scholarly journals Annuloplasty ring dehiscence after mitral valve repair: incidence, localization and reoperation

2019 ◽  
Author(s):  
Thilo Noack ◽  
Philipp Kiefer ◽  
Nina Vivell ◽  
Franz Sieg ◽  
Mateo Marin-Cuartas ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mortality Rate ◽  
Survival Rates ◽  
Clinical Problem ◽  
Valve Repair ◽  
Term Survival ◽  
Annuloplasty Ring ◽  
Ring Annuloplasty ◽  
Short And Long Term

Abstract OBJECTIVES Mitral valve (MV) annuloplasty ring dehiscence with subsequent recurrent mitral regurgitation represents an unusual but challenging clinical problem. Incidence, localization and outcomes for this complication have not been well defined. METHODS From 1996 to 2016, a total of 3478 patients underwent isolated MV repair with ring annuloplasty at the Leipzig Heart Centre. Of these patients, 57 (1.6%) underwent reoperation due to annuloplasty ring dehiscence. Echocardiographic data, operative and early postoperative characteristics as well as short- and long-term survival rates after MV reoperation were analysed. RESULTS Occurrences of ring dehiscence were acute (<30 days), early (≤1 year) and late (>1 year) in 44%, 33% and 23% of patients, respectively. Localization of annuloplasty ring dehiscence was found most frequently in the P3 segment (68%), followed by the P2 (51%) and the P1 segments (47%). The 30-day mortality rate and 1- and 5-year survival rates after MV reoperation were 2%, 89% and 74%, respectively. During reoperation, MV replacement was performed in 38 (67%) and MV re-repair in 19 (33%) patients. CONCLUSIONS Annuloplasty ring dehiscence is clinically less common, localized more frequently on the posterior annulus and occurs mostly acutely or early after MV repair. MV reoperation can be performed safely in such patients.

scholarly journals Valve Endocarditis, to repair or not to repair, is that really the question?

2021 ◽  
Author(s):  
Michele Di Mauro ◽  
Giorgia Bonalumi ◽  
Antonio Calafiore ◽  
Roberto Lorusso
Keyword(s):  
Mitral Valve ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Valve Repair ◽  
Total Removal ◽  
Term Survival ◽  
Mitral Repair ◽  
Short And Long Term ◽  
Wide Experience

The meta-analysis by He and collaborators [has the worth to cover, as much as possible, a gap of scientific evidence where conducting a randomized trial appears very complex for ethical and logistical reasons. The authors concluded that mitral valve repair (MVP) provide better pooled results, both early and late, with respect to mitral valve replacement (MVR). However, the superiority of MVP is driven by some single large cohort-studies where surgeons had wide experience in the field of MVP for IE. This finding is also confirmed by other studies. But if mitral repair produces such a better short- and long-term survival than replacement, why are there no clear indications from consensus and guidelines pushing surgeons toward the pursuit of a reconstructive procedure at almost any cost? We wonder but to repair or not to repair, is that really the question? The AATS consensus suggests to repair “whenever possible” but without providing more specific indications. If the two primary goals of surgery are total removal of infected tissues and reconstruction of cardiac morphology, including repair or replacement of the affected valve(s), probably MVP as to perform in case of less extensive tissue detriment by the infection. In more wide valve involvement, MVP may be the choice but only in very expert hands and in Centers with very large volume of valve repairing. This decision cannot therefore be the result of the choice of an individual but must derive from a careful multidisciplinary discussion to be held in an EndoTeam.

Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Long Term Results ◽  
Term Survival ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Short And Long Term ◽  
Good Treatment Option ◽  
Matched Comparison

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>

scholarly journals Genetic Alterations in Patients With Esophageal Cancer With Short- and Long-Term Survival Rates After Curative Esophagectomy

1997 ◽  
Vol 226 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Yutaka Shimada ◽  
Masayuki Imamura ◽  
Ichio Shibagaki ◽  
Hisashi Tanaka ◽  
Tokiharu Miyahara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Survival Rates ◽  
Genetic Alterations ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term ◽  
Curative Esophagectomy

scholarly journals Very Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Dania Mohty ◽  
Thomas A. Orszulak ◽  
Hartzell V. Schaff ◽  
Jean-Francois Avierinos ◽  
Jamil A. Tajik ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Reoperation Rate ◽  
Surgical Correction ◽  
Valve Repair ◽  
Term Survival ◽  
Long Term Survival ◽  
Leaflet Prolapse

