1
|
Bonfioli GB, Pagnesi M. Pulmonary vein flow pattern: A marker of successful repair in primary mitral regurgitation? Int J Cardiol 2024; 416:132498. [PMID: 39214470 DOI: 10.1016/j.ijcard.2024.132498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Giovanni Battista Bonfioli
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| |
Collapse
|
2
|
Truong S, Petersen J, Schmiegelow MDS, Due H, Havers-Borgersen E, Smerup M, Køber L, Fosbøl E, Østergaard L. Incidence and factors associated with mitral valve reoperation in patients undergoing surgery for mitral regurgitation: A nationwide cohort study. Int J Cardiol 2024; 418:132608. [PMID: 39368651 DOI: 10.1016/j.ijcard.2024.132608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 09/04/2024] [Accepted: 09/30/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND When patients undergo surgery for mitral regurgitation, risk of reoperation is of concern. AIMS To examine the incidence and factors associated with mitral reoperation following surgery for mitral regurgitation according to type of surgery. METHODS Patients undergoing first-time surgery for mitral regurgitation, 1996-2021, were identified from nationwide registries. According to index surgery, the population was categorized into 1) mitral repair; 2) mechanical prostheses; 3) bioprostheses. Patients were followed from discharge with a maximum of 15 years of follow-up and cumulative incidence of reoperation was examined. Multivariable Cox analysis was used to examine factors associated with reoperation. RESULTS We identified 6958 patients: 4624 with mitral repair (72 % male, median age 66), 1250 with mechanical prosthesis (52 % male, median age 59), and 1084 with bioprosthesis (57 % male, median age 74). Cumulative incidence of reoperation was 7.3 % for repair (median 7.2 years follow-up), 6.1 % for mechanical prostheses (median 10.9 years follow-up), and 7.1 % for bioprostheses (median 4.5 years follow-up). Within first year, 22.6 % of reoperations were preceded by infective endocarditis. In long-term follow-up, bioprosthetic replacement was associated with a higher reoperation rate, while increasing age, male sex and mechanical prosthesis were associated with lower reoperation rate. CONCLUSIONS In patients operated for mitral regurgitation, reoperation was infrequent at approximately 7 % for all intervention types during a maximum of 15-year follow-up. In adjusted analysis, bioprosthetic replacement was associated with a higher rate of reoperation, while increasing age, male sex and mechanical prosthesis was associated with a lower rate of reoperation.
Collapse
Affiliation(s)
- Sofie Truong
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Jeppe Petersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans Due
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eva Havers-Borgersen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Smerup
- Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Shin JH, Lee SH, Joo HC, Youn YN, Kim JH, Lee S. Long-term Outcomes of Mitral Valve Repair for Atrial Functional Mitral Regurgitation. Ann Thorac Surg 2024:S0003-4975(24)00764-1. [PMID: 39277158 DOI: 10.1016/j.athoracsur.2024.09.001] [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: 05/29/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Atrial functional mitral regurgitation (AFMR), defined by normal left ventricular function, enlarged left atrium, and a dilated mitral valve annulus, has been a concept discussed for >10 years. However, there are still no established guidelines for its treatment in the American College of Cardiology/American Heart Association recommendations. This study aimed to determine the long-term outcomes of mitral annuloplasty as a treatment for AFMR. METHODS We analyzed 1435 patients who underwent mitral valve repair at our institution between 2005 and 2020, with 162 classified as having AFMR. Exclusion criteria for AFMR were established based on preoperative echocardiography and operative notes. The primary outcome was overall mortality, and the secondary outcome was MR recurrence, which was defined as moderate or greater mitral regurgitation observed on echocardiography during the follow-up period, analyzed using our hospital's medical records and data from the National Statistical Office. RESULTS The median follow-up duration for the entire patient cohort was 6.1 years (interquartile range, 3.2-11.2 years). Patients had a 5-year survival rate of 86% and a 10-year survival rate of 73%, with freedom from MR recurrence rates of 89% and 80% at 5 and 10 years, respectively. Although all 162 patients had moderate or greater MR before surgery, most experienced trivial or mild MR after mitral valve repair throughout the follow-up period. CONCLUSIONS In summary, mitral valve repair effectively treats patients with AFMR, addressing survival and mitigating MR recurrence.
Collapse
Affiliation(s)
- Jung-Hoon Shin
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hyun Lee
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Chul Joo
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Kim
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
4
|
Malas J, Chen Q, Emerson D, Gill G, Rowe G, Egorova N, Trento A, Chikwe J, Bowdish ME. Socioeconomic disparities in midterm outcomes after repair for degenerative mitral regurgitation. J Thorac Cardiovasc Surg 2024; 168:809-817.e20. [PMID: 37385524 PMCID: PMC11181753 DOI: 10.1016/j.jtcvs.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The influence of socioeconomic disparities on survival after mitral repair is poorly defined. We examined the association between socioeconomic disadvantage and midterm outcomes of repair in Medicare beneficiaries with degenerative mitral regurgitation. METHODS US Centers for Medicare and Medicaid Services data were used to identify 10,322 patients undergoing isolated first-time repair for degenerative mitral regurgitation between 2012 and 2019. Zip code-level socioeconomic disadvantage was dichotomized with the Distressed Communities Index, which incorporates education level, poverty, unemployment, housing security, median income, and business growth; those with Distressed Communities Index score ≥80 were classified as distressed. The primary outcome was survival, censored at 3 years. Secondary outcomes included cumulative incidences of heart failure readmission, mitral reintervention, and stroke. RESULTS Of the 10,322 patients undergoing degenerative mitral repair, 9.7% (n = 1003) came from distressed communities. Patients from distressed communities underwent surgery at lower volume centers (11 vs 16 cases/year) and traveled further for surgical care (40 vs 17 miles) (both P values < .001). At 3 years, unadjusted survival (85.4%; 95% CI, 82.9%-87.5% vs 89.7%; 95% CI, 89.0%-90.4%) and cumulative incidence of heart failure readmission (11.5%; 95% CI, 9.6%-13.7% vs 7.4%; 95% CI, 6.9%-8.0%) were worse in patients from distressed communities (all P values < .001), whereas mitral reintervention rates were similar (2.7%; 95% CI, 1.8%-4.0% vs 2.8%; 95% CI, 2.5%-3.2%; P = .75). After adjustment, community distress was independently associated with 3-year mortality (hazard ratio, 1.21; 95% CI, 1.01-1.46) and heart failure readmissions (hazard ratio, 1.28; 95% CI, 1.04-1.58). CONCLUSIONS Community-level socioeconomic distress is associated with worse outcomes in degenerative mitral repair among Medicare beneficiaries.
Collapse
Affiliation(s)
- Jad Malas
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif
| | - Qiudong Chen
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif
| | - Dominic Emerson
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif
| | - George Gill
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif
| | - Georgina Rowe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif
| | - Natalia Egorova
- Department of Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alfredo Trento
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif
| | - Michael E Bowdish
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, Calif.
| |
Collapse
|
5
|
Handa K, Kawamura M, Yoshioka D, Saito S, Kawamura T, Kawamura A, Misumi Y, Taira M, Shimamura K, Komukai S, Kitamura T, Miyagawa S. Impact of the Aortomitral Positional Anatomy on Atrioventricular Conduction Disorder Following Mitral Valve Surgery. J Am Heart Assoc 2024; 13:e035826. [PMID: 39158546 DOI: 10.1161/jaha.124.035826] [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: 03/31/2024] [Accepted: 07/26/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Variations in the aortomitral positional anatomy, including aortic root rotation appear to be related to variations in the location of the conduction system, including the bundle of His. However, little is known about their clinical significance. METHODS AND RESULTS This study included 147 patients with normal ECGs who underwent mitral valve surgery. The aortomitral anatomy was classified using preoperative 3-dimensional transesophageal echocardiography, and postoperative conduction disorders, including atrioventricular block and bundle branch block, were analyzed. Variations classified as aortomitral appearance were designated as having a center appearance (85.7%, n=126/147) or lateral appearance (14.3%, n=21/147) on the basis of whether the aortic root was located at the center or was shifted to the left fibrous trigone side. Subsequently, those with a center appearance, aortic root rotation was classified as having a center rotation (83.3% [n=105/126]), in which the commissure of the left and noncoronary aortic leaflet was located at the center, lateral rotation (14.3% [n=18/126]), rotated to the left trigone side, or medial rotation (2.4% [n=3/126]), rotated to the right. The incidence of 3-month persistent new-onset conduction disorder was higher in the lateral appearance than the center appearance group (21.1% versus 5.0%; P=0.031) and higher in the lateral rotation than in the center or medial rotation groups (29.4% versus 1.0% versus 0.0%, respectively; P<0.001). CONCLUSIONS Aortomitral variations can be classified using 3-dimensional transesophageal echocardiography. Lateral appearance and lateral rotation are risk factors for conduction disorders in mitral valve surgery.
Collapse
Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Masashi Kawamura
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Shunsuke Saito
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Yusuke Misumi
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Masaki Taira
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| | - Sho Komukai
- Department of Integrated Medicine, Institute of Biomedical Statistics, Osaka University Graduate School of Medicine Osaka Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery Osaka University Graduate School of Medicine Osaka Japan
| |
Collapse
|
6
|
Babu A, Bertolini M, Mullen M, Cook A, Mullen A, Capelli C. Effectiveness of a new 3D printed simulator for mitral transcatheter edge-to-edge repair in enhancing the confidence and procedural skills of the operator. 3D Print Med 2024; 10:26. [PMID: 39102099 PMCID: PMC11299365 DOI: 10.1186/s41205-024-00230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/11/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND . Mitral transcatheter edge-to-edge repair (m-TEER) is a minimally invasive procedure for treating mitral regurgitation (MR). m-TEER is a highly technical procedure, and a steep learning curve needs to be overcome for operators to ensure optimal patient outcomes and minimise procedural complications. Training via online simulation and observation of procedures is not sufficient to establish operator confidence; thus, advanced hands-on training modalities need to be explored and developed. METHODS . In this study, a novel anatomical simulator for m-TEER training was evaluated in comparison to a standard model. The proposed simulator resembled the anatomical features of the right and left atrium, left ventricle and mitral valve apparatus. Participants in the questionnaire (n = 18) were recruited across 4 centres in London with (n = 8) and without (n = 10) prior experience in m-TEER. Participants were asked to simulate procedures on both an idealised, routinely used simulator and the newly proposed anatomical model. The questionnaire was designed to assess (i) participants' confidence before and after training and (ii) the realism of the model in the context of the m-TEER procedure. The results of the questionnaires were collected, and statistical analysis (t-test) was performed. RESULTS . Both models were equally beneficial in increasing operator confidence before and after the simulation of the intervention (P = 0.43). However, increased confidence after training with the anatomical model was recorded (P = 0.02). Participants with prior experience with m-TEER therapy were significantly more confident about the procedure after training with the anatomical model than participants who had no prior experience (P = 0.002). On average, all participants thought that the anatomical model was effective as a training simulator (P = 0.013) and should be integrated into routine training (P = 0.015)). Participants with experience thought that the anatomical model was more effective at reproducing the m-TEER procedure than the idealised model (P = 0.03). CONCLUSIONS . This study showed how a more realistic simulator can be used to improve the effectiveness of m-TEER procedural training. Such pilot results suggest planning future and large investigations to evaluate improvements in clinical practice.
