Minimal invasive mitral valve surgery does make a difference: Should it be the gold standard for mitral valve repair?

2015 ◽  
Vol 25 (5) ◽  
pp. 466-468
Author(s):  
Danny Ramzy ◽  
Alfredo Trento
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Gold Standard ◽  
Mitral Valve Surgery ◽  
Minimal Invasive ◽  
Valve Surgery ◽  
Valve Repair

Redo mitral valve surgery following prior mitral valve repair

2018 ◽  
Author(s):  
Arman Kilic ◽  
Mark R. Helmers ◽  
Jason J. Han ◽  
Rahul Kanade ◽  
Michael A. Acker ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair

scholarly journals Microinvasive Mitral Valve Surgery: A New Frontier to Tackle Mitral Regurgitation

2021 ◽  
Author(s):  
Solomon Seifu ◽  
Eduardo de Marchena
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Repair System ◽  
Valve Repair ◽  
Mitral Repair ◽  
New Frontier ◽  
Clinical Benefits

Microinvasive, catheter-based mitral valve repair of severe mitral regurgitation utilizes less invasive approaches with less procedural morbidity and mortality. The procedural steps and clinical benefits of the transcatheter transapical mitral valve annuloplasty (AMEND mitral repair implant) and transcatheter transapical chordal repair systems (Neochord DS 1000 device and Harpoon Mitral Valve Repair System) are reviewed in this manuscript.

scholarly journals Can We Predict Failure of Mitral Valve Repair?

2019 ◽  
Vol 8 (4) ◽  
pp. 526 ◽  
Author(s):  
Simone Gasser ◽  
Maria von Stumm ◽  
Christoph Sinning ◽  
Ulrich Schaefer ◽  
Hermann Reichenspurner ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Redo Surgery ◽  
Valve Repair

Objective: To identify echocardiographic and surgical risk factors for failure after mitral valve repair. Methods: We identified a total of 77 consecutive patients from our institutional mitral valve surgery database who required redo mitral valve surgery due to recurrence of mitral regurgitation after primary mitral valve repair. A control group of 138 patients who had a stable echocardiographic long-term result was included based on propensity score matching. Systematic analysis of echocardiographic parameters was performed before primary surgery; after mitral valve repair and prior to redo surgery. Risk factor analysis was performed using multivariate Cox regression model. Results: Redo surgery was associated with the presence of pulmonary hypertension ≥ 50 mmHg (p = 0.02), a mean transmitral gradient > 5 mmHg (p = 0.001), left ventricular ejection fraction ≤ 45% (p = 0.05) before surgery and mitral regurgitation ≥moderate at time of discharge (p = 0.002) in the whole cohort. Patients with functional mitral valve regurgitation had a higher tendency to undergo redo surgery if preoperative left ventricular end-diastolic diameter exceeded 65 mm (p = 0.043) and if postoperative tenting height exceeded 6 mm (p = 0.018). Low ejection fraction was not significantly associated with the need for redo mitral valve surgery in the functional subgroup. Conclusions: Recurrent mitral regurgitation is still a valuable problem and is associated with relevant perioperative mortality. Patients with severe mitral regurgitation should undergo early mitral valve repair surgery as long as systolic pulmonary artery pressure is low, left ventricular ejection fraction is preserved, and LVEED is deceeds 65 mm.

scholarly journals Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery

2020 ◽  
pp. 23-28
Author(s):  
O. D. Babliak ◽  
V. M. Demianenko ◽  
D. Y. Babliak ◽  
A. I. Marchenko ◽  
K. A. Revenko ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Repair ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Standard Approach ◽  
Wound Complications ◽  
Tricuspid Valve Repair ◽  
Valve Repair

