Impact of Septal Myectomy Volume on Mitral-Valve Replacement Rate in Hypertrophic Cardiomyopathy Patients

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 161-167 ◽  
Author(s):  
Antonio R. Polanco ◽  
Alex D’Angelo ◽  
Nicholas Shea ◽  
Sarah N. Yu ◽  
Yuting P. Chiang ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Perioperative Outcomes ◽  
Septal Myectomy ◽  
Group I ◽  
Institutional Volume ◽  
Group Ii ◽  
The Impact

Objective: Mitral regurgitation (MR) induced by systolic anterior motion in patients with hypertrophic cardiomyopathy (HCM) can frequently be abolished with a proficient septal myectomy (SM) without the need for mitral-valve replacement (MVR). ACC guidelines stress the importance of volume in improving outcomes after SM, but there is a lack of data measuring the impact of volume on the need for MVR during SM. This study was designed to assess the impact of institutional volume on MVR rates using national outcomes data. Methods: The Nationwide Inpatient Sample was queried from 1998 to 2011 and a total of 6,207 patients had a diagnosis of HCM and a procedure code for SM. Outcomes were compared between patients who underwent SM (group I) and SM and MVR (group II). Furthermore, patients were stratified into 3 groups based on the number of SMs at the performing institution: low experience (1–24 cumulative SMs), medium experience (25–49 SMs), and high experience (>50 SMs). These patients underwent multivariable analysis to determine the impact of institutional volume on MVR rate. Results: The total MVR rate was 26%. Perioperative outcomes were worse, i.e., there were higher rates of mortality, kidney injury, and urinary complications, in group II than in group I. Only 37.6% of patients were operated on at institutions meeting the guideline criteria of >50 cumulative SMs. When compared to patients in the high-experience group, patients in the low- (OR 2.7, 95% CI 2.3–3.2, p < 0.05) and medium-experience (OR 3.0, 95% CI 2.5–3.6, p < 0.05) groups were more likely to undergo MVR. Conclusion: Compared to reports from SM reference centers, national data suggest that MVR rates are quite high at SM. Patients undergoing SM at centers that do not meet the guideline standard have >2.5× the odds of undergoing MVR compared to those operated on at guideline-endorsed centers.

scholarly journals Early outcome of mitral valve replacement through right anterolateral thoracotomy versus standard median sternotomy

2018 ◽  
Vol 11 (1) ◽  
pp. 94
Author(s):  
Heemel Saha ◽  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Jubayer Ahmed ◽  
Sanjoy Kumar Saha ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Median Sternotomy ◽  
Wound Dehiscence ◽  
Study Groups ◽  
Sitting Posture ◽  
Anterolateral Thoracotomy ◽  
Group I ◽  
Group Ii

<p class="Abstract">This study was aimed to compare the peri-operative outcomes among the mitral valve replace-ment using anterolateral thoracotomy (n=17) and standard median sternotomy (n=17) in a single surgeons practice. The mean age was 24.1 ± 5.3 years in Group I and 41.0 ± 11.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time were significant in both the study groups. Incision scar was not visible in females in Group I but full incision scar was visible in Group II in sitting posture. In Group I patients, majority (52.9%) patients needed short duration of ICU stay in comparison to Group II, and the difference was statistically significant (p&lt;0.05) between the two groups. During discharge, 94.1% wound was well healed in Group I and 70.6% in Group II. Wound dehiscence was nil in Group I, but 23.5% patients developed dehiscence in Group II. However, only 5.9% patient developed unstable sternum in Group II. Cosmetic mitral valve replacement can be done safely through anterolateral thoracotomy and it is cost effective especially for the developing countries.</p>

scholarly journals Short Term Clinical Outcome in Patients with Mitral Valve Replacement with or without Preservation of Subvalvular Apparatus

2017 ◽  
Vol 12 (1) ◽  
pp. 3-7
Author(s):  
Sabrina Sharmeen Husain ◽  
Chaudhury Meshkat Ahmed ◽  
Arif Mohmmad Sohan ◽  
Sohel Mahmud ◽  
Md Mustafizur Rahman ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Age Distribution ◽  
Left Ventricular ◽  
Hospital Death ◽  
P Value ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background: Preservation of subvalvular apparatus (SAP) during mitral valve replacement (MVR) was introduced about forty years back, but the outcome of this procedure is not well studied yet. Our study aimed to measure the in-hospital outcome of this procedure in rheumatic patients.Method: 44 patients of rheumatic heart disease undergoing for MVR in the department of cardiac surgery, BSMMU were enrolled for the study. The technique of SAP was according to choice of surgeon. Patients were divided into two groups- I) with preservation: complete preservation, where entire chordo-papillary apparatus was preserved & partial preservation, where posterior leaflet was preserved, II) no preservation: where subvalvular apparatus was completely excised. Surgical technique was different according to patient’s requirement and one of either technique was adopted by Fuster et al or Miki et al. Patients’ demographic profile and mitral valve status were recorded. Outcome was recorded in terms of hemoynamic outcome and in hospital death. Data was analyzed by Chi squired test.Result: Mean±SD of age of patients was 32±8 years, 29±7years in group-I, 36±9years in group-II. There was no significant difference in age distribution between two groups. Both groups were female predominant, 82% in group-I and 73% in group-II. Low cardiac output syndrome was observed in 4.5% of group-I and 32% in group-II (P-value was <0.001). Left ventricular failure was observed as 0% & 32% respectively (p value was <0.001). Inotropic agent was needed 45% & 75% respectively (p value was <0.01). In hospital death occurred in 4.5% & 13.5% in two groups respectively with no significant difference.Conclusion: Hemodynamic outcome and in hospital mortality was better when subvalvular apparatus was preserved during mitral valve replacement in rheumatic population.University Heart Journal Vol. 12, No. 1, January 2016; 3-7