Collapse
Affiliation(s)
- Angel Babu
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
| | - Michele Bertolini
- Department of Mechanical Engineering, Politecnico di Milano, Milan, 20133, Italy.
| | | | - Andrew Cook
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
| | - Aigerim Mullen
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
- Abbott Structural Heart UK and Ireland, Blyth Valley Business Park, Solihull, B90 8AJ, UK
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK.
| |
Collapse
|
7
|
Jedrzejczyk JH, Krog S, Skov SN, Poulsen KB, Sharghbin M, Benhassen LL, Nielsen SL, Hasenkam JM, Tjørnild MJ. Entire Mitral Valve Reconstruction Using Porcine Extracellular Matrix: Adding a Ring Annuloplasty. Cardiovasc Eng Technol 2024; 15:451-462. [PMID: 38504076 PMCID: PMC11319488 DOI: 10.1007/s13239-024-00727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE This study investigated the implications of inserting a flexible annuloplasty ring after reconstructing the entire mitral valve in a porcine model using a previously investigated tube graft design made of 2-ply small intestinal submucosa extracellular matrix (CorMatrix®). METHODS An acute model with eight 80-kg pigs, each acting as its own control, was used. The entire mitral valve was reconstructed with a 2-ply small intestinal submucosa extracellular matrix tube graft (CorMatrix®). Subsequently, a Simulus® flexible ring was inserted. The characterization was based on mitral annular geometry and valvular dynamics with sonomicrometry and echocardiography. RESULTS After adding the ring annuloplasty, the in-plane annular dynamics were more constant throughout the cardiac cycle compared to the reconstruction alone. However, the commissure-commissure distance was statistically significantly decreased [35.0 ± 3.4 mm vs. 27.4 ± 1.9 mm, P < 0.001, diff = - 7.6 mm, 95% CI, - 9.8 to (-5.4) mm] after ring insertion, changing the physiological annular D-shape into a circular shape which created folds at the coaptation zone resulting in a central regurgitant jet on color Doppler. CONCLUSION We successfully reconstructed the entire mitral valve using 2-ply small intestinal submucosal extracellular matrix (CorMatrix®) combined with a flexible annuloplasty. The annuloplasty reduced the unphysiological systolic widening previously found with this reconstructive technique. However, the Simulus flex ring changed the physiological annular D-shape into a circular shape and hindered a correct unfolding of the leaflets. Thus, we do not recommend a flexible ring in conjunction with this reconstructive technique; further investigations are needed to discover a more suitable remodelling annuloplasty.
Collapse
Affiliation(s)
- Johannes H Jedrzejczyk
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark.
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark.
| | - Stine Krog
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
| | - Søren N Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
| | - Karen B Poulsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
| | - Mona Sharghbin
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
| | - Leila L Benhassen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
| | - Sten L Nielsen
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
| | - J Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Århus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Århus, Denmark
| |
Collapse
|
8
|
Tribouilloy C, Rusinaru D, Grigioni F, Avierinos JF, Vanoverschelde JL, Benfari G, Bursi F, Barbieri A, Bohbot Y, Essayagh B, Michelena H, Enriquez-Sarano M. Indexing left ventricular end-systolic dimension to body size: Association with mortality in patients with degenerative mitral regurgitation. Eur J Heart Fail 2024. [PMID: 39036937 DOI: 10.1002/ejhf.3393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/16/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
AIMS In patients with degenerative mitral regurgitation (DMR), left ventricular (LV) dysfunction is associated with increased risk of heart failure and excess mortality. LV end-systolic diameter (LVESD) is an established trigger for intervention, yet recommended LVESD thresholds apply poorly to patients with small body size. Whether LV normalization to body surface area (BSA) may be used as a trigger for DMR correction is unknown. We examined the link between LVESD index (LVESDi) and outcome in DMR to identify appropriate thresholds for excess mortality. METHODS AND RESULTS This study focuses on 2753 consecutive patients with DMR due to flail leaflets diagnosed in tertiary centres from Europe and the United States, with prospective echocardiographic measurement of LVESD and BSA and long-term follow-up. The primary endpoint was mortality after diagnosis under conservative management. Secondary endpoints were mortality under conservative and surgical management and postoperative mortality of patients who underwent surgery. The optimal LVESDi cut-off for mortality prediction was 20 mm/m2. Irrespective of management type, 10-year survival was lower with LVESDi ≥20 mm/m2 than with LVESDi <20 mm/m2 (both p < 0.001). After covariate adjustment, LVESDi ≥20 mm/m2 was independently predictive of mortality under conservative management (adjusted hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.15-1.75), and with conservative and surgical management (adjusted HR 1.34, 95% CI 1.17-1.54). LVESDi remained associated with poorer postoperative outcome in patients who underwent intervention. LVESDi showed higher incremental predictive value over the baseline model compared to LVESD. The association between LVESDi ≥20 mm/m2 and outcome was consistent in subgroups of patients with DMR. CONCLUSIONS In severe DMR due to flail leaflets, LVESDi is a marker of risk additive and incremental to LVESD. Its use in clinical practice should lead to earlier referral to mitral valve surgery and improved long-term outcome.
Collapse
Affiliation(s)
- Christophe Tribouilloy
- UR UPJV 7517, Jules Verne University, Amiens, France
- University Hospital Amiens, Amiens, France
| | - Dan Rusinaru
- UR UPJV 7517, Jules Verne University, Amiens, France
- University Hospital Amiens, Amiens, France
| | - Francesco Grigioni
- Fondazione Policlinico Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | | | - Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Giovanni Benfari
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, Modena, Italy
| | - Yohann Bohbot
- UR UPJV 7517, Jules Verne University, Amiens, France
- University Hospital Amiens, Amiens, France
| | - Benjamin Essayagh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- Division of Echocardiography, Cardio X Clinic, Cannes, France
| | - Hector Michelena
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Maurice Enriquez-Sarano
- Department of Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| |
Collapse
|
9
|
Poschner T, Laengle S, Tasdelen S, Suria A, Baysal F, Kocher A, Andreas M. Innovative Mitral Valve Repair Using a Novel Automated Suturing System: Preliminary Data. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1138. [PMID: 39064567 PMCID: PMC11278705 DOI: 10.3390/medicina60071138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 06/23/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
(1) Background and Objectives: Mitral regurgitation is a common valve disease requiring surgical repair. Even with satisfactory results, repair techniques may underlie subjectivity and variability and require long learning curves. A novel approach, the "Roman Arch" technique, may ease the technical burden. This study assessed an automated suturing device's feasibility and time efficiency for a proposed simplified technique. (2) Materials and Methods: Using the MiStitch™ and MiKnot™ devices (LSI Solutions, Inc., Victor, NY, USA), the suture pattern was performed in a cadaver model. Three surgeons with different expertise levels conducted the procedures. Repair and suture placement times were recorded and analyzed. (3) Results: The modified "Roman Arch" repair was completed on all ten human heart specimens with an average total repair time of 3:01 ± 00:59 min and a trend toward reduced times as experience increased. The study confirmed the technical feasibility with 90% of the attempts rated as rather satisfactory or very satisfactory. (4) Conclusions: The MiStitch™ system effectively facilitated the modified "Roman Arch" repair in an ex vivo setting, suggesting its potential to reduce the technical complexity of mitral valve repairs. Further studies are needed to confirm its efficacy and safety in clinical practice.
Collapse
Affiliation(s)
- Thomas Poschner
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (S.T.); (A.S.); (F.B.); (A.K.); (M.A.)
| | | | | | | | | | | | | |
Collapse
|
10
|
Hage F, Hage A, Cervetti MR, Chu MWA. Mitral valve replacement in young patients: review and current challenges. Future Cardiol 2024; 20:409-417. [PMID: 38985451 PMCID: PMC11457673 DOI: 10.1080/14796678.2024.2343592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 04/12/2024] [Indexed: 07/11/2024] Open
Abstract
Mitral valve repair is the ideal intervention for mitral valve disease with excellent long-term survival comparable to the age-matched general population. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. Patients presenting for mitral valve surgery after failed transcatheter mitral valve-in-valve have high rates of postoperative mortality and morbidity, exceeding those seen with reoperative mitral valve surgery, which poses issues in young patients who have a higher cumulative incidence of reintervention.
Collapse
Affiliation(s)
- Fadi Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Manuel R Cervetti
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Michael W. A. Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
11
|
Avierinos JF, Tribouilloy C, Bursi F, Grigioni F, Vanoverschelde JL, Resseguier N, Théron A, Pasquet A, Pradier J, Biagini E, Barbieri A, Michelena H, Benfari G, Rusinaru D, Zaffran S, Vancraeynest D, Collart F, Bohbot Y, Essayagh B, Enriquez-Sarano M. Degenerative mitral regurgitation due to flail leaflet: sex-related differences in presentation, management, and outcomes. Eur Heart J 2024; 45:2306-2316. [PMID: 38751052 DOI: 10.1093/eurheartj/ehae265] [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: 07/21/2023] [Revised: 02/26/2024] [Accepted: 04/15/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND AND AIMS Presentation, outcome, and management of females with degenerative mitral regurgitation (DMR) are undefined. We analysed sex-specific baseline clinical and echocardiographic characteristics at referral for DMR due to flail leaflets and subsequent management and outcomes. METHODS In the Mitral Regurgitation International Database (MIDA) international registry, females were compared with males regarding presentation at referral, management, and outcome (survival/heart failure), under medical treatment, post-operatively, and encompassing all follow-up. RESULTS At referral, females (n = 650) vs. males (n = 1660) were older with more severe symptoms and higher MIDA score. Smaller cavity diameters belied higher cardiac dimension indexed to body surface area. Under conservative management, excess mortality vs. expected was observed in males [standardized mortality ratio (SMR) 1.45 (1.27-1.65), P < .001] but was higher in females [SMR 2.00 (1.67-2.38), P < .001]. Female sex was independently associated with mortality [adjusted hazard ratio (HR) 1.29 (1.04-1.61), P = .02], cardiovascular mortality [adjusted HR 1.58 (1.14-2.18), P = .007], and heart failure [adjusted HR 1.36 (1.02-1.81), P = .04] under medical management. Females vs. males were less offered surgical correction (72% vs. 80%, P < .001); however, surgical outcome, adjusted for more severe presentation in females, was similar (P ≥ .09). Ultimately, overall outcome throughout follow-up was worse in females who displayed persistent excess mortality vs. expected [SMR 1.31 (1.16-1.47), P < .001], whereas males enjoyed normal life expectancy restoration [SMR 0.92 (0.85-0.99), P = .036]. CONCLUSIONS Females with severe DMR were referred to tertiary centers at a more advanced stage, incurred higher mortality and morbidity under conservative management, and were offered surgery less and later after referral. Ultimately, these sex-related differences yielded persistent excess mortality despite surgery in females with DMR, while males enjoyed restoration of life expectancy, warranting imperative re-evaluation of sex-specific DMR management.
