scholarly journals Mitral valve surgery after a failed MitraClip procedure

2020 ◽  
Author(s):  
Francesco Melillo ◽  
Luca Baldetti ◽  
Alessandro Beneduce ◽  
Eustachio Agricola ◽  
Alberto Margonato ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Surgical Intervention ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair

Abstract OBJECTIVES Among patients undergoing transcatheter mitral valve repair with the MitraClip device, a relevant proportion (2–6%) requires open mitral valve surgery within 1 year after unsuccessful clip implantation. The goal of this review is to pool data from different reports to provide a comprehensive overview of mitral valve surgery outcomes after the MitraClip procedure and estimate in-hospital and follow-up mortality. METHODS All published clinical studies reporting on surgical intervention for a failed MitraClip procedure were evaluated for inclusion in this meta-analysis. The primary study outcome was in-hospital mortality. Secondary outcomes were in-hospital adverse events and follow-up mortality. Pooled estimate rates and 95% confidence intervals (CIs) of study outcomes were calculated using a DerSimionian–Laird binary random-effects model. To assess heterogeneity across studies, we used the Cochrane Q statistic to compute I2 values. RESULTS Overall, 20 reports were included, comprising 172 patients. Mean age was 70.5 years (95% CI 67.2–73.7 years). The underlying mitral valve disease was functional mitral regurgitation in 50% and degenerative mitral regurgitation in 49% of cases. The indication for surgery was persistent or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas 6% of patients presented with mitral stenosis. At the time of the operation, 80% of patients presented in New York Heart Association functional class III–IV. Despite favourable intraoperative results, in-hospital mortality was 15%. The rate of periprocedural cerebrovascular accidents was 6%. At a mean follow-up of 12 months, all-cause death was 26.5%. Mitral valve replacement was most commonly required because the possibility of valve repair was jeopardized, likely due to severe valve injury after clip implantation. CONCLUSIONS Surgical intervention after failed transcatheter mitral valve intervention is burdened by high in-hospital and 1-year mortality, which reflects reflecting the high-risk baseline profile of the patients. Mitral valve replacement is usually required due to leaflet injury.

The Use of Rapid Deployment Valves in Combined Aortic and Mitral Valve Surgery

2017 ◽  
Vol 12 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Markus Schlömicher ◽  
Matthias Bechtel ◽  
Zulfugar Taghiyev ◽  
Yazan Al-Jabery ◽  
Peter Lukas Haldenwang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair ◽  
The Mean ◽  
Mitral Disease ◽  
Rapid Deployment

Objective Patients undergoing multiple valve surgery represent a high-risk group who could potentially benefit from a reduction of cross-clamp and cardiopulmonary bypass times because prolonged bypass and cross-clamp times are considered independent risk factors for increased morbidity and mortality after cardiac surgery. Methods Between July 2013 and November 2014, 16 patients underwent rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system in the setting of concomitant mitral disease. Fifteen patients showed mitral regurgitation, whereas one patient had severe mitral stenosis. Fourteen patients received mitral valve repair and two patients received biological mitral valve replacement. Tricuspid valve repair was performed additionally in two patients. The mean ± SD age was 72.8 ± 8.4 years, and the mean ± SD logistic EuroSCORE II is 8.7% ± 3.4%. Results Within a 30-day perioperative period, no patient was lost (n = 0). The mean ± SD follow-up time was 11 ± 2 months. At 1 year, the overall survival was 81% (n = 13). A mean ± SD transaortic gradient of 10.7 ± 2.3 mm Hg and a mean ± SD effective orifice area of 1.7 ± 0.3 cm2 were measured echocardiographically. No higher-grade paravalvular leak (aortic insufficiency > 1+) occurred. Eight patients (61%) had no residual mitral regurgitation, four patients (30%) showed trivial regurgitation (1/4), and one patient (7.3%) had moderate mitral regurgitation (2/4). No interference of the subannular stent frame with the reconstructed valve or the biological mitral prosthesis was seen. Conclusions Rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system in combined aortic and mitral valve surgery can be performed safely with reproducible results. One-year follow-up data of this small series shows encouraging results potentially justifying the extension of the indication for rapid deployment valves to patients with concomitant mitral disease. Especially elderly patients undergoing multiple valve surgery may benefit from a reduction of cardiopulmonary bypass and myocardial ischemic times.

