Contemporary outcomes in reoperative mitral valve surgery

Heart ◽  
2017 ◽  
Vol 104 (8) ◽  
pp. 652-656 ◽  
Author(s):  
Hunter J Mehaffey ◽  
Robert B Hawkins ◽  
Sarah Schubert ◽  
Clifford Fonner ◽  
Leora T Yarboro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Artery Bypass ◽  
Random Effect ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Resource Utilisation ◽  
Regional Society ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Mitral Surgery

ObjectiveData suggest that redo mitral valve surgery is being performed in increasing numbers, possibly with superior results according to single-centre studies. The purpose of this study is to describe outcomes of redo mitral valve surgery and identify risk-adjusted predictors of poor outcomes.MethodsAll (11 973) open mitral valve cases were evaluated (2002–2016) from a regional Society of Thoracic Surgery (STS) database. Patients were stratified by primary versus redo mitral valve surgery. Mixed effects logistic regression models including hospital as a random effect were used to identify risk factors for patients undergoing redo mitral valve surgery.ResultsOf all mitral valve cases, 1096 (9.7%) had a previous mitral operation. Redo patients had higher rates of valve replacement and preoperative comorbidities resulting in more complications, operative mortalities (11.1%vs6.5%, p<0.0001) and higher resource utilisation. Several factors independently increased risk for composite STS major morbidity and 30-day mortality, including cardiogenic shock (OR 10.3, p=0.0001), severe tricuspid insufficiency (OR 2.3, p=0.001), urgent/emergent status (OR 1.8, p=0.001) and concurrent coronary artery bypass grafting (OR 2.4, p=0.002). The volume of redo mitral valve surgery increased 10% per year and the observed-to-expected ratios (O/E) for operative mortality in redo mitral surgery improved from 1.44 early in the study period to 0.72 in the most recent era.ConclusionsRedo mitral valve surgery accounts for approximately 10% of mitral valve operations and is associated with increased risk and resource utilisation. However, as the volume of redo mitral surgery increases, outcomes have dramatically improved and are now better than predicted.

scholarly journals Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study

2018 ◽  
Vol 155 (4) ◽  
pp. 1474-1482.e2 ◽  
Author(s):  
Pierpaolo Chivasso ◽  
Vito D. Bruno ◽  
Shakil Farid ◽  
Pietro Giorgio Malvindi ◽  
Amit Modi ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Degenerative Disease ◽  
Mitral Surgery ◽  
Surgery In Octogenarians

Concomitant Beating-Heart Mitral Valve Surgery and Coronary Artery Bypass in Patients with Compromised Ventricular Function

2006 ◽  
Vol 1 (4) ◽  
pp. 151-154
Author(s):  
Gabriele Di Luozzo ◽  
Pierluca Lombardi ◽  
Alberto Maldonado ◽  
Marco Ricci ◽  
Tomas A. Salerno
Keyword(s):  
Coronary Artery ◽  
Mitral Valve ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Beating Heart ◽  
Valve Surgery

Background Surgical repair of mitral valve disease and concomitant coronary artery occlusive disease has high operative risk. Myocardial protection for protracted, complicated procedures is seminal to the overall operative outcome; specifically, preservation of left ventricular function. Methods The authors conducted a retrospective review of 25 patients undergoing combined mitral valve repair/replacement (MVR) and coronary artery bypass surgery (CABG) using the beating-heart technique at the Miller/University of Miami School of Medicine. The CABG was performed without cardiopulmonary bypass support. During the mitral valve surgery the perfusion pressure was maintained at 80–90 mm Hg and the systemic temperature at 35–36°C. The aorta was not cross-clamped. Results Twenty-five patients underwent MVR/CABG, including 7 patients with acute myocardial infarction. Preoperative echocardiograms revealed a mean ejection fraction (EF) of 41 ± 4.5%. One patient required a preoperative intraarterial balloon pump. An average of 2.12 ± 0.9 grafts and a total of 10 mitral valve repairs were performed. The average length of stay in the intensive care unit was 14 ± 1.8 days, and average hospitalization time was 23 ± 3. The mean postoperative EF was 41 ± 4.5%. The mortality in this patient group was 12 % (3/25) with a morbidity rate of 52% (13/25). Conclusions The data suggest that the technique is safe and reproducible, and that it potentially has a short-term benefit on left ventricular function. Therefore, this particular technique may be efficacious in patients with compromised left ventricular function requiring a combined MVR/CABG.

scholarly journals Percutaneous drainage of delayed post-cardiac surgery pericardial effusion

2020 ◽  
Vol 2 (3) ◽  
pp. 105-113
Author(s):  
Mohammed Sanad ◽  
Sherif Arafa ◽  
Shady Elhusseiny ◽  
Mohammed Adel ◽  
Mohammed Elshabrawy Saleh
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Percutaneous Drainage ◽  
Artery Bypass ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Large Pericardial Effusion

Background: Pericardial effusion and tamponade are common following valve surgery. The optimal treatment of symptomatic pericardial effusions remains controversial. The objective of this study was to present our experience in non-surgical management of delayed postoperative pericardial effusion. Methods: This retrospective study was conducted on 64 patients who had delayed pericardial effusion after cardiac surgery from 2016 to 2020. Eight patients were excluded due to the presence of inaccessible posterior or clotted pericardial effusion and were managed surgically, and 56 patients had percutaneous drainage of the pericardial fluid and were included in the analysis. Results: The mean age was 46.84±11.67 years (range: 22- 68 years), and 46.43% were females. The patients had coronary artery bypass grafting (n= 9), Aortic valve replacements  (n= 13), Mitral valve surgery (n= 21), double valve replacements (n= 8) and  combined procedures (n= 5).  All patients complained of varying degrees of exertional dyspnea. There were statistically significant differences between INR in different cardiac surgeries. Mean INR following mitral valve replacement (4.72±0.63) was significantly higher than in aortic valve replacement patients (3.32±0.34; p<0.001) and aortic valve patients (1.76±0.24; p<0.001). Fifteen patients (26.78%) had a large pericardial effusion. Successful drainage was achieved in all cases. Complications were pneumothorax (n= 2, 3.57%), recurrent effusions (n= 4, 7.14%), arrhythmias (n= 7, 12.5%), myocardial punctures (n= 2, 3.57%) and no mortality was reported. Conclusions: percutaneous drainage of postoperative pericardial effusion under radiological guidance is generally safe. Pericardial effusion is common after mitral valve surgery, which could be related to higher INR in these patients.

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