Collapse
Affiliation(s)
- Jean-Fançois Avierinos
- Département de Cardiologie, Centre Hospitalier Universitaire Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, 264 rue Saint-Pierre, 13005 Marseille, France
- U1251 INSERM, Marseille Medical Genetics, Aix-Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - Christophe Tribouilloy
- Département de Cardiologie, Centre Hospitalier Universitaire d'Amiens, Amiens, France
- EA 7517, Jules Verne University of Picardie, Amiens, France
| | - Francesca Bursi
- Department of Health Sciences, University of Milan, Milano, Italy
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Jean-Louis Vanoverschelde
- Service de Cardiologie, Clinique Universitaire Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Noémie Resseguier
- Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
- CEReSS-Health Services and Quality of Life Research, Aix Marseille Université, Marseille, France
| | - Alexis Théron
- U1251 INSERM, Marseille Medical Genetics, Aix-Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Agnes Pasquet
- Service de Cardiologie, Clinique Universitaire Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Julie Pradier
- Département de Cardiologie, Centre Hospitalier Universitaire Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, 264 rue Saint-Pierre, 13005 Marseille, France
| | - Elena Biagini
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hector Michelena
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Giovanni Benfari
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Dan Rusinaru
- Département de Cardiologie, Centre Hospitalier Universitaire d'Amiens, Amiens, France
- EA 7517, Jules Verne University of Picardie, Amiens, France
| | - Stéphane Zaffran
- U1251 INSERM, Marseille Medical Genetics, Aix-Marseille Université, 27 Bd Jean Moulin, 13385 Marseille, France
| | - David Vancraeynest
- Service de Cardiologie, Clinique Universitaire Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Fréderic Collart
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Yohann Bohbot
- Département de Cardiologie, Centre Hospitalier Universitaire d'Amiens, Amiens, France
- EA 7517, Jules Verne University of Picardie, Amiens, France
| | - Benjamin Essayagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
12
|
Hahn RT. Sex-related differences in degenerative mitral regurgitation: a call to action. Eur Heart J 2024; 45:2317-2319. [PMID: 38866496 DOI: 10.1093/eurheartj/ehae360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| |
Collapse
|
13
|
Kwon Y, Kim HJ, Kim JB, Kim HR, Yoo JS, Jung SH, Lee JW. Mitral valve repair with leaflet resection versus preservation for degenerative posterior leaflet prolapse. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00549-X. [PMID: 38964494 DOI: 10.1016/j.jtcvs.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/31/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES The optimal technique for repairing posterior mitral valve leaflet prolapse remains undetermined. We aimed to compare leaflet resection and neochordae implantation in patients undergoing mitral valve repair for posterior leaflet prolapse, focusing on transmitral pressure gradient and recurrence of mitral regurgitation. METHODS We enrolled patients undergoing mitral valve repair using either leaflet resection or neochordae implantation for single-segment prolapse of posterior mitral valve leaflet between 2000 and 2021 at our institution. Longitudinal outcomes were evaluated after adjustments with inverse-probability-of-treatment weighting. Repeat echocardiographic measurements (n = 3473, 5.4/patient) of transmitral pressure gradient and significant (moderate or severe) mitral regurgitation recurrence were estimated using nonlinear mixed-effect models. Subgroup analyses were conducted based on the size and type of prosthesis. RESULTS Among 639 patients, leaflet resection was used in 479 (75.0%) and neochordae implantation was used in 160 (25.0%). In the inverse-probability-of-treatment weighting adjusted cohort, the risk of death (P = .623) and mitral valve reoperation (P = .340) did not significantly differ between the 2 groups during a median follow-up of 97.3 months. Echocardiographic data showed comparable mean (at 5 years, 3.8 vs 4.0 mm Hg; P = .442) and peak (9.6 vs 10.4 mm Hg; P = .131) pressure gradients between groups, which persisted in most subgroup analyses. However, neochordae implantation was associated with a higher probability of significant mitral regurgitation recurrence compared with leaflet resection (at 5 years, 16.1% vs 7.0%; P < .001). CONCLUSIONS Leaflet resection yielded similar clinical outcomes and transmitral pressure gradients compared with neochordae implantation after mitral valve repair, with a lower mitral regurgitation recurrence rate. These findings underscore the need to reassess the efficacy of neochordae implantation relative to leaflet resection.
Collapse
Affiliation(s)
- Youngkern Kwon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Buchoen, Gyeonggi-do, Republic of Korea
| |
Collapse
|
14
|
Formica F, Gallingani A, Tuttolomondo D, Hernandez-Vaquero D, D'Alessandro S, Singh G, Benassi F, Grassa G, Pattuzzi C, Maestri F, Nicolini F. Long-term outcomes comparison of mitral valve repair or replacement for secondary mitral valve regurgitation. An updated systematic review and reconstructed time-to-event study-level meta-analysis. Curr Probl Cardiol 2024; 49:102636. [PMID: 38735348 DOI: 10.1016/j.cpcardiol.2024.102636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND AND AIM The ideal surgical intervention for secondary mitral regurgitation (SMR), a disease of the left ventricle not the mitral valve itself, is still debated. We performed an updated systematic review and study-level meta-analysis investigating mitral valve repair (MVr) versus mitral valve replacement (MVR) for adult patients with SMR, with or without coronary artery disease (CAD). METHODS PubMed, CENTRAL and EMBASE were searched for studies comparing MVr versus MVR. Randomized trial or observational studies were considered eligible. Primary endpoint was long-term mortality for any cause. Kaplan-Meier survival curves were reconstructed and compared with Cox linear regression. Landmark analysis and time-varying hazard ratio (HR) were analyzed. Sensitivity analyses included meta-regression and separate sub-analysis. A random effects model was used. RESULTS Twenty-three studies (MVr=3,727 and MVR=2,839) were included. One study was a randomized trial, and 19 studies were adjusted. The mean weighted follow-up was 3.7±2.8 years. MVR was associated with significative greater late mortality (HR=1.26; 95 % CI, 1.14-1.39; P<0.0001) at 10-year follow-up. There was a time-varying trend showing an increased risk of mortality in the first 2 years after MVR (HR=1.38; 95 % CI, 1.21-1.56; P<0.0001), after which this difference dissipated (HR=0.94; 95 % CI, 0.81-1.09; P=0.41). Separate sub-analyses showed comparable long-term mortality in patients with concomitant coronary surgery ≥90 %, left ventricle ejection fraction ≤40 %, and sub-valvular apparatus preservation rate of 100 %. CONCLUSIONS Compared to repair, MVR is associated with higher probability of mortality in the first 2 years following surgery, after which the two procedures showed comparable late mortality rate.
Collapse
Affiliation(s)
- Francesco Formica
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy.
| | - Alan Gallingani
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | - Gurmeet Singh
- Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Filippo Benassi
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Grassa
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Claudia Pattuzzi
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | | | - Francesco Nicolini
- University of Parma, Department of Medicine and Surgery, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| |
Collapse
|
15
|
Leviner DB, Abraham D, Ronai T, Sharoni E. Mechanical Valves: Past, Present, and Future-A Review. J Clin Med 2024; 13:3768. [PMID: 38999334 PMCID: PMC11242849 DOI: 10.3390/jcm13133768] [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: 04/18/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
The mechanical valve was first invented in the 1950s, and since then, a wide variety of prostheses have been developed. Although mechanical valves have outstanding durability, their use necessitates life-long treatment with anticoagulants, which increases the risk of bleeding and thromboembolic events. The current guidelines recommend a mechanical prosthetic valve in patients under 50-60 years; however, for patients aged 50-70 years, the data are conflicting and there is not a clear-cut recommendation. In recent decades, progress has been made in several areas. First, the On-X mechanical valve was introduced; this valve has a lower anticoagulant requirement in the aortic position. Second, a potential alternative to vitamin K-antagonist treatment, rivaroxaban, has shown encouraging results in small-scale trials and is currently being tested in a large randomized clinical trial. Lastly, an innovative mechanical valve that eliminates the need for anticoagulant therapy is under development. We attempted to review the current literature on the subject with special emphasis on the role of mechanical valves in the current era and discuss alternatives and future innovations.
Collapse
Affiliation(s)
- Dror B Leviner
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
| | - Dana Abraham
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth & Baruch Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel
| | - Tom Ronai
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
- The Ruth & Baruch Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel
| | - Erez Sharoni
- Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel
| |
Collapse
|
16
|
Shim CY, Kim EK, Cho DH, Park JB, Seo JS, Son JW, Kim IC, Lee SH, Heo R, Lee HJ, Lee S, Sun BJ, Yoon SJ, Lee SH, Kim HY, Kim HM, Park JH, Hong GR, Jung HO, Kim YJ, Kim KH, Kang DH, Ha JW, Kim H. 2023 Korean Society of Echocardiography position paper for the diagnosis and management of valvular heart disease, part II: mitral and tricuspid valve disease. J Cardiovasc Imaging 2024; 32:10. [PMID: 38951920 PMCID: PMC11218416 DOI: 10.1186/s44348-024-00021-6] [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: 09/05/2023] [Accepted: 11/30/2023] [Indexed: 07/03/2024] Open
Abstract
This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the diagnosis and management of valvular heart diseases with referring to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee sought to reflect national data on the topic of valvular heart diseases published to date through a systematic literature search based on validity and relevance. In the part II of this article, we intend to present recommendations for diagnosis and treatment of mitral valve disease and tricuspid valve disease.
Collapse
Affiliation(s)
- Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hyun Lee
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun Hwa Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
| |
Collapse
|
17
|
Florissi IS, Acton M, Kolesnik I, Pasrija C, Patel I, Etchill E, Holmes SD, Quinn R, Gammie JS. Non-resectional cordal repair for Barlow mitral valve disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:289-295. [PMID: 38511306 DOI: 10.23736/s0021-9509.24.12899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair. METHODS Patients included in this analysis underwent mitral valve repair from 01/2004-11/2021 by a single surgeon. RESULTS Of 2798 patients undergoing mitral valve operations, 46% (N.=1292) had degenerative pathology and 7% (N.=184) had Barlow disease. Of the 179 Barlow patients, median age at surgery was 62 (51-70) years; 64% were male (115/179). Rates of non-resectional cordal repair and resectional repair were 86% (154/179) and 14% (25/179). Among patients undergoing non-resectional repair, the median number of cordal pairs inserted on the anterior and posterior leaflets was 2 (2-3) and 4 (3-4). Incidence of return to bypass for systolic anterior motion of the mitral valve, perioperative death, stroke, and renal failure was 2% (4/179), 1% (2/179), 0% (0/179), and 0% (0/179). Rates of clinical and echocardiographic follow-up were 93% (165/177) and 89% (157/177). Median time to latest postoperative clinical and echocardiographic follow-up was 2.4 (0.8-6.1) and 2.1 (0.6-4.7) years. Mitral regurgitation grade at latest follow-up or time of repair failure was none/trace, mild, mild to moderate, and severe in 63% (98/157), 26% (41/157), 8% (12/157), and 4% (6/157); five of six patients with severe MR underwent reoperation. Since 2011 97% (139/144) of patients underwent cordal repair without resection. CONCLUSIONS Non-resectional artificial cordal repair is safe and feasible in almost all patients with Barlow valves and is associated with excellent mid-term results.
Collapse
Affiliation(s)
- Isabella S Florissi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Acton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Kolesnik
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ishani Patel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric Etchill
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sari D Holmes
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachael Quinn
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James S Gammie
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA -
| |
Collapse
|
18
|
Hamid N, Bursi F, Benfari G, Vanoverschelde JL, Tribouilloy C, Biagini E, Avierinos JF, Barbieri A, Fan Y, Guerra F, Leng CY, Essayagh B, Pasquet A, Szymansky C, Théron A, Michelena HI, Nkomo VT, Vancraeynest D, Rusinaru D, Grigioni F, Enriquez-Sarano ML, Pin DZ, Pui-Wai Lee A. Degenerative Mitral Regurgitation Outcomes in Asian Compared With European-American Institutions. JACC. ASIA 2024; 4:468-480. [PMID: 39100700 PMCID: PMC11291393 DOI: 10.1016/j.jacasi.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 08/06/2024]
Abstract
Background Clinical outcome and interventional thresholds for degenerative mitral regurgitation (DMR) were developed in studies of patients at European and American institutions (EAIs), but little is known about patients at Asian institutions (AsIs). Objectives This study sought to contrast DMR presentation/management/outcomes of AsI patients vs EAI patients. Methods Patients with DMR due to flail leaflet from Hong Kong and Singapore (AsI cohort, n = 737) were compared with EAI patients (n = 682) enrolled in the MIDA (Mitral regurgitation International Database) registry with similar eligibility criteria. Results AsI patients presented similar DMR lesion/consequences vs EAI patients, but they were younger, with fewer symptoms (74% vs 44% Class I), more sinus rhythm (83% vs 69%), and lower EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) (0.9 ± 0.5 vs 1.4 ± 1.5; all P < 0.0001). Imaging showed smaller absolute left atrial/ventricular dimensions in AsI patients, belying cardiac dilatation with larger body surface area-indexed diameters (all P < 0.01). Surgical/interventional mitral repair was similarly predominant (90% vs 91%; P = 0.47), and early repair was similarly beneficial (for AsI patients, adjusted HR: 0.28; 95% CI: 0.16-0.49; for EAI patients, HR: 0.32; 95% CI: 0.20-0.49; both P < 0.0001). However, AsI patients underwent fewer interventions (55% ± 2% vs 77% ± 2% at 1 year; P < 0.0001) and incurred excess mortality (adjusted HR: 1.60 [95% CI: 1.13-2.27] vs EAI patients; P = 0.008) at long-term postdiagnosis. Propensity score matching (434 patient pairs), which balanced all clinical characteristics, confirmed that there was undertreatment and excess mortality in the long term in AsI patients with DMR (P < 0.0001). Conclusions Imaging may underestimate volume overload in AsI patients due to smaller cardiac cavities related to smaller body size compared with EAI patients with similar mitral lesions and DMR severity. AsI patients enjoy similar mitral repair predominance and early intervention benefits but undergo fewer mitral interventions than EAI patients and incur subsequent excess mortality, suggesting the need to account for imaging and cultural specificity to improve DMR outcomes worldwide.
Collapse
Affiliation(s)
- Nadira Hamid
- National Heart Centre Singapore, Singapore
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Francesca Bursi
- University of Milan, Department of Health Sciences, Division of Cardiology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giovanni Benfari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
- University of Verona, Department of Medicine, Section of cardiology, Verona, Italy
| | - Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules Verne University Hospital, Amiens, France
| | - Elena Biagini
- Cardiovascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | | | - Andrea Barbieri
- Divison of Cardiology, Department of Diagnostics, Clinical and Health Public, University of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Yiting Fan
- Shanghai Chest Hospital, Shanghai, P.R. China
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy
| | | | - Benjamin Essayagh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
| | - Agnés Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Catherine Szymansky
- Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules Verne University Hospital, Amiens, France
| | - Alexis Théron
- Cardiovascular Division, Aix-Marseille Université, INSERM MMG U1251, Marseille, France
| | - Hector I. Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
| | - David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules Verne University Hospital, Amiens, France
| | | | - Maurice L. Enriquez-Sarano
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | | | - Alex Pui-Wai Lee
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong, P.R. China
| | - the MIDA Investigators
- National Heart Centre Singapore, Singapore
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
- University of Milan, Department of Health Sciences, Division of Cardiology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA
- University of Verona, Department of Medicine, Section of cardiology, Verona, Italy
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules Verne University Hospital, Amiens, France
- Cardiovascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy
- Cardiovascular Division, Aix-Marseille Université, INSERM MMG U1251, Marseille, France
- Divison of Cardiology, Department of Diagnostics, Clinical and Health Public, University of Modena, University of Modena and Reggio Emilia, Modena, Italy
- Shanghai Chest Hospital, Shanghai, P.R. China
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy
- Cardiovascular Department, University Campus Bio-Medico, Rome, Italy
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong, P.R. China
| |
Collapse
|
19
|
Gallegos J, Neuburger PJ, Pospishil L. Interventions for Mitral Valve Dysfunction in the Presence of Mitral Annular Calcification: Is There a Preferred Approach? J Cardiothorac Vasc Anesth 2024; 38:1068-1070. [PMID: 38413345 DOI: 10.1053/j.jvca.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Jose Gallegos
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY.
| |
Collapse
|
20
|
Recco DP, Kneier NE, Earley PD, Kizilski SB, Hammer PE, Hoganson DM. Fiberscope-Based Measurement of Coaptation Height for Intraoperative Assessment of Mitral Valve Repair. World J Pediatr Congenit Heart Surg 2024; 15:371-379. [PMID: 38327093 DOI: 10.1177/21501351231221459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Restoring adequate coaptation height is a key principle of mitral valve (MV) repair. This study aimed to evaluate the utility of fiberscope (FS) technology to assess MV coaptation height for intraoperative use. METHODS Ex-vivo testing was performed on five adult porcine hearts. The left atrium (LA) was resected, and the left ventricle (LV) was pressurized retrograde to 27 ± 1mm Hg. An endoscope was inserted into the LV apex, centered under the MV orifice. An FS system (Milliscope II camera, LED light source, and 0.7 mm diameter × 15 cm long) 90° semirigid scope with 1.2 mm focal length) was mounted above the MV annulus in a custom alignment and measuring fixture. Three blinded measurements were taken at two locations on each MV, A2 and P2 segment, from the top of coaptation to the leaflet edge identified by the FS. Accurate positioning was verified using the LV endoscope. A control (metal rod of similar thickness) was used for comparison, with coaptation height recorded when the control was seen via the endoscope. RESULTS Coaptation heights were similar for the control and FS methods across all hearts at A2 (11.6 ± 2.6 mm control vs 11.8 ± 2.2 mm FS) and P2 (13.3 ± 2.6 mm control vs 13.4 ± 2.9 mm FS) segments, with similar measurement variability (control SD 0.1-1.0 mm; FS SD 0.1-0.9 mm). One outlier was excluded from analysis (n = 19/20). The maximum absolute difference and percent error between measurement methods were less than 1.1 mm (median [IQR], 0.6 [0.3-0.9] mm) and less than 14% (4.1 [2.2-7.6]%). CONCLUSIONS Utilization of a miniaturized FS enabled precise and accurate quantification of MV coaptation. This technique is promising for evaluating post-repair valve competence and coaptation height.
Collapse
Affiliation(s)
- Dominic P Recco
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicholas E Kneier
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patrick D Earley
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Shannen B Kizilski
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter E Hammer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David M Hoganson
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Wang C, Yang W, Shi Z, Fang Y. Renal function improvement correlates with 3D echocardiographic findings: Effect of surgical mitral valve repair. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:385-393. [PMID: 38344863 DOI: 10.1002/jcu.23646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The association between surgical treatment of mitral regurgitation (MR) and renal function is not sufficiently well-known. We tried to evaluate renal function before and after the procedure of surgical mitral valve repair (SMVR) in degenerative severe MR. METHODS Patients with primary severe (4+) MR and normal left ventricular ejection fraction (LVEF) that underwent SMVR, examined by a cutting-edge 3-dimensional (3D) echocardiographic probe were enrolled in this study. We took three CKD-EPI equations to measure estimated glomerular filtration rate (eGFR) before SMVR and shortly before patients discharge. A total of 40 patients with baseline lower mean eGFR were evaluated. RESULTS Measurements substantiated statistically significant improvements in eGFR (p < 0.001), multivariable linear regression modeling indicating prominent associations between increase in eGFR and decrease of MR (p = 0.003), decline of pulmonary arterial systolic pressure (p = 0.018), as well as increment of forward stroke volume (p = 0.02), in spite of LVEF reduction, left ventricular global longitudinal strain worsening and left atrial ejection fraction impairment. CONCLUSIONS Renal function improves after SMVR in patients with degenerative significant MR and preserved LVEF, regardless of cardiac functional worsening.
Collapse
Affiliation(s)
- Chenchen Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbo Yang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongwei Shi
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Fang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
22
|
Zhu Y, Yajima S, Park MH, Venkatesh A, Stark CJ, Tran NA, Walsh SK, Ethiraj S, Wilkerson RJ, Lin LE, Lee SH, Gates KY, Arthur JD, Baker SW, Mullis DM, Wu CA, Harima S, Pokhrel B, Resuello D, Bergamasco H, Wu MA, Baccouche BM, Pandya PK, Elde S, Wang H, Woo YJ. Large Animal Translational Validation of 3 Mitral Valve Repair Operations for Mitral Regurgitation Using a Mitral Valve Prolapse Model: A Comprehensive In Vivo Biomechanical Engineering Analysis. Circ Cardiovasc Interv 2024; 17:e013196. [PMID: 38626077 DOI: 10.1161/circinterventions.123.013196] [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: 04/22/2023] [Accepted: 01/19/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Various mitral repair techniques have been described. Though these repair techniques can be highly effective when performed correctly in suitable patients, limited quantitative biomechanical data are available. Validation and thorough biomechanical evaluation of these repair techniques from translational large animal in vivo studies in a standardized, translatable fashion are lacking. We sought to evaluate and validate biomechanical differences among different mitral repair techniques and further optimize repair operations using a large animal mitral valve prolapse model. METHODS Male Dorset sheep (n=20) had P2 chordae severed to create the mitral valve prolapse model. Fiber Bragg grating force sensors were implanted to measure chordal forces. Ten sheep underwent 3 randomized, paired mitral valve repair operations: neochord repair, nonresectional leaflet remodeling, and triangular resection. The other 10 sheep underwent neochord repair with 2, 4, and 6 neochordae. Data were collected at baseline, mitral valve prolapse, and after each repair. RESULTS All mitral repair techniques successfully eliminated regurgitation. Compared with mitral valve prolapse (0.54±0.18 N), repair using neochord (0.37±0.20 N; P=0.02) and remodeling techniques (0.30±0.15 N; P=0.001) reduced secondary chordae peak force. Neochord repair further decreased primary chordae peak force (0.21±0.14 N) to baseline levels (0.20±0.17 N; P=0.83), and was associated with lower primary chordae peak force compared with the remodeling (0.34±0.18 N; P=0.02) and triangular resectional techniques (0.36±0.27 N; P=0.03). Specifically, repair using 2 neochordae resulted in higher peak primary chordal forces (0.28±0.21 N) compared with those using 4 (0.22±0.16 N; P=0.02) or 6 neochordae (0.19±0.16 N; P=0.002). No difference in peak primary chordal forces was observed between 4 and 6 neochordae (P=0.05). Peak forces on the neochordae were the lowest using 6 neochordae (0.09±0.11 N) compared with those of 4 neochordae (0.15±0.14 N; P=0.01) and 2 neochordae (0.29±0.18 N; P=0.001). CONCLUSIONS Significant biomechanical differences were observed underlying different mitral repair techniques in a translational large animal model. Neochord repair was associated with the lowest primary chordae peak force compared to the remodeling and triangular resectional techniques. Additionally, neochord repair using at least 4 neochordae was associated with lower chordal forces on the primary chordae and the neochordae. This study provided key insights about mitral valve repair optimization and may further improve repair durability.
Collapse
Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
- Department of Bioengineering (Y.Z., Y.J.W.), Stanford University, CA
| | - Shin Yajima
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Matthew H Park
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
- Department of Mechanical Engineering (M.H.P., P.K.P.), Stanford University, CA
| | - Akshay Venkatesh
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Charles J Stark
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Nicholas A Tran
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Sabrina K Walsh
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Sidarth Ethiraj
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Robert J Wilkerson
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Luca E Lin
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Seung Hyun Lee
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Kate Y Gates
- Department of Comparative Medicine (K.Y.G., J.D.A., S.W.B.), Stanford University, CA
| | - Justin D Arthur
- Department of Comparative Medicine (K.Y.G., J.D.A., S.W.B.), Stanford University, CA
| | - Sam W Baker
- Department of Comparative Medicine (K.Y.G., J.D.A., S.W.B.), Stanford University, CA
| | - Danielle M Mullis
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Catherine A Wu
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Shun Harima
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Bipul Pokhrel
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Dominique Resuello
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Hunter Bergamasco
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Matthew A Wu
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Basil M Baccouche
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Pearly K Pandya
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
- Department of Mechanical Engineering (M.H.P., P.K.P.), Stanford University, CA
| | - Stefan Elde
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Hanjay Wang
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery (Y.Z., S.Y., M.H.P., A.V., C.J.S., N.A.T., S.K.W., S. Ethiraj, R.J.W., L.E.L., S.H.L., D.M.M., C.A.W., S.H., B.P., D.R., H.B., M.A.W., B.M.B., P.K.P., S. Elde, H.W., Y.J.W.), Stanford University, CA
- Department of Bioengineering (Y.Z., Y.J.W.), Stanford University, CA
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Lee HA, Chang FC, Yeh JK, Tung YC, Wu VCC, Hsieh MJ, Chen CY, Yeh CH, Chu PH, Chen SW. Mitral Valve Repair vs. Replacement by Different Etiologies - A Nationwide Population-Based Cohort Study. Circ J 2024; 88:568-578. [PMID: 38281764 DOI: 10.1253/circj.cj-23-0640] [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] [Indexed: 01/30/2024]
Abstract
BACKGROUND When mitral valve (MV) surgery is indicated, repair is preferred over replacement; however, this preference is not supported by evidence from clinical trials. Furthermore, the benefits of MV repair may not be universal for all etiologies of MV disease. METHODS AND RESULTS This study identified a total of 18,428 patients who underwent MV repair (n=4,817) or MV replacement (n=13,611) during 2001-2018 from Taiwan's National Health Insurance Research Database. These patients were classified into 4 etiologies: infective endocarditis (IE, n=2,678), rheumatic heart disease (RHD, n=4,524), ischemic mitral regurgitation (IMR, n=3,893), and degenerative mitral regurgitation (DMR, n=7,333). After propensity matching, all-cause mortality during follow-up was lower among patients receiving MV repair than among patients receiving MV replacement in the IE, IMR, and DMR groups (hazard ratio [HR]=0.72, 95% confidence interval [CI]: 0.55-0.93; HR=0.82, 95% CI: 0.73-0.92; and HR 0.73, 95% CI: 0.64-0.84, respectively). However, in the RHD group, the MV reoperation rate was higher after MV repair than after MV replacement (subdistribution HR=1.91, 95% CI: 1.02-3.55). CONCLUSIONS In comparison with MV replacement, MV repair was associated with a lower late mortality in patients with IE, IMR, and DMR, and a higher risk of reoperation in patients with RHD.
Collapse
Affiliation(s)
- Hsiu-An Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
- Division of Cardiovascular Surgery, Cardiovascular Center, Taichung Veterans General Hospital
| | - Feng-Cheng Chang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Jih-Kai Yeh
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Ying-Chang Tung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Ming-Jer Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Chi-Hsiao Yeh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center
| |
Collapse
|
25
|
Chang FC, Chen CY, Chan YH, Cheng YT, Lin CP, Wu VCC, Hung KC, Chu PH, Chou AH, Chen SW. Sex Differences in Epidemiological Distribution and Outcomes of Surgical Mitral Valve Disease. Circ J 2024; 88:579-588. [PMID: 38267036 DOI: 10.1253/circj.cj-23-0687] [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] [Indexed: 01/26/2024]
Abstract
BACKGROUND Mitral valve (MV) disease is the most common form of valvular heart disease. Findings that indicate women have a higher risk for unfavorable outcomes than men remain controversial. This study aimed to determine the sex-based differences in epidemiological distributions and outcomes of surgery for MV disease. METHODS AND RESULTS Overall, 18,572 patients (45.3% women) who underwent MV surgery between 2001 and 2018 were included. Outcomes included in-hospital death and all-cause mortality during follow up. Subgroup analysis was conducted across different etiologies, including infective endocarditis (IE), degenerative, ischemic, and rheumatic mitral pathology. The overall MV repair rate was lower in women than in men (20.5% vs. 30.6%). After matching, 6,362 pairs (woman : man=1 : 1) of patients were analyzed. Women had a slightly higher risk for in-hospital death than men (10.8% vs. 9.8%; odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.99-1.24; P=0.075). Women tended to have a higher incidence of de novo dialysis (9.8% vs. 8.6%; P=0.022) and longer intensive care unit stay (8 days vs. 7.1 days; P<0.001). Women with IE had poorer in-hospital outcomes than men; however, there were no sex differences in terms of all-cause mortality. CONCLUSIONS Sex-based differences of MV intervention still persist. Although long-term outcomes were comparable between sexes, women, especially those with IE, had worse perioperative outcomes than men.
Collapse
Affiliation(s)
- Feng-Cheng Chang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Chia-Pin Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | | | - Kuo-Chun Hung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center
| |
Collapse
|
26
|
Lurz P, Kresoja KP. Surgical or percutaneous treatment of mitral regurgitation: clip or cut? Eur Heart J 2024; 45:950-951. [PMID: 38379446 DOI: 10.1093/eurheartj/ehae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Philipp Lurz
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, D-55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Karl-Patrik Kresoja
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, D-55131, Mainz, Germany
| |
Collapse
|
27
|
Zhu Y, Lee SH, Venkatesh A, Wu CA, Stark CJ, Ethiraj S, Lee JJ, Park MH, Yajima S, Woo YJ. Biomechanical engineering analysis of neochordae length's impact on chordal forces in mitral repair. Eur J Cardiothorac Surg 2024; 65:ezae008. [PMID: 38258541 DOI: 10.1093/ejcts/ezae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES Artificial neochordae implantation is commonly used for mitral valve (MV) repair. However, neochordae length estimation can be difficult to perform. The objective was to assess the impact of neochordae length changes on MV haemodynamics and neochordal forces. METHODS Porcine MVs (n = 6) were implanted in an ex vivo left heart simulator. MV prolapse (MVP) was generated by excising at least 2 native primary chordae supporting the P2 segments from each papillary muscle. Two neochordae anchored on each papillary muscle were placed with 1 tied to the native chord length (exact length) and the other tied with variable lengths from 2× to 0.5× of the native length (variable length). Haemodynamics, neochordal forces and echocardiography data were collected. RESULTS Neochord implantation repair successfully eliminated mitral regurgitation with repaired regurgitant fractions of approximately 4% regardless of neochord length (P < 0.01). Leaflet coaptation height also significantly improved to a minimum height of 1.3 cm compared with that of MVP (0.9 ± 0.4 cm, P < 0.05). Peak and average forces on exact length neochordae increased as variable length neochordae lengths increased. Peak and average forces on the variable length neochordae increased with shortened lengths. Overall, chordal forces appeared to vary more drastically in variable length neochordae compared with exact length neochordae. CONCLUSIONS MV regurgitation was eliminated with neochordal repair, regardless of the neochord length. However, chordal forces varied significantly with different neochord lengths, with a preferentially greater impact on the variable length neochord. Further validation studies may be performed before translating to clinical practices.
Collapse
Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Seung Hyun Lee
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Akshay Venkatesh
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Catherine A Wu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Charles J Stark
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Sidarth Ethiraj
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Justin J Lee
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Matthew H Park
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Shin Yajima
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| |
Collapse
|
28
|
Deng MX, Barodi B, Elbatarny M, Yau TM. Considerations & challenges of mitral valve repair in females: diagnosis, pathology, and intervention. Curr Opin Cardiol 2024; 39:86-91. [PMID: 38116820 DOI: 10.1097/hco.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Disparities in mitral valve (MV) repair outcomes exist between men and women. This review highlights sex-specific differences in MV disease aetiology, diagnosis, as well as timing and type of intervention. RECENT FINDINGS Females present with more complicated disease: anterior or bileaflet prolapse, leaflet dysplasia/thickening, mitral annular calcification, and mixed mitral lesions. The absence of indexed echocardiographic mitral regurgitation (MR) severity parameters contributes to delayed intervention in women, resulting in more severe symptom burden at time of surgery. The sequelae of chronic MR also necessitate concomitant procedures (e.g. tricuspid repair, arrhythmia surgery) at the time of mitral surgery. Complex MV pathology, greater patient acuity, and more complicated procedures collectively pose challenges to successful MV repair and postoperative recovery. As a consequence, women receive disproportionately more MV replacement than men. In-hospital mortality after MV repair is also greater in women than men. Long-term outcomes of MV repair are comparable after risk-adjustment for preoperative status; however, women experience a greater incidence of postoperative heart failure. SUMMARY To address the inequity in MV repair outcomes between sexes, indexed diagnostic measurements, diligent surveillance of asymptomatic MR, increased recruitment of women in large clinical trials, and mandatory reporting of sex-based subgroup analyses are recommended.
Collapse
Affiliation(s)
- Mimi Xiaoming Deng
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
- Department of Surgery, University of Toronto, Canada
| | - Batol Barodi
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
| | - Malak Elbatarny
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
- Department of Surgery, University of Toronto, Canada
| | - Terrence M Yau
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network
- Department of Surgery, University of Toronto, Canada
| |
Collapse
|
29
|
Sugimori H, Nakao T, Okada Y, Okita Y, Yaku H, Kobayashi J, Uesugi H, Takanashi S, Ito T, Koyama T, Sakaguchi T, Yamamoto K, Yoshikawa Y, Sawa Y. Mid-term outcomes of surgical aortic valve replacement using a mosaic porcine bioprosthesis with concomitant mitral valve repair. Heart Vessels 2024; 39:252-265. [PMID: 37843552 DOI: 10.1007/s00380-023-02325-x] [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: 04/06/2022] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
This study retrospectively evaluated the mid-term outcomes of surgical aortic valve replacement (SAVR) using a stented porcine aortic valve bioprosthesis (Mosaic; Medtronic Inc., Minneapolis, MN, USA) with concomitant mitral valve (MV) repair. From 1999 to 2014, 157 patients (median [interquartile range] age, 75 [70-79] years; 47% women) underwent SAVR with concomitant MV repair (SAVR + MV repair), and 1045 patients (median [interquartile range] age, 76 [70-80] years; 54% women) underwent SAVR only at 10 centers in Japan as part of the long-term multicenter Japan Mosaic valve (J-MOVE) study. The 5-year overall survival rate was 81.5% ± 4.1% in the SAVR + MV repair group and 85.1% ± 1.4% in the SAVR only group, and the 8-year overall survival rates were 75.2% ± 5.7% and 78.1% ± 2.1%, respectively. Cox proportional hazards analysis showed no significant difference in the survival rates between the two groups (hazard ratio, 0.87; 95% confidence interval, 0.54-1.40; P = 0.576). Among women with mild or moderate mitral regurgitation who were not receiving dialysis, those who underwent SAVR + MV repair, were aged > 75 years, and had a preoperative left ventricular ejection fraction of 30-75% tended to have a lower mortality risk. In conclusion, this subgroup analysis of the J-MOVE cohort showed relevant mid-term outcomes after SAVR + MV repair.
Collapse
Affiliation(s)
- Haruhiko Sugimori
- Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
| | - Tatsuya Nakao
- Department of Cardiovascular Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Yukikatsu Okada
- Department of Cardiovascular Surgery, Midori Hospital, 1-16 Edayoshi, Nishi-ku, Kobe, Hyogo, 651-2133, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki General Hospital, 1-3-13 Kosobe-Machi, Takatsuki, Osaka, 569-1192, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshin-Machi, Suita, Osaka, 564-0018, Japan
| | - Hideyuki Uesugi
- Department of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4101, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, 31-27 Omiya-Chyou, Saiwai-ku, Kawasaki, Kanagawa, 212-0014, Japan
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-Chyou, Nakamura-ku, Nagoya, Aichi, 453-0046, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo, 650-0045, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Tottori University, 4-101 Koyama-Cho, Minami, Tottori, 680-8550, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
30
|
Hagendorff A, Helfen A, Brandt R, Knebel F, Altiok E, Ewers A, Haghi D, Knierim J, Merke N, Romero-Dorta E, Ruf T, Sinning C, Stöbe S, Ewen S. Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography. Clin Res Cardiol 2024; 113:393-411. [PMID: 37212864 PMCID: PMC10881739 DOI: 10.1007/s00392-023-02227-y] [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: 03/23/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
The assessment of valvular pathologies in multiple valvular heart disease by echocardiography remains challenging. Data on echocardiographic assessment-especially in patients with combined aortic and mitral regurgitation-are rare in the literature. The proposed integrative approach using semi-quantitative parameters to grade the severity of regurgitation often yields inconsistent findings and results in misinterpretation. Therefore, this proposal aims to focus on a practical systematic echocardiographic analysis to understand the pathophysiology and hemodynamics in patients with combined aortic and mitral regurgitation. The quantitative approach of grading the regurgitant severity of each compound might be helpful in elucidating the scenario in combined aortic and mitral regurgitation. To this end, both the individual regurgitant fraction of each valve and the total regurgitant fraction of both valves must be determined. This work also outlines the methodological issues and limitations of the quantitative approach by echocardiography. Finally, we present a proposal that enables verifiable assessment of regurgitant fractions. The overall interpretation of echocardiographic results includes the symptomatology of patients with combined aortic and mitral regurgitation and the individual treatment options with respect to their individual risk. In summary, a reproducible, verifiable, and transparent in-depth echocardiographic investigation might ensure consistent hemodynamic plausibility of the quantitative results in patients with combined aortic and mitral regurgitation.
Collapse
Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - A Helfen
- Department of Cardiology, Kath. St. Paulus Gesellschaft, St-Marien-Hospital Lunen, Altstadtstrasse 23, 44534, Lünen, Germany
| | - R Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2‑8, 61231, Bad Nauheim, Germany
| | - F Knebel
- Klinik Für Innere Medizin II, Kardiologie, Sana Klinikum Lichtenberg, Fanningerstrasse 32, 10365, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Berlin, German Heart Center Charité Berlin, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany
| | - E Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Ewers
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, de La Camp-Platz 1, 44789, Bochum, Germany
| | - D Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis der Universitat Mannheim-Ludwig-Guttmann, Strasse 11, 67071, Ludwigshafen, Germany
| | - J Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Paulinenkrankenhaus Berlin, Klinik Für Innere Medizin Und Kardiologie, Dickensweg 25‑39, 14055, Berlin, Germany
| | - N Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Romero-Dorta
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Berlin, German Heart Center Charité Berlin, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany
| | - T Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - C Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lubeck, Martinistrasse 52, 20251, Hamburg, Germany
| | - S Stöbe
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - S Ewen
- Zentrale Notaufnahme and Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Homburg, Germany
| |
Collapse
|
31
|
Nanchahal S, Arjomandi Rad A, Naruka V, Chacko J, Liu G, Afoke J, Miller G, Malawana J, Punjabi P. Mitral valve surgery assisted by virtual and augmented reality: Cardiac surgery at the front of innovation. Perfusion 2024; 39:244-255. [PMID: 36314484 DOI: 10.1177/02676591221137480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Given the variety in mitral valve (MV) pathology and associated surgical techniques, extended reality (XR) holds great potential to assist MV surgeons. This review aims to systematically evaluate the currently available evidence investigating the use of XR and associated technologies in MV surgery. METHODS A systematic database search was conducted of original articles and case reports that explored the use of XR and MV surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to February 2022. RESULTS Our search yielded 171 articles, of which 15 studies were included in this review, featuring 328 patients. Two main areas of application were identified: (i) pre-operative planning and (ii) predicting post-operative outcomes. The articles reporting outcomes relating to pre-operative planning were further categorised as exploring themes relevant to (i) mitral annular assessment; (ii) training; (iii) evaluation of surgical technique; (iv) surgical approach or plan and (v) selecting ring size or type. Preoperatively, XR has been shown to evaluate mitral annular pathology more accurately than echocardiography, informing the surgeon about the optimal surgical technique, approach and plan for a particular patient's MV pathology. Furthermore, XR could simulate and aid ring size/type selection for MV annuloplasty, creating a personalized surgical plan. Additionally, XR could estimate the postoperative MV biomechanical and physiological characteristics, predicting and pre-empting post-operative complications. CONCLUSION XR demonstrated promising applications for assisting MV surgery, enhancing outcomes and patient-centred care, nevertheless, there remain the need for randomized studies to ascertain its feasibility, safety, and validity in clinical practice.
Collapse
Affiliation(s)
- Sukanya Nanchahal
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Vinci Naruka
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Jacob Chacko
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Guiqing Liu
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Jonathan Afoke
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, UK
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, UK
| | - Prakash Punjabi
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
32
|
Zheng S, Wang J, Zhang H, Wang S, Meng X. The effect of surgery started at different time point during the day on the clinical outcomes of mitral valve surgery. Front Cardiovasc Med 2024; 11:1360763. [PMID: 38433755 PMCID: PMC10904606 DOI: 10.3389/fcvm.2024.1360763] [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: 01/01/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Background The clinical prognosis of mitral valve surgery at morning, afternoon, and evening is not yet clear. The aim of the study is to investigate the impact of different time periods of surgery in the morning, afternoon and evening on the short-term and long-term results of mitral valve surgery. Methods From January 2018 to December 2020, 947 patients with mitral valve surgery in our department were selected. These patients were divided into 3 groups according to the starting time of surgery. Morning group (operation start time 8:00-10:30, n = 231), afternoon group (operation start time 12:00-14:30, n = 543), and evening group (operation start time 17:30-20:00, n = 173). The short-term and long-term results of the three groups were compared. Results There were no significant difference in the long-term mortality, long-term risk of stroke and reoperation. And there were no significant difference in in-hospital outcomes, including mortality, stroke, cardiopulmonary bypass time, aortic cross clamp time, mitral valve repair convert to mitral valve replacement, number of aortic cross clamp ≥2 times, unplanned secondary surgery during hospitalization (including thoracotomy hemostasis, thoracotomy exploration, redo mitral valve surgery, and debridement), intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous renal replacement therapy, mechanical ventilation time, and intensive care unit length of stay. Conclusion There is no significant difference in the risk of short-term and long-term survival and adverse events after mitral valve surgery at different time periods in the morning, afternoon, and evening. Mitral valve surgery at night is safe.
Collapse
Affiliation(s)
- Shuai Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | | | | |
Collapse
|
33
|
Caldonazo T, Sá MP, Jacquemyn X, Van den Eynde J, Kirov H, Harik L, Fischer J, Vervoort D, Bonatti J, Sultan I, Doenst T. Respect Versus Resect Approaches for Mitral Valve Repair: A Meta-Analysis of Reconstructed Time-to-Event Data. Am J Cardiol 2024; 213:5-11. [PMID: 38104750 DOI: 10.1016/j.amjcard.2023.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/15/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
Mitral valve repair (MVr) has been associated with superior long-term survival and freedom from valve-related complications compared with mitral valve replacement for primary mitral regurgitation (MR). The 2 main approaches for MVr are chordal replacement ("respect approach") and leaflet resection ("resect approach"). We performed a systematic review and a meta-analysis using 3 search databases to compare the long-term end points between both approaches. The primary end point was long-term survival. The secondary end points were long-term MR recurrence and reoperation. After reconstruction of time-to-event data for the individual survival analysis, pooled Kaplan-Meier curves for the end points were generated. A total of 14 studies (5,565 patients) were included in the analysis. The respect approach was associated with superior survival compared with the resect approach in the overall sample (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56 to 0.96, p = 0.024, n = 3,901 patients) but not in the risk-adjusted sample (HR 1.00, 95% CI 0.55 to 1.82, p = 0.991, n = 620 patients). There was no difference between the approaches in the rate of MR recurrence in the overall sample (HR 1.39, 95% CI 0.92 to 2.08, p = 0.116, n = 1,882 patients) or in the risk-adjusted sample (HR 1.62, 95% CI 0.76 to 3.47, p = 0.211, n = 288 patients). The data for reoperation were only available in the overall sample and did not reveal a difference (HR 0.92, 95% CI 0.62 to 1.35, p = 0.663, n = 3,505 patients). In conclusion, the current evidence suggests no difference in long-term mortality, MR recurrence, or reoperation between the resect and respect approaches for MVr after adjusting for patient risk factors. More long-term follow-up data are warranted.
Collapse
Affiliation(s)
- Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany.
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| |
Collapse
|
34
|
Chan J, Narayan P, Fudulu DP, Dong T, Angelini GD. Trend in mitral valve prostheses of choice and early outcomes in the United Kingdom. Int J Cardiol 2024; 397:131607. [PMID: 38013051 DOI: 10.1016/j.ijcard.2023.131607] [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: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Despite the superiority of mitral valve repair, surgical mitral valve replacement (SMVR) remains an important intervention for patients with valve stenosis, infective endocarditis and complex mitral valve degeneration. There has been an increasing popularity in the worldwide use of biological valves due to the avoidance of long-term anti-coagulation and recent advancements in transcatheter techniques. We aim to evaluate the trend, early clinical outcomes and the choice of prostheses use in isolated SMVR over a 23 years period in the United Kingdom. METHODS All patients (n = 13,147) who underwent elective or urgent isolated SMVR from March 1996 to April 2019 were identified from the National Adult Cardiac Surgery Audit database. Trends in clinical outcomes, predicted/observed mortality of patients and the utilization of biological prostheses across 5 different age groups: <50, 50-59, 60-69, 70-79 and ≥80 years old were investigated. Early clinical outcomes associated with the use of mechanical and biological mitral valve prostheses in patients between the age of 60-70 years old were analysed. RESULTS The number of isolated SMVR performed has remained stable with approximately 600 cases annually since 2010. The in-hospital/30-day mortality rate has decreased from 7.41% (1996) to 3.92% (2018), despite the EuroScore II increasing from 1.42% in 1996 to 2.43% in 2018. Biological prostheses usage increased across all age group, and particularly in the 60-69 and 70-79 group, from 17.86% and 53.85% in 1996 to 48.85% and 82.38% in 2018, respectively. The use of mechanical prostheses was reduced in patients between the age of 50-59 from 100% in 1996 to 80.65% in 2018. There were no differences in short term outcomes among patients aged 60-70 years who received either a biological or mechanical prostheses. CONCLUSION There has been a significant reduction in surgical mitral valve replacement early in-hospital mortality, despite an observed increase in the risk profile of patients over 23 years. A shifting trend in valve replacement choices was observed with a rise in the use of biological prostheses, particularly within the 60-69 and 70-79 age group. Early in hospital outcomes for patients aged 60-70 were not determined by the implanted valve type.
Collapse
Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Tim Dong
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom.
| |
Collapse
|
35
|
Powers A, Lavoie N, Le Nezet E, Clavel MA. Unique Aspects of Women's Valvular Heart Diseases: Impact for Diagnosis and Treatment. CJC Open 2024; 6:503-516. [PMID: 38487043 PMCID: PMC10935694 DOI: 10.1016/j.cjco.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/15/2023] [Indexed: 03/17/2024] Open
Abstract
Valvular heart diseases (VHDs) are a major cause of cardiovascular morbidity and mortality worldwide. As degenerative and functional mechanisms represent the main etiologies in high-income countries are degenerative and functional, while in low income countries etiologie is mostly rheumatic. Although therapeutic options have evolved considerably in recent years, women are consistently diagnosed at later stages of their disease, are delayed in receiving surgical referrals, and exhibit worse postoperative outcomes, compared to men. This difference is a result of the historical underrepresentation of women in studies from which current guidelines were developed. However, in recent years, important research, including more female patients, has been conducted and has highlighted substantial sex-specific differences in the etiology, diagnosis, and treatment of VHDs. Systematic consideration of these sex-specific differences in VHD patients is crucial for providing equitable healthcare and optimizing clinical outcomes in both female and male patients. Hence, this review aims to explore implications of sex-specific particularities for diagnosis, treatment options, and outcomes in women with VHDs.
Collapse
Affiliation(s)
- Andréanne Powers
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| | - Nicolas Lavoie
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Emma Le Nezet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| |
Collapse
|
36
|
Kakuta T, Peng D, Yong MS, Skarsgard P, Cook R, Ye J. Long-term outcome of isolated mitral valve repair versus replacement for degenerative mitral regurgitation in propensity-matched patients. JTCVS OPEN 2024; 17:84-97. [PMID: 38420543 PMCID: PMC10897656 DOI: 10.1016/j.xjon.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/22/2023] [Accepted: 12/10/2023] [Indexed: 03/02/2024]
Abstract
Objective This study was performed to investigate the long-term outcomes in patients with degenerative mitral regurgitation (MR) undergoing mitral valve repair (MVr) versus mitral valve replacement (MVR) without concomitant surgeries. Methods The study cohort comprised 1493 patients with degenerative MR who were treated with isolated mitral valve surgery between January 2000 and December 2017 in a large multicenter (5 hospitals) registry of the Province of British Columbia, Canada, including 991 with repair and 502 with replacement. A propensity-matched comparison and risk-adjusted model were used to analyze the outcomes. Results After propensity matching (415 matched pairs), the 30-day mortalities were 2.4% and 3.6% in the MVr and MVR groups respectively (odds ratio [OR], 1.500; 95% confidence interval [CI], 0.674-3.339; P = .32). The MVR group had significantly greater rates of prolonged inotrope usage >24 hours (P = .024), prolonged ventilation (P = .039), and blood transfusion (P = .023). The respective 1-, 5-, 10-, and 15-year survival rates were 95.7%, 88.8%, 71.4%, and 53.3% in the MVr group, and 93.0%, 81.6%, 61.3%, and 46.0% in the MVR group (hazard ratio [HR], 1.355; 95% CI, 1.105-1.661; P = .004). A multivariable analysis revealed that MVR was an independent risk factor for 30-day mortality (OR, 2.270; 95% CI, 1.089-4.732; P = .029) and long-term mortality (HR, 1.417; 95% CI, 1.161-1.729; P < .001). The HR of MVR over MVr remained consistently greater than 1.0 across all ages. Conclusions MVr is associated with lower postoperative morbidity and better long-term survival compared with MVR in patients undergoing isolated mitral valve surgery for degenerative MR. The benefit of MVr appears age-independent.
Collapse
Affiliation(s)
- Takashi Kakuta
- Division of Cardiovascular Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Defen Peng
- Division of Cardiovascular Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew S Yong
- Division of Cardiovascular Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Skarsgard
- Division of Cardiovascular Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Cook
- Division of Cardiovascular Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Division of Cardiovascular Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
37
|
Glaser N, Sartipy U, Dismorr M. Prosthetic Valve Endocarditis After Aortic Valve Replacement With Bovine Versus Porcine Bioprostheses. J Am Heart Assoc 2024; 13:e031387. [PMID: 38156596 PMCID: PMC10863842 DOI: 10.1161/jaha.123.031387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/05/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Whether a bovine or porcine aortic valve bioprosthesis carries a higher risk of endocarditis after aortic valve replacement is unknown. The aim of this study was to compare the risk of prosthetic endocarditis in patients undergoing aortic valve replacement with a bovine versus porcine bioprosthesis. METHODS AND RESULTS This nationwide, population-based cohort study included all patients who underwent surgical aortic valve replacement with a bovine or porcine bioprosthesis in Sweden from 1997 to 2018. Regression standardization was used to account for intergroup differences. The primary outcome was prosthetic valve endocarditis, and the secondary outcomes were all-cause mortality and early prosthetic valve endocarditis. During a maximum follow-up time of 22 years, we included 21 022 patients, 16 603 with a bovine valve prosthesis and 4419 with a porcine valve prosthesis. The mean age was 73 years, and 61% of the patients were men. In total, 910 patients were hospitalized for infective endocarditis: 690 (4.2%) in the bovine group and 220 (5.0%) in the porcine group. The adjusted cumulative incidence of prosthetic valve endocarditis at 15 years was 9.5% (95% CI, 6.2%-14.4%) in the bovine group and 2.8% (95% CI, 1.4%-5.6%) in the porcine group. The absolute risk difference between the groups at 15 years was 6.7% (95% CI, 0.8%-12.5%). CONCLUSIONS The risk of endocarditis was higher in patients who received a bovine compared with a porcine valve prosthesis after surgical aortic valve replacement. This association should be considered in patients undergoing both surgical and transcatheter aortic valve replacement.
Collapse
Affiliation(s)
- Natalie Glaser
- Department of CardiologyStockholm South General HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Cardiothoracic SurgeryKarolinska University HospitalStockholmSweden
| | - Michael Dismorr
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Cardiothoracic SurgeryKarolinska University HospitalStockholmSweden
| |
Collapse
|
38
|
Stanley A, Athanasuleas C. Timing of Surgery for Asymptomatic Primary Mitral Regurgitation: Possible Value of Early, Serial Measurements of Left Ventricular Sphericity. Curr Cardiol Rev 2024; 20:93-101. [PMID: 38351687 PMCID: PMC11107465 DOI: 10.2174/011573403x277223240206062319] [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: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 04/30/2024] Open
Abstract
Asymptomatic primary mitral regurgitation due to myxomatous degeneration of the mitral valve leaflets may remain so for long periods, even as left ventricular function progresses to a decompensated stage. During the early compensated stage, the ventricle's initial response to the volume overload is an asymmetric increase in the diastolic short axis dimension, accomplished by a diastolic shift of the interventricular septum into the right ventricular cavity, creating a more spherical left ventricular diastolic shape, increasing diastolic filling and stroke volume. Early valve repair is recommended to reduce postoperative left ventricular dysfunction. Early serial measurements of left ventricular sphericity index [LV-Si]. during the compensated stage of mitral regurgitation might identify subtle changes in left ventricular shape and assist in determining the optimal earliest timing for surgical intervention.
Collapse
Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham AL and Kemp-Carraway Heart Institute, Birmingham, AL, USA
| | - Constantine Athanasuleas
- Department of Surgery, North Alabama Medical Center and Kemp-Carraway Heart Institute, Birmingham, AL, USA
| |
Collapse
|
39
|
Shi N, Zhang N, Zhang S, Zhang H, Zou C, Zhu M. Mitral valvuloplasty using real-time three-dimensional transesophageal echocardiography. Ann Noninvasive Electrocardiol 2024; 29:e13104. [PMID: 38288512 PMCID: PMC10795079 DOI: 10.1111/anec.13104] [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: 04/14/2023] [Revised: 10/08/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the structure of the mitral valve in patients undergoing mitral valvuloplasty (MVP) using real-time three-dimensional transesophageal echocardiography (RT-3D-TEE). The main objective was to study the relationship between intraoperative annuloplasty ring size and mitral valve structure dimensions, with a focus on exploring the application value of RT-3D-TEE in MVP. METHODS A total of 28 patients with degenerative mitral regurgitation (DMR), who underwent MVP between February and September 2022, as well as 12 normal control cases, were enrolled in this study. The MV annulus and leaflets were quantitatively analyzed using MVN software. RESULTS The DMR group exhibited significantly greater dimensions in various parameters of the mitral valve, including the anterolateral-to-posteromedial diameter (DAlPm ), anterior-to-posterior diameter (DAP ), annulus height (HA ), three-dimensional annulus circumference (CA3D ), two-dimensional annulus area (AA2D ), anterior leaflet area (Aant ), posterior leaflet area (Apost ), anterior leaflet length (Lant ), posterior leaflet length (Lpost ), and tenting volume (Vtent ) compared to the control group. CONCLUSION Real-time three-dimensional transesophageal echocardiography provides valuable insights into the morphological structure of the mitral valve and lesion location. It can aid in surgical decision-making, validate the success of MVP, and potentially reduce mortality and complications associated with mitral valve repair procedures.
Collapse
Affiliation(s)
| | - Nan Zhang
- Department of UltrasoundShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Shuo Zhang
- Department of UltrasoundShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Hai‐Zhou Zhang
- Department of Cardiovascular SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Cheng‐Wei Zou
- Department of Cardiovascular SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| | - Mei Zhu
- Department of UltrasoundShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanChina
| |
Collapse
|
40
|
Tomšič A, de Weger A, van der Stoel M, Klautz RJM, Palmen M. A Nationwide Study on Mitral Valve Repair vs Replacement for Active Endocarditis. Ann Thorac Surg 2024; 117:120-126. [PMID: 37714504 DOI: 10.1016/j.athoracsur.2023.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Real-world evidence supporting the reproducibility and superiority of valve repair over replacement in active mitral valve infective endocarditis is lacking. METHODS Data from a prospective nationwide database, including all cardiac surgical procedures in The Netherlands, were used. Adult patients undergoing primary mitral valve intervention who had a diagnosis of active infective endocarditis and who underwent surgery between 2013 and 2020 were included. Survival analysis was performed for the whole follow-up period as well as after applying the landmark of 90 days. RESULTS Of 715 patients who met the inclusion criteria, 294 (41.1%) underwent valve repair. Mitral valve repair rates decreased slightly over the course of the study. The early mortality rate was 13.0%, and a trend of steadily declining early mortality rates over the course of the study, despite a steady increase in patient complexity, was observed. On risk-adjusted analysis, mitral valve replacement demonstrated inferior results when compared with valve repair (adjusted hazard ratio, 2.216; 95% CI, 1.425-3.448; P < .001), even after a landmark analysis was performed (adjusted hazard ratio 2.489; 95% CI, 1.124-5.516; P = .025). These results were confirmed by a propensity score-adjusted analysis (adjusted hazard ratio 2.251; 95% CI, 1.029-4.21; P = .042). CONCLUSIONS Contemporary trends in mitral valve surgery for active infective endocarditis suggest growing patient complexity but slightly declining early mortality rates. A trend of decreasing mitral valve repair rates was seen. The results of this study suggest improved late outcomes of valve repair compared with valve replacement.
Collapse
Affiliation(s)
- Anton Tomšič
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Arend de Weger
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
41
|
Delgado V, Ajmone Marsan N, Bonow RO, Hahn RT, Norris RA, Zühlke L, Borger MA. Degenerative mitral regurgitation. Nat Rev Dis Primers 2023; 9:70. [PMID: 38062018 DOI: 10.1038/s41572-023-00478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/18/2023]
Abstract
Degenerative mitral regurgitation is a major threat to public health and affects at least 24 million people worldwide, with an estimated 0.88 million disability-adjusted life years and 34,000 deaths in 2019. Improving access to diagnostic testing and to timely curative therapies such as surgical mitral valve repair will improve the outcomes of many individuals. Imaging such as echocardiography and cardiac magnetic resonance allow accurate diagnosis and have provided new insights for a better definition of the most appropriate timing for intervention. Advances in surgical techniques allow minimally invasive treatment with durable results that last for ≥20 years. Transcatheter therapies can provide good results in select patients who are considered high risk for surgery and have a suitable anatomy; the durability of such repairs is up to 5 years. Translational science has provided new knowledge on the pathophysiology of degenerative mitral regurgitation and may pave the road to the development of medical therapies that could be used to halt the progression of the disease.
Collapse
Affiliation(s)
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert O Bonow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Russell A Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Liesl Zühlke
- South African Medical Research Council, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics, Institute of Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| |
Collapse
|
42
|
Wagner CM, Fu WW, Brescia AA, Hawkins RB, Romano MA, Ailawadi G, Bolling SF. Repeat crossclamp after failed initial degenerative mitral valve repair is safe and successful. JTCVS OPEN 2023; 16:209-217. [PMID: 38204717 PMCID: PMC10775030 DOI: 10.1016/j.xjon.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 01/12/2024]
Abstract
Objective Surgical risk and long-term outcomes when re-crossclamp is required during degenerative mitral valve repair are unknown. We examined the outcomes of patients who required re-crossclamp for mitral valve reintervention. Methods Adults undergoing mitral valve repair for degenerative mitral valve disease at a single center from 2007 to 2021 who required more than 1 crossclamp for mitral valve reintervention were included. Outcomes including major morbidity and 30-day mortality were collected. Kaplan-Meier analysis characterized survival and freedom from recurrent mitral regurgitation. Results A total of 69 patients required re-crossclamp for mitral valve reintervention. Of those, 72% (n = 50) underwent successful re-repair and the remaining underwent mitral valve replacement (28%, n = 19). Major morbidity occurred in 23% (n = 16). There was no 30-day mortality, and median long-term survival was 10.9 years for those undergoing re-repair and 7.2 years for those undergoing replacement (P = .79). Midterm echocardiography follow-up was available for 67% (33/50) of patients who were successfully re-repaired with a median follow-up of 20 (interquartile range, 7-37) months. At late follow-up, 90% of patients had mild or less mitral regurgitation. Of those re-repaired, 2 patients later required mitral valve reintervention. Conclusions Patients requiring re-crossclamp for residual mitral regurgitation had low perioperative morbidity and no mortality. Most patients underwent successful re-repair (vs mitral valve replacement) with excellent valve function and long-term survival. In the event of unsatisfactory repair at the time of mitral valve repair, attempt at re-repair is safe and successful with the appropriate valvar anatomy.
Collapse
Affiliation(s)
- Catherine M. Wagner
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Whitney W. Fu
- Department of General Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | | | - Robert B. Hawkins
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Matthew A. Romano
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| | - Steven F. Bolling
- Department of Cardiac Surgery, University of Michigan Medicine, Ann Arbor, Mich
| |
Collapse
|
43
|
Zhu L, Chua YL. Mitral Annular Disjunction: Clinical Implications and Surgical Considerations. Cardiol Res 2023; 14:421-428. [PMID: 38187510 PMCID: PMC10769617 DOI: 10.14740/cr1584] [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: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 01/09/2024] Open
Abstract
Mitral annular disjunction is a cardiac structural abnormality characterized by the distinct separation between the top of the left ventricular myocardium and the mitral annulus supporting the posterior mitral leaflet occurring during systole. It has recently gained wide attention due to the increasing recognition of the link between mitral annular disjunction and arrhythmogenic mitral valve prolapse, particularly, with the increased risks of ventricular arrhythmias resulting in sudden cardiac death. This review has summarized the recent progress in the diagnostic modalities, clinical implications of mitral annular disjunction, and its specific surgical considerations.
Collapse
Affiliation(s)
- Ling Zhu
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore 169609, Singapore
| | - Yeow Leng Chua
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore 169609, Singapore
| |
Collapse
|
44
|
Hu YN, Lee WH, Tsai MT, Wang YC, Shih CJ, Huang YC, Roan JN. The Predictors and Outcomes of Functional Mitral Stenosis following Surgical Mitral Valve Repair: A Retrospective Analysis. J Cardiovasc Dev Dis 2023; 10:470. [PMID: 37998528 PMCID: PMC10672255 DOI: 10.3390/jcdd10110470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
To optimize mitral valve repair outcomes, it is crucial to comprehend the predictors of functional mitral valve stenosis (FMS), to enhance preoperative assessments, and to adapt intraoperative treatment strategies. This study aimed to identify FMS risk factors, contributing valuable insights for refining surgical techniques. Among 228 selected patients, 215 underwent postoperative echocardiography follow-ups, and 36 met the FMS criteria based on a mean trans-mitral pressure gradient of >5 mmHg. Patients with FMS exhibited higher pulmonary systolic arterial pressure and increased late mortality during the follow-up. Univariable logistic regression analysis identified several risk factors for FMS, including end-stage renal disease, anterior leaflet lesion, concomitant aortic valve replacement, smaller ring size, ring type, and neochordae implantation. Conversely, resection alone and resection combined with neochordae implantation had protective effects against FMS. Multivariable logistic regression analysis revealed that smaller ring sizes and patch repair independently predicted FMS. When focusing on degenerative mitral regurgitation, the neochordae implantation without resection in leaflet repair, emerged as an independent predictor of FMS. Surgeons should weigh the substantial impact of surgical procedures on postoperative trans-mitral pressure gradients, emphasizing preoperative evaluation and techniques such as precise ring size assessment and effective leaflet management.
Collapse
Affiliation(s)
- Yu-Ning Hu
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Wen-Huang Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Meng-Ta Tsai
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Yi-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Chao-Jung Shih
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Yu-Ching Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-N.H.); (M.-T.T.); (Y.-C.W.); (C.-J.S.); (Y.-C.H.)
| |
Collapse
|
45
|
Urena M, Lurz P, Sorajja P, Himbert D, Guerrero M. Transcatheter mitral valve implantation for native valve disease. EUROINTERVENTION 2023; 19:720-738. [PMID: 37994096 PMCID: PMC10654769 DOI: 10.4244/eij-d-22-00890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/07/2023] [Indexed: 11/24/2023]
Abstract
Mitral regurgitation is the second most frequent heart valve disease in Europe and the most frequent in the US. Although surgery is the therapy of choice when intervention is indicated, transcatheter mitral valve repair or replacement are alternatives for patients who are not eligible for surgery. However, the development of transcatheter mitral valves is slower than expected. Although several transcatheter heart valves have been developed, only one has been commercialised. Indeed, most of these devices are being evaluated in clinical studies, with promising initial results. In this review, we propose an overview on transcatheter mitral valve replacement for the treatment of native mitral valve disease, from indication to results, including patients with severe annular calcification, and we provide you with a glimpse into the future of these therapies.
Collapse
Affiliation(s)
- Marina Urena
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philipp Lurz
- Department of Cardiology, Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Dominique Himbert
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
46
|
Kang Y, Sohn SH, Choi JW, Hwang HY, Kim KH. Machine-learning-based prediction of survival and mitral regurgitation recurrence in patients undergoing mitral valve repair. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad176. [PMID: 37966944 PMCID: PMC10903183 DOI: 10.1093/icvts/ivad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/25/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES This study was conducted to assess long-term clinical outcomes after mitral valve repair using machine-learning techniques. METHODS We retrospectively evaluated 436 consecutive patients (mean age: 54.7 ± 15.4; 235 males) who underwent mitral valve repair between January 2000 and December 2017. Actuarial survival and freedom from significant (≥ moderate) mitral regurgitation (MR) were clinical end points. To evaluate the independent risk factors, random survival forest (RSF), extreme gradient boost (XGBoost), support vector machine, Cox proportional hazards model and general linear models with elastic net regularization were used. Concordance indices (C-indices) of each model were estimated. RESULTS The operative mortality was 0.9% (N = 4). Reoperation was required in 15 patients (3.5%). In terms of C-index, the overall performance of the XGBoost (C-index 0.806) and RSF models (C-index 0.814) was better than that of the Cox model (C-index 0.733) in overall survival. For the recurrent MR, the C-index for XGBoost was 0.718, which was the highest among the 5 models. Compared to the Cox model (C-index 0.545), the C-indices of the XGBoost (C-index 0.718) and RSF models (C-index 0.692) were higher. CONCLUSIONS Machine-learning techniques can be a useful tool for both prediction and interpretation in the survival and recurrent MR. From the machine-learning techniques examined here, the long-term clinical outcomes of mitral valve repair were excellent. The complexity of MV increased the risk of late mitral valve-related reoperation.
Collapse
Affiliation(s)
- Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
47
|
Simpson MT, Kachel M, Neely RC, Erwin WC, Yasin A, Patel A, Rao DP, Pandey K, George I. Rheumatic Heart Disease in the Developing World. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100219. [PMID: 38046860 PMCID: PMC10692356 DOI: 10.1016/j.shj.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 12/05/2023]
Abstract
Despite recent public policy initiatives, rheumatic heart disease (RHD) remains a major source of morbidity worldwide. Rheumatic heart disease occurs as a sequela of Streptococcus pyogenes (group A streptococcal [GAS]) infection in patients with genetic susceptibility. Strategies for prevention of RHD or progression of RHD include prevention of GAS infection with community initiatives, effective treatment of GAS infection, and secondary prophylaxis with intramuscular penicillin. The cardiac surgical community has attempted to improve the availability of surgery in RHD-endemic areas with some success, and operative techniques and outcomes of valve repair continue to improve, potentially offering patients a safer, more durable operation. Innovation offers hope for a more scalable solution with improved biomaterials and transcatheter delivery technology; however, cost remains a barrier.
Collapse
Affiliation(s)
- Michael T. Simpson
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Mateusz Kachel
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | | | - W. Clinton Erwin
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Aleena Yasin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA
| | - Amisha Patel
- Division of Cardiology, Mount Sinai Medical Center, New York, New York, USA
| | - Dasari Prasada Rao
- Department of Cardiothoracic Surgery, Apollo Spectra Hospital, Hyderabad, India
| | - Kaushal Pandey
- Centre for Cardiac Care, Hinduja Hospital, Mumbai, India
| | - Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| |
Collapse
|
48
|
Deja MA, Malinowski M, Widenka K, Stożyński N, Bartuś K, Kapelak B, Kuśmierczyk M, Hirnle G, Suwalski P, Jasiński M, Gerber W, Tobota Z, Barański K, Maruszewski BJ. Comparison of Repair vs Replacement in Calcific and Rheumatic Mitral Disease. Ann Thorac Surg 2023; 116:954-961. [PMID: 37271445 DOI: 10.1016/j.athoracsur.2023.04.048] [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: 11/19/2022] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The benefit of repair over replacement of rheumatic or calcified mitral valve (MV) is debatable. METHODS Patients who underwent MV repair or replacement for rheumatic or calcified MV disease between 2006 and 2020 were identified in the Polish National Registry of Cardiac Surgery Procedures. Patients who underwent additional procedures other than coronary artery bypass grafting or tricuspid valve surgery, as well as redo or emergency cases, were excluded. The long-term survival was verified based on National Health Fund registry data. The survival was compared between MV repair and replacement in the whole cohort and after propensity score matching. RESULTS We included 4338 patients: 1859 (43%) with pure mitral regurgitation and 2479 (57%) with mitral stenosis. MV was repaired in 543 patients (29%) with pure regurgitation and 126 (5.1%) with stenosis (P < .001). In total, 984 (23%) patients underwent concomitant coronary artery bypass grafting and 1358 (32%) tricuspid valve surgery. MV repair improved survival (hazard ratio 0.81; 95% CI 0.68-0.97; P = .022) in patients with no mitral stenosis, and had no effect in mitral stenosis (hazard ratio 1.17; 95% CI 0.85-1.59; P = .332). The results were confirmed in propensity-matched cohorts. The freedom from MV reoperation at 10 years was 95.5% ± 1.2% after repair and 96.0% ± 0.7% after MV replacement (P = .416) in the absence of stenosis and 91.8% ± 3.4% after repair vs 95.9% ± 0.5% after replacement in patients with mitral stenosis (P = .065). CONCLUSIONS Repair of rheumatic/calcified mitral valve should be a preferred option in patients with no mitral stenosis, but confers no benefit if mitral stenosis is present.
Collapse
Affiliation(s)
- Marek A Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
| | - Marcin Malinowski
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Kazimierz Widenka
- Department of Cardiac Surgery, University of Rzeszów, Rzeszów, Poland
| | - Nikodem Stożyński
- Department of Cardiac Surgery, District Hospital No 2, Rzeszów, Poland
| | - Krzysztof Bartuś
- Department of Surgery of Heart, Vessels and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | - Bogusław Kapelak
- Department of Surgery of Heart, Vessels and Transplantology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Grzegorz Hirnle
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery, Silesian Centre for Heart Disease, Zabrze, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warszawa, Poland
| | - Marek Jasiński
- Department of Cardiac Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Zdzisław Tobota
- Department of Cardiac Surgery, Children's Memorial Health Institute, Warszawa, Poland
| | - Kamil Barański
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - Bohdan J Maruszewski
- Department of Cardiac Surgery, Children's Memorial Health Institute, Warszawa, Poland
| |
Collapse
|
49
|
Demal TJ, Conradi L. Management of valve dysfunction in patients with mitral annular calcification. Heart 2023; 109:1639-1646. [PMID: 37137678 DOI: 10.1136/heartjnl-2022-321572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
50
|
Carvalho JL, Iribarne A. The Sustained Benefit of Mitral Valve Repair vs Replacement in Elderly Patients With Degenerative Mitral Regurgitation. Ann Thorac Surg 2023; 116:742-743. [PMID: 37517531 DOI: 10.1016/j.athoracsur.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Affiliation(s)
| | - Alexander Iribarne
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, 501 Seaview Ave, Ste 202, Staten Island, NY 10305.
| |
Collapse
|