scholarly journals Prognostic value of left atrial function in patients with severe primary mitral regurgitation undergoing mitral valve repair

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Stassen ◽  
A L Van Wijngaarden ◽  
S C Butcher ◽  
M Palmen ◽  
J J Bax ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Prognostic Value ◽  
Mitral Valve Surgery ◽  
Volume Index ◽  
Class Iii ◽  
Valve Repair ◽  
Chi Square ◽  
All Cause Mortality ◽  
Incremental Prognostic Value

Abstract Background Timing of mitral valve surgery for primary mitral regurgitation (MR) remains challenging. Since MR has a significant hemodynamic impact on the left atrium (LA), assessment of LA function may have prognostic value in these patients which is incremental to LA volume and left ventricular (LV) remodeling parameters. Purpose This study sought to investigate whether preoperative assessment of LA reservoir strain (LASr) by speckle tracking echocardiography is associated with long-term outcome in patients undergoing mitral valve repair for severe primary MR. Methods Echocardiography was performed prior to mitral valve surgery in 566 patients (age 64±12 years, 66% men) with severe primary MR. Complete clinical information was collected and the endpoint was all-cause mortality after operation. The study population was divided based on a cut-off value of LASr (22%) derived from a spline curve analysis (hazard ratio for all-cause mortality >1). Results Patients with LASr ≤22% (n=277) were significantly older, had more impaired renal function and were more symptomatic (NYHA functional class III to IV) compared to patients with LASr >22% (n=289). In terms of echocardiographic data, patients with LASr ≤22% had significantly lower LV ejection fraction and LV global longitudinal strain (LV-GLS) and significantly higher systolic pulmonary artery pressures and LA volume index compared with patients with LASr >22%. During a median follow-up of 95 (56 – 147) months, 129 patients (22.8%) died. Patients with LASr ≤22% experienced significantly higher mortality rates compared to patients with LASr >22% (log rank chi-square 35.1; p<0.001) (Figure). On multivariable analysis, age (hazard ratio (HR): 1.06; 95% confidence interval (CI): 1.03 to 1.09; p<0.001), LV-GLS (HR: 1.08; 95% CI: 1.02 to 1.15; p=0.014) and LASr (HR: 0.96; 95% CI: 0.93 to 0.99; p=0.014) were independently associated with all-cause mortality. The addition of LASr to a clinical model (including: age, coronary artery disease, estimated glomerular filtration rate, NYHA class III-IV, atrial fibrillation, LV end-diastolic volume index, LV ejection fraction, LV-GLS, LA volume index and systolic pulmonary artery pressure) showed a significant increase in the chi-square value (chi-square differences = 6.9; p=0.011), demonstrating the incremental prognostic value of LASr in patients with primary MR. Conclusions Preoperative LASr is independently associated with all-cause mortality in patients undergoing mitral valve repair for primary MR, has incremental prognostic value over LA volume and LVEF and might therefore be helpful to guide surgical timing. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Jan Stassen has received an ESC training grant (Appehab724.011364741) Association of LASr and outcome

scholarly journals Favorable course of tricuspid regurgitation after percutaneous mitral valve repair is associated with improved survival and clinical outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Meijerink ◽  
J Baan ◽  
B.J Bouma
Keyword(s):  
Mitral Valve ◽  
Clinical Outcome ◽  
Mitral Valve Repair ◽  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Funding Source ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
All Cause Mortality

