scholarly journals 426 Involvment of anterior lefleat and persistent MR at discharge are the 2 predictive risk factors for reintervention after mitral valve repair for significant and symptomatic MR

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Fauvel ◽  
R Breil ◽  
F Doguet ◽  
O Raitiere ◽  
F Bauer
Keyword(s):  
Risk Factors ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Repair ◽  
Predictive Factors ◽  
Anterior Leaflet ◽  
Valve Repair ◽  
Grade 3 ◽  
Predictive Risk

Abstract Background Mitral regurgitation (MR) is the second most common valve disease in Europe with mitral valve repair being the treatment of choice in symptomatic patients with degenerative MR grade 3+. Purpose the study goal is to evaluate the long-term survival, the rate and the predictive factors of reintervention following mitral valve repair. Method All patients admitted for mitral valve repair in the context of significant MR defined by symptoms and/or critical left ventricular enlargement were included in this retrospective registry from January 2001 to 31 December 2011. The only exclusion criteria was scheduled mitral valve repair converted into mitral valve replacement. Results 426 consecutive patients had mitral valve repair. There were 137 women and 289 men with an average age of 62 ± 13 y. Twenty-two percent, 37%, 36% and 5 % patients were in NYHA functional class 1, 2, 3 and 4, respectively. All patients had MR grade 3+. Indication for mitral valve repair was endocarditis (n = 21), ring dilation (n = 21), ischemic functional MR (n = 26), rheumatic mitral valve (n = 8) and degenerative MR (n = 350). Operating room successful attained 95% % for mitral valve repair with only 5% in-hospital conversion to valve replacement. Of the 426 patients discharged after mitral valve repair, 39 patients died with a survival rate of 10.8 years (95% CI [10.4-11.3], 78.5% > 10 years) and 25 were re-operated. The two predictive factors for reintervention were anterior leaflet degeneration (OR = 3.4 IC95% [1.05-9.8]; p = 0.02) and persistence of mitral leak grade 2+ at discharge (OR = 6.7 IC95% [2-22]; p = 0.001). Conclusion Preoperative degenerative anterior leaflet and post-operative persistent grade 2+ mitral regurgitation are the 2 predictive risk factors for reintervention after mitral valve repair for significant MR.

Surgery for Degenerative Mitral Regurgitation Valve Repair v. Valve Replacement with Chordal Preservation

1994 ◽  
Vol 2 (2) ◽  
pp. 90-94
Author(s):  
Masaharu Shigenobu ◽  
Shunji Sano
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Valve Repair ◽  
Repair Group

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.

Comparison of Outcomes following Mitral Valve Repair versus Replacement for Chronic Ischemic Mitral Regurgitation: A Meta-Analysis

2016 ◽  
Vol 65 (06) ◽  
pp. 432-441 ◽  
Author(s):  
Deng Yun-dan ◽  
Du Wen-jing ◽  
Xiao Xi-jun
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Repair ◽  
Operative Mortality ◽  
Meta Analysis ◽  
Ischemic Mitral Regurgitation ◽  
Valve Repair ◽  
High Quality ◽  
Chronic Ischemic Mitral Regurgitation

Background The selection of mitral valve surgery, including mitral valve repair and mitral valve replacement, is still an important dilemma for patients with chronic ischemic mitral regurgitation. We carry out a meta-analysis to evaluate the effectiveness and safety of mitral valve repair versus replacement for ischemic mitral regurgitation. Methods We searched PubMed, Embase, the Cochrane Library, and Web of Science to identify studies from their inception to July 2015. A meta-analysis was performed using RevMan 5.3 software (Cochrane Collaboration, Oxford, United Kingdom). A random-effect model was used and sensitivity analysis was performed on studies reporting on operation after 2000, high-quality studies, and those studies reporting on more than 150 patients. Result A total of 2,324 patients were identified from 10 retrospective studies. Mitral valve repair was associated with a trend toward lower operative mortality (odds ratio [OR] = 0.45; 95% confidence interval [CI]: 0.31–0.65; p < 0.0001) and higher recurrence of mitral regurgitation (OR = 5.89; 95% CI: 3.34–10.39; p < 0.00001). Five-year survival rate was similar between the two groups (OR = 1.20; 95% CI: 0.88–1.65; p = 0.25). No differences in reoperation, the incidence of acute renal failure and acute respiratory failure, the length of ICU stay, and the length of hospital stay were found. Conclusion Mitral valve repair was associated with lower operative mortality but a higher recurrence of mitral regurgitation compared with mitral valve replacement. Owing to the limited quantity and quality of the included studies, this conclusion still needs to be further confirmed by conducting more high-quality, multicenter randomized controlled trials with large sample size.

scholarly journals Totally endoscopic aortic valve replacement with concomitant trans-aortic mitral valve repair for mitral regurgitation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Antonios Pitsis ◽  
Nikolaos Tsotsolis ◽  
Harisios Boudoulas ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Chordae Tendineae ◽  
Surgical Aortic Valve Replacement ◽  
Secondary Mr

Abstract Background Minimally invasive aortic valve procedures through a hemi-sternotomy or a right anterior mini-thoracotomy have gained popularity over the last several years. Totally endoscopic aortic valve replacement (TEAVR) is an innovative and a less invasive (incision-wise) surgical aortic valve replacement technique. The operative steps of TEAVR have been reported previously from our group. Mitral regurgitation (MR) frequently accompanies aortic valve disease that at times may also require repair. Totally endoscopic surgery in such cases has not been tested. Presentation of the technique We present a surgical technique for a totally endoscopic approach to aortic valve replacement and concomitant mitral valve repair for primary and secondary MR. An aortotomy incision was used avoiding an atriotomy, which results in an increase in cross-clamp (XC) and cardiopulmonary bypass (CPB) times that could be associated with higher mortality and morbidity. Neochords (artificial chordae tendineae) were used for primary MR and an edge-to-edge approach for secondary MR. Conclusion TEAVR and concomitant mitral valve repair can be performed successfully with reasonable XC and CPB times with excellent short-term results.

