Abstract 15993: Survival Benefit of Mechanical Valve Over Biological Valve for Isolated Mitral Valve Replacement in Young Dialysis Patients: National Database Analysis

Introduction: Optimal valve choice for mitral valve replacement (MVR) in dialysis patients remains unclear. Hypothesis: Mechanical valve (MV) provides survival benefit over biological valve (BV) in young dialysis patients who are undergoing MVR. Methods: Using the United States Renal Data System, a total of 2,905 patients were found to have undergone isolated MVR from 2000 through 2015. Median follow up period was 1.27 years (IQR: 0.23-3.33). We stratified patients into 3 groups by age, and adjusted baseline characteristics between patients who received BV and MV using propensity score matching in each age group: Group1, 18 to 49 (n=456); Group2, 50 to 69 (n=1030); and Group3, 70 or older (n=338). Primary endpoint was 10-year mortality. Cox-hazard model was used to compare 10-year mortality between BV and MV in matched cohorts. Results: Overall in-hospital and 10-year mortality rates were 16.8% and 87.1%, respectively. Use of BV increased from 17.8% in 2000 to 47.2% in 2015 (Figure 1). In the propensity matched groups, Cox hazard analysis revealed BV was independently associated with higher risk of mortality in Group1 (HR 1.51, 95% CI 1.22-1.86, P<0.001), but not for Group 2 (HR 1.01, 95% CI 0.88-1.15, P=0.88) or Group 3 (HR 0.9, 95% CI 0.72-1.13, P=0.37) (Figure 2). Conclusions: MV is associated with better long-term survival over BV in well-matched young dialysis patients who are undergoing isolated MVR.

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Abstract 2287: Prosthesis-Patient Mismatch is an Independent Predictor of Short-Term Mortality Following Mitral Valve Replacement

Circulation ◽

10.1161/circ.118.suppl_18.s_698-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Julien Magne ◽

Patrick Mathieu ◽

Jean G Dumesnil ◽

Eric Charbonneau ◽

Philippe Pibarot

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Operative Mortality ◽

Independent Predictor ◽

Effective Orifice Area ◽

Term Survival ◽

Short Term Mortality ◽

Clinically Significant ◽

Cabg Patients

Recent studies have shown that prosthesis-patient mismatch (PPM) is associated with an increased incidence of pulmonary hypertension and congestive heart failure and with reduced long-term survival following mitral valve replacement (MVR). The objective of this study was to examine the effect of PPM on operative mortality following MVR. The indexed valve effective orifice area (EOA) was estimated for each type and size of prosthesis being implanted in 1049 consecutive patients undergoing MVR±CABG and used to define PPM as not clinically significant if >1.2 cm 2 /m 2 , as moderate if >0.9 cm 2 /m 2 and ≤1.2 cm 2 /m 2 and as severe if ≤0.9 cm 2 /m 2 . Moderate PPM was present in 56% of patients and severe PPM in 12%. The overall operative mortality (OM) was 7% (n=73) and 84% were from cardiac causes (n=61, 6% of the whole cohort). Patients with severe PPM had higher overall OM (14%, p=0.0003) as well as operative cardiac-related death (CRD) (12%, p=0.007) than patients with moderate (OM: 6%, CRD: 5%) or nonsignificant PPM (OM: 6%, CRD: 4%). On multivariate analysis, severe PPM was an independent predictor of overall OM (Odds-ratio [OR]= 2.6 [95% confidence interval (CI): 1.3– 4.8], p=0.0045) and of operative CRD (OR= 2.3 [95%CI: 1.1– 4.4], p=0.02). Among the subset of 703 patients undergoing isolated MVR (i.e. without concomitant CABG), patients with severe PPM also had higher overall OM (12%, p=0.0025) than patients with moderate (4%) or nonsignificant PPM (3%). Mitral PPM was also a powerful independent predictor of both overall OM (OR=4.8, 95%CI: 1.8 –12.1, p=0.0009) and operative CRD (OR=3.2, 95%CI: 1.03– 8.7, p=0.03) in this subset of patients. Severe PPM is a strong independent predictor of both overall operative mortality and cardiac-related death after MVR. Hence, the projected indexed EOA should be systematically calculated at the time of operation prior to prosthesis implantation and an effort should be made to implant prosthesis with a larger EOA in patients who are identified as being at risk of severe PPM

