The age-adjusted Charlson comorbidity index in minimally invasive mitral valve surgery

Abstract OBJECTIVES Mitral valve repair is the preferred method used to address mitral valve regurgitation, whereas transcatheter mitral valve repair is recommended for high-risk patients. We evaluated the risk-predictive value of the age-adjusted Charlson comorbidity index (aa-CCI) in the setting of minimally invasive mitral valve surgery. METHODS The perioperative course and 1-year follow-up of 537 patients who underwent isolated or combined minimally invasive mitral valve surgery were evaluated for 1-year mortality as the primary end point and other adverse events. The predictive values of the EuroSCORE II and STS score were compared to that of the aa-CCI by a comparative analysis of receiver operating characteristic curves. Restricted cubic splines were applied to find optimal aa-CCI cut-off values for the increased likelihood of experiencing the predefined adverse end points. Consequently, the perioperative course and postoperative outcome of the aa-CCI ≥8 patients and the remainder of the sample were analysed. RESULTS The predictive value of the aa-CCI does not significantly differ from those of the EuroSCORE II or STS score. Patients with an aa-CCI ≥8 were identified as a subgroup with a significant increase of mortality and other adverse events. CONCLUSIONS The aa-CCI displays a suitable predictive ability for patients undergoing minimally invasive mitral valve surgery. In particular, multimorbid or frail patients may benefit from the extension of the objectively assessed parameters, in addition to the STS score or EuroSCORE II. Patients with an aa-CCI ≥8 have a very high surgical risk and should receive very careful attention.

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Two Different Methods of Minimally Invasive Mitral Valve Surgery: Minimally Invasive Mitral Valve Repair Via Right Thoracotomy and Transapical Off-pump Mitral Valve Repair with Neochord Implantasyon. Eary Results

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2016.075 ◽

2016 ◽

Author(s):

Ali Sait Kavaklı ◽

Nilgün Kavrut Öztürk

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Repair ◽

Off Pump ◽

Right Thoracotomy

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Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/20.3803/013023-028 ◽

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.

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Minimally Invasive Mitral Valve Surgery II Surgical Technique and Postoperative Management

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000300 ◽

2016 ◽

Vol 11 (4) ◽

pp. 251-259 ◽

Cited By ~ 19

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.

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Predictive Value of Body Mass Index in Minimally Invasive Mitral Valve Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1723973 ◽

2021 ◽

Author(s):

Jan-Philipp Minol ◽

Vanessa Dimitrova ◽

Georgi Petrov ◽

Robert Langner ◽

Udo Boeken ◽

...

Keyword(s):

Body Mass Index ◽

Decision Making ◽

Mitral Valve ◽

Minimally Invasive ◽

Body Mass ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Predictive Values ◽

Sts Score ◽

Underweight Patients

Abstract Background With this study we aimed to analyze if the separate consideration of body mass index (BMI) could provide any superior predictive values compared with the established risk scores in isolated minimally invasive mitral valve surgery (MIMVS). This might facilitate future therapeutic decision-making, e.g., regarding the question surgery versus transcatheter mitral valve repair (TMVr). Methods We assessed the relevance of BMI in non-underweight patients who underwent isolated MIMVS. The risk predictive potential of BMI for mortality and several postoperative adverse events was assessed in 429 consecutive patients. This predictive potential was compared with that of European System for Cardiac Outcome Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons score (STS score) using a comparative receiver operating characteristic curve analysis. Results BMI was a significant numeric predictor of wound healing disorders (p = 0.001) and proved to be significantly superior in case of this postoperative adverse event compared with the EuroSCORE II (p = 0.040) and STS score (p = 0.015). Except for this, the predictive potential of BMI was significantly inferior compared with that of the EuroSCORE II and STS score for several end points, including 30-day (p = 0.029 and p = 0.006) and 1-year (p = 0.012 and p = 0.001) mortality. Conclusion Therefore, we suggest that, in the course of decision-making regarding the right treatment modality for non-underweight patients with isolated mitral valve regurgitation, the sole factor of BMI should not be given a predominant weight.

