Long-term thromboembolic and bleeding complications after isolated bioprosthetic mitral valve replacement: Incidence, predictors and clinical implications

Background and Aim of the Study: Negative impact of prosthesis-patient mismatch (PPM) on long term survival after valve replacement has been reported. However, the effect of PPM after bioprosthetic mitral valve replacement (MVR) has not yet been well examined. The purpose of this study was to investigate the effect of PPM on late outcomes after bioprosthetic MVR for mitral regurgitation (MR). Methods: A total of 181 patients underwent bioprosthetic MVR between April 2008 and December 2016. After excluding patients with mitral stenosis and those with incomplete data, 128 patients were included in the study. Postoperative transthoracic echocardiography was performed for all patients and the effective orifice area (EOA) was calculated using the pressure half-time method. The effective orifice area index (EOAI) was calculated by the formula: EOA/body surface area (BSA). PPM was defined as a postoperative EOAI ≤ 1.2 cm2/m2. The characteristics and outcomes were compared between the groups. Results: There were 34 patients (26.6%) with PPM and 94 patients (73.4%) without PPM. Although proportion of males and BSA were higher in the PPM group, valve size distributions were similar between the two groups. There were no significant differences in the in-hospital mortality and morbidities. Multivariable analysis showed that PPM was an independent predictor of late mortality (hazard ratio [HR] 3.38; 95% confidence interval [CI] 1.69-6.75; p = .001) and death from heart failure (HR 31.03, 95% CI 4.49-214.40, p < .001). Conclusions: PPM after MVR for MR was associated with long-term mortality and death from heart failure.

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IMMEDIATE AND LONG-TERM OUTCOMES AFTER BIOPROSTHETIC MITRAL VALVE REPLACEMENT WITH THE PRESERVATION OF THE SUBVALVULAR APPARATUS

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2018-7-2-38-49 ◽

2018 ◽

Vol 7 (2) ◽

pp. 38-49

Author(s):

Yu. N. Odarenko ◽

N. V. Rutkovskaya ◽

S. G. Kokorin ◽

A. N. Stasev ◽

L. S. Barbarash

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Invasive Monitoring ◽

Central Hemodynamics ◽

Long Term Outcomes ◽

Group 2 ◽

Bioprosthetic Mitral Valve ◽

Group 1

Aim. To assess the immediate and long-term outcomes after bioprosthetic mitral valve replacement with the preservation of the subvalvular apparatus. Methods. 304 patients who underwent primary bioprosthetic mitral valve replacement in the period from 2001 to 2009 were included in the study. Patients were enrolled into two groups with either preserved subvalvular structures (Group 1. n = 142, 47%) or resected structures (Group 2, n = 162) during bioprosthetic mitral valve replacement. For the unbiased assessment of the efficiency of valve-preserving approach, randomly selected patients from Group 1 (n = 75) and Group 2 (n = 40) underwent preoperative and postoperative invasive monitoring of the central hemodynamics using the Swan-Ganz thermodilution catheter. Results In-hospital mortality was 1.4% (n = 2) in Group 1 and 4.3% in Group 2. The most common cause of death was acute left ventricular failure. We found that the preservation of subvalvular structures allows ensuring the optimal linear and volumetric echocardiography parameters in the immediate postoperative period, despite the hemodynamic profile of the defect. However, the positive effects were more pronounced in patients with more severe mitral regurgitation. Patients with preserved subvalvular structures had more durable surgical mitral valve replacement according to the echocardiographic findings in the long-term period. The invasive monitoring of central hemodynamics allowed determining that total subvalvular apparatus preservation was associated with more significant pressure decline in the pulmonary circulation (mean pulmonary arterial pressure and pulmonary capillary wedge pressure) and improved cardiac index and output. Posterior leaflet preservation was associated with less pronounced changes and patients who underwent routine mitral valve replacement had the worst intermediate outcomes. Conclusion The results of the presented study suggest that the preservation of subvalvular apparatus, unless otherwise indicated, is associated with improved immediate and long-term outcomes after mitral valve replacement.

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Long-term outcome in a case of translocated mitral valve replacement for massive mitral annular calcification

Clinical Case Reports ◽

10.1002/ccr3.862 ◽

2017 ◽

Vol 5 (4) ◽

pp. 454-457

Author(s):

Go Kataoka ◽

Kiyoharu Nakano ◽

Ryota Asano ◽

Atsuhiko Sato ◽

Wataru Tatsuishi

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Annular Calcification ◽

Term Outcome ◽

Long Term Outcome ◽

Annular Calcification

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Pulmonary Autograft Mitral Valve Replacement (Ross II): Long-Term Follow-Up of a US Center

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118792196 ◽

2018 ◽

Vol 9 (6) ◽

pp. 645-650

Author(s):

David Blitzer ◽

Jeremy L. Herrmann ◽

John W. Brown

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Sudden Cardiac Arrest ◽

Right Heart Failure ◽

Atrioventricular Canal ◽

Pulmonary Autograft ◽

Atrioventricular Canal Defect

Background: Mitral valve replacement (MVR) with a pulmonary autograft (Ross II) may be a useful technique for pediatric and young adult patients who wish to avoid anticoagulation. Our aim was to evaluate the long-term outcomes of the Ross II procedure at our institution. Methods: Patients undergoing the Ross II procedure between June 2002 and April 2008 were included. Preoperative diagnoses included rheumatic disease (n = 5), congenital mitral valve (MV) pathology (partial atrioventricular canal defect [n = 2], complete atrioventricular canal defect [n = 1], Shone's complex [n = 1]), and myocarditis (n = 1). Results: Ten patients (eight females and two males) between 7 months and 46 years were included. Mean age at surgery was 25.2 ± 15.7 years. There were no in-hospital deaths. Mean follow-up was 11.7 ± 5.2 years. There were three late deaths at 11 months, 5 years, and 11 years, respectively. Causes of death included right heart failure, sepsis, and sudden cardiac arrest. Three patients required subsequent mechanical MVR a median of two years after the Ross II procedure (range: 1-4 years). There was no mortality with reoperation. Echocardiographic follow-up demonstrated mean MV gradients ranging from 2.2 to 9.6 mm Hg. Two patients had greater than mild MV regurgitation postoperatively, and all others had minimal mitral regurgitation or less. Two patients developed moderate MV stenosis. Conclusions: The Ross II procedure is an option for select older children and young adults desiring a durable tissue MVR to avoid long-term anticoagulation.

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