Depression of cardiovascular autonomic function is more pronounced after mitral valve surgery: evidence for direct trauma

The analysis of baroreflex sensitivity (BRS) and heart rate variability (HRV) leads to additional insights into patients' prognosis after cardiovascular events. The following study was performed to assess the differences in the post-operative recovery of autonomic regulation after mitral valve (MV) and aortic valve (AV) surgery with a heart–lung machine. Among the 43 consecutive male patients enrolled in a prospective study, 26 underwent isolated AV surgery and 17 isolated MV surgery. Blood pressure as well as ECG signals were recorded the day before, 24 hours after and one week after surgery. BRS was calculated according to the dual sequence method, and HRV was calculated using standard linear as well as nonlinear parameters. There were no major differences between the two groups in the pre-operative values. At 24 hours a comparable depression of HRV and BRS in both groups was observed, while at 7 days there was partial recovery in AV patients, which was absent in MV patients: p (AV versus MV)<0.001. While the response of the autonomic system to surgery is similar in AV and MV patients, there is obviously a decreased ability to recover in MV patients, probably attributed to traumatic lesions of the autonomic nervous system by opening the atria. Ongoing research is required for further clarification of the pathophysiology of this phenomenon and to establish strategies to restore autonomic function.

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Takotsubo syndrome after mitral valve surgery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa327 ◽

2020 ◽

Author(s):

Ana Devesa ◽

Rafael Hernández-Estefanía ◽

José Tuñón ◽

Álvaro Aceña

Keyword(s):

Mitral Valve ◽

Fatal Outcome ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Lv Function ◽

Partial Recovery ◽

Takotsubo Syndrome ◽

Left Circumflex Artery ◽

Coronary Syndrome

Abstract Background Takotsubo syndrome is a frequent entity; however, it has never been described after a mitral valve surgery. Case summary We present the case of a 79-year-old woman, with background of atrial fibrillation and a left atrial appendage closure device, who was admitted for elective mitral valve replacement, because of asymptomatic severe primary mitral regurgitation. Biologic mitral valve was implanted without incidences, but in the postoperative, she developed cardiogenic shock. Electrocardiogram (ECG) showed inverted T waves in precordial leads and an echocardiography showed severe left ventricular (LV) dysfunction with mid to distal diffuse hypokinesis, and better contractility in basal segments. Troponin levels were mildly elevated. With the suspicion of a postoperative acute coronary syndrome, a coronary angiography was performed and showed no significant coronary lesions. The haemodynamic situation was compromised for the next 48 h, in which vasoactive support and intra-aortic balloon counterpulsation were implemented. After 48 h, the haemodynamic situation suddenly improved. The ECG was normalized, and a control echocardiogram showed partial recovery of the LV function with resolution of regional wall motion abnormalities. The patient could be discharged at 1 week. The clinical picture was interpreted as a stress cardiomyopathy after mitral valve surgery. Discussion Takotsubo syndrome is a threatening condition; complications in acute phase could lead to a fatal outcome. Mitral valve surgery has to be considered as a trigger for this entity, after excluding coronary involvement, specially of left circumflex artery.

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Mini-thoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation

American Journal of Surgical Research and Reviews ◽

10.28933/ajsrr-2021-04-0806 ◽

2021 ◽

pp. 21

Author(s):

Keyword(s):

Mitral Valve ◽

Blood Loss ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Wound Infections ◽

Operative Outcomes ◽

Group I ◽

Group Ii ◽

Operative Recovery

Background: Mitral valve surgery is routinely performed through a Median full sternotomy (MFS) with excellent long term outcomes. Minimally invasive mitral (MIMVS) valve surgery is also a surgical approach that improves operative outcomes. In this study we report early post-operative outcomes in minimally invasive mitral valve surgery compared with MFS access with reference to Blood Loss, Wound infections, post-operative Recovery, Morbidity, Mortality and others variables. Patient and Methods: This study was a prospective data collection from 52 consecutive patients who underwent isolated mitral valve surgery at our institution from November 2017 to October 2019. Population study was divided to two groups, MIMVS (group I n= 26) and MFS (group II n=26). Pre-operative planning were performed so that to obtain similar characteristics. Intra and post-operative data were analysed. Results: The baselines characteristics were similar in both groups. Of the 26 patients in group I, 23 (88.46%) underwent mitral valve replacement and 3 a mitral valve repair. All the patients in group II underwent mitral valve replacement. There was no difference in term of mortality and morbidity. MIMVS was associated with longer CPB time (mean 161.9 vs 89.8 mins, P =.025) but similar ACC (99 mins vs 64 P=.468) time. MIMVS Patients had likely lower incidence of red blood cells transfusion (12.2% vs 34.7%,), post-operative haemoglobin was similar before transfusion. Haemorrhage complications were more likely in the group II (26.08 vs 7.7%); requiring inotropic support was found to be higher in the group II (54.5 vs 19%). In addition, patients in the MIMVS group had a shorter mechanical ventilation time (1.6 [1-6] vs 3.6 [2-8] hours; P <.01), shorter ICU stay 1.36 [1-6] vs 3.6 [2-8] days, p<.01. Length of hospital stay and chest tube stay were found to be shorter, respectively 6.9 [6-16] vs 7, 7 [7-13] and (1.38 [1-2] days vs 2.64 [2-4], P <.01). Wound infections were not found in both groups. Conclusion: Although the controversy interest of minimally invasive mitral valve surgery, it may be associated with less blood loss, faster post-operative recovery but increases operation time.

