Prognostic Role of Secondary Mitral Regurgitation in Patients with Aortic Valve Stenosis under Medical Follow-up

Objective: We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.Methods: From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.Results: There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.Conclusion: Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.

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Faculty Opinions recommendation of Management of moderate secondary mitral regurgitation at the time of aortic valve surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718024199.793479775 ◽

2013 ◽

Author(s):

Edward Savage

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Secondary Mitral Regurgitation

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Tumor Heterogenity in Gastro-Entero-Pancreatic Neuroendocrine Neoplasia

Endocrines ◽

10.3390/endocrines2010003 ◽

2021 ◽

Vol 2 (1) ◽

pp. 28-36

Author(s):

Ludovica Magi ◽

Maria Rinzivillo ◽

Francesco Panzuto

Keyword(s):

Functional Imaging ◽

Clinical Heterogeneity ◽

Therapeutic Approaches ◽

Prognostic Role ◽

Neuroendocrine Neoplasia ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Owing to the rarity and the biological and clinical heterogeneity of gastroenteropancreatic neuroendocrine neoplasia (GEP NEN), the management of these patients may be challenging for physicians. This review highlights the specific features of GEP NEN with particular attention on the role of Ki67 heterogeneity, the potential prognostic role of novel radiological techniques, and the clinical usefulness of functional imaging, including 68Ga-DOTA-SST PET/CT and 18F-FDG PET/CT. Understanding these specific features may help to plan proper and tailored follow-up programs and therapeutic approaches.

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Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing

Heart ◽

10.1136/heart.86.4.381 ◽

2001 ◽

Vol 86 (4) ◽

pp. 381-386 ◽

Cited By ~ 197

Author(s):

M C M Amato

Keyword(s):

Aortic Valve ◽

Aortic Valve Stenosis ◽

Exercise Testing ◽

Treatment Decision

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Abstract 19440: Reintervention Rates Following Balloon Aortic Valvuloplasty versus Surgical Valve Repair in Isolated Congenital Aortic Valve Stenosis - A Meta-analysis

Circulation ◽

10.1161/circ.132.suppl_3.19440 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

May T Saung ◽

Courtney McCracken ◽

Ritu Sachdeva ◽

Christopher J Petit

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Stenosis ◽

Meta Analysis ◽

Valve Repair ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Primary Indication ◽

Aortic Valvuloplasty

Introduction: The optimal treatment for congenital aortic stenosis (AS) is debated despite decades of experience with both balloon aortic valvuloplasty (BAV) and surgical aortic valve repair (SAV). While BAV has been the mainstay of therapy for AS, recent single-center reports suggest optimal results following SAV. Hypothesis: We propose that reintervention rates following SAV and BAV are equivalent. Methods: We queried Medline, EMBASE and Web of Science for eligible studies using the keywords: “congenital aortic stenosis”, “balloon valvotomy”, “aortic valve stenosis surgery” and “treatment outcome or reintervention”. Studies were excluded when cohort size was <20 pts, when follow-up was < 2.5 yrs from primary intervention, and when primary indication was not AS (e.g. SAV in the setting of aortic valve regurgitation (AR)). Outcomes analyzed included death, reintervention and moderate or severe AR. Analysis was performed using Comprehensive Meta Analysis v3 using random effects models. Results: A total of 20 studies were included in our meta-analysis: SAV alone (n=3), BAV alone (n=12), and both (n=5). The mean age at BAV was 3.1 years (range, 4 days - 7 years) with a mean follow-up duration of 6.8 years, while mean age at SAV was 2.8 years (range, 14.2 days - 7.1 years) with a mean follow-up duration of 9.1 years. Mortality rates following BAV and SAV were 12.3% (95% CI: 7.7 - 19.1) and 10.2% (95% CI: 7.0 - 14.5), respectively (p=0.27). Reintervention following initial procedure for treatment of AS was higher following BAV (35.7% [95% CI: 29 - 43.1]) compared to SAV (25.2% [95% CI: 19.9 - 31.3])(p=0.012). Long-term and mid-term follow-up in these studies showed moderate to severe AR was present in 24.1% and 28.1% of BAV and SAV patients, respectively. Conclusions: Notwithstanding publication bias, both survival rates and development of late AR following BAV and SAV are similar. However, reintervention rates are significantly higher following BAV compared to SAV.

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Evaluation of a multimarker panel in chronic heart failure: a 10-year follow-up

Biomarkers in Medicine ◽

10.2217/bmm-2020-0722 ◽

2021 ◽

Author(s):

Susanne Bauer ◽

Christina Strack ◽

Ekrem Ücer ◽

Stefan Wallner ◽

Ute Hubauer ◽

...

Keyword(s):

Heart Failure ◽

Prognostic Role ◽

Blood Samples ◽

Kaplan Meier ◽

Risk Of Mortality ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Long Time

Aim: We assessed the 10-year prognostic role of 11 biomarkers with different pathophysiological backgrounds. Materials & methods/results: Blood samples from 144 patients with heart failure were analyzed. After 10 years of follow-up (median follow-up was 104 months), data regarding all-cause mortality were acquired. Regarding Kaplan–Meier analysis, all markers, except TIMP-1 and GDF-15, were significant predictors for all-cause mortality. We created a multimarker model with nt-proBNP, hsTnT and IGF-BP7 and found that patients in whom all three markers were elevated had a significantly worse long-time-prognosis than patients without elevated markers. Conclusion: In a 10-year follow-up, a combination of three biomarkers (NT-proBNP, hs-TnT, IGF-BP7) identified patients with a high risk of mortality.

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