Mitral valve repair for infective endocarditis: Kobe experience

Objectives We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups ( p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B ( p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

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Mitral valve repair using edge-to-edge technique in various situations: real-world experiences

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz130 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1110-1116 ◽

Cited By ~ 1

Author(s):

Sameer A Hirji ◽

Fernando Ramirez Del Val ◽

Farhang Yazdchi ◽

Jiyae Lee ◽

Julius Ejiofor ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Real World ◽

Systolic Anterior Motion ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival ◽

Cumulative Survival ◽

Ring Annuloplasty ◽

Transaortic Approach

AbstractOBJECTIVESEdge-to-edge (E2E) mitral valve repair (MVP) is a versatile technique used in various situations for mitral regurgitation (MR). This technique has been regaining attention, given the increasing use of the MitraClip procedure. This real-world study evaluates the durability of the E2E technique in different settings.METHODSFrom January 2002 to May 2015, a total of 303 patients with at least moderate MR who underwent E2E MVP were identified. Patients undergoing isolated MVP (n = 133) and concomitant coronary artery bypass grafting or other valvular procedures (N = 170) were included. Cox proportional hazards modelling was used to evaluate the risk factors for cumulative survival, or MV event (i.e. MV reintervention or MR recurrence) while event-free survival—defined as time to composite outcome of either death or MV event—was determined using competing risk Kaplan–Meier analysis. Median follow-up duration was 6.9 (interquartile range 5.8) years.RESULTSThe most common MR aetiology was myxomatous (34%), followed by Barlow’s disease (27.7%), and ischaemic (21.5%). E2E MVP was performed for the following indications: persistent MR (51.5%), systolic anterior motion prophylaxis (22.1%), transaortic approach (17.5%) and systolic anterior motion treatment post-MVP (8.9%). Concomitant ring annuloplasty was performed in 224 patients (73.9%). Operative mortality was 3.6% and MV event rate was 18.5%. Significant predictors of decreased survival included age, renal insufficiency, peripheral vascular disease and ischaemic MR aetiology (all P < 0.050). No ring annuloplasty (HR 2.79; P < 0.001) was the only significant predictor of MV events. Estimated event-free survival for the overall cohort was 8.5 years, and shortest for functional (non-ischaemic; 6.6 years) and ischaemic aetiology (5.5 years).CONCLUSIONSE2E repair is a versatile MVP technique, which can be used in prevention and treatment of systolic anterior motion, transaortic approach or with concomitant techniques, with reasonable outcomes. Ischaemic aetiology and absence of ring annuloplasty were associated with worse cumulative survival and MV event rates, respectively, which raises some concern in light of the expanding indication for MitraClip system.

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Mitral valve repair provides improved event-free survival in infective endocarditis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-862033 ◽

2005 ◽

Vol 53 (S 01) ◽

Author(s):

E Ruttmann ◽

G Pölzl ◽

C Legit ◽

O Chevtchik ◽

S Müller ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival

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Acute response of right ventricular function following transcatheter mitral valve repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.1969 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Sugiura ◽

M.W Weber ◽

N.T Tabata ◽

S.Z Zimmer ◽

U.B Becher ◽

...

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Mitral Valve Repair ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival ◽

Transcatheter Mitral Valve Repair ◽

Increased Risk

Abstract Background Little is known about early right ventricular (RV) response to transcatheter mitral valve repair (TMVR) and its association with clinical outcomes. We assessed the early effect of TMVR on the RV function (RVF) and sought to investigated the prognostic impact of post-procedural RV dysfunction. Methods From January 2011 through April 2019, consecutive patients who underwent MitraClip for severe mitral regurgitation were analyzed. We excluded patients in which the evaluation of RVF were un available. RV dysfunction was defined by an RV fractional area change (RVFAC) <35% or tricuspid annular planar systolic excursion (TAPSE) <16 mm. A Cox proportional regression analysis was conducted to investigate the association of post-procedural RV dysfunction with adverse outcomes (all-cause mortality and rehospitalization due to heart failure [HF]). Results A total of 403 patients were analyzed.Overall, the mean age was 78 years old and 59% of patients were male. The median left-ventricular ejection fraction (LVEF) was 46.1% [IQR 33.1–59.4], RVFAC was 41.9% [IQR 32.9–49.5], and TAPSE was 17 mm [IQR 14–22]. While 68 patients showed an acute improvement of RVF (35% of patients with baseline RV dysfunction), 51 patients (25% of patients with baseline normal RVF) showed an acute worsening of RVF. In patients with baseline normal RVF, atrial fibrillation (OR 4.57, 95% CI 1.56–13.40, p=0.006, HF duration >18 months (OR 2.95, 95% CI 1.32–6.60, p=0.009), LVEF <50% (OR 3.09, 95% CI 1.32–7.25, p=0.009), and tricuspid regurgitation≥3+ (OR 5.62, 2.28–13.90, p<0.001)were associated with an increased risk of acute worsening of RVF. By contrast, in patients with baseline RV dysfunction, HF duration >18 months (OR 0.43, 95% CI 0.22–0.85, p=0.01) and larger RV volume (OR 0.98, 95% CI 0.97–0.99, p<0.001) were associated with less probability of acute RVF improvement. The event-free survival was significantly different according to the subgroup of variation of RVF (p=0.003). Furthermore, post-procedural RV dysfunction was associated with an increased risk of outcomes (adjusted-HR 2.38, 95% CI 1.28–4.43, p=0.006). Conclusion Both acute improvement and worsening of RVF can be observed after TMVR. Post-procedural RV dysfunction is an independent predictor of adverse outcomes. Event-free survival curve Funding Acknowledgement Type of funding source: None

