Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease

Abstract Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.

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Minimally invasive mitral valve repair for degenerative etiology: a comparative study

The Cardiothoracic Surgeon ◽

10.1186/s43057-021-00055-2 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Mohamed Abdel Hafez Fouly ◽

Tarek K. Mousa

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Repair ◽

Significant Difference ◽

The Mean ◽

Group 2

Abstract Background There is a paucity of data comparing the minimally invasive mitral valve repair (MiMVr) to the conventional approach in patients with degenerative disease. Our objective was to compare the outcomes of MiMVr to the traditional mitral valve repair through median sternotomy in patients with degenerative mitral valve disease. We conducted a retrospective study on 215 patients classified into two groups. Group 1 (n = 80) included those who had mitral valve repair through a right anterolateral video-assisted mini-thoracotomy, and group 2 (n = 135) was approached through a conventional median sternotomy. We compared the preoperative, operative, and postoperative data between groups. Both groups had echocardiographic follow-ups after 6 and 12 months. Results There was no difference in gender distribution between both groups, and patients who had median sternotomy were significantly older (median 37 (Q1-Q3, 29-44) vs. 54 (48-60) years; P < 0.001). Cardiopulmonary bypass (134.5 (130-138.5) vs. 99 (97-104) min; P < 0.001) and ischemic times (99 (95-105.5) vs. 78 (75-81) min; P < 0.001) were significantly shorter in patients who had median sternotomy. Patients with MiMVr had significantly lower blood loss (370 (315-390) vs. 550 (490-600) ml; P < 0.001) and ICU stay (5 (4.5-6) vs. 7 (7-8) days; P < 0.001). There was no difference between both groups regarding re-exploration for bleeding, postoperative stroke, wound infection, renal failure, and mortality. As regards postoperative echocardiography follow-up at 6 and 12 months after the operation, there were no significant changes in the mean mitral valve gradient within each group; however, the mean gradient was lower in the MiMVr group (3 (3-3.5) vs. 4 (3-5) mmHg; P < 0.001). There was no significant difference between both groups regarding mitral regurgitation severity during 6 and 12 months follow-up. Conclusion Minimally invasive mitral valve repair in patients with degenerative pathology could be an alternative to conventional mitral valve surgery with comparable short-term and long-term outcomes.

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10-Year Follow-up of 1,829 Patients Undergoing Minimally Invasive Mitral Valve Repair: A Single-Center Experience

10.1055/s-0040-1705438 ◽

2020 ◽

Author(s):

H. Schaefer ◽

D. Krankenberg ◽

U. Walle ◽

M. Liebrich ◽

D. Roser ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Single Center ◽

Valve Repair ◽

Single Center Experience

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Early and Mid-term Results of Mitral Valve Repair in Patients with Degenerative Mitral Regurgitation

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m133 ◽

2021 ◽

Author(s):

Hasan Erdem ◽

Emre Selçuk

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Survival Rates ◽

Mitral Valve Regurgitation ◽

Valve Repair ◽

Repair Rate ◽

Mitral Repair ◽

Mid Term Results

Objectives: In this study, we present the mid-term results of patients who underwent valve repair due to degenerative mitral valve regurgitation in the first five years of our mitral valve repair program. Patients and Methods: In this retrospective study, all patients who were operated for degenerative mitral regurgitation by a single surgical team between 2013 and 2017 were investigated. We determined early and mid-term cumulative survival rates, repair failure and freedom from reoperation. In addition, as a specific subgroup, the results of patients under 18 years of age after mitral valve repair were investigated Results: Mitral repair was performed in 121 of 153 degenerative mitral regurgitation patients during the study period. The overall repair rate was 79%. Mitral valve repair rate increased significantly over years. The Median follow-up time was 63 (range 10-92) months. Early mortality was 2.5% (n=3 patients). During the follow-up period, moderate-to-severe mitral regurgitation was observed in 14 (11.8%) patients, mitral valve reoperation was required in 7 (5.9%) patients. Valve repair was performed in 4 of 7 patients under the age of 18. There was no pediatric case requiring reoperation during the follow-up period (median 46 months). Conclusion: Mid-term results of mitral valve repair in degenerative mitral valve patients are satisfactory. The success rate of repair increases in line with surgical experience.

