', to 'respect', to 'restore': the micro-invasive approach based on Neochord implant implies a transapical beating heart surgery which is based on the concept of implanting artificial chordae, preserving the physiological dynamics of the mitral annulus and avoiding the disadvantages of cardiopulmonary bypass and cardioplegic arrest of the heart.
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Affiliation(s)
- Florinda Mastro
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
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Carpenito M, Gelfusa M, Mega S, Cammalleri V, Benfari G, De Stefano D, Ussia GP, Tribouilloy C, Enriquez-Sarano M, Grigioni F. Watchful surgery in asymptomatic mitral valve prolapse. Front Cardiovasc Med 2023; 10:1134828. [PMID: 37123469 PMCID: PMC10130568 DOI: 10.3389/fcvm.2023.1134828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
The most common organic etiology of mitral regurgitation is degenerative and consists of mitral valve prolapse (MVP). Volume overload because of mitral regurgitation is the most common complication of MVP. Advocating surgery before the consequences of volume overload become irreparable restores life expectancy, but carries a risk of mortality in patients who are often asymptomatic. On the other hand, the post-surgical outcome of symptomatic patients is dismal and life expectancy is impaired. In the present article, we aim to bridge the gap between these two therapeutic approaches, unifying the concepts of watchful waiting and early surgery in a "watchful surgery approach".
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Affiliation(s)
- Myriam Carpenito
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Martina Gelfusa
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Simona Mega
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Valeria Cammalleri
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico De Stefano
- Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Correspondence: Francesco Grigioni
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Stefanelli G. Different methods of neo-chordal fixation to the papillary muscle: Do they have any influence on the chordal biomechanical characteristics? J Card Surg 2022; 37:4416-4417. [PMID: 36229972 DOI: 10.1111/jocs.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023]
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14
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Dreyfus GD, Dulguerov F. Respect or resect in Barlow disease. J Card Surg 2022; 37:4047-4052. [PMID: 36183379 DOI: 10.1111/jocs.16993] [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: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 01/07/2023]
Abstract
Mitral regurgitation in Barlow disease may still be challenging to be repaired. Most often it involves the posterior leaflet. Many techniques and concepts are currently available; the main goal being to restore a good surface of coaptation. Basic principles such as thorough analysis is still required whatever the approach to assess excess tissue height, width, and prolapse. Nowadays it seems that two different ways of treating mitral prolapse coexist: the nonresection one and the resection one. Both will be discussed and analyzed. Similarly, the use of artificial chordae seems to have a preponderant role to support the free edge and correct a prolapse. Native secondary chord transfer are easy and reliable but seem abandoned by many. Anterior leaflet prolapse is also dealt with and fewer options are available to address this leaflet. Then commissural prolapse is mentioned. It is an important area of the valve which should deserve better treatment than commissuroplasty. Finally, a special entity will be described; mitro annular disjunction. The approach is not or no longer an issue as only good long-term results are important in an era where percutaneous therapy is the only noninvasive technique.
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Affiliation(s)
- Gilles D Dreyfus
- Cardiac Surgery, Hopital Europeen Georges Pompidou, Paris, Ile de France, 75015, France
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15
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Burns DJP, Angelini GD, Benedetto U, Caputo M, Ciulli F, Vohra HA. Early mortality and neurologic outcomes following mitral valve surgery in the very elderly. J Card Surg 2022; 37:4510-4516. [PMID: 36335608 DOI: 10.1111/jocs.17098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Valve repair is the gold standard for treatment of degenerative mitral valve disease. As the population ages, patients undergoing valve degeneration and therefore considered for mitral valve surgery will naturally be getting older. We sought to evaluate whether mitral repair retained a survival advantage over replacement in patients ≥80 years old. METHODS A retrospective cohort study was performed using data acquired from the United Kingdom National Adult Cardiac Surgery Audit for the outcomes of in-hospital mortality and postoperative cerebrovascular event (CVA). Individual multivariable logistic regression models were created to investigate adjusted associations between these outcomes and type of mitral valve operation, repair or replacement. Additionally, associations between the individual model parameters and in-hospital mortality and CVA were investigated. RESULTS A total of 1140 patients underwent mitral repair (66.4%, median age 82.3), and 577 patients underwent mitral replacement (33.6%, median age 82.1). The overall age range was 80-92. The incidence of in-hospital mortality favored the repair group (4.4% vs. 8.3%, p = .001). Multivariable logistic regression modeling demonstrated an increased adjusted odds of in-hospital mortality for mitral valve replacement (MVR) (odd ratio [OR]: 2.01, 1.15-3.50, p = .01). The only other parameter associated with an increased adjusted odds of in-hospital mortality was postoperative dialysis (OR: 14.2, 7.67-26.5, p < .001). There was not a demonstrated association between MVR and perioperative CVA (OR: 1.11, 0.49-2.4, p = .8). CONCLUSIONS In patients ≥80 years old, mitral valve repair (MVr) was shown to be associated with a decreased adjusted odds of mortality, with a null association with CVA. These results suggest that, if feasible, MVr should remain the preferred management strategy, even in the very elderly.
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Affiliation(s)
- Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Franco Ciulli
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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16
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Liu X, Miao Q, Liu X, Zhang C, Ma G, Liu J. Repair versus replacement for active endocarditis of the mitral valve: 9 years of experience. J Card Surg 2022; 37:3713-3719. [PMID: 36073065 DOI: 10.1111/jocs.16904] [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: 04/20/2022] [Revised: 05/24/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM To determine the factors contributing to successful mitral valve repair (MVP) and to discuss the effect of complex techniques on the durability of MVP for active infective endocarditis (IE) affecting the mitral valve. METHODS One hundred and eighty-seven patients were enrolled; 39.6% underwent mitral valve replacement (MVR) and 60.4% underwent MVP. We used logistic regression to identify influencing factors of the choice of surgical technique. The results were compared between groups and subgroups after propensity score matching (PSM). RESULTS Risk factors for MVR included poor valve quality (odds ratio [OR] 23.3, p = .001), a large defect after debridement (OR 16.4, p < .001), and heavy valve infection (OR 3.7, p = .027). After PSM, we did not find a significant difference in the frequency of major postoperative complications or the in-hospital or postdischarge death rate. The reintervention rate for MVP was significantly higher than that for MVR (p = .047). Subgroup analysis found a significant relationship between the use of a complex repair technique and the need for reoperation (p = .020). CONCLUSIONS The choice of valve repair or replacement for patients with active IE affecting the mitral valve was influenced by the intraoperative characteristics of the infected valve rather than the severity of systemic infection or overall health status. The choice of surgical treatment strategy had no effect on major postoperative complications, in-hospital mortality, or medium-term survival. However, the medium-term durability of MVP was poorer than that of MVR. The use of the patch technique for free margins or extensive leaflet defects was associated with a need for reintervention.