scholarly journals Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation

2012 ◽  
Vol 9 (1) ◽  
pp. 64-68 ◽  
Author(s):  
S Pradhan ◽  
N C Gautam ◽  
Y M Singh ◽  
S Shakya ◽  
R B Timala ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Functional Class ◽  
Group I ◽  
Group Ii ◽  
Repair Group ◽  
Tricuspid Repair

Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. http://dx.doi.org/10.3126/kumj.v9i1.6266 Kathmandu Univ Med J 2011;9(1):64-8

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

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.

Infective endocarditis in hypertrophic cardiomyopathy: Analysis of 5 patients requiring mitral valve replacement

1982 ◽  
Vol 49 (4) ◽  
pp. 949 ◽  
Author(s):  
Joan C. Kishel ◽  
Altagracia M. Chavez ◽  
Barry J. Maron ◽  
Stephen E. Epstein ◽  
Andrew G. Morrow ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement

scholarly journals Single versus bilateral chordo-papillary apparatus preservation in mitral valve replacement: a hemodynamic study

2020 ◽  
Vol 2 (2) ◽  
pp. 62-69
Author(s):  
Mostafa Alaaeldin Abdelfatah Shalaby ◽  
Haytham Mohamed Abd el.Moaty ◽  
Mohamed Hossiny Mahmoud ◽  
Mohamed S H Abdallah
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Geometry ◽  
Ventricular Ejection Fraction ◽  
Group Iii ◽  
Group I ◽  
Single Versus

Background: It has been postulated that disruption of the mitral valve apparatus at the time of mitral valve replacement (MVR) is a risk factor for postoperative ventricular dysfunction. The aim of this study was to evaluate the effect of single versus bilateral chordo-papillary preservation on the left ventricular function in comparison to no preservation. Methods: This study was conducted from 2015 to 2018 on sixty patients who had MVR. The patients were classified into group I included 20 patients who underwent MVR with complete excision of the subvalvular chordae and tips of papillary muscles, group II: included 20 patients who underwent MVR with preservation of posterior chordo-papillary apparatus, and group III: included 20 patients who underwent MVR with preservation of both posterior and anterior chordo-papillary apparatus. Results: There were 20 males (33.3%), and the mean age was 48.76± 8.91 years. Patients in group III were significantly older (37.15 ±4.92, 39.8 ± 5.49, and 57.25 ± 6.93 years in groups I, II, and III, respectively; p< 0.001). The left ventricular end-diastolic (5.40 ±0.34, 4.96 ± 0.43, and 4.44 ± 0.55 mm in group I, II and III, respectively, p<0.001) and end-systolic diameter (4.33 ±0.48, 3.58 ±0.43 and 3.20 ±0.43 mm in group I, II and III; respectively, p<0.001) were significantly reduced in partial and complete preservation groups after 6 months. Left ventricular ejection fraction improved in the bilateral preservation and partial preservation groups after 6 months (45.32 ±9.78, 56.79 ±10.14, and 56.60 ±11.68 % in groups I, II and III respectively, p<0.001). Mechanical ventilation was significantly longer in group I (24.10 ± 6.6, 16.80 ± 5.97, and 15.80 ± 5.24 hours in groups I, II and III, respectively, p<0.001) and the duration of ICU stay was significantly longer in group I (78.65 ± 15.32, 65.40 ± 14.21, and 60.20 ± 12.58 hours in groups I, II and III, respectively, p<0.001). Conclusion: Preservation of the annulo-papillary continuity may preserve left ventricular geometry and performance. Total preservation of chordae could be superior to partial preservation with better left ventricular remodeling and improvement in the left ventricular functions.