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Patient-Specific Approach to Mitral Valve Replacement in Infants Weighing 10 kilograms or less

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119837200 ◽

2019 ◽

Vol 10 (3) ◽

pp. 304-312

Author(s):

Kathryn Mater ◽

Julian Ayer ◽

Ian Nicholson ◽

David Winlaw ◽

Richard Chard ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Surgical Techniques ◽

Somatic Growth ◽

Mechanical Valve ◽

Left Ventricular ◽

Patient Specific ◽

Mechanical Prostheses

Background: Mitral valve replacement (MVR) is the only option for infants with severe mitral valve disease that is not reparable; however, previously reported outcomes are not always favorable. Our institution has followed a tailored approach to sizing and positioning of mechanical valve prostheses in infants requiring MVR in order to obtain optimal outcomes. Methods: Outcomes for 22 infants ≤10 kg who have undergone MVR in Sydney, Australia, from 1998 to 2016, were analyzed. Patients were at a mean age of 6.8 ± 4.1 months (range: 0.8-13.2 months) and a mean weight of 5.4 ± 1.8 kg at the time of MVR. Most patients (81.8%) had undergone at least one previous cardiac surgical procedure prior to MVR, and 36.4% had undergone two previous procedures. Several surgical techniques were used to implant mechanical bileaflet prostheses. Results: All patients received bileaflet mechanical prostheses, with 12 receiving mitral prostheses and 10 receiving inverted aortic prostheses. Surgical technique varied between patients with valves implanted intra-annularly (n = 6), supra-annularly (n = 11), or supra-annularly with a tilt (n = 5). After a mean follow-up period of 6.2 ± 4.4 years, the survival rate was 100%. Six (27.3%) patients underwent redo MVR a mean of 102.2 ± 10.7 months after initial MVR. Four (18.2%) patients required surgical reintervention for development of left ventricular outflow tract obstruction and three (13.6%) patients required permanent pacemaker placement during long-term follow-up. Conclusions: The tailored surgical strategy utilized for MVR in infants at our institution has resulted in reliable valve function and excellent survival. Although redo is inevitable due to somatic growth, the bileaflet mechanical prostheses used displayed appropriate durability.

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Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study

Journal of Cardiothoracic Surgery ◽

10.1186/1749-8090-3-17 ◽

2008 ◽

Vol 3 (1) ◽

Cited By ~ 10

Author(s):

Christopher Rao ◽

Jonathan Hart ◽

Andre Chow ◽

Fotios Siannis ◽

Polyxeni Tsalafouta ◽

...

Keyword(s):

Quality Of Life ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Term Survival ◽

Long Term Survival

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Valvular heart diseases. (1). Results of mitral valve replacement with mechanical valve prosthesis. Comparative study of Bjoerk-Shiley convexo-concave valve, duromedics valve and Medtronic-Hall valve.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.19.684 ◽

1990 ◽

Vol 19 (4) ◽

pp. 684-685

Author(s):

H. Kanda

Keyword(s):

Mitral Valve ◽

Comparative Study ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Diseases ◽

Mechanical Valve ◽

Valve Prosthesis ◽

Valvular Heart Diseases

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Use of an On-X Prosthetic Valve In A 42-Year Old Female With Antiphospholipid Syndrome

The Heart Surgery Forum ◽

10.1532/hsf.1805 ◽

2018 ◽

Vol 21 (1) ◽

pp. 026

Author(s):