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Affiliation(s)
- XinPei Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Dongcheng, China
| | - Qi Miao
- Peking Union Medical College Hospital, Dongcheng, China
| | - XingRong Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Dongcheng, China
| | - ChaoJi Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Dongcheng, China
| | - GuoTao Ma
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Dongcheng, China
| | - JianZhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Dongcheng, China
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17
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Sidiki AI, Akulova AA, Hussein MH, Al-Ariki MK, Donsov VV, Iluhin MA, Limeshkin AA, Ananko VA. Physio and Physio II rings: beyond the annular physiology. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:529-535. [PMID: 35848871 DOI: 10.23736/s0021-9509.22.11874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Engineering of the Carpentier-Edwards Physio (PR-I) and Physio II (PR-II) rings (Edwards Lifesciences Corp., Irvine, CA, USA) combines flexibility with remodeling. PR-II is considered an improvement of PR-I, as it boasts of an improved shape, a double saddle, and a sewing cuff that reduces tension on sutures. Beyond the superior effect of the PR-II on the annular physiology, it has not been proven to be clinically better than the PR-I. This study compares the long-term clinical outcomes of MV repair for degenerative disease with these rings. METHODS From 2004 to 2020, MV repair with Physio ring annuloplasty (group PR-I) was performed in 231 patients, and with Physio-II ring annuloplasty (group PR-II) in 255 patients. A propensity score-matching analysis was used to pair 104 in each group. Primary outcome was recurrent MR≥3 and secondary outcomes were long-term survival, cardiac death, and MV-related events (MVREs). The 15-year follow-up data were complete in 97.3% of patients. RESULTS There were no differences in 15-year freedom from recurrent MR (P=0.721), survival and cardiac death between the matched groups (P=0.693 and P=0.135, respectively). MVREs, including cardiac death, pacemaker implantation, thromboembolism, bleeding, and reoperation were also similar between the matched groups (P=0.603). However, 5-year recurrent MR was significantly higher in PR-I than in PR-II (P=0.010). Multivariate analysis showed Barlow's disease and preoperative MR≥3 as risk factors for late MR recurrence. CONCLUSIONS Type of annuloplasty rings did not influence long-term clinical outcomes. Better annular dynamics seen in PR-II annuloplasty does not translate into superior freedom from recurrent MR.
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Affiliation(s)
- Abubakari I Sidiki
- Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia -
| | - Anastasia A Akulova
- Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
| | - Marina H Hussein
- Department of Cardiothoracic Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
| | - Malik K Al-Ariki
- Department of Surgery, People's Friendship University of Russia (RUDN-University), Moscow, Russia
| | - Vladislav V Donsov
- Department of Cardiac Surgery, M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - Mikhail A Iluhin
- Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia
| | - Andrei A Limeshkin
- Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia
| | - Vadim A Ananko
- Cardiovascular Center, FSBI 3 Central Vishnevsky Hospital, Moscow, Russia
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18
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Castaño M, Maiorano P, Castillo L, Laguna G, Martín-Gutiérrez E, Gualis Cardona J, Guevara A. Reparación mitral en prolapso de velo anterior: técnicas, indicaciones y resultados. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Kawajiri H, Schaff HV, Dearani JA, Daly RC, Greason KL, Arghami A, Rowse PG, Viehman JK, Lahr BD, Gallego-Navarro C, Crestanello JA. Clinical Outcomes of Mitral Valve Repair for Degenerative Mitral Regurgitation in Elderly Patients. Eur J Cardiothorac Surg 2022; 62:6582572. [PMID: 35532171 DOI: 10.1093/ejcts/ezac299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/21/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study analyzes the safety and outcomes of mitral valve repair for degenerative mitral valve regurgitation in patients 75 years of age or older. METHODS We retrospectively reviewed the clinical results of 343 patients aged ≥75 years who underwent mitral valve repair for degenerative mitral valve regurgitation as a primary indication between January 1998 and June 2017. RESULTS The median (IQR) age of the patients was 79.4 (76.9, 82.9) years, and 132 (38.5%) patients were women. Concomitant procedures were performed in 123 patients: tricuspid surgery in 68 (19.8%) and a maze procedure or pulmonary vein isolation in 55 (16.0%). Operative mortality was 1.2%. Operative complications included atrial fibrillation in 37.9%, prolonged ventilation in 7.0%, pacemaker implantation in 3.8, renal failure requiring dialysis in 1.5, and troke in 3 (0.9%). Median follow-up was 7.4 years (IQR, 3.5-14.1 years). The cumulative incidence rates of mitral valve reoperation were 2.2%, 3.2%, and 3.2% at 1, 5, and 10 years, respectively. Overall survival at 1, 5, and 10 years were 95%, 83%, and 51%, respectively. Older age, smoking, and over and under weight were associated with increased risk of mortality, while higher left ventricular ejection fraction and hypertension were associated with reduced risk. CONCLUSIONS Mitral valve repair in elderly patients can be accomplished with low operative mortality and complications. Mitral valve repair in the elderly remains the preferred treatment for degenerative mitral regurgitation.