  Background. Minimally invasive mitral valve surgery provides many advantages for patients. The aim. To investigate and represent our own experience in minimally invasive mitral valve surgery, and to describe the operative technique. Materials and methods. The study was included 100 consecutive patients who underwent a minimally invasive mitral valve repair or replacement through the right lateral minithoracotomy from June 2017 to December 2019. Results. Mitral valve repair was performed in 87 patients (87%), and 13 patients (13%) were required mitral valve replacement. In 24 patients (24%), concomitant procedures were performed: tricuspid valve repair, atrial septal defect repair and left atrial myxomectomy. Ring anuloplasty was performed in all patients who underwent mitral valve repair. Additional methods of correction were used in accordance to the lesion anatomy: neochords implantation, cleft and leaflet perforation closure, leaflet resection, Alfieri (edge-to-edge) stitch, posterior leaflet plication. There was no in-hospital and 30-day mortality. Post-operative strokes were not reported. No wound complications were observed in the femoral cannulation area. The total length of stay in a hospital was 6 ± 1.46 (3–9) days. There were no cases of mitral valve insufficiency greater more than mild degree after mitral valve repair at the time of discharge. Conclusions. Minimally invasive mitral valve surgery can be performed as a routine standard approach, provides safe and effective correction of the mitral valve defects, allows excellent results of mitral valve repair and replacement in various abnormalities. Minimally invasive approach enables to perform a large number of reconstructive valve techniques and perform simultaneous correction of atrial septal defects, tricuspid valve repair and atrial neoplasm removal.

Abstract 3: Declining Early And Late Mortality After Mitral Valve Surgery Among Medicare Patients

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
John A Dodson ◽  
Yun Wang ◽  
Mayur Desai ◽  
Sabit Hashim ◽  
Lissa Sugeng ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Fee For Service ◽  
Valve Repair ◽  
Operative Care ◽  
Relative Decline ◽  
One Year ◽  
Over Time

Background: Mitral valve surgery in older adults has substantial morbidity and mortality. While changes in operative techniques and post-operative care over time may lead to improved outcomes, there are currently a paucity of national surveillance data. The aims of our study were therefore to define trends in incidence, surgical technique, and mortality among patients undergoing mitral valve surgery. Methods: Inpatient Medicare standard analytic files were used to identify 100% of fee-for-service patients ≥65 years of age who underwent mitral valve surgery between 1999 and 2008. We constructed a denominator file from Medicare administrative data to report operative rates per 100,000 beneficiaries. Mortality (30-day and 1-year) was ascertained through corresponding vital status files. Surgery was classified as repair or replacement. Risk-standardized mortality rates were calculated using a multivariable model from Medicare claims data adjusting for medical comorbidities. Results: A total of 156,917 patients underwent mitral valve surgery during the study period. While the overall rate of mitral valve surgery per beneficiary remained relatively stable over time (1999: 136/100,000, 2008: 134/100,000), the proportion of patients ≥85 years of age increased (1999: 8.8%; 2008: 12.3%). The rate of mitral valve repair (vs. replacement) nearly doubled (1999: 24.7%; 2008: 46.8%). From 1999-2008, risk adjusted 30-day mortality decreased from 10.6% to 5.1% (OR 0.66; 95% CI, 0.60-0.71), a relative decline of 51.9%. Risk-adjusted one-year mortality decreased from 20.3% to 13.3% (OR 0.74; 95% CI, 0.69-0.78), a relative decline of 34.5%. Similar trends were seen across all age strata (Figure). Conclusions: From 1999-2008, despite an increase in the proportion of Medicare mitral valve surgery patients ≥85 years of age, postoperative risk-adjusted 30-day and one-year mortality decreased markedly across all age strata. Whether increasing rates of mitral valve repair or other management strategies are contributing factors deserves further investigation.

Sex Differences in Procedure Selection and Outcomes of Patients Undergoing Mitral Valve Surgery

2011 ◽  
Vol 14 (5) ◽  
pp. 276 ◽  
Author(s):  
Christina M. Vassileva ◽  
Lacey M. Stelle ◽  
Steve Markwell ◽  
Theresa Boley ◽  
Stephen Hazelrigg
Keyword(s):  
Sex Differences ◽  
Mitral Valve ◽  
Hospital Mortality ◽  
Mitral Valve Repair ◽  
Propensity Scores ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Maze Procedure ◽  
Valve Repair ◽  
Procedure Selection