Abstract 2286: Short- and Long-Term Survival of Mitral Valve Repair Versus Mitral Valve Replacement in Patients with Functional Mitral Regurgitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Mario Senechal ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Term Survival ◽  
Long Term Mortality

Mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR) when compared to mitral valve replacement (MVR). However, there is an important controversy about the type of surgical treatment that should be used in patients with functional MR (FMR). The aim of this study was to compare MVRp (i.e. restrictive annuloplasty) and MVR in patients with FMR. Pre- and operative demographic and clinical data of 392 patients (64% of male, mean age: 65±10 years) with FMR who underwent mitral surgery between 1992 and 2007 were prospectively collected in a computerized database. MVRp was performed in 52% of patients (n=204) and MVR in 48% (n=188). Compared to patients undergoing MVRp, those with MVR were significantly more frequently symptomatic (77% vs. 59%, p=0.0002), had lower left ventricular ejection fraction (LVEF) (40±15%, vs. 46±15%, p=0.0003) and had higher prevalence of pulmonary hypertension (36% vs. 24%, p=0.01) preoperatively. However, there was no significant difference between the 2 groups with regards to age, gender, MR severity, diabetes, obesity, systemic hypertension and atrial fibrillation (p>0.3). Although operative mortality was significantly lower after MVRp compared to MVR (9% vs. 17%, p=0.02), long-term survival was not statistically different between procedures (6 years: 74±4% vs. 72±4%; 12 years: 54±5% vs. 52±7%; p=0.58). After adjusting for other risk factors, the type of procedure (MVRp vs. MVR) did not come out as an independent predictor of either operative (Odds-ratio=1.7, 95% confidence interval [CI]: 0.8 –3.8, p=0.15) or long-term mortality (Hazard-ratio [HR]=1.1, 95%CI: 0.9 –1.4, p=0.29). The independent predictors of long-term mortality were age (HR= 1.04, 95%CI: 1.01–1.07, p=0.003), NYHA class ≥III (HR=1.4, 95%CI: 1.1–2, p=0.02) and LVEF (HR=1.02, 95%CI: 1.01–1.04, p=0.0009). As opposed to what has been reported in patients with organic MR, there is no evidence that MVRp provides any benefit in terms of survival compared to MVR in patients with FMR. These findings suggest that MVRp is not an optimal surgical treatment for FMR and provide an impetus toward the development of new surgical approaches for these patients.

scholarly journals Risk factors of persistent ventricular arrhythmias after mitral valve repair in Barlow disease patients: six-year follow-up

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Malev ◽  
M Omelchenko ◽  
L Mitrofanova ◽  
M Gordeev ◽  
B Bondarenko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Valve Repair ◽  
Myxomatous Degeneration

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Improvement in malignant ventricular arrhythmias (VA) has been reported after mitral valve surgery in some mitral valve prolapse patients (MVP) with severe degenerative mitral regurgitation. Mitral annular disjunction, posterior systolic curling, and mitral annular abnormal contractility are associated with arrhythmic MVP and underwent correction during the mitral valve repair. However, mitral valve disease progression and ventricular arrhythmic substrates (left ventricular fibrosis of papillary muscles and basal posterior wall) could be potential substrates for persistent malignant arrhythmias even after surgical correction.  Our aim was to evaluate the risk factors of persistent VA after mitral valve repair in Barlow’s disease patients in six-year follow-up.  Methods  30 consecutive patients (mean age 53.1 ± 9.4, 47% male) who underwent mitral valve repair for severe mitral regurgitation (MR) due to mitral valve prolapse were enrolled in our observational, prospective, single-center study. Resected abnormal segments of the mitral leaflets were examined by experienced pathologists for signs of myxomatous degeneration. Transthoracic echocardiography and 24-hour Holter monitoring were performed pre- and postoperatively annually. PVCs and nonsustained ventricular tachycardia (VT) runs were reviewed.  Results  All patients survived the operation. There was only one sudden cardiac death on sixth year of follow-up. During 173 person-years of follow-up 3 patients (10%) had developed recurrent moderate to severe (≥2) MR. The total number of PVCs and non-sustained ventricular tachycardia runs dropped significantly in 1st (p=.04, Wilcoxon matched pairs test) and 2nd (p=.03), years of postoperative follow-up.  Postoperative incidence of PVCs and VT correlated strongly with postoperative end-diastolic LV diameter (EDD rs=.69; p=.005), moderate negatively with LV ejection fraction (EF rs=-.55; p=.001).   Advanced myxomatous degeneration assessed by pathologists and MV posterior leaflet’s thickness ≥5 mm after repair assessed by echocardiographer associated with postoperative PVCs and VT (rτ=.58; p=.045 and rs=.62; p=.002, respectively). Recurrent MR also strongly associated with postoperative PVCs and VT (rs=.76; p=.0018).  In univariate analysis, advanced myxomatous degeneration (p=.008), postoperative end-diastolic LV diameter (p=.001), and low EF (p=.003) were identified as risk factors of persistent PVCs/VT after surgery.  Conclusions  Advanced myxomatous degeneration assessed by pathologists or echocardiographer and postoperative left ventricular remodeling are associated with persistent malignant ventricular arrhythmias. Further investigation in larger cohorts to evaluate the association between degenerative mitral valve disease and ventricular arrhythmias is needed.

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