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Affiliation(s)
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Philip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jason K Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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20
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Filsoufi F, Carpentier A. Principles of Carpentier's Reconstructive Surgery in Degenerative Mitral Valve Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Celmeta B, Bisogno A, Glauber M, Miceli A. Respect or resect? Patient tailored approach. Trends Cardiovasc Med 2022; 33:240-241. [PMID: 35231613 DOI: 10.1016/j.tcm.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
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22
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D’Onofrio A, Mastro F, Nadali M, Fiocco A, Pittarello D, Aruta P, Evangelista G, Lorenzoni G, Gregori D, Gerosa G. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6540696. [PMID: 35234902 PMCID: PMC9252130 DOI: 10.1093/icvts/ivac053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/31/2022] [Accepted: 02/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- A D’Onofrio
- Division of Cardiac Surgery, University of Padova, Padova, Italy
- Corresponding author. Division of Cardiac Surgery, University of Padova, Via Giustiniani 2, Padova 35178, Italy. Tel: +39-0498212410; e-mail: (A. D’Onofrio)
| | - F Mastro
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - M Nadali
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - A Fiocco
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - D Pittarello
- Division of Anesthesiology, University of Padova, Padova, Italy
| | - P Aruta
- Division of Cardiology, Echo Lab, University of Padova, Padova, Italy
| | - G Evangelista
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - G Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - D Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - G Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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23
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Burns DJ, Suri RM, Gillinov AM. Targeted triangular resection for repair of degenerative mitral valve disease. JTCVS Tech 2021; 10:47-52. [PMID: 34977704 PMCID: PMC8691865 DOI: 10.1016/j.xjtc.2021.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
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24
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Yost CC, Rosen JL, Guy TS. Commentary: Pushing the limits: Robotic mitral valve surgery in cardiac dextroversion. JTCVS Tech 2021; 11:17-18. [PMID: 35169723 PMCID: PMC8828920 DOI: 10.1016/j.xjtc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
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25
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Brescia AA, Watt TMF, Rosenbloom LM, Murray SL, Wu X, Romano MA, Bolling SF. Anterior versus posterior leaflet mitral valve repair: A propensity-matched analysis. J Thorac Cardiovasc Surg 2021; 162:1087-1096.e3. [PMID: 32305185 PMCID: PMC7483316 DOI: 10.1016/j.jtcvs.2019.11.148] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/09/2019] [Accepted: 11/23/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Mitral valve repair is superior to replacement for degenerative disease, but long-term outcomes of anterior versus posterior leaflet repair remain poorly defined. We propensity matched anterior and posterior repairs to compare long-term outcomes. METHODS Patients undergoing first-time degenerative mitral repair between 1992 and 2018 were identified. Primary outcome was overall survival. Secondary outcomes were postprocedural residual mitral regurgitation and reoperation. From 1025 patients, 1:1 propensity score matching was performed, yielding 309 anterior (isolated anterior = 85, bileaflet = 224) and 309 isolated posterior repairs. RESULTS Age was 58 ± 15 years, ejection fraction was 57% ± 10%, and matched groups were well balanced. Anterior repairs had longer bypass (122 ± 53 vs 109 ± 43 minutes, P = .001) and crossclamp (94 ± 44 vs 85 ± 62 minutes, P = .033) times. Mean residual mitral regurgitation grade was 0.44 (95% confidence interval, 0.24-0.65) for anterior repair and 0.30 (95% confidence interval, 0.13-0.47) for posterior repair (P = .31). Overall, 92% (569/618) of matched patients had no residual mitral regurgitation, with no differences in mitral regurgitation grade between groups (P = .77). Survival did not differ between anterior (10 years: 72% ± 7%; 15 years: 63% ± 7%) and posterior (10 years: 74% ± 7%; 15 years: 60% ± 8%) groups (log-rank P = .93). Linearized incidence of reoperation was 0.62% per patient-year, including 0.74% for anterior and 0.48% for posterior repairs. Cumulative incidence of reoperation at 15 years was 7.5% after anterior repair and 4.9% after posterior repair (Gray's test P = .26). CONCLUSIONS No long-term survival or reoperation difference was found between posterior and anterior repair. On the basis of these findings, surgeons at centers of excellence should aim for repair of both anterior and posterior leaflet pathology with the same decision-making threshold over valve replacement for degenerative mitral disease.
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Affiliation(s)
| | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Liza M Rosenbloom
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Shannon L Murray
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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26
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Belluschi I, Miceli A. Commentary: Is There a Second Chance to Treat Mitral Disease After Irradiation? Semin Thorac Cardiovasc Surg 2021; 34:1206-1207. [PMID: 34500072 DOI: 10.1053/j.semtcvs.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy.
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Reshmi JL, Gopan G, Varma PK, Thushara M, Sudheer VB, Madavathazhathil RG, Jayant A. Transesophageal Echocardiographic Assessment of the Repaired Mitral Valve: A Proposed Decision Pathway. Semin Cardiothorac Vasc Anesth 2021; 26:68-82. [PMID: 34470530 DOI: 10.1177/10892532211036655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The indications for mitral valve repair extend across the entire spectrum of degenerative mitral valve disease, ranging from fibroelastic degeneration to Barlow's disease. Collaboration between the surgeon and anesthesiologist is essential for ensuring optimal results. Echocardiographic assessment of the repair can be challenging but is essential to the success of the procedure, as even mild residual mitral regurgitation can portend poor patient outcomes. In addition to determining the severity of residual regurgitation, the anesthesiologist must elucidate the mechanism of disease in order to inform appropriate re-intervention measures. Finally, there are unique complications of mitral valve surgery for the anesthesiologist to understand and assess by echocardiography. This review describes a systematic pathway for a comprehensive intraoperative assessment of the mitral valve following surgical repair.
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Affiliation(s)
- Jose Liza Reshmi
- Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
| | - G Gopan
- Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
| | | | - Madathil Thushara
- Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
| | - Vanga Babu Sudheer
- Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
| | | | - Aveek Jayant
- Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India
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28
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Blanc A, Lairez O, Cariou E, Fournier P, Poenar AM, Marcheix B, Cron C, Grunenwald E, Porterie J, Labaste F, Elbaz M, Galinier M, Carrié D, Lavie-Badie Y. Participating in Sports After Mitral Valve Repair for Primary Mitral Regurgitation: A Retrospective Cohort Study. Clin J Sport Med 2021; 31:414-422. [PMID: 31809282 DOI: 10.1097/jsm.0000000000000769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Participating in either competitive or leisure sports is restrictive after surgical mitral valve repair (MVR). In this study, we examine the impact of sports on outcomes after MVR. DESIGN Retrospective cohort study. SETTING Patients aged 18 to 65 years who underwent a first-time MVR for primary mitral regurgitation (MR) in a tertiary care center. PATIENTS One hundred twenty-one consecutive patients were included in the study. The exclusion criteria were as follows: other concomitant procedures, early perioperative death or repeat intervention, noncardiac death or endocarditis during follow-up, and general contraindications for normal physical activity. ASSESSMENT OF RISK FACTORS Participation in sports was quantified by the number of hours per week during the past 6 months, classified according to the Mitchell classification and assessed with the International Physical Activity Questionnaire (IPAQ) short form. MAIN OUTCOME MEASURES The primary composite endpoint was MVR failure defined as MR grade ≥2 or mean transmitral gradient ≥8 mm Hg, signs and symptoms of heart failure, or late-onset postoperative AF (>3 months). RESULTS The mean age was 50 ± 11 years, and there were 85 (71%) men. The median follow-up was 34 months [interquartile range (IQR): 20-50]. Fifty-six (46%) patients participated in sports regularly (median of 3 h/wk; IQR: 2-5). Twenty (17%) patients reached the primary composite endpoint with no correlation with participation in sports (P = 0.537), IPAQ categories (P = 0.849), in any of the Mitchell classification subgroups and a high level of participation in sports ≥6 hours (P = 0.679). CONCLUSIONS Sports seem to be unrelated to the worst outcome after MVR.
