Outcomes of mitral valve repair in acute native mitral valve infective endocarditis

AbstractOBJECTIVESMitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis.METHODSBetween January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events.RESULTSThe mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively.CONCLUSIONSAlthough MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.

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Role of mitral valve repair in active infective endocarditis: long term results

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-017-0604-6 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 10

Author(s):

Carlo Rostagno ◽

Enrico Carone ◽

Pier Luigi Stefàno

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Long Term Results ◽

Valve Repair ◽

Active Infective Endocarditis

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Ten-Year Experience of Chordal Replacement With Expanded Polytetrafluoroethylene in Mitral Valve Repair

Circulation ◽

10.1161/circ.102.suppl_3.iii-30 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Author(s):

Junjiro Kobayashi ◽

Yoshikado Sasako ◽

Ko Bando ◽

Kenji Minatoya ◽

Kazuo Niwaya ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Maze Procedure ◽

Long Term Results ◽

Valve Repair ◽

Expanded Polytetrafluoroethylene ◽

Chordal Replacement

Background —Mitral valve repair is the procedure of choice to correct mitral regurgitation (MR). Although chordal replacement with expanded polytetrafluoroethylene (ePTFE) has been widely accepted to repair anterior mitral prolapse and other difficult situations, the long-term results of the repair and the fate of ePTFE have not been delineated. Methods and Results —From July 1988 to April 1999, 74 patients (49 males, 25 females) aged 17 to 77 years (mean age 55.3±14.8 years) underwent mitral valve repair with chordal replacement with ePTFE. The follow-up period was from 6 months to 11.3 years (mean 4.6±3.2 years). The causes of MR were degenerative in 65 patients (88%) and infective in 9 (12%). Three patients had active infective endocarditis. Valve lesions were anterior in 35 patients, posterior in 10, and both anterior and posterior in 29. Various procedures for plasty of leaflets were necessary in 37 patients (50%). Atrial fibrillation was associated in 38 patients (51%), and the maze procedure has been performed in a selected group of 30 patients (41%) since July 1992. There was 1 in-hospital death (1.4%) and 3 late cardiac deaths (4.1%). More than moderate MR developed in 12 patients (17%) during the follow-up period. Three of these patients required early reoperation within 1 year due to hemolysis. Two patients underwent mitral valve replacement at 6 and 8 years after repair, respectively. The actuarial reoperation-free rates at 5 and 10 years were 94.3±2.8% and 81.7±9.1%, respectively. Sinus rhythm was restored in 21 patients (70%) with the maze procedure. There was only 1 thromboembolic episode (0.3%/patient-y) in a patient with atrial fibrillation who did not undergo the maze procedure. Event-free survival rates as assessed by the freedom from cardiac death, thromboembolism, reoperation, and anticoagulation-related hemorrhage at 5 and 10 years were 91.3±3.4% and 71.6±9.7%, respectively. There was no relationship between recurrent MR and the change of ePTFE. Structural analysis of the ePTFE resected during reoperation revealed no calcification and showed remaining flexibility and pliability. Protein infiltration was observed in the ePTFE, and collagenous proliferation was recognized at the site of fixation to the valve leaflet and the papillary muscle. The surface of the ePTFE was completely endothelialized, which may induce antithrombogenicity. C onclusions —The long-term durability and biological adaptation of ePTFE as artificial chordae for mitral valve repair of MR were proved for >10 years.

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Very Long-Term Results (More Than 20 Years) of Valve Repair With Carpentier’s Techniques in Nonrheumatic Mitral Valve Insufficiency

Circulation ◽

10.1161/circ.104.suppl_1.i-8 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Cited By ~ 1

Author(s):

E. Braunberger ◽

A. Deloche ◽

A. Berrebi ◽

A. Fayssoil ◽

J.A Celestin ◽

...

Keyword(s):

New York ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Heart Association ◽

Mitral Valve Insufficiency ◽

Functional Class ◽

Long Term Results ◽

Valve Repair

Background Mitral valve repair is considered the gold standard in surgery of degenerative mitral valve insufficiency (MVI), but the long-term results (>20 years) are unknown. Methods and Results We reviewed the first 162 consecutive patients who underwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacterial endocarditis in 16 patients (10%). MVI was isolated or, in 18 cases, associated with tricuspid insufficiency. The mean age of the 162 patients (104 men and 58 women) was 56±10 years (age range 22 to 77 years). New York Heart Association functional class was I, II, III, and IV in 2%, 39%, 52%, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58±0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier’s functional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier’s ring annuloplasty in all cases, a valve resection in 126 patients, and shortening or transposition of chordae in 49 patients. During the first postoperative month, there were 3 deaths (1.9%) and 3 reoperations (2 valve replacements and 1 repeat repair [1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a median of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kaplan-Meier survival rate was 48% (95% CI 40% to 57%), which is similar to the survival rate for a normal population with the same age structure. The 20-year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardiac cause, stroke, and reoperation). During the 20 years of follow-up, 7 patients were underwent surgery at 3, 7, 7, 8, 8, 10, or 12 years after the initial operation. Valve replacement was carried out in 5 patients, and repeat repair was carried out in 2 patients. At the end of the study, 65 patients remained alive (median follow-up 19 years). Their median age was 76 years (age range 41 to 95 years). All except 1 were in New York Heart Association functional class I/II. Conclusions Mitral valve repair using Carpentier’s technique in patients with nonrheumatic MVI provides excellent long-term results with a mortality rate similar to that of the general population and a very low incidence of reoperation.

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Mitral valve repair: Infective endocarditis after MitralClip

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332630 ◽

2013 ◽

Vol 61 (S 01) ◽

Cited By ~ 2

Author(s):

D Maznikoski ◽

K Denk ◽

I Karliova ◽

CF Vahl

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

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10-Year Follow-up of 1,829 Patients Undergoing Minimally Invasive Mitral Valve Repair: A Single-Center Experience

10.1055/s-0040-1705438 ◽

2020 ◽

Author(s):

H. Schaefer ◽

D. Krankenberg ◽

U. Walle ◽

M. Liebrich ◽

D. Roser ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Single Center ◽

Valve Repair ◽

Single Center Experience

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Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

European Heart Journal ◽

10.1093/ehjci/ehaa946.2636 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Benito Gonzalez ◽

X Freixa ◽

C Godino ◽

M Taramasso ◽

R Estevez-Loureiro ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

One Year ◽

The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

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MIDA mortality risk score in patients undergoing percutaneous edge-to-edge mitral repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.1965 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Kavsur ◽

C Iliadis ◽

C Metze ◽

M Spieker ◽

V Tiyerili ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Risk Score ◽

Patient Selection ◽

Mortality Risk ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Valve Repair ◽

Ventricular Ejection Fraction

Abstract Background Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR). Aim We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure. Methods In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation. Results During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p<0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029). Conclusion The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients. Funding Acknowledgement Type of funding source: None

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.1945 ◽

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

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