The Role of Risk Factors and Trigger Factors in Cerebrovascular Events After Mitral Valve Replacement: Implications for Antithrombotic Management

Objective: To determine the role of perioperative milrinone on pulmonary hypertension in patients with mitral valve disease undergoing mitral valve replacement surgery. Study Design: Randomized Control Trial. Setting: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad. Period: June 2019 to June 2020. Material & Methods: A total of 80 patients with mitral valve disease who underwent mitral valve replacement were included. The patients were divided into a control group of 40, who were not administered milrinone, and a study group of 40 who received milrinone perioperatively. TVPG, LVEF and NYHA class were recorded preoperatively and postoperatively and were compared. Results: In the study group, postoperative LVEFs and NYHA class were not statistically significant in both groups while postoperative TVPG was significantly lower in study group as compare to control group and is statistically significant (P<0.001). Conclusion: Our study concludes that milrinone can be used as an effective therapy to reduce pulmonary pressure in patients with pulmonary hypertension undergoing mitral valve replacement surgery.

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Critical Role of the Mitral Valve Leaflet in Hypertrophic Subaortic Stenosis and Amelioration of the Disease by Mitral Valve Replacement

CHEST Journal ◽

10.1378/chest.59.4.378 ◽

1971 ◽

Vol 59 (4) ◽

pp. 378-382 ◽

Cited By ~ 10

Author(s):

Joseph G. Ellis ◽

Orlando J. Terneny ◽

William L. Winters ◽

Robert D. Leachman

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Critical Role ◽

Subaortic Stenosis ◽

Valve Leaflet ◽

Mitral Valve Leaflet

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Mitral Valve Replacement—Current and Future Perspectives

Open Journal of Cardiovascular Surgery ◽

10.1177/1179065217719023 ◽

2017 ◽

Vol 9 ◽

pp. 117906521771902 ◽

Cited By ~ 11

Author(s):

Johan van der Merwe ◽

Filip Casselman

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Future Perspectives ◽

Valve Repair ◽

Experimental Approaches ◽

Repair Techniques

The favorable outcomes achieved with modern mitral valve repair techniques redefined the role of mitral valve replacement. Various international databases report a significant decrease in replacement procedures performed compared with repairs, and contemporary guidelines limit the application of surgical mitral valve replacement to pathology in which durable repair is unlikely to be achieved. The progressive paradigm shift toward endoscopic and robotic mitral valve surgery is also paralleled by rapid developments in transcatheter devices, which is progressively expanding from experimental approaches to becoming clinical reality. This article outlines the current role and future perspectives of contemporary surgical mitral valve replacement within the context of mitral valve repair and the dynamic evolution of exciting transcatheter alternatives.

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Patient-Related Risk Factors as Predictors of Results Following Isolated Mitral Valve Replacement

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)63450-9 ◽

1977 ◽

Vol 24 (6) ◽

pp. 519-530 ◽

Cited By ~ 69

Author(s):

Neal W. Salomon ◽

Edward B. Stinson ◽

Randall B. Griepp ◽

Norman E. Shumway

Keyword(s):

Risk Factors ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Related Risk

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The Influence of Sex on Clinical Outcomes after Surgical Mitral Valve Replacement in Spain (2001–2015)

Journal of Clinical Medicine ◽

10.3390/jcm9124108 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4108

Author(s):

Nuria Muñoz-Rivas ◽

Ana López-de-Andrés ◽

Manuel Méndez-Bailón ◽

Emmanuel Andrès ◽

Valentín Hernández-Barrera ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Developed Countries ◽