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Affiliation(s)
- Adrien Blanc
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, France
- Medical School of Rangueil, Paul Sabatier University, Toulouse, France
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
| | - Eve Cariou
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Medical School of Rangueil, Paul Sabatier University, Toulouse, France
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
| | - Ana Maria Poenar
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
| | - Bertrand Marcheix
- Medical School of Rangueil, Paul Sabatier University, Toulouse, France
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
- Department of Cardiac Surgery, University Hospital of Rangueil, Toulouse, France
| | - Christophe Cron
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
- Department of Cardiac Surgery, University Hospital of Rangueil, Toulouse, France
| | - Etienne Grunenwald
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
- Department of Cardiac Surgery, University Hospital of Rangueil, Toulouse, France
| | - Jean Porterie
- Medical School of Rangueil, Paul Sabatier University, Toulouse, France
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
- Department of Cardiac Surgery, University Hospital of Rangueil, Toulouse, France
| | - François Labaste
- Department of Cardiac Surgery, University Hospital of Rangueil, Toulouse, France
- Department of Anesthesiology, University Hospital of Rangueil, Toulouse, France ; and
| | - Meyer Elbaz
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Medical School of Rangueil, Paul Sabatier University, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Medical School of Rangueil, Paul Sabatier University, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Medical School of Purpan, Paul Sabatier University, Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, France
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
- Heart Valve Center, University Hospital of Rangueil, Toulouse, France
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Jabagi H, Chan V, Ruel M, Mesana TG, Boodhwani M. Aortic valve repair decreases risks of VRE in AI at 10 years: a propensity score-matched analysis. Ann Thorac Surg 2021; 113:1469-1475. [PMID: 34228974 DOI: 10.1016/j.athoracsur.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/14/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic valve repair(AVr) has emerged as a feasible and effective alternative to replacement(AVR) in patients with aortic insufficiency(AI), however, little data exists comparing outcomes. Thus, the objective of this study was to compare early and long-term valve related complications between AVr and AVR in the treatment of AI. METHODS Single centre, retrospective study of all patients(n=417) undergoing AVr (n=264) or AVR (n=153) for primary AI. Propensity-matching using a 1:1 greedy matching algorithm identified 140 patients using six covariates (age, gender, LV function, size, presence of aortopathy, and urgency of operation) for comparison. The primary outcome was a composite of all valve-related events(VRE), including: endocarditis, myocardial infarction(MI), stroke, transient ischemic attack(TIA), thromboembolisms, bleeding, and aortic valve(AV) reoperation. VRE were defined as per published guidelines. Survival and freedom from VRE were reported using the Kaplan-Meier method. RESULTS Propensity-matching identified 70 well matched pairs with no major differences in baseline demographics, comorbidities, or AI severity(p=0.57). Perioperative outcomes showed no significant differences in VRE (AVR 8 vs AVr 7,p=0.78) or mortality (AVR 3 vs AVr 1,p=0.62). Event-free survival from the primary outcome at 10-years was significantly better after AVr than after AVR (82%vs68%,p=0.024), with no significant differences in 10-year overall survival between groups(82%vs72%,p=0.29). No significant differences in AI severity(p=0.07) or reoperation rate(p=0.44) were detected between groups. CONCLUSIONS This study demonstrated a lower long-term risk of VRE with repair compared to replacement, with low mortality and comparable durability. Further prospective randomized control trials are necessary to formally compare outcomes and determine superiority.
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Affiliation(s)
- Habib Jabagi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada
| | - Thierry G Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada.
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Abstract
PURPOSE OF REVIEW Mitral valve repair surgery has recently shifted from resection-based techniques to leaflet sparing approaches using synthetic neochordae. This has facilitated the growth of a new strategy of transapical off-pump mitral valve intervention with neochord implantation. RECENT FINDINGS Minimally invasive approaches for mitral valve repair with robotic or video-assisted mini-right anterolateral thoracotomy have been developed to mitigate the morbidity associated with conventional median sternotomy. Recently, an alternative, less invasive surgical strategy has emerged. This transapical off-pump technique employs the NeoChord DS1000 (NeoChord, Inc., Minneapolis, MN, USA) system to achieve repair with neochordae via a left minithoracotomy incision. With appropriate patient selection, advanced cardiac imaging, and training in device deployment are important for procedural success. SUMMARY Early results suggest that transapical off-pump mitral valve intervention with NeoChord implantation is a safe procedure with favorable outcomes for select patients with degenerative mitral regurgitation. Continued experience and clinical trials will assess the potential of this minimally invasive strategy, but this technique is likely to become part of the surgical repertoire for managing chronic degenerative mitral valve disease.
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31
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Brescia AA, Watt TMF, Rosenbloom LM, Williams AM, Bolling SF, Romano MA. Patient and Surgeon Predictors of Mitral and Tricuspid Valve Repair for Infective Endocarditis. Semin Thorac Cardiovasc Surg 2021; 34:67-77. [PMID: 33865973 DOI: 10.1053/j.semtcvs.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
Mitral repair (MVr) is superior to replacement for degenerative disease; however, its benefit is less established for endocarditis. We report outcomes of repair or replacement for mitral/tricuspid endocarditis and identify predictors of MVr. Patients undergoing first-time surgery for mitral (n = 260) or tricuspid (n = 71) endocarditis between 1992 to 2018 were identified. Patients with aortic endocarditis were excluded. Primary outcome was all-cause mortality and secondary outcome was MVr. Patients were stratified into active and treated endocarditis separately for mitral and tricuspid groups. Predictors of MVr were assessed through multivariable logistic regression and adjusted likelihood of MVr through marginal effects estimates. A mitral specialist was defined by performing ≥25 annual degenerative MVr. Among 331 patients, 70% (181/260) of those with mitral valve endocarditis and 52% (37/71) of those with tricuspid endocarditis underwent repair. The MVr group compared with replacement had a higher proportion of elective acuity and less diabetes, hypertension, active endocarditis, cardiogenic shock, and dialysis. Estimated 5-year survival did not differ between repair versus replacement for active mitral (68 ± 14% vs 60 ± 14%, P = 0.34) or tricuspid endocarditis (60 ± 17% vs 61 ± 19%, P = 0.67), but was superior after repair for treated mitral endocarditis (86 ± 7% vs 51 ± 24%, P = 0.014). Independent predictors of mortality included dialysis for active and treated mitral endocarditis, and mitral replacement (vs MVr) for treated mitral endocarditis. The likelihood of MVr was 82 ± 5% for mitral specialists and 47 ± 9% for non-specialists (P < 0.001). MVr for endocarditis should be pursued, if feasible. Importantly, achieving MVr was driven not only by patient factors, but also surgeon experience.