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Short Term Outcome of Double Valve Replacement vs. Aortic Valve Replacement with Mitral Valve Repair in Bangladesh: A Comparison

Cardiovascular Journal ◽

10.3329/cardio.v13i2.52970 ◽

2021 ◽

Vol 13 (2) ◽

pp. 164-171

Author(s):

Mohammad Rokonujjaman ◽

Syed Tanvir Ahmad ◽

Shaheedul Islam ◽

Md Ibrahim Khalilullah ◽

ZA Faruquee ◽

...

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Mitral Valve Repair ◽

Valve Repair ◽

Short Term ◽

Double Valve Replacement ◽

Group A ◽

Group B

Background: Although all mitral valves are not repairable, most non rheumatic valves and a substantial proportion of rheumatic valves are amenable to repair. Repair preserves the normal valvular tissue, so the left ventricular function is well maintained post-operatively. Combined aortic and mitral valve surgery is associated with increased mortality and morbidity. Several studies have shown the superiority of DVR (Double valve replacement) in this entity to prevent reoperation. Some other data suggested superiority of aortic valve replacement combined with mitral valve repair in double valve disease. No study had been done over Bangladeshi population. Our aim was to compare the short-term outcome of mitral valve repair and aortic valve replacement with double valve replacement. Methods: It was a prospective non-randomized observational study took place in the Department of Cardiac Surgery of National Institute of Cardiovascular Disease. In this study post-operative result of double valve replacement was compared with aortic valve replacement and mitral valve repair. Total 60 patients under went aortic valve replacement with either mitral valve replacement (n=30) marked as group A or (n=30) repair marked as Group B. Results: Aortic cross clamp time and cardiopulmonary bypass time was higher in group B than group A but it was well tolerated without any short-term measurable consequences. Required inotrope support was 49.8±2.3 hours in group B and 87.2±3.5 hours in group A (p<0.05). Duration of ICU stay were 91.1±3.2 hours in group A and 60.3±2.9 hours in group B (p<0.05). Development of postoperative low output syndrome was significantly higher (23.33%) in group A versus 3.33% in group B. Patients of group A suffered more from CHF in the follow up period than the group B. But the result was statistically insignificant. There was an early post-operative fall of ejection fraction in both groups but it was recovered after 3 months. Post-operative thromboembolism was 13.79% in group A and 3.33% in group B. There was no early death in repair group though total three (10%) cases died after DVR. There was no valve failure, re-stenosis or regurgitation in any group in this limited follow up period. Higher dose of warfarin was required in group A to maintain INR. Consequently, post-operative major bleeding occurred in 24.14% patients of group A. On the contrary, no patient of repair group suffered from this catastrophe. Conclusion: This study reveals that the result of mitral valve repair with aortic valve replacement is equally comparable or in some cases superior to that of double valve replacement. Therefore, in feasible cases, mitral valve repair should be attempted who need concomitant aortic valve replacement. Cardiovasc. j. 2021; 13(2): 164-171

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Mid-Term Results Comparing the Use of Artificial Chords Versus Native Chords for Mitral Valve Repair in Children

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120930678 ◽

2020 ◽

Vol 11 (5) ◽

pp. 579-586

Author(s):

Sivakumar Sivalingam ◽

Maruti Haranal ◽

Paneer Selvam Krishna Moorthy ◽

Jeswant Dillon ◽

Pau Kiew Kong ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Functional Class ◽

Class Iii ◽

Valve Repair ◽

Reconstructive Procedures ◽

Significant Difference ◽

Group A ◽

Group B

Background: Our study is aimed at evaluating the mid-term surgical outcomes of mitral valve repair in children using various chordal reconstructive procedures (autologous in situ chords or artificial chords). Methods: A retrospective analysis of 154 patients who underwent mitral valve repair using various chordal reconstructive procedures from 1992 to 2012. Patients were divided into group A and group B based on use of artificial chords and autologous in situ chords, respectively, for the repair. There were 102 (66.2%) patients in group A and 52 (33.8%) patients in group B. The mean age at repair was 11.1 ± 4.5 years. Associated cardiac anomalies were found in 94 (61%) patients. Results: The median follow-up period was 4.2 years (Interquartile range: 2.0-9.9). There were two (1.3%) early deaths and five (3.2%) late deaths. There was no significant difference in survival at 15 years between the two groups (group A: 91.8% vs group B: 95.1%; P = .66). There was no significant difference in the freedom from reoperation at 15 years between group A (79.4%) and group B (97.2%; P = .06). However, there was significant difference in freedom from valve failure between group A (56.5%) and group B (74.1%; P = .03). Carpentier functional class III and postoperative residual mitral regurgitation (2+ MR, ie, mild–moderate MR) were the risk factors for valve failure. Conclusions: Severity of the disease and its progression has profound effect on the valve repair than the technique itself. Both chordal reconstructive procedures can be used to produce satisfactory results in children.

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