Impact of sex on cardiac remodeling and long‐term outcomes, following mitral valve replacement

Abstract OBJECTIVES We aimed to analyse the pathology of paravalvular leak (PVL), and determine the long-term outcomes of redo mitral valve replacement and risk factors of all-cause mortality. METHODS Seventy-nine patients (mean age 70 ± 9 years; 54 female, 68%) who underwent redo mitral valve replacement for mitral PVL between January 2000 and May 2019 were retrospectively reviewed. Indications for PVL intervention were haemolytic anaemia (57/79, 72%), New York Heart Association class III/IV congestive heart failure (56/79, 71%) and prosthetic valve endocarditis with PVL (2/79, 3%). RESULTS PVL most commonly occurred at lateral sectors (42/79, 55%). Early mortality occurred in 2 patients (3%) due to low cardiac output syndrome. Two patients (3%) had residual PVL at discharge. Sixteen patients (23%) developed late PVL (mean follow-up, 3.4 ± 2.9 years), among whom 11 (69%) developed PVL at same area as that preoperatively. Additionally, 9 patients (56%) developed PVL at lateral sectors in late follow-up. At 1, 5 and 10 years, the survival rate was 93%, 72% and 45%; rate of freedom from cardiac death was 96%, 92% and 78%; and rate of freedom from PVL recurrence was 94%, 82% and 54%, respectively. Chronic kidney disease was the only risk factor in the multivariate analysis for mortality [P = 0.013; hazard ratio 4.0 (1.4–11.0)]. CONCLUSIONS Surgery for mitral PVL confers reasonable early and long-term outcomes. Greater attention to the anterolateral annulus may help prevent PVL.

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Faculty Opinions recommendation of Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short- and Long-Term Outcomes in a Propensity-Matched Cohort.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726586639.793522322 ◽

2016 ◽

Author(s):

John A Paraskos

Keyword(s):

Mitral Valve ◽

Elderly Patients ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Matched Cohort ◽

Valve Repair ◽

Long Term Outcomes ◽

Short And Long Term

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Is Rheumatic Mitral Valve Disease Still Maintaining its Prevalence in Our Country? Early and Long-term Outcomes After Mitral Valve Replacement with Rheumatic Origin

Kosuyolu Heart Journal ◽

10.5578/khj.67338 ◽

2018 ◽

Vol 21 (3) ◽

pp. 198-203

Author(s):

Mehmet Erin Tüysüz ◽

Mehmet Dedemoğlu

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Disease ◽

Valve Disease ◽

Long Term Outcomes

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Mitral valve repair versus mitral valve replacement in octogenarians - review of long-term outcomes in the past two decades

Journal of Cardiothoracic Surgery ◽

10.1186/1749-8090-10-s1-a341 ◽

2015 ◽

Vol 10 (S1) ◽

Author(s):

Miriam Silaschi ◽

Sanjay Chaubey ◽

Habib Khan ◽

Mohsin Uzzaman ◽

Mrinal Singh ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Valve Repair ◽

Long Term Outcomes ◽

The Past

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Long-Term Outcomes Comparison of Mitral Valve Replacement Versus Repair in Elderly Patients

Heart Lung and Circulation ◽

10.1016/j.hlc.2017.03.123 ◽

2017 ◽

Vol 26 ◽

pp. S396

Author(s):

Anthony Furnary

Keyword(s):

Mitral Valve ◽

Elderly Patients ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Long Term Outcomes

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IMMEDIATE AND LONG-TERM OUTCOMES AFTER BIOPROSTHETIC MITRAL VALVE REPLACEMENT WITH THE PRESERVATION OF THE SUBVALVULAR APPARATUS

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2018-7-2-38-49 ◽

2018 ◽

Vol 7 (2) ◽

pp. 38-49

Author(s):

Yu. N. Odarenko ◽

N. V. Rutkovskaya ◽

S. G. Kokorin ◽

A. N. Stasev ◽

L. S. Barbarash

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Invasive Monitoring ◽

Central Hemodynamics ◽

Long Term Outcomes ◽

Group 2 ◽

Bioprosthetic Mitral Valve ◽

Group 1

Aim. To assess the immediate and long-term outcomes after bioprosthetic mitral valve replacement with the preservation of the subvalvular apparatus. Methods. 304 patients who underwent primary bioprosthetic mitral valve replacement in the period from 2001 to 2009 were included in the study. Patients were enrolled into two groups with either preserved subvalvular structures (Group 1. n = 142, 47%) or resected structures (Group 2, n = 162) during bioprosthetic mitral valve replacement. For the unbiased assessment of the efficiency of valve-preserving approach, randomly selected patients from Group 1 (n = 75) and Group 2 (n = 40) underwent preoperative and postoperative invasive monitoring of the central hemodynamics using the Swan-Ganz thermodilution catheter. Results In-hospital mortality was 1.4% (n = 2) in Group 1 and 4.3% in Group 2. The most common cause of death was acute left ventricular failure. We found that the preservation of subvalvular structures allows ensuring the optimal linear and volumetric echocardiography parameters in the immediate postoperative period, despite the hemodynamic profile of the defect. However, the positive effects were more pronounced in patients with more severe mitral regurgitation. Patients with preserved subvalvular structures had more durable surgical mitral valve replacement according to the echocardiographic findings in the long-term period. The invasive monitoring of central hemodynamics allowed determining that total subvalvular apparatus preservation was associated with more significant pressure decline in the pulmonary circulation (mean pulmonary arterial pressure and pulmonary capillary wedge pressure) and improved cardiac index and output. Posterior leaflet preservation was associated with less pronounced changes and patients who underwent routine mitral valve replacement had the worst intermediate outcomes. Conclusion The results of the presented study suggest that the preservation of subvalvular apparatus, unless otherwise indicated, is associated with improved immediate and long-term outcomes after mitral valve replacement.

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