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Affiliation(s)
| | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Liza M Rosenbloom
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Aaron M Williams
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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32
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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33
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Del Forno B, Ascione G, De Bonis M. Advances in Mitral Valve Repair for Degenerative Mitral Regurgitation: Philosophy, Technical Details, and Long-Term Results. Cardiol Clin 2021; 39:175-184. [PMID: 33894931 DOI: 10.1016/j.ccl.2021.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Degenerative mitral valve disease represents the most common cause of mitral regurgitation in industrialized countries. When left untreated, patients with severe degenerative mitral regurgitation show a poor clinical outcome. Conversely, a timely and appropriate correction provides a restored life expectancy and a good quality of life. Therefore, in this scenario, surgical mitral valve repair represents the gold standard of treatment. This review aims to analyze the indications, timing, and contemporary surgical techniques of mitral valve repair for degenerative mitral regurgitation. Moreover, the value of heart team approach and centers of excellence for mitral valve repair are also deeply discussed.
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Affiliation(s)
- Benedetto Del Forno
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
| | - Guido Ascione
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
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34
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Abstract
In most patients, minimally invasive approaches to mitral valve surgery are technically possible. However, in practice, patient selection is critical to mitigate safety concerns when performing the procedure. In this article, we describe our approach to preoperative assessment for minimally invasive mitral valve surgery candidacy, as well as discussing the technical aspects of procedure execution.
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Affiliation(s)
- Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue / J4-1, Cleveland, OH 44195, USA.
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue / J4-1, Cleveland, OH 44195, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue / J4-1, Cleveland, OH 44195, USA
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35
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. Rev Port Cardiol 2021; 40:293-304. [PMID: 33745777 DOI: 10.1016/j.repc.2020.10.011] [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: 08/12/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
Degenerative mitral valve disease (myxomatous degeneration or fibroelastic deficiency) is the most common indication for surgical referral to treat mitral regurgitation. Mitral valve repair is the procedure of choice whenever feasible and when the results are expected to be durable. Posterior leaflet prolapse is the commonest lesion, found in up to two-thirds of patients. It is the easiest to repair, particularly when limited to one segment. In these cases, rates of repairability and procedural success approach 100%, and there is now ample evidence that the immediate and long-term results are better than those of valve replacement. Notably, minimally invasive valvular procedures, surgical or interventional, have attracted increasing interest in the last decade. When performed by experienced groups, mitral valve repair is unrivaled irrespective of the severity of lesions, from simple to complex, which leaflets are involved, and the type of degenerative involvement (myxomatous or fibroelastic). Its results should be viewed as the benchmark for other present and future technologies. By contrast, percutaneous mitral valve repair is still in its infancy and its results so far fall short of those of surgical repair. Nevertheless, continued investment in transcatheter procedures is of great importance to enable development and improved accessibility, particularly for patients who are considered unsuitable for surgery. In this review, we analyze the current status of management of degenerative mitral valve disease, discussing mitral valve anatomy and pathology, indications for intervention, and current surgical and transcatheter mitral valve procedures and results.
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Affiliation(s)
- Gonçalo F Coutinho
- Cardiothoracic Surgery Department, University Hospital and Center of Coimbra, Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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36
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Budra M, Janušauskas V, Drąsutienė A, Zorinas A, Zakarkaitė D, Lipnevičius A, Ručinskas K. Midterm results of transventricular mitral valve repair: Single-center experience. J Thorac Cardiovasc Surg 2021; 164:1820-1828. [PMID: 33612306 DOI: 10.1016/j.jtcvs.2020.12.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study objective was to evaluate the midterm outcomes of transventricular mitral valve repair and its association with the initial anatomy of the mitral valve. METHODS This nonrandomized observational study included 88 patients (mean age, 60 years; 69% were men) who underwent transventricular mitral valve repair for severe degenerative mitral regurgitation between 2011 and 2017. Mitral valve function was assessed by echocardiography at 1 and 6 months and annually after the procedure. According to the location of mitral valve pathology, all patients were stratified into 4 anatomic types (A, B, C, and D). Results were assessed using Kaplan-Meier method, mixed-effects continuation ratio model, and multivariable Cox regression. RESULTS Median follow-up of 42 months (interquartile range, 27-55) was complete for 83 patients (94.3%). There were 3 late deaths: 2 cardiac and 1 noncardiac. Recurrent mitral regurgitation greater than 2+ was observed in 29 patients (33%), and 18 patients (20.5%) underwent repeat surgery. Device success was 82% in type A at 6 months and thereafter; 87%, 85%, and 75% at 6, 12, and 36 months in type B, respectively; and 53% at 1 month and 20% at 24 months in type C. Probability of postoperative mitral regurgitation progression was higher in patients with greater preoperative left ventricular end-diastolic diameter, type B pathology, and type C pathology (P < .05). Risk factors of mitral regurgitation recurrence included increased left ventricle size (hazard ratio, 1.11; 95% confidence interval, 1.04-1.20; P = .001) and type C pathology (hazard ratio, 5.99; 95% confidence interval, 1.87-19.21; P = .003). CONCLUSIONS Initial acceptable mitral regurgitation reduction after transventricular mitral valve repair of isolated P2 prolapse was possible but found durable in only 82% at 3 years. Higher risk of mitral regurgitation recurrence occurred with complex degenerative pathology.
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Affiliation(s)
- Mindaugas Budra
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania.
| | - Vilius Janušauskas
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Agnė Drąsutienė
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Aleksejus Zorinas
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Diana Zakarkaitė
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Artūras Lipnevičius
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | - Kęstutis Ručinskas
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
| | -
- Vilnius University Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Vilnius, Lithuania
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37
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Workup and Management of Primary Mitral Regurgitation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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Abstract
Mitral regurgitation (MR) is the most prevalent form of moderate or severe valve disease in the developed world. MR can result from impairment of any part of the mitral valve apparatus and is classified as primary (disease of the leaflets) or secondary (functional). The presence of at least moderate MR is associated with increased morbidity and mortality. With the goal of avoiding the risks of traditional surgery, transcatheter mitral valve therapies have been developed. The current transcatheter repair techniques are limited by therapeutic target and incomplete MR reduction, and thus transcatheter mitral valve replacement (TMVR) has been pursued. Several devices (both transapical and transseptal) are under development, with both early feasibility and pivotal trials under way. As this field develops, the decision to treat with TMVR will require a heart team approach that takes patient-, disease-, and device-specific factors into account.