Ayumi Koga ◽

Ken Okamoto ◽

Hirokazu Tazume ◽

Toshihiro Fukui

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Therapeutic Option ◽

Mechanical Valve ◽

Young Female ◽

Valve Function ◽

Anticoagulation Intensity

Antiphospholipid syndrome is a rare autoimmune disease with a hypercoagulable state causing vascular thrombosis. We present the case of a 42-year old female who underwent mitral valve replacement with a mechanical valve 15 months ago. The postoperative course was uneventful, and echocardiography performed 14 months postoperatively showed good valve function. The patient developed sudden dyspnea 15 months postoperatively and was referred to our hospital. Echocardiography revealed mitral stenosis with stuck leaflets. Emergent re-mitral valve replacement was successfully performed using an On-X valve (On-X Life Technologies, Austin, TX, USA). The patient tested positive for antiphospholipid antibodies. Antiphospholipid syndrome should be considered when valve dysfunction occurs suddenly in relatively young female patients. The On-X valve may be considered as a therapeutic option in patients with antiphospholipid syndrome because of its low anticoagulation intensity.

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Chordae Tendineae Rupture in the United States: Trends of Outcomes, Costs and Surgical Interventions

The Heart Surgery Forum ◽

10.1532/hsf.1625 ◽

2017 ◽

Vol 20 (1) ◽

pp. 019

Author(s):

Elena V. Dolmatova ◽

Kasra Moazzami ◽

James Maher ◽

Marc Klapholz ◽

Justin Sambol ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

International Classification Of Diseases ◽

The United States ◽

Valve Repair ◽

Chordae Tendineae ◽

Surgical Interventions ◽

Comorbidity Index

Objectives: To describe national trends in the incidence and outcomes of patients with chordae tendineae rupture (CTR).Methods: Patients who were diagnosed with CTR between 2000 and 2012 were identified in National (Nationwide) Inpatient Sample (NIS) registry. CTR was defined using validated International Classification of Diseases, 9th Edition, Clinical Modification diagnosis (ICD9-CM) codes. Results: A total of 37,287 (14,833 mitral valve repair, 7780 mitral valve replacement) CTR cases were identified. Overall, in-hospital mortality in CTR decreased by 3% from 2000 to 2012 (P < 0.001). From 2000 to 2012, the rate of mitral valve repair increased from 27.2% to 46.4%, (P < 0.001) with a concurrent decrease in the rate of mitral valve replacement (from 27.8 to 17.7%, P < 0.001). After multivariate adjustment, patient age (OR = 1.04, 95% CI 1.03-1.06, P < 0.001), congestive heart failure (CHF) (OR = 2.08, 95% CI 1.19-3.64, P = 0.01), myocardial infarction (MI) (OR = 3.58, 95% CI 2.10-6.11, P < 0.001), Deyo/Charlson comorbidity index (OR = 1.23, 95% CI 1.07-1.41, P < 0.003) and use of the intra aortic balloon pump (IABP) (OR = 4.81 95% CI 2.71-8.55, P < 0.001) were found to be independently associated with greater odds of mortality in these patients. Additionally, mitral valve replacement was significantly associated with higher costs of hospitalization (coefficient 15693, 95% CI 12638-18749, P < 0.001)Conclusion: Mitral valve repair is associated with reduced inpatient mortality and costs compared with mitral valve replacement. A substantial increase in the percentage of cases undergoing mitral valve repair with a concurrent decrease in cases undergoing mitral valve replacement were observed. Increasing age and comorbidity index, history of CHF and MI, and use of IABP were identified as factors that could increase the risk of mortality in patients with CTR.

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Supra-Annular Mitral Valve Replacement in Infants with Congenital Mitral Valve Disease

The Heart Surgery Forum ◽

10.1532/hsf.2593 ◽

2019 ◽

Vol 22 (5) ◽

pp. E315-E316

Author(s):