Factors Associated ◽

Cerebrovascular Events ◽

Male Sex ◽

Discharge Database ◽

Bioprosthetic Valves ◽

Over Time

(1) Background: Mitral regurgitation (MR) is the second most prevalent valvular heart disease in developed countries. Mitral valve (MV) disease is a common cause of heart failure and a leading cause of morbidity and mortality in the U.S.A. and Europe. (2) Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001–2015. We included patients that had surgical mitral valve replacement (SMVR) listed as a procedure in their discharge report. We sought to (i) examine trends in incidence of SMVR among women and men in Spain, (ii) compare in-hospital outcomes for mechanical and bioprosthetic SMVR by sex, and (iii) identify factors associated with in-hospital mortality (IHM) after SMVR. (3) Results: We identified 44,340 hospitalizations for SMVR (84% mechanical, 16% bioprosthetic). The incidence of SMVR was higher in women (IRR 1.51; 95% CI 1.48–1.54). The use of mechanical SMVR decreased over time in both sexes and the use of bioprosthetic valves increased over time in both sexes. Men who underwent mechanical and bioprosthetic SMVR had higher comorbidity than women. IHM was significantly lower in women who underwent SMVR than in men (10% vs. 12% p < 0.001 for mechanical and 14% vs. 16% p = 0.025 for bioprosthetic valve, respectively). Major adverse cardiovascular and cerebrovascular events (MACCE) were also significantly lower in women who underwent mechanical and bioprosthetic SMVR. A significant reduction in both in-hospital MACCEs and IHM was observed over the study period regardless of sex. After multivariable logistic regression, male sex was associated with increased IHM only in bioprosthetic SMVR (OR 1.28; 95% CI 1.1–1.5). (4) Conclusions: This nationwide analysis over 15 years of sex-specific outcomes after SMVR showed that incidences are significantly higher in women than men for mechanical and bioprosthetic SMVR. IHM and MACCE have improved over time for SMVR in both sexes. Male sex was independently associated with higher mortality after bioprosthetic SMVR.

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A Treatise on The Surgical Management and A Suggested Amendment of Surgical Classification of Left Ventricular Rupture Following Mitral Valve Replacement

10.31487/j.jicoa.2019.03.01 ◽

2019 ◽

pp. 1-23

Author(s):

Ujjwal K. Chowdhury ◽

Basubabu Gudala ◽

Sukhjeet Singh ◽

Niwin George ◽

Lakshmi Kumari Sankhyan ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Clinical Presentation ◽

Left Ventricular ◽

Valve Repair ◽

Ventricular Rupture ◽

Left Ventricular Rupture ◽

Different Types

The present perspective is a synthesis of 108 published investigations in the setting of different types of left ventricular rupture following mitral valve replacement (MVR). We identified 109 investigations and reviewed the clinical presentation, diagnostic modalities, surgical techniques and outcomes. Clinical presentation, roentgenography, cross-sectional transthoracic/transesophageal echocardiography and computerized tomography provided the diagnostic information and defined the causative mechanism. Magnetic resonance imaging had been used for further clarification of the native ventricular anatomy in high-risk subset of patients, undergoing non-traditional transapical off-pump mitral valve repair with neochordal implantation. In this article, we have attempted to address several concerning issues and controversies with reference to the possible causative mechanisms, preventive measures, the issue of chordal preservation during MVR, the degree of decalcification required in cases of heavily calcified mitral annulus, selection of appropriate sized prosthetic valves, the surgical importance of a small left ventricle, various techniques of repair, role of cardiopulmonary bypass and cardioplegic arrest during the repair of left ventricular rupture, the role of biodegradable epicardial tissue sealants, to repair or not to repair the atrio-ventricular groove hematoma during mitral valve surgery, and the role of intra-aortic balloon counterpulsation in the perioperative period. Additionally, we have highlighted a new type of left ventricular rupture described in the literature located between the base of the papillary muscle and the apex, which can be categorized as a complication of new technologies of mitral valve repair such as NeoChord device artificial chordal implantation. We have classified this category as type IV ventricular rupture. Overall, this review attempts to address the guidelines for different surgical approaches and techniques of repair of different types of left ventricular rupture for a successful outcome. We submit that an increased appreciation of the causative mechanisms of different types of left ventricular rupture and its prevention may well contribute to improved surgical management.

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