Abstract Background Tricuspid Regurgitation (TR) is often present in patients with mitral regurgitation (MR) and is associated with increased mortality and morbidity after percutaneous mitral valve repair (PMVR) using the MitraClip (Abbott Vascular). It is unclear to what extent TR is reduced after PMVR and whether the reduction of TR is related to survival and functional outcome. Purpose The aim of this study was to determine (1) the TR course after PMVR and (2) if this was related to survival and clinical outcome. Methods Patients who underwent PMVR and had complete echocardiographic data at baseline and follow-up were included. TR severity was graded as none, mild, moderate or severe (according to current guidelines) and was determined before treatment and at 6-months of follow up. Favorable TR course was defined as improvement of ≥1 grade or ≤ mild TR at 6-months. Clinical endpoints were all-cause mortality during 1-year of follow-up and improvement in New York Heart Association (NYHA) functional class after 6 months. Results A total of 67 patients were included (mean age 76 years, 57% male, 81% NYHA class ≥3 and 69% baseline TR ≥ moderate). Favorable TR course was achieved in 31 patients (46%) (figure 1A). All-cause mortality at 1 year was 7.5%, and was lower in the favorable TR course group (0% vs. 13.9%, p=0.057) (figure 1B). Improvement in NYHA class at 6-months was seen in 45% of patients without vs. 81% of patients with favorable TR course (p=0.01) (figure 1C). Conclusion A favorable TR course is achieved in 46% of PMVR patients and is associated with improved survival and improvement of NYHA class. The relatively high rate of an unfavorable TR course at 6-months, indicates that interventional treatment of the tricuspid valve might benefit these patients. TR course (A) and NYHA improvement (B) Funding Acknowledgement Type of funding source: Other. Main funding source(s): Abbott

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 Mitral Valve Replacement—Current and Future Perspectives

2017 ◽  
Vol 9 ◽  
pp. 117906521771902 ◽  
Author(s):  
Johan van der Merwe ◽  
Filip Casselman
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Future Perspectives ◽  
Valve Repair ◽  
Experimental Approaches ◽  
Repair Techniques

The favorable outcomes achieved with modern mitral valve repair techniques redefined the role of mitral valve replacement. Various international databases report a significant decrease in replacement procedures performed compared with repairs, and contemporary guidelines limit the application of surgical mitral valve replacement to pathology in which durable repair is unlikely to be achieved. The progressive paradigm shift toward endoscopic and robotic mitral valve surgery is also paralleled by rapid developments in transcatheter devices, which is progressively expanding from experimental approaches to becoming clinical reality. This article outlines the current role and future perspectives of contemporary surgical mitral valve replacement within the context of mitral valve repair and the dynamic evolution of exciting transcatheter alternatives.

The Use of the Mini-Cardiopulmonary Bypass Circuit in Robotic Mitral Valve Surgery

2008 ◽  
Vol 3 (1) ◽  
pp. 16-18 ◽  
Author(s):  
Robert W. Emery ◽  
Goya V. Raikar ◽  
Barbara Murphy ◽  
Anton Rohan ◽  
Kris Nielsen
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
High Efficiency ◽  
Mitral Valve Surgery ◽  
Circulatory Support ◽  
Valve Repair ◽  
Mitral Repair ◽  
Perfusion Time ◽  
Mitral Surgery

Background Computer enabled robotic mitral valve repair cases have longer cross-clamp and perfusion times because of the more technically difficult procedure. To modify some of the well-documented side effects of standard cardiopulmonary bypass (CPB), we used a new mini-circuit on three robotic mitral cases. Methods Three patients having mitral valve repair (triangular resection of P2 and annuloplasty ring) using the daVinci Robot (Intuitive Surgical, Sunnyvale, CA) had circulatory support using a modified Resting Heart System (Medtronic, Inc., Fridley, MN), a vertically oriented space saving CPB configuration incorporating a high efficiency miniaturized oxygenator, centrifugal pump, shortened heparin coated tubing and an air evacuation system with a closed circuit. Results All patients had successful mitral repair (echo = 0 to trace residual leakage) under a cross-clamp time of 161 ± 54 minutes and perfusion time of 229 ± 31 minutes. No blood was given during CPB and 0.7 ± 1.2 red cell units after the CPB run and 0.7 ± 1.2 units during the postoperative course. Conclusion Miniaturized bypass circuit reducing the level of necessary anticoagulation, hemodilation, and blood trauma can be used despite the increased perfusion time necessary for robotic mitral surgery.

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.

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