scholarly journals Mitral valve repair in heart failure: Five-year follow-up from the mitral valve replacement stratum of the Acorn randomized trial

2011 ◽  
Vol 142 (3) ◽  
pp. 569-574.e1 ◽  
Author(s):  
Michael A. Acker ◽  
Mariell Jessup ◽  
Steven F. Bolling ◽  
Jae Oh ◽  
Randall C. Starling ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Randomized Trial ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair

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.

scholarly journals Tricuspid valve annuloplasty and mitral valve replacement are associated with bradyarrhythmia after mitral valve surgery

2021 ◽  
Vol 32 (4) ◽  
pp. 1103-1110
Author(s):  
Florian E. M. Herrmann ◽  
Anne‐Sophie Schleith ◽  
Helen Graf ◽  
Sebastian Sadoni ◽  
Christian Hagl ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Annuloplasty

scholarly journals Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

2018 ◽  
Vol 26 (11) ◽  
pp. 552-561 ◽  
Author(s):  
R. Jansen ◽  
B. R. van Klarenbosch ◽  
M. J. Cramer ◽  
R. C. A. Meijer ◽  
P. H. M. Westendorp ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
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 Video-assisted Minimally Invasive Mitral Valve Surgery versus Conventional Mitral Surgery in Rheumatic Patients

2020 ◽  
Author(s):  
Ayman Badawy ◽  
Mohamed Alaa Nady ◽  
Mohamed Ahmed Khalil Salama Ayyad ◽  
Ahmed Elminshawy
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Invasive Approach ◽  
Video Assisted ◽  
Group A ◽  
Group B

Background: Minimally invasive mitral valve surgery became an attractive option because of its cosmetic advantages over the conventional approach. The superiority of the minimally invasive approach regarding other aspects is still debatable. The aim of our study was to determine the potential benefits of minimally invasive mitral valve replacement with intraoperative video assistance over conventional surgery. Methods: This is a single-center prospective cohort study that included 60 patients with rheumatic heart disease who underwent mitral valve replacement. Patients were divided into two groups: group (A) included patients who had conventional sternotomy (n= 30), and group (B) included patients who had video-assisted minimally invasive mitral valve replacement (n= 30). Intraoperative and postoperative outcomes were compared between both groups. Results: Mortality occurred in one patient in the group (A). Cardiopulmonary bypass time was 118.93 ± 29.84 minutes vs. 64.73 ± 19.16 minutes in group B and A respectively (p< 0.001), and ischemic time was 102.27 ± 30.03 minutes vs. 53.67± 18.46 minutes in group B and A respectively (P < 0.001). Ventilation time was 2.77± 2.27 vs. 6.28 ± 4.48 hours in group B and A respectively (p< 0.001) and blood transfusion was 0.50 ± 0.63 vs. 2.83 ± 1.34 units in group B and A respectively (p< 0.001).  ICU stay was 1.73 ± 0.64 days in the group (B) vs. 4.47 ± 0.94 days in group A (p< 0.001). Postoperative bleeding was 353.33 ± 146.77 ml in the group (B) vs. 841.67 ± 302.03 ml in group A (p <0.001). No conversion to full sternotomy was reported in group B. In group (B), two cases (6.6%) required re-exploration for bleeding vs. four cases (13.2%) in group (A) (p=0.67). The hospital stay was 6.13 ± 1.59 days in the group (B) vs. 13.27 ± 7.62 days in group A (p< 0.001). Four cases (13.3%) developed mediastinitis in group A and in the group (B), there was one case of acute right lower limb embolic ischemia. Conclusion: Video-assisted minimally invasive mitral operations could be a safe alternative to conventional sternotomy with the potential of lesser morbidity and earlier hospital discharge.

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