Intermediate-Term Results of 505 Consecutive Minithoracotomy Mitral Valve Procedures

2006 ◽  
Vol 1 (3) ◽  
pp. 99-104 ◽  
Author(s):  
Jeffrey S. Martin ◽  
R. Duane Davis ◽  
Donald D. Glower
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Late Complications ◽  
Mitral Valve Surgery ◽  
Bacterial Endocarditis ◽  
Valve Surgery ◽  
Subacute Bacterial Endocarditis ◽  
Term Survival ◽  
Few Data

Background Patient demand for less invasive surgery and interest in avoiding sternotomy has led to the increased use of the minithoracotomy for mitral valve surgery. Although the feasibility of this approach has been established, few data are available regarding intermediate-term results. Methods A total of 505 consecutive minithoracotomy mitral valve procedures performed between 1996 and 2004 were analyzed. Procedures were mitral replacement (191/505, 38%) and repair (314/505, 62%). Concomitant cardiac procedures were performed in 78 cases (13%) (maze 36, tricuspid 29, atrial septal defect/patent foramen ovale 13) and reoperation in 92 cases (18%). Arterial cannulation was ascending aorta in 403 cases (80%), femoral in 101 cases (20%), and axillary in 1 case (< 1%). An endoluminal aortic clamp was used in 406 cases (80%), an external clamp was used in 19 cases (4%), and 80 procedures (16%) were performed with ventricular fibrillation. Robotic assistance was used in 12 cases (2%). Results Mean patient age was 58.7 years (range 18–90 years). Median follow-up was 3.1 years. Operative mortality was 4 of 505 cases (<1%). Major complications included stroke in 7 cases (1%) and reoperation for bleeding in 18 cases (4%); there were no cases of mediastinitis. Late complications included chronic aortic dissection in 1 case (<1%) and mitral reoperation in 13 cases (3%) (subacute bacterial endocarditis 6, failed repair 2, other 5). Five-year survival was (83% ± 2%) and freedom from mitral reoperation was (96% ± 1%). Follow-up echocardiograms were available in 246 of 314 cases (78%) mitral repairs and mean mitral regurgitation grade was 1 ± 1. Mitral regurgitation was grade 3–4+ in 14 of 246 cases (6%) (subacute bacterial endocarditis 4, low ejection fraction 5, other 5). Five-year freedom from 3–4+ mitral regurgitation was 89% ± 3%. Conclusions Mitral valve surgery via minithoracotomy can be performed safely with a low perioperative complication rate. A durable technical result and excellent long-term survival can be expected.

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 Preoperative and predischarge predictors for persistent pulmonary hypertension after mitral valve surgery in patients with chronic organic mitral regurgitation

2015 ◽  
pp. 70-9
Author(s):  
Rina Ariani ◽  
Indriwanto Sakidjan ◽  
Budhi Setianto
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Multivariate Analysis ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Persistent Pulmonary Hypertension ◽  
Post Operative Atrial Fibrillation

Objectives. This study sought to evaluate the prevalence of pulmonary hypertension after mitral valve surgery ini patients with chronic organic mitral regurgitation and to determine preoperative and predischarge predictors for persistent pulmonary hypertension after surgeryMethods. This is a cohort retrospective study involving subjects with chronic organic mitral regurgitation with preoperative systolic PA pressure > 50 mmHg undergoing surgery. Demographic and echocardiography datas were collected prior to surgery, predischarge, and follow up datas were evaluated after minimal 6 months duration. Subjects were then devided into groups based on existence of persistent pulmonary hypertension after follow up. Bivariate and multivariate analysis was done to determine contributing factors.Results.There were 92 subjects with dominant mitral regurgitation included in this study with median age 40 (range 17-68) years with slight female predominance (55%). Persistent pulmonary hypertension was observed in 23 subjects (25%) predischarge and in 20 subjects (20.7%) after mean follow up of 11 + 5.5 months. Bivariate analysis revealed preoperative TAPSE, underlying etiology, severity of pulmonary hypertension preoperatively, postoperative atrial fibrilation, mean mitral valve gradient predischarge, and the presence of residual pulmonary hypertension predischarge were related with persistent pulmonary hypertension. From multivariate analysis, post operative atrial fibrillation [OR 7.3 (CI 95% 1.64-33.33, p=0.09)], mean mitral valve gradient predischarge [OR 1.67 (CI 95% 1,3-2.7, p=0.038)], and preoperative TAPSE [OR 0.143 (CI 95% 0.03-0.70, p=0.017)] were independent predictors for persistent pulmonary hypertension after mitral valve surgery.Conclusion. Persistent pulmonary hypertension was observed in 20.7% subjects after mitral valve surgery. Preoperative TAPSE, post operative atrial fibrillation, and predischarge mean mitral valve gradient were independent predictors.

