Transesophageal Echocardiographic Assessment of the Repaired Mitral Valve: A Proposed Decision Pathway

2021 ◽  
pp. 108925322110366
Author(s):  
Jose Liza Reshmi ◽  
G. Gopan ◽  
Praveen Kerala Varma ◽  
Madathil Thushara ◽  
Vanga Babu Sudheer ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Patient Outcomes ◽  
Surgical Repair ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair ◽  
Poor Patient ◽  
Intervention Measures ◽  
Barlow’S Disease ◽  
Echocardiographic Assessment

The indications for mitral valve repair extend across the entire spectrum of degenerative mitral valve disease, ranging from fibroelastic degeneration to Barlow’s disease. Collaboration between the surgeon and anesthesiologist is essential for ensuring optimal results. Echocardiographic assessment of the repair can