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Affiliation(s)
- Paul N Fiorilli
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - Howard C Herrmann
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
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39
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Papadimas E, Tan YK, Choong AMTL, Kofidis T, Teoh KLK. Anticoagulation After Isolated Mitral Valve Repair: A Systematic Review and Meta-Analysis of Clinical Outcomes. Heart Lung Circ 2020; 30:247-253. [PMID: 33082110 DOI: 10.1016/j.hlc.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/29/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
Recommendations from international guidelines on optimal thromboprophylaxis after mitral repair are controversial and based on underpowered observational studies. This study aimed to evaluate the prophylactic use of warfarin after isolated mitral valve repair (MVr). A PubMed, EMBASE and Scopus search for studies in English on postoperative thromboprophylaxis for isolated MVr published to February 2020 was performed. The analysis excluded all studies with combined operations, mitral valve replacement and preoperative or postoperative atrial fibrillation. Clinical endpoints that were studied were thromboembolic events, bleeding complications and mortality. Random effects meta-analyses of the effect of postoperative warfarin use as compared with no warfarin use across all clinical endpoints was conducted. Warfarin use did not confer benefit in terms of thromboembolic prophylaxis after isolated MVr in patients without atrial fibrillation (OR, 0.97; 95% CI, 0.72-1.31). At the same time, it did not increase the risk of bleeding complications (OR, 1.10; 95% CI, 0.53-2.30) or affect overall survival during the follow-up period of the included studies (OR, 1.06; 95% CI, 0.28-4.05). To conclude, warfarin use is not necessary for patients after isolated MVr who remain in sinus rhythm. Recommendations from international guidelines may need to be revisited for this group of patients.
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Affiliation(s)
- Evangelos Papadimas
- Department of Cardiac Thoracic & Vascular Surgery, National University Heart Centre, Singapore.
| | | | - Andrew M T L Choong
- Department of Cardiac Thoracic & Vascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Theo Kofidis
- Department of Cardiac Thoracic & Vascular Surgery, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kristine L K Teoh
- Department of Cardiac Thoracic & Vascular Surgery, National University Heart Centre, Singapore
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40
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Chan V, Mazer CD, Ali FM, Quan A, Ruel M, de Varennes BE, Gregory AJ, Bouchard D, Whitlock RP, Chu MW, Dokollari A, Mesana T, Bhatt DL, Latter DA, Zuo F, Tsang W, Teoh H, Jüni P, Leong-Poi H, Verma S. Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet Resection Versus Leaflet Preservation on Functional Mitral Stenosis. Circulation 2020; 142:1342-1350. [DOI: 10.1161/circulationaha.120.046853] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Equipoise exists between the use of leaflet resection and preservation for surgical repair of mitral regurgitation caused by prolapse. We therefore performed a randomized, controlled trial comparing these 2 techniques, particularly in regard to functional mitral stenosis.
Methods:
One hundred four patients with degenerative mitral regurgitation surgically amenable to either leaflet resection or preservation were randomized at 7 specialized cardiac surgical centers. Exclusion criteria included anterior leaflet or commissural prolapse, as well as a mixed cause for mitral valve disease. Using previous data, we determined that a sample size of 88 subjects would provide 90% power to detect a 5–mm Hg difference in mean mitral valve gradient at peak exercise, assuming an SD of 6.7 mm with a 2-sided test with α=5% and 10% patient attrition. The primary end point was the mean mitral gradient at peak exercise 12 months after repair.
Results:
Patient age, proportion who were female, and Society of Thoracic Surgeons risk score were 63.9±10.4 years, 19%, and 1.4±2.8% for those who were assigned to leaflet resection (n=54), and 66.3±10.8 years, 16%, and 1.9±2.6% for those who underwent leaflet preservation (n=50). There were no perioperative deaths or conversions to replacement. At 12 months, moderate mitral regurgitation was observed in 3 subjects in the leaflet resection group and 2 in the leaflet preservation group. The mean transmitral gradient at 12 months during peak exercise was 9.1±5.2 mm Hg after leaflet resection and 8.3±3.3 mm Hg after leaflet preservation (
P
=0.43). The participants had similar resting peak (8.3±4.4 mm Hg versus 8.4±2.6 mm Hg;
P
=0.96) and mean resting (3.2±1.9 mm Hg versus 3.1±1.1 mm Hg;
P
=0.67) mitral gradients after leaflet resection and leaflet preservation, respectively. The 6-minute walking distance was 451±147 m for those in the leaflet resection versus 481±95 m for the leaflet preservation group (
P
=0.27).
Conclusions:
In this adequately powered randomized trial, repair of mitral prolapse with either leaflet resection or leaflet preservation was associated with similar transmitral gradients at peak exercise at 12 months postoperatively. These data do not support the hypothesis that a strategy of leaflet resection (versus preservation) is associated with a risk of functional mitral stenosis.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier NCT02552771.
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Affiliation(s)
- Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)
- School of Epidemiology, Public Health and Preventive Medicine (V.C.), University of Ottawa, ON, Canada
| | - C. David Mazer
- Department of Anesthesia (C.D.M.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine (C.D.M.), University of Toronto, ON, Canada
- Department of Physiology (C.D.M.), University of Toronto, ON, Canada
| | - Faeez Mohamad Ali
- Division of Cardiology (F.M.A., W.T., H.L.-P.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Adrian Quan
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)
- Department of Cellular and Molecular Medicine (M.R.), University of Ottawa, ON, Canada
| | - Benoit E. de Varennes
- Division of Cardiac Surgery, Royal Victoria Hospital, McGill University Health Center, Montréal, QC, Canada (B.E.d.V.)
| | - Alexander J. Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, AB, Canada (A.J.G.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Libin Cardiovascular Institute of Alberta, Calgary, Canada (A.J.G.)
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, QC, Canada (D.B.)
| | - Richard P. Whitlock
- Division of Cardiac Surgery (R.P.W.), McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact (R.P.W.), McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada (R.P.W.)
| | - Michael W.A. Chu
- Division of Cardiac Surgery, London Health Sciences Center, University of Western Ontario, Canada (M.W.A.C.)
| | - Aleksander Dokollari
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, ON, Canada (V.C., M.R., T.M.)