Abstract 18019: Successful Surgical Management of Severely Symptomatic Hypertrophic Cardiomyopathy Patients With Minimal Septal Hypertrophy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Raabia N Ahmad ◽  
Barry J Maron ◽  
Ethan J Rowin ◽  
Tammy S Haas ◽  
Joseph A Dearani ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Heart Block ◽  
Valve Repair ◽  
Outflow Obstruction ◽  
Septal Wall ◽  
Septal Hypertrophy ◽  
Surgical Myectomy

Background: Marked septal hypertrophy is considered a requirement for effective myectomy in obstructive hypertrophic cardiomyopathy (HCM), with mitral valve replacement recommended as the alternative strategy in patients with minimal hypertrophy. However, it remains uncertain whether relief of obstruction can be effectively abolished without mitral valve replacement in patients with minimal septal wall thickening. Methods: Of 500 patients who underwent surgical myectomy from 2004 to January 2014, 21 (4.2%) were identified with a maximum LV wall thickness ≤ 15mm and constitute the study cohort. Results: All 21 patients (56 ± 10 years old; 62% male) were followed for advanced heart failure symptoms refractory to drug therapy with a maximal septal wall thickness of 13.6 ± 1.7 mm (range: 10-15 mm; ≤ 12 mm in 5 patients). Outflow obstruction ≥ 30 mmHg due to mitral valve-septal contact was present after exercise in 17 of 21 patients (range: 50-150 mmHg), and under resting conditions in 4 patients (range: 30-65 mmHg). In all patients, surgical relief of obstruction consisted of muscular resection of the basal septum with revision of abnormal and apically displaced papillary muscles, which were judged intraoperatively to be contributing to obstruction. In addition, in 10 patients (47%) myectomy alone was not sufficient to relieve obstruction due to the limited opportunity for septal reduction and adjunctive mitral valve repair was performed to shorten an elongated anterior leaflet. No patient required mitral valve replacement or incurred a ventricular septal defect. Post-operatively, 4 patients developed complete heart block requiring permanent pacemaker (1 patient with pre-operative right bundle branch block) and 1 had a cerebrovascular event. At most recent follow up 18 ± 19 months post-myectomy, septal thickness was reduced to 10 ± 2 mm, no patient had an outflow gradient at rest or with provocation, and all patients were alive with the majority asymptomatic (class I: n=13; 62% and class II n=8; 38%). Conclusion: In patients with minimal septal hypertrophy, outflow obstruction can be effectively abolished with surgical myectomy and adjunctive mitral valve repair with a small increased risk of heart block, but without the need for mitral valve replacement.

scholarly journals Mid-Term Outcome of Mitral Valve Replacement During Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

2021 ◽  
Author(s):  
Hon Chun ◽  
Bo Mei ◽  
Guang-xian Chen ◽  
Kang-ni Feng ◽  
Meng-ya Liang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Prosthetic Valve ◽  
Disease Free Survival ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Valve Repair ◽  
Free Survival ◽  
Septal Myectomy ◽  
Disease Free

Abstract Background The mitral valve shows significant involvement in hypertrophic obstructive cardiomyopathy (HOCM). The mid-term outcomes of management of HOCM by prosthetic valve replacement with septal myectomy remain unclear. This study compared the prognosis of patients with and without prosthetic valve replacement. Methods From 01/2009 until 10/2015, 24 patients with HOCM underwent septal myectomy with or without valve repair/replacement were recruited. A total of 23 patients underwent echocardiographic evaluation before and after the operation. The follow-up duration ranged from 0.4 to 7 years (median 2.5 years). The Kaplan-Meier test was used to explore the association between prosthetic valve replacement and overall/disease-free survival among HOCM patients. Results A total of 9 patients underwent septal myectomy with/without mitral valve repair (MVr), and the other 15 patients underwent septal myectomy with mitral valve replacement (MVR). Six patients treated with MVR had unfavorable outcomes, including one peri-operative and three late deaths; one patient suffered from aborted sudden death, and one patient was treated for prosthetic valve endocarditis. Prosthetic valve replacement was associated with poor disease-free survival (p = 0.025). Conclusions Septal myectomy with or without-MVr was associated with a better outcome than septal myectomy with MVR in HOCM patients. The differences in prognosis were caused by more complicated left ventricular outflow tract structures and more prosthetic valve complications among patients undergoing MVR.

scholarly journals Comparison of quality of life in patients who underwent mechanical mitral valve replacement: star GK vs SJM

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jiang-Shan Huang ◽  
Ning Xu ◽  
Kai-Peng Sun ◽  
Zhi-Nuan Hong ◽  
Liang-Wan Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Chinese Population ◽  
Sound Pressure ◽  
Nyha Class ◽  
Sf 36 ◽  
The Impact

Abstract Background We want to compare the impact on health-related quality of life (HRQoL) between the Star GK and the SJM valve in the Chinese population. Methods We retrospectively enrolled a total of 172 patients who had undergone mechanical mitral valve replacement (MVR) (SJM valve in 87 patients and Star GK valve in 85 patients) at our institution from January 2013 to December 2015. We measured the sound pressure level, and used 2 self-administered questionnaires and the Chinese version of SF-36 to measure the HRQoL and valve-specific questions to evaluate patient anxiety. Results The Star GK group and the SJM group were similar in age, gender, body surface area, diameter of the implanted valve, underlying disease and current median NYHA class. Regarding the valve sound pressure perceived 1 year after operation, the SJM valve was slightly quieter than the Star GK valve, but the sound pressures of the two valves showed no significant differences. No significant differences in any of the eight subscales of the SF-36 were found between the two groups. Conclusions The present study suggests that the Star GK valve is similar to the SJM valve in its impact on HRQoL and audibility of mechanical sound in the Chinese population.

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