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DELAYED RECOVERY OF CARDIOVASCULAR AUTONOMIC FUNCTION AFTER MITRAL VALVE SURGERY - Evidence for Direct Trauma?

Proceedings of the First International Conference on Bio-inspired Systems and Signal Processing ◽

10.5220/0001064705040507 ◽

2008 ◽

Keyword(s):

Mitral Valve ◽

Autonomic Function ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Direct Trauma ◽

Cardiovascular Autonomic Function ◽

Delayed Recovery

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A multidisciplinary team nursing model in the treatment of patients undergoing transapical mitral valve clamping: a prospective study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01588-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sailan Li ◽

Haoruo Zhang ◽

Meihua Chen ◽

Zhenzhen Wang ◽

Yanjuan Lin

Keyword(s):

Mitral Valve ◽

Nursing Care ◽

Multidisciplinary Team ◽

Mitral Valve Surgery ◽

Cardiac Insufficiency ◽

Severe Illness ◽

Scale Scores ◽

Cardiac Status ◽

A Prospective Study ◽

Team Nursing

Abstract Background As a new surgical method for older adults with cardiac insufficiency, transapical mitral valve clamp surgery requires the cooperation of practitioners across multiple disciplines to ensure appropriate treatment and nursing care. This study aimed to explore the utility of a multidisciplinary team nursing model in the clinical treatment and nursing care of patients undergoing transapical mitral valve clamping. Methods Our sample of ten patients included four men (40%) and six women (60%), with a mean age of 71.4 ± 5.2 years. The multidisciplinary team comprised nurses that specialized in severe illness, cardiac health, rehabilitation, psychology, nutrition, and pain. The team engaged in comprehensive discussions regarding problems specific to the patients undergoing transapical mitral valve surgery, allowing them to formulate individualized nursing measures and implement precise policies. Results No serious postoperative complications occurred in any of the ten patients included in this study, and a significant improvement was noted in the cardiac status of all the patients. Color ultrasound findings at discharge indicated that the degree of reflux of all the patients was ≤2+. Among the ten patients, the Activity of Daily Living Scale scores at discharge were significantly higher than before the operation (69.0 ± 4.6 vs. 55.0 ± 5.8). In addition, the 6-min walking test results at discharge were significantly better than those observed before the operation (318.0 ± 21.7 m vs. 295.2 ± 18.4 m). Conclusions Utilization of a multidisciplinary team allows nurses across various specialties to provide more comprehensive and systematic care for patients undergoing a mitral valve clamping operation, thus promoting patient recovery.

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Comparative study: Transseptal approach versus Transatrial approach in mitral valve replacement in redo patients

10.31219/osf.io/as2n3 ◽

2019 ◽

Author(s):

Mohammed Abdelazeem Hitawy ◽

Mohamed Shaffik Hassan ◽

Farag Ibrahim Abdelwahab ◽

Mohamed Elsayed Mousa

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Surgery ◽

University Hospital ◽

Group I ◽

Significant Difference ◽

Transseptal Approach ◽

Group Ii ◽

A Prospective Study

Background: Previous cardiac operations may complicate mitral valve exposure, as adhesions and loss of mobility in the surrounding tissues may be present. In such cases, the conventional left atrial (LA) incision may not offer satisfactory visualization in the surgical site of the valve. Therefore, several alternative approaches have been proposed for satisfactory visualization of the mitral valve intraoperatively.Aim of the work: to evaluate the outcome of the transseptal and transatrial approaches for mitral valve replacement in patients undergoing redo mitral valve surgery.Patients and Method: This is a prospective study that was conducted at Cardio-thoracic surgery department of Al-Azhar University hospital (Damietta) and other centers during the period from the January 2018 to May 2019. It included 30 patients undergoing redo mitral valve surgery; 15 of them had transseptal approach and 15 with transatrial approach.Results: Age was comparable between studied groups. There was 6 males (40.0%) in group I and 7 males (46.7%) in group II. Smoking was reported in 8 (53.3%) in group I and 7 (46.7%) in group II. Hypertension and pulmonary disease were reported in 6 (40.0%) versus 7 (46.7%) and 2 (13.3%) versus 3 (20.0%) in groups I and II respectively. Diabetes mellitus was reported in 9 (60.0%) in group I versus 4 (26.7%) in group II. Finally, there was no significant difference between both approaches as regard to intraoperative or postoperative data.Conclusion: Transatrial approach has been used in most of previous studies; the transseptal approach appears to be equally effective.

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