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - David A. Latter
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery (D.A.L., S.V.), University of Toronto, ON, Canada
| | - Fei Zuo
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Wendy Tsang
- Division of Cardiology (F.M.A., W.T., H.L.-P.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine (W.T., P.J., H.L.-P.), University of Toronto, ON, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Division of Endocrinology and Metabolism (H.T.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Peter Jüni
- Applied Health Research Centre (F.Z., P.J.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine (W.T., P.J., H.L.-P.), University of Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation (P.J.), University of Toronto, ON, Canada
| | - Howard Leong-Poi
- Division of Cardiology (F.M.A., W.T., H.L.-P.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine (W.T., P.J., H.L.-P.), University of Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery (A.Q., A.D., D.A.L., H.T., S.V.), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery (D.A.L., S.V.), University of Toronto, ON, Canada
- Department of Pharmacology and Toxicology (S.V.), University of Toronto, ON, Canada
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41
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Agnino A, Graniero A, Roscitano C, Villari N, Marvelli A, Verhoye JP, Anselmi A. Continued follow-up of the free margin running suture technique for mitral repair. Eur J Cardiothorac Surg 2020; 58:847-854. [PMID: 32380519 DOI: 10.1093/ejcts/ezaa122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The free margin running suture (FMRS) technique was recently proposed to treat complex degenerative mitral lesions. Limited follow-up data are available. We evaluated the midterm reliability of this technique and the associated mitral valve parameters using rest/stress echocardiography. METHODS One-hundred-eight consecutive patients at 2 European centres were included. Prospective follow-up was performed (266.1 patient-years, average duration 2.5 ± 2.5 years). Echocardiographic scans at rest were obtained for all patients at hospital discharge and at follow-up. Stress echocardiography was also performed in 17 patients. RESULTS There were no operative deaths. FMRS was performed through a right minithoracotomy in 86.1% of patients, with a robotic-assisted technique in 5.6% and through a sternotomy in 8.3%. Bileaflet disease was noted in 31.4%. One patient (0.9%) presented a 2+/4+ residual mitral regurgitation at discharge; lower-degree or no residual regurgitation was noted in the remaining patients. At the follow-up examination, 1 patient (0.9%) presented with a 2+/4+ mitral regurgitation. Coaptation length at discharge versus that at follow-up was 1.3 ± 0.2 vs 1.3 ± 0.1 cm (P = 0.13); the average transmitral gradient was 4.8 ± 1.5 vs 3.5 ± 0.9 mmHg (P < 0.001). In a subpopulation, follow-up echocardiography indicated that the average transmitral gradient at rest versus that at peak effort was 3.2 ± 0.7 vs 5.1 ± 1.3 mmHg (P < 0.001), with no appearance of significant mitral regurgitation and marginally significant increases in pulmonary artery systolic pressures (P = 0.049). CONCLUSIONS Data indicate effectiveness and reproducibility of FMRS, with stability of valve function at midterm. FMRS was also associated with promising outcomes in diastolic performance both at rest and during exercise.
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Affiliation(s)
- Alfonso Agnino
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Ascanio Graniero
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Nicola Villari
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Antonino Marvelli
- Division of Minimally Invasive and Video-Assisted Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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Cohen BD, Napolitano MA, Edelman JJ, Thourani KV, Thourani VH. Contemporary Management of Mitral Valve Disease. Adv Surg 2020; 54:129-147. [PMID: 32713426 DOI: 10.1016/j.yasu.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brian D Cohen
- Department of Surgery, MedStar Georgetown/Washington Hospital Center, 3800 Reservoir Road Northwest, 2051 Gorman, Washington, DC 20007, USA
| | - Michael A Napolitano
- Department of Surgery, George Washington University, 1255 New Hampshire Avenue Northwest Apartment 1001, Washington, DC 20036, USA
| | - J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
| | - Keegan V Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, 95 Collier Road, Suite 5015, Atlanta, GA 30342, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, 95 Collier Road, Suite 5015, Atlanta, GA 30342, USA.
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Barth S, Hautmann MB, Arvaniti E, Kikec J, Kerber S, Zacher M, Halbfass P, Ranosch P, Lehmkuhl L, Foldyna B, Lüsebrink U, Hamm K. Mid-term hemodynamic and functional results after transcatheter mitral valve leaflet repair with the new PASCAL device. Clin Res Cardiol 2020; 110:628-639. [PMID: 32845361 DOI: 10.1007/s00392-020-01733-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
AIMS To examine the functional and hemodynamic mid-term outcome at 5 months of mitral regurgitation (MR) reduction using the PASCAL repair system. METHODS AND RESULTS Between July 2019 and February 2020 31 consecutive patients with MR 3 +/4 + (mean age 77.5 years, all in New York Heart Association (NYHA) class III-IV, STS score 9.1 ± 7.4) underwent MR reduction in our institute using the PASCAL device. 61.3% had a functional, 29.0% a degenerative, and 9.7% a mixed etiology. Successful implantation was achieved in 30/31 (96.8%) patients. 27/31 patients (87.1%) completed 5-month follow-up with clinical, echocardiographic, laboratory and hemodynamic assessment. At 5 months, 70.4% of the patients had MR grade ≤ 1 (p < 0.001). 85.2% were in NYHA class I or II (p < 0.001). Six-minute walk distance improved by 145 m (p = 0.010), Kansas City cardiomyopathy questionnaire and European quality of life 5 dimensions questionnaire (EQ5D) improved by 31 (p < 0.001) and 9 points (p = 0.001), respectively. Mean pulmonary capillary wedge pressure decreased significantly from 22.1 ± 9 mmHg to 17.3 ± 8 mmHg (p = 0.041) and right atrial pressure from 10.3 ± 6 mmHg to 8.0 ± 6 mmHg (p = 0.013) from baseline to 5 months. In addition, propensity score matching showed that PASCAL and MitraClip procedures resulted in equally hemodynamic and functional improvement. CONCLUSION MR reduction of severe MR with the PASCAL device is feasible and safe regardless of etiologies. Mid-term follow-up at 5 months showed a sustained MR reduction, improvement of exercise capacity, quality of life, proBNP levels and hemodynamics regarding pulmonary capillary wedge pressure and right atrial pressure.
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Affiliation(s)
- Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany.
| | - Martina B Hautmann
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Eleni Arvaniti
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Jan Kikec
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Michael Zacher
- Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Philipp Halbfass
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Patrick Ranosch
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Lukas Lehmkuhl
- Department of Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Borek Foldyna
- Department of Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Ulrich Lüsebrink
- Department of Cardiology, University of Marburg, Marburg, Germany
| | - Karsten Hamm
- Department of Cardiology, ANregiomed Klinikum Ansbach, Ansbach, Germany
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Pfannmueller B, Misfeld M, Verevkin A, Garbade J, Holzhey DM, Davierwala P, Seeburger J, Noack T, Borger MA. Loop neochord versus leaflet resection techniques for minimally invasive mitral valve repair: long-term results. Eur J Cardiothorac Surg 2020; 59:180-186. [DOI: 10.1093/ejcts/ezaa255] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Non-leaflet resection techniques including loop chordal replacement are being used with increasing frequency, but the long-term results of these techniques are still unknown. The aim of this study was to compare the long-term results of loop neochord replacement with leaflet resection techniques in patients undergoing minimally invasive mitral valve (MV) repair for MV prolapse.
METHODS
Between 1999 and 2014, 2134 consecutive MV prolapse patients underwent minimally invasive MV repair with isolated loop (n = 1751; 82.1%) or resection techniques (n = 383, 17.9%) at our institution. Follow-up data were available for 86% of patients with a mean follow-up time of 6.1 ± 4.3 years.