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Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000301 ◽

2016 ◽

Vol 11 (4) ◽

pp. 243-250 ◽

Cited By ~ 24

Author(s):

Gorav Ailawadi ◽

Arvind K. Agnihotri ◽

John R. Mehall ◽

J. Alan Wolfe ◽

Brian W. Hummel ◽

...

Keyword(s):

Mitral Valve ◽

Best Practices ◽

Minimally Invasive ◽

Myocardial Protection ◽

Preoperative Planning ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Patient Evaluation ◽

Valve Repair ◽

Selection For

Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection.

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Contemporary trends in mitral valve surgery in East China: a 10-year experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320932743 ◽

2020 ◽

Vol 28 (7) ◽

pp. 404-412

Author(s):

Liang Ma ◽

Renyuan Li ◽

Lijun Jiang ◽

Weidong Li ◽

Haige Zhao ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Invasive Surgery ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

East China ◽

Valve Repair ◽

Valve Lesions

Background Contemporary nationwide data from mainland China on trends in mitral valve surgery are scarce. The purpose of the present study was to review a single-center experience with mitral valve surgery over a 10-year period in East China. Methods Between July 2009 and June 2019, 3238 consecutive patients who underwent mitral valve surgery in our center were retrospectively reviewed. The patients were evenly divided into three periods: July 2009 to October 2012 (period I), November 2012 to February 2016 (period II), March 2016 to June 2019 (period III). Results The 3238 patients included 536 (16.6%) who had mitral valve repair and 2702 (83.4%) who had mitral valve replacement. Early mortalities for mitral valve repair and mitral valve replacement were 0.2% and 0.9%, respectively. There were trends towards a higher proportion of degenerative valve lesions (24.6%, 35.8%, 54.7% in periods I, II, and III, respectively) and a lower proportion of rheumatic valve lesions (71.0%, 62.6%, 38.0%) in more recent years. The proportions of minimally invasive surgery (0.7%, 2.1%, 30.2%), mitral valve repair (8.3%, 15.4%, 27.5%), use of a bioprosthesis (10.1%, 17.0%, 23.1%), and concomitant tricuspid valve procedures (13.2%, 28.5%, 46.0%) increased dramatically, while early mortality remained constant during the 10-year period (1.0%, 0.3%, 0.9%). Conclusions In the past 10 years, the spectrum of mitral valve disease experienced a trend towards more degenerative valve lesions and less rheumatic valve lesions in East China. Mitral valve repair, bioprostheses, tricuspid valve repair, and minimally invasive surgery have been more often applied in recent years.

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Concomitant Tricuspid Valve Repair in Minimally Invasive Mitral Valve Surgery

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.04.263 ◽

2018 ◽

Vol 27 ◽

pp. S593

Author(s):

Anh Vo ◽

Dinh Nguyen ◽

Trang Nguyen ◽

Huy Ngo ◽

Thien Vu ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair

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Role of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation during Minimally Invasive Mitral Valve Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0033-1333844 ◽

2013 ◽

Vol 61 (05) ◽

pp. 386-391 ◽

Cited By ~ 13

Author(s):

Alexander Verevkin ◽

Michael Borger ◽

Meinhard Mende ◽

Piroze Davierwala ◽

Jens Garbade ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair

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Minimally Invasive Mitral Valve Surgery for Rheumatic Valve Disease

The Heart Surgery Forum ◽

10.1532/hsf.2529 ◽

2019 ◽

Vol 22 (5) ◽

pp. E390-E395 ◽

Cited By ~ 2

Author(s):

Anh Tuan Vo ◽

Khoi Minh Le ◽

Trang Thu Nguyen ◽

Thien Tam Vu ◽

Chuong Viet Tran Pham ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Tricuspid Regurgitation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Disease ◽

Recent Experience ◽

Valve Repair ◽

Rheumatic Valve Disease

Background: The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients. Methods: Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group. Results: The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%. Conclusions: In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.

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