Haoyong Yuan ◽

Zhongshi Wu ◽

Yifeng Yang ◽

Can Huang

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Early Death ◽

Mechanical Valve ◽

Ptfe Graft ◽

Prosthetic Valves ◽

Mechanical Valves ◽

Neonates And Infants

Mitral valve replacement in infants is rare and causes a relatively high mortality, especially for patients under the age of 1. Supra-annular valve replacement is a viable technique for infants with a small valve annulus. Here, we report two infants who underwent mitral valve replacement via the supra-annular technique. The age and body weight of these babies were 2 months and 3 months and 4.1 kg and 4.7 kg, respectively. Aortic mechanical valves were reversely implanted with a short segment of PTFE graft. The purpose of this strategy was to insert a larger mechanical valve and delay resternotomy. A two-year follow-up exam showed normal ventricular function without mechanical valve-related complications. This method is useful in treating neonates and infants. Although the technique of mitral valve repair has improved over several decades, mitral valve replacement still is necessary at times. In neonates and infants with a small annulus, implantation of commercially available prosthetic valves in the annular position can be a challenge, and an age less than 1 year is a risk factor for early death [Selamet 2008]. Supra-annular mitral valve replacement (SMVR) is an alternative when a traditional annular implantation is not feasible [Sung 2008]. Herein, we report the cases of two patients, who underwent SMVR with a follow-up after two years.

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Redo mitral valve surgery

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v11i1.35583 ◽

2018 ◽

Vol 11 (1) ◽

pp. 89

Author(s):

Redoy Ranjan ◽

Mushfiqur Rahman ◽

Heemel Saha ◽

Dipannita Adhikary ◽

Sanjoy Kumar Saha ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Color Doppler ◽

Systolic Pressure ◽

Mechanical Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Pulmonary Artery Systolic Pressure ◽

Female Ratio

<p class="Abstract">This study is based on the findings of a single surgeon’s practice of mitral valve replacement of 167 patients from April 2005 to June 2017 who developed symptomatic mitral restenosis after closed or open mitral commisurotomy. Both clinical and color doppler echocardiographic data of peri-operative and six months follow-up period were evaluated and compared to assess the early outcome of the redo mitral valve surgery. With male-female ratio of 1: 2.2 and after a duration of 6 to 22 years symptom free interval between the redo procedures, the selected patients with mitral valve restenosis undergone valve replacement with either mechanical valve in 62% cases and also tissue valve in 38% cases. Particular emphasis was given to separate the adhered pericardium from the heart completely to ameliorate base to apex and global contraction of the heart. Besides favorable post-operative clinical outcome, the echocardiographic findings were also encouraging as there was statistically significant increase in the mitral valve area and ejection fraction with significant decrease in the left atrial diameter, pressure gradient across the mitral valve and pulmonary artery systolic pressure. Therefore, in case of inevitable mitral restenosis after closed or open commisurotomy, mitral valve replacement is a promising treatment modality.</p>

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Left ventricular pseudoaneurysm following atrioventricular groove rupture after mitral valve replacement

SAGE Open Medical Case Reports ◽

10.1177/2050313x18823456 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1882345

Author(s):

Miha Antonic ◽

Anze Djordjevic ◽

Tamara Mohorko ◽

Rene Petrovic ◽

Robert Lipovec ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Unusual Case ◽

Mechanical Valve ◽

Left Ventricular ◽

Valve Surgery ◽

Pericardial Patch ◽

Left Ventricular Pseudoaneurysm ◽

Atrioventricular Groove

Left ventricular pseudoaneurysm is a partial cardiac rupture, contained by the surrounding pericardium that maintains communication with the left ventricular lumen. Whereas most cases of left ventricular pseudoaneurysms are related to myocardial infarction (loss of myocardial integrity), only a handful are associated with valve surgery. We present a female patient, who was admitted for elective mitral valve replacement. After the implantation of the mechanical valve, we encountered a rupture of the atrioventricular groove. After 3 months, a left ventricular pseudoaneurysm was found and the patient was reoperated. The valve was explanted and the inspection of the annulus and previously implanted pericardial patch revealed a loosened stitch on the inferior (ventricular) side. The defect was reinforced with additional stitches and the valve was reimplanted. In conclusion, we report an unusual case with two serious complications after mitral valve replacement – atrioventricular groove rupture and left ventricular pseudoaneurysm.

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