RESULTS
The 30-day mortality was 0.8% for all patients (loop: 0.7%, resection: 1.6%; P = 0.09). Leaflet resection was associated with more moderate or more mitral regurgitation on predischarge echocardiography (P = 0.003). The 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003). Significant predictors for late mortality were MV repair technique (P = 0.004), left ventricular ejection fraction (P < 0.001), age (P < 0.001) and myocardial infarction (P < 0.001). Freedom from MV reoperation at 1, 5 and 10 years was 98 ± 1%, 97 ± 1%, 97 ± 1% and 97 ± 1%, 97 ± 1%, 96 ± 1% for patients operated on with the loop technique and leaflet resection (P = 0.4).
CONCLUSIONS
In our patient cohort, MV repair with loop chordal replacement is associated with less early recurrent mitral regurgitation and very good long-term results when compared to classical leaflet resection techniques for MV prolapse and is therefore an excellent option for such patients.
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Affiliation(s)
| | - Martin Misfeld
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Alexander Verevkin
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Jens Garbade
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David M Holzhey
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Piroze Davierwala
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Joerg Seeburger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Thilo Noack
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Makhdom F, Hage A, Manian U, Ginty O, Losenno KL, Kiaii B, Chu MWA. Echocardiographic Method to Determine the Length of Neochordae Reconstruction for Mitral Repair. Ann Thorac Surg 2020; 111:519-528. [PMID: 32698022 DOI: 10.1016/j.athoracsur.2020.05.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/28/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND We evaluated a novel formula using preoperative transesophageal echocardiographic measurements to determine neochordae length for repair of degenerative mitral regurgitation (MR). METHODS The formula is based on measuring the distance from the adjacent papillary head to the intended coaptation zone of the flail/prolapsing leaflet segment and subtracting the redundant leaflet length. Between 2008 and 2017, 264 consecutive patients underwent mitral valve repair (82.2% endoscopic, minimally invasive approach and 17.8% sternotomy) with neochordae loop reconstruction (68.6% posterior, 6.4% anterior, and 25% bileaflet repair). Mean patient age was 63 ± 13.6 years, 73.5% were men, and mean left ventricular ejection fraction was 63.1% ± 6.7%. RESULTS Mitral valve repair was successful in 100% of patients, with no patient requiring conversion to replacement. Neochordae length measurement was accurate in 259 patients (98%), with 4 patients requiring conversion to resection and 1 patient requiring longer anterior leaflet neochordae. Median anterior and posterior neochordae lengths were 27 mm (range, 18-32) and 17 mm (range, 9-27), respectively. Intraoperative transesophageal echocardiography demonstrated no or trace residual MR in 254 patients and mild residual MR in 10 patients. In-hospital mortality occurred in 1 patient, and complications included respiratory failure (2.7%) and renal failure (1.8%). At the median follow-up of 12.6 months (interquartile range, 11.1), 98.9% of patients remained free from ≥2+ MR, whereas freedom from reoperation was 100%. CONCLUSIONS Preoperative transesophageal echocardiographic measurements can accurately and reproducibly predict the required length of neochordae loop reconstruction for degenerative mitral valve repair with good results. Longer-term follow-up is necessary.
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Affiliation(s)
- Fahd Makhdom
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Usha Manian
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Olivia Ginty
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Katie L Losenno
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada.
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Allen N, O'Sullivan K, Jones JM. The most influential papers in mitral valve surgery; a bibliometric analysis. J Cardiothorac Surg 2020; 15:175. [PMID: 32690042 PMCID: PMC7370429 DOI: 10.1186/s13019-020-01214-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
This study is an analysis of the 100 most cited articles in mitral valve surgery. A bibliometric analysis is a tool to evaluate research performance in a given field. It uses the number of times a publication is cited by others as a proxy marker of its impact. The most cited paper Carpentier et al. discusses mitral valve repair in terms of restoring the geometry of the entire valve rather than simply narrowing the annulus (Carpentier, J Thorac Cardiovasc Surg 86:23–37, 1983). The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923 (Cohn et al., Ann Cardiothorac Surg 4:315, 2015). More recently percutaneous and minimally invasive techniques that were originally designed as an option for high risk patients are being trialled in other patient groups (Hajar, Heart Views 19:160–3, 2018). Comparison of percutaneous method with open repair represents an expanding area of research (Hajar, Heart Views 19:160–3, 2018). This study will analyse the top 100 cited papers relevant to mitral valve surgery, identifying the most influential papers that guide current management, the institutions that produce them and the authors involved.
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Affiliation(s)
- N Allen
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK.
| | - K O'Sullivan
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - J M Jones
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK
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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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48
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Outcomes of mitral valve repair compared with replacement for patients with rheumatic heart disease. J Thorac Cardiovasc Surg 2020; 162:72-82.e7. [PMID: 32169372 DOI: 10.1016/j.jtcvs.2020.01.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Whether mitral valve repair is superior to replacement in the population with rheumatic heart disease has been debated. This study aims to compare outcomes of repair with replacement by the propensity score method. METHODS This observational, prospective study enrolled patients with rheumatic heart disease who underwent mitral valve repair and replacement from January 2011 to April 2019. The propensity score method was used to select 2 groups with similar baseline characteristics. Baseline, clinical, and follow-up data were collected. Clinical outcomes included death from any cause, reoperation, and valve-related complications. RESULTS The overall population before matching (N = 1644) included 612 patients who underwent repair and 1032 patients who underwent replacement. The propensity score analysis generated matches for 1058 patients (529 pairs). The median follow-up time was 4.12 years. Early mortality and death from any cause during follow-up were significantly lower in the repair group compared with the replacement group (hazard ratio, 0.19; 95% confidence interval [CI], 0.05-0.64; P = .003; hazard ratio, 0.38; 95% CI, 0.19-0.74; P = .003, respectively). Patients in the repair group had a lower risk of valve-related complications compared with patients in the replacement group (subhazard ratio, 0.44; 95% CI, 0.21-0.90; P = .025). In terms of reoperation, no significant difference was observed between the repair and replacement groups (subhazard ratio, 2.54; 95% CI, 0.89-7.22; P = .081). CONCLUSIONS The results suggest that rheumatic mitral valve repair in select patients is superior to mitral valve replacement with regard to lower mortality and fewer valve-related complications; meanwhile, it has a comparable risk of reoperation compared with replacement.
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Miceli A. Commentary: Be flexible! JTCVS Tech 2020; 1:37-38. [PMID: 34317704 PMCID: PMC8288627 DOI: 10.1016/j.xjtc.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Antonio Miceli
- Department of Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
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50
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Gillinov M, Burns DJP, Wierup P. The 10 Commandments for Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:4-10. [DOI: 10.1177/1556984519883875] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marc Gillinov
- The Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel J. P. Burns
- The Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Per Wierup
- The Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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