Background Mitral regurgitation (MR) due to mitral valve prolapse (MVP) is often treatable by surgical repair. However, the very long-term (>10-year) durability of repair in both anterior leaflet prolapse (AL-MVP) and posterior leaflet prolapse (PL-MVP) is unknown. Methods and Results In 917 patients (aged 65±13 years, 68% male), surgical correction of severe isolated MR due to MVP (679 repairs and 238 replacements [MVRs]) was performed between 1980 and 1995. Survival after repair was better than survival after MVR for both PL-MVP (at 15 years, 41±5% versus 31±6%, respectively; P =0.0003) and AL-MVP (at 14 years, 42±8% versus 31±5%, respectively; P =0.003). In multivariate analysis adjusting for predictors of survival, repair was independently associated with lower mortality in PL-MVP (adjusted risk ratio [RR] 0.61, 95% CI 0.44 to 0.85; P =0.0034) and in AL-MVP (adjusted RR 0.67, 95% CI 0.47 to 0.96; P =0.028). The reoperation rate was not different after repair or MVR overall (at 19 years, 20±5% for repair versus 23±5% for MVR; P =0.4) or separately in PL-MVP ( P =0.3) or AL-MVP ( P =0.3). However, the reoperation rate was higher after repair of AL-MVP than after repair of PL-MVP (at 15 years, 28±7% versus 11±3%, respectively; P =0.0006). From the 1980s to the 1990s, the RR of reoperation after repair of AL-MVP versus PL-MVP did not change (RR 2.5 versus 2.7, respectively; P =0.58), but the absolute rate of reoperation decreased similarly in PL-MVP and AL-MVP (at 10 years, from 10±3% to 5±2% and from 24±6% to 10±2%, respectively; P =0.04). Conclusions In severe MR due to MVP, mitral valve repair compared with MVR provides improved very long-term survival after surgery for both AL-MVP and PL-MVP. Reoperation is similarly required after repair or replacement but is more frequent after repair of AL-MVP. Recent improvement in long-term durability of repair suggests that it should be the preferred mode of surgical correction of MVP whether it affects anterior or posterior leaflets and is an additional incentive for early surgery of severe MR due to MVP.

scholarly journals Risk factors and clinical significance of elevated mitral valve gradient following valve repair for degenerative disease

2019 ◽  
Vol 57 (2) ◽  
pp. 293-299
Author(s):  
Anton Tomšič ◽  
Yasmine L Hiemstra ◽  
Bardia Arabkhani ◽  
Bart J A Mertens ◽  
Thomas J van Brakel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mitral Valve ◽  
Standard Error ◽  
Linear Regression Analysis ◽  
Multivariable Analysis ◽  
Clinical Results ◽  
Degenerative Disease ◽  
Valve Repair ◽  
Annuloplasty Ring

Abstract OBJECTIVES The risk factors and clinical effect of elevated mitral valve (MV) gradients after valve repair for degenerative valve disease remain insufficiently understood. METHODS Between January 2004 and December 2015, a total of 484 patients underwent valve repair for degenerative disease. A true-sized full annuloplasty ring was implanted in all cases. We analysed the effect of preoperative and intraoperative factors on the postrepair gradient. Additionally, we explored the effect of postrepair gradients on long-term outcomes. RESULTS On linear regression analysis, postrepair MV gradients were associated with patient age (coefficient = −0.110, standard error = 0.005, P = 0.034), body surface area (coefficient = 0.905, standard error = 0.340, P = 0.008), implanted annuloplasty ring size (coefficient = −0.181, standard error = 0.018, P &lt; 0.001) and the use of Physio I ring (coefficient = 0.414, standard error = 0.122, P = 0.001). On multivariable analysis, postrepair MV gradient was not associated with overall survival [hazard ratio (HR) 1.034, 95% confidence interval (CI) 0.889–1.203; P = 0.66] or freedom from atrial fibrillation (HR 0.849, 95% CI 0.682–1.057; P = 0.14), but did emerge as a risk factor for MV reintervention (HR 1.378, 95% CI 1.033–1.838; P = 0.029). Two out of 11 reinterventions were performed due to MV stenosis and in both patients, high postrepair gradients were seen readily on predischarge echocardiography. CONCLUSIONS Following valve repair for degenerative MV disease, elevated gradients occur even when true-sized annuloplasty is performed. The late clinical results of valve repair with elevated postrepair gradient are impaired and further studies are needed to explore preventive measures aimed at resolving the issue.

scholarly journals Comparison of prognosis between emergency and scheduled hemodialysis

2019 ◽  
Vol 47 (3) ◽  
pp. 1221-1231 ◽  
Author(s):  
Zhixiang Bian ◽  
Huiyi Gu ◽  
Peihua Chen ◽  
Shijian Zhu
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Survival Rates ◽  
Overall Survival Rate ◽  
Short Term ◽  
Term Survival ◽  
Renal Replacement Therapies

Background The survival rate of patients undergoing hemodialysis and other renal replacement therapies has been extensively studied, but comparative studies of emergency and scheduled hemodialysis are limited. Methods This study included 312 patients who underwent emergency hemodialysis and 274 who received scheduled hemodialysis. We investigated the prognostic differences between these two groups of patients, including the short-term and long-term survival rates. Results The overall survival rate was significantly better among the patients in the scheduled hemodialysis group than emergency hemodialysis group. The mortality rate within 3 months of emergency hemodialysis was 4.8%, while that within 3 months of scheduled hemodialysis was 1.1%. Conclusions Significant differences were present between emergency and scheduled hemodialysis, especially the levels of serum creatinine and hemoglobin.

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