Effects of Pregnancy on Long-Term Follow-Up of Mitral Valve Bioprostheses

Between 1986 and 1990, 304 females between 11 and 45 (mean, 33.9 ± 6.9) years of age underwent isolated mitral valve replacement with a bioprosthesis. Thirty-nine of the 285 survivors experienced 48 pregnancies during the late follow-up period (group 1). Structural valve deterioration occurred in 25 (64.1%) of these patients and in 70 (28.4%) of the 246 patients (group 2) who did not become pregnant (p < 0.01). The mean time at which structural valve deterioration occurred was 7.01 ± 1.19 years postoperatively (range, 4.74 to 8.36 years) for group 1 patients and 6.76 ± 1.34 years (range, 2.33 to 10.17 years) for group 2 patients (p > 0.05). Freedom from structural valve deterioration at 10 years was 22.9% ± 8.11% for group 1 and 29.24% ± 6.09% for group 2 (p > 0.05). We concluded that pregnancy did not influence the long-term outcome after mitral valve replacement with a bioprosthesis.

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Long-term outcome in a case of translocated mitral valve replacement for massive mitral annular calcification

Clinical Case Reports ◽

10.1002/ccr3.862 ◽

2017 ◽

Vol 5 (4) ◽

pp. 454-457

Author(s):

Go Kataoka ◽

Kiyoharu Nakano ◽

Ryota Asano ◽

Atsuhiko Sato ◽

Wataru Tatsuishi

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Annular Calcification ◽

Term Outcome ◽

Long Term Outcome ◽

Annular Calcification

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Holmium laser transurethral incision of the prostate: Can prostate size predict the long-term outcome?

Canadian Urological Association Journal ◽

10.5489/cuaj.2735 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 248 ◽

Cited By ~ 6

Author(s):

Mohamed A. Elkoushy ◽

Ahmed M. Elshal ◽

Mostafa M. Elhilali

Keyword(s):

Adverse Events ◽

Prostate Volume ◽

Term Outcome ◽

Long Term Outcome ◽

Prostate Size ◽

Group 2 ◽

Transurethral Incision ◽

Group 1

Introduction: We determine the impact of prostate size on the long-term outcome of holmium laser transurethral incision of the prostate (Ho-TUIP) for bladder outlet obstruction (BOO) secondary to benign prostate enlargement (BPE).Methods: A retrospective review of prospectively collected data was performed for patients undergoing Ho-TUIP by a single surgeon for patients presenting with lower urinary tract symptoms (LUTS) secondary to BOO. Patients were stratified into 2 groups: Group 1 included patients with prostate ≤30 cc and Group 2 included patients with prostate >30 cc. Demographic, operative and followup data were recorded and analyzed. In addition, intraoperative and long-term adverse events were included.Results: In total, 82 patients underwent surgery between March 1998 and March 2013, including 9 (11%) reoperated patients. Only prostate size independently predicted reoperation after Ho-TUIP (adjusted odds ratio [aOR], 95% confidence interval [CI] 7.12 [2.92–9.14], p = 0.01). The receiver operating characteristic (ROC) analysis showed an optimal cutoff value of prostate volume of 29 cc to characterize long-term reoperation after TUIP, with area under the curve (AUC) of 0.96, sensitivity of 89.7 and specificity of 88.9. Group 1 included 51 patients and Group 2 included 31 patients. The international prostate symptoms score (IPSS) and peak flow rate (Qmax) significantly improved in both groups at different follow-up points. At the 12-month follow-up, the percent change in IPSS and Qmax were comparable between both groups. However, after 12 months, the degree of improvement in all voiding parameters was significantly higher in Group 1 (p < 0.001 at all points of follow-up). After a median follow-up of 5.3 years (range: 1–13), both groups had comparable early and late adverse events with significantly higher reoperation rate in Group 2 (3.9% vs. 22.6%, p = 0.02). Overall retrograde ejaculation was detected in 25.6% of sexually active men and it was comparable between both groups (23.5% vs. 29%, p = 0.61). On multivariable analysis, patients with prostate volume >30 cc were associated with significantly higher reoperation for BOO (aOR 95% CI 5.72 [2.83– 8.14], p = 0.02), significantly higher IPSS (aOR 1.72), higher quality of life index (aOR 1.72) and lower Qmax (aOR 0.28).Conclusion: Ho-TUIP is a durable, safe and efficient treatment of BOO secondary to a small-sized prostate. The long-term outcome could be improved and the re-operation rate could be minimized with appropriate selection of cases, with prostate glands no bigger than 30 cc.

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Evaluation of long term outcome of congenital diaphragmatic hernia survivors: a single centre 8 years’ experience in a developing nation with limited facilities

International Surgery Journal ◽

10.18203/2349-2902.isj20201517 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1366

Author(s):

Natasha L. Vageriya ◽

Rasik Shah ◽

Shivaji B. Mane ◽

Taha Daginawala ◽

Prathamesh More

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Long Term Outcomes ◽

Term Outcome ◽

Long Term Outcome ◽

Developing Nation ◽

Group 2 ◽

Group 1

Background: The objective of the study was to find out incidence of long term complications in congenital diaphragmatic hernia (CDH) survivors in a developing nation with limited facilities.Methods: A retrospective study was done on patients who underwent CDH repair at our institution from 2012 to 2019. 71 patients were identified of these 55 patients operated in neonatal age were considered. After applying exclusion criteria 42 patients included in the study were then divided in 2 groups. Group 1 (26 patients): neonates requiring ventilation within 6 hrs of birth and group 2 (16 patients): not requiring ventilation or intubated after 6hrs of birth. Data from medical records were supplemented by a questionnaire regarding perceived physical function and medical follow up till date. Respiratory, central nervous, musculoskeletal and gastrointestinal systems were concentrated upon and questionnaire set. These were then compared with respect to their long term outcomes. Also, overall incidence of these in the two groups combined was noted compared with other studies.Results: On comparing these 2 groups incidence of long term complications was found more in group 1; however on statistical analysis difference was not significant. As also incidence of individual long term complications in all patients together were identical or lower than in other published series. Mortality in our study was 8 of 49 neonates which was 17% of all patients presenting with CDH or born at our centre.Conclusions: Despite the growing population of CDH survivors the morbidity is not very significant and most patients lead a normal average active life.

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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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