High-risk mitral valve surgery

As patients with cardiac disease live longer, reoperative mitral valve surgery has become more common. Although these operations are technically challenging and of high risk, outcomes continue to improve. Minimally invasive techniques, better cardioprotective strategies, and advanced perioperative care have contributed to this. In this review, we discuss surgical approaches, intraoperative strategies, novel catheter-directed devices, and clinical outcomes of contemporary reoperative mitral valve surgery.

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Beating Heart Video-Assisted Mitral Valve Surgery: A Useful Technique for High-Risk Patients

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2009.00816.x ◽

2009 ◽

Vol 24 (3) ◽

pp. 312-314 ◽

Cited By ~ 5

Author(s):

Saqib Masroor ◽

Garland Dance ◽

Stephen J. Angeli

Keyword(s):

High Risk ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Beating Heart ◽

Valve Surgery ◽

High Risk Patients ◽

Video Assisted ◽

Risk Patients

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Impact of Myocardial Preservation Technique in High Risk Complex Ischemic Mitral Valve Surgery: From Experience to Evidence

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0035-1544324 ◽

2015 ◽

Vol 63 (S 01) ◽

Author(s):

J. Garbade ◽

R. Kluttig ◽

L. Matz ◽

P. Davierwala ◽

S. Lehmann ◽

...

Keyword(s):

High Risk ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Myocardial Preservation ◽

Preservation Technique

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Minimally Invasive Mitral Valve Surgery in Truly High-Risk Patients: Are We Pushing the Boundaries? An Observational Study

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000197 ◽

2015 ◽

Vol 10 (5) ◽

pp. 328-333 ◽

Cited By ~ 2

Author(s):

Marco Moscarelli ◽

Rafik Margaryan ◽

Alfredo Cerillo ◽

Enkel Kallushi ◽

Pierandrea Farneti ◽

...

Keyword(s):

High Risk ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Discrimination Power ◽

High Risk Patients ◽

Risk Patients

Objective This study aimed to assess in a retrospective series of truly high-risk patients who underwent minimally invasive mitral valve surgery: (1) postoperative and long-term results and (2) logistic EuroSCORE and EuroSCORE II discrimination power. Methods Between 2003 and 2013, we reviewed in our institution patients who underwent minimally invasive mitral valve surgery with or without tricuspid valve repair via right minithoracotomy with logistic EuroSCORE of 20 or higher. Results Among a total number of 1604, 88 patients were identified. Median logistic and EuroSCORE II was 27.29 (interquartile range, 15.3) and 12.7% (11.3%), respectively. Mean (SD) age was 71.9 (8.4) years; 42 were female (47.7%); 60 patients (68.1%) underwent previous sternotomy. Mitral valve was replaced in 59 (67%) and repaired in 29 (32.9%) patients; tricuspid valve repair was performed in 23 patients (26.1%). Median cardiopulmonary bypass and cross-clamp times were 157 minutes (interquartile range, 131–187 minutes) and 83 minutes (81–116 minutes), respectively; conversion to sternotomy and reopening for bleeding was necessary in 4 (4.5%) and 3 (3.4%) patients; permanent and transient neurological injuries were reported in 6 (6.8%) and 3 (3.4%) patients; acute kidney injury was reported in 13 patients (14.7%); 15 patients (17%) had pulmonary complications. Ten patients died while in the hospital (11.2%). Survival at 6 years was 78% (95% confidence interval, 69–88). Conclusions In this series of truly high-risk patients, minimally invasive mitral surgery was associated with acceptable early mortality and morbidity as well as long-term outcomes; both logistic and EuroSCORE II showed suboptimal discrimination power.

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