<p><b>Background:</b> There is a paucity of data on sex differences in procedure selection and outcomes of patients undergoing mitral valve surgery.</p><p><b>Methods and Results:</b> The National Inpatient Sample database from 2005 to 2008 was searched to identify patients ?30 years of age who underwent mitral valve repair or replacement (ICD-9-CM codes 35.12, 35.23, and 35.24). Women constituted 51.6% of the patients, and they were older, were less affluent, had higher values for the Charlson comorbidity index, and more often presented on an urgent/emergent basis. Women underwent repair less often than men (37.9% versus 55.9%, <i>P</i> < .001) and more often underwent concomitant tricuspid surgery or a Maze procedure. After adjustment for propensity scores, women were more likely to undergo replacement (odds ratio, 1.78; 95% confidence interval, 1.64-1.93; <i>P</i> = .0001), they had longer lengths of stay, and less favorable disposition. Among the patients who underwent mitral valve repair, women had a higher hospital mortality (2.06% versus 1.36%, <i>P</i> = .0328). After adjustment for propensity scores and concomitant procedures, this relationship was no longer statistically significant.</p><p><b>Conclusions:</b> Women are less likely than men to receive mitral valve repair. Although the higher hospital mortality of women presenting for mitral valve surgery was accounted for by their worse preoperative profiles, this sex disparity reflects the current reality in surgical practice and identifies an important area for future improvement in the care of patients with valvular heart disease.</p>

scholarly journals Minimally Invasive Mitral Valve Surgery II Surgical Technique and Postoperative Management

2016 ◽  
Vol 11 (4) ◽  
pp. 251-259 ◽  
Author(s):  
J. Alan Wolfe ◽  
S. Chris Malaisrie ◽  
R. Saeid Farivar ◽  
Junaid H. Khan ◽  
W. Clark Hargrove ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Surgical Technique ◽  
Best Practices ◽  
Minimally Invasive ◽  
Mitral Valve Repair ◽  
Postoperative Care ◽  
Postoperative Management ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair

Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.

scholarly journals Bretschneider (Custodiol®) and St. Thomas 2 Cardioplegia Solution in Mitral Valve Repair via Anterolateral Right Thoracotomy: A Propensity-Modelled Comparison

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Constantin Mork ◽  
Luca Koechlin ◽  
Thibault Schaeffer ◽  
Lena Schoemig ◽  
Urs Zenklusen ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Geometric Mean ◽  
High Sensitivity ◽  
Mitral Valve Surgery ◽  
Minimal Invasive ◽  
Valve Repair ◽  
Treatment Groups ◽  
Right Thoracotomy

Background. Single-dose cardioplegia is preferred in minimal invasive mitral valve surgery to maintain the adjustment of the operative site without change of preset visualization. The aim of our study was to compare two widely used crystalloid cardioplegias Bretschneider (Custodiol®) versus St. Thomas 2 in patients who underwent mitral valve repair via small anterolateral right thoracotomy. Material and Methods. From May 2012 until February 2019, 184 isolated mitral valve procedures for mitral valve repair via anterolateral right thoracotomy were performed using Bretschneider (Custodiol®) cardioplegia (n=123) or St. Thomas (n=61). Primary efficacy endpoint was peak postoperative high-sensitivity cardiac troponin (hs-cTnT) during hospitalization. Secondary endpoints were peak creatine kinase-muscle brain type (CK-MB) and creatine kinase (CK) as well as safety outcomes. We used inverse probability of treatment weighting (IPTW) in order to adjust for confounding by indication. Results. Peak hs-cTnT was higher after use of Bretschneider (Custodiol®) (geometric mean 716 mg/L, 95% confidence interval (CI) 605-847 mg/L) vs. St. Thomas 2 (561 mg/L, CI 467-674 mg/L, p=0.047). Peak CK-MB (geometric mean after Bretschneider (Custodiol®): 40 μg/L, CI 35-46, St. Thomas 2: 33 μg/L, CI 27-41, p=0.295) and CK (geometric mean after Bretschneider (Custodiol®): 1370 U/L, CI 1222-1536, St. Thomas 2: 1152 U/L, CI 972-1366, p=0.037) showed the same pattern. We did not see any difference with respect to postoperative complications between treatment groups after IPTW. Conclusion. Use of St. Thomas 2 cardioplegia was associated with lower postoperative peak levels of all cardiac markers that reflect cardiac ischemia such as hs-cTnT, CK, and CK-MB as compared to Bretschneider (Custodiol®) in propensity-weighted treatment groups.

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