Abstract 2305: Determinants of Outcomes Following Mitral Valve Surgery in Patients with Severe Organic Mitral Regurgitation and No or Mild Symptoms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Eric Charbonneau ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Long Term Survival ◽  
Long Term Mortality

The optimal timing of mitral valve surgery in patients with severe organic mitral regurgitation (OMR) and no or mild symptoms is highly controversial. The aim of this study was thus to determine the preoperative predictors of mortality following mitral valve surgery in patients with severe OMR and no or mild symptoms. Preoperative and operative data of 324 patients (65% of male, mean age: 65±13 years) with severe OMR and no/mild symptoms (NYHA class I and II) who underwent mitral valve surgery between 1992 and 2007 were prospectively collected in a computerized database. Mitral valve repair (MVRp) was performed in 132 (41%) and mitral valve replacement (MVR) in 187 (59%) patients. Operative mortality was low for both procedures (whole cohort: n=9, 2.7%; MVRp: n=2, 1.5%; MVR: n=7, 3.7%; p=0.34) but was significantly higher in the patients (n=167, 56%) with impaired preoperative left ventricular ejection fraction (LVEF) (<60%) (5.3% vs. 1.2%, p=0.04). Long-term survival was 93±2% at 5 years and 87±3% at 10 years. Patients with LVEF<60% had significantly reduced long-term survival compared to patients with normal LVEF (5-year: 89±4% vs. 95±5%, 10-year: 80±6% vs. 88±4%, p=0.049). Multivariate analysis identified age (Hazard-ratio [HR]= 1.03, 95% confidence interval (CI): 1–1.08, p=0.02), heart failure (HR= 1.9, 95%CI: 1.3–3, p= 0.0018), and LVEF (HR= 1.04, 95%CI: 1.01–1.07, p=0.0253) as independent predictors of long-term mortality. Furthermore, MVR was not associated with worse long-term survival on both univariate (p=0.83) and multivariate (p=0.98) analysis. Performing mitral valve surgery is safe in patients with severe OMR and no or mild symptoms. Impaired LVEF is associated with increased short- and long-term mortality, suggesting that these patients should be promptly operated before the onset of LV dysfunction.

Abstract 18515: Forward Flow Ejection Fraction as a Major Determinant of Outcome in Organic Mitral Regurgitation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marlène Dupuis ◽  
Marie-Annick Clavel ◽  
Haïfa Mahjoub ◽  
Kim O’Connor ◽  
Mario Sénéchal ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Cardiac Events

Introduction: The optimal timing of mitral valve (MV) surgery in patients with organic mitral regurgitation (OMR) is controversial. The objective of this study was to determine independent predictors of cardiac events in patients with OMR and no triggers for mitral valve surgery. Hypothesis: We hypothesized that forward LV ejection fraction (LVEF) calculated by the Dumesnil’s method (i.e. stroke volume measured in LV outflow tract divided by left ventricular end diastolic volume) is superior to the LVEF measured by the biplane Simpson’s method. Methods: Two hundred seventy eight patients with OMR (i.e. severity grade ≥1/4) and Doppler echocardiography exam at least 6 months before MV surgery or death were included. Clinical and echocardiographic data of 278 patients with OMR were analyzed retrospectively. The study end-point was the composite of death or need for mitral valve surgery. Results: During a mean follow-up of 5.4 ± 3.2 years, there were 147 (53%) events: 96 (35%) mitral surgeries and 66 (24%) deaths. There was no difference in the Simpson LVEF (65 ± 6% vs 65 ± 4%; p=0.86) and global longitudinal strain (-21.18 ± 3.26 % vs -21.26 ± 2.44 %; p=0.86) between patients who had an event versus those who were event-free during follow-up. However, LVEF calculated by Dumesnil’s method at baseline was lower in the event-group (47 ± 15%vs 59 ± 15%; p<0.0001) compared to the non-event group. After adjustment for age, sex, Charlson’s probability, coronary artery disease, ACE inhibitors, β-blockers, diuretics, AF and MR grade, forward LVEF by Dumesnil’s method remained an independent predictor of the occurrence of cardiac events (adjusted hazard ratio: 1.09, 95% interval confidence: 1.02-1.17; p=0.01). Conclusion: This study shows that the forward LVEF calculated by the Dumesnil’s method is superior to the standard LVEF or to longitudinal strain to predict outcomes in OMR. These results could help to improve risk stratification of patients with OMR and thereby individualized the treatment’s strategy. Further prospective studies are needed to confirm these findings.

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 &gt;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.

Long term follow-up in quality of life after mitral valve surgery

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
I Kammerer ◽  
M Höhn ◽  
AH Kiessling ◽  
S Becker ◽  
FU Sack
Keyword(s):  
Quality Of Life ◽  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Long Term Follow Up
Sign in / Sign up

Export Citation Format

Share Document