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Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

Netherlands Heart Journal ◽

10.1007/s12471-018-1159-4 ◽

2018 ◽

Vol 26 (11) ◽

pp. 552-561 ◽

Cited By ~ 1

Author(s):

R. Jansen ◽

B. R. van Klarenbosch ◽

M. J. Cramer ◽

R. C. A. Meijer ◽

P. H. M. Westendorp ◽

...

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair

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Minimally invasive mitral valve surgery. An anesthesiologist''s viewpoint

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2013-4-11-14 ◽

2015 ◽

Vol 17 (2) ◽

pp. 11 ◽

Cited By ~ 1

Author(s):

V. A. Shmyrev ◽

A. V. Bogachev-prokofev ◽

V. V. Lomivorotov ◽

D. N. Ponomarev ◽

P. P. Perovskiy

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Fatal Outcome ◽

Median Sternotomy ◽

Group Versus ◽

Mitral Valve Surgery ◽

Control Group ◽

Complication Rates ◽

Valve Repair ◽

Invasive Group

We conducted a retrospective comparative analysis of 75 patients undergoing video-assisted mitral valve repair with right minithoracotomy over a period from November 2011 to August 2013. The control group comprised 71 patients operated on mitral valve by using median sternotomy during the same period. Median (25th; 75th) times of cardiopulmonary bypass and aortic cross-clamping were significantly longer in the minimally invasive group (180 [139; 224] and 111 [87; 145] min, respectively) as compared to the controls (84 [69; 117] and 62 [49; 81 ] min, respectively), p<0.01. Fatal outcome occurred in 2 (2.7%) cases in the minimally invasive group versus none in the controls. In both cases death resulted from intraoperative aortic dissection. While ventilation time and intensive care unit stay were comparable across the groups, postoperative respiratory failure occurred in 6 (8%) cases in the minimally invasive group versus none in the controls (p<0.05). No other significant differences in the postoperative course were observed between the groups. The results of the present study are generally consistent with the world's tendencies. On the other hand, complication rates observed in the minimally invasive group present a considerable economic burden and require substantial human resources in the postoperative period.

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The age-adjusted Charlson comorbidity index in minimally invasive mitral valve surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz240 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1124-1130 ◽

Cited By ~ 1

Author(s):

Jan-Philipp Minol ◽

Vanessa Dimitrova ◽

Georgi Petrov ◽

Robert Langner ◽

Udo Boeken ◽

...

Keyword(s):

Mitral Valve ◽

Adverse Events ◽

Minimally Invasive ◽

Predictive Value ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Repair ◽

Comorbidity Index ◽

Sts Score ◽

Perioperative Course

Abstract OBJECTIVES Mitral valve repair is the preferred method used to address mitral valve regurgitation, whereas transcatheter mitral valve repair is recommended for high-risk patients. We evaluated the risk-predictive value of the age-adjusted Charlson comorbidity index (aa-CCI) in the setting of minimally invasive mitral valve surgery. METHODS The perioperative course and 1-year follow-up of 537 patients who underwent isolated or combined minimally invasive mitral valve surgery were evaluated for 1-year mortality as the primary end point and other adverse events. The predictive values of the EuroSCORE II and STS score were compared to that of the aa-CCI by a comparative analysis of receiver operating characteristic curves. Restricted cubic splines were applied to find optimal aa-CCI cut-off values for the increased likelihood of experiencing the predefined adverse end points. Consequently, the perioperative course and postoperative outcome of the aa-CCI ≥8 patients and the remainder of the sample were analysed. RESULTS The predictive value of the aa-CCI does not significantly differ from those of the EuroSCORE II or STS score. Patients with an aa-CCI ≥8 were identified as a subgroup with a significant increase of mortality and other adverse events. CONCLUSIONS The aa-CCI displays a suitable predictive ability for patients undergoing minimally invasive mitral valve surgery. In particular, multimorbid or frail patients may benefit from the extension of the objectively assessed parameters, in addition to the STS score or EuroSCORE II. Patients with an aa-CCI ≥8 have a very high surgical risk and should receive very careful attention.

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Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications

Medicina ◽

10.3390/medicina55100709 ◽

2019 ◽

Vol 55 (10) ◽

pp. 709

Author(s):

Anselmino ◽

Rovera ◽

Marchetto ◽

Castagno ◽

Morello ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Minimally Invasive ◽

Surface Area ◽

Mitral Valve Repair ◽

Body Surface ◽

Left Atrial ◽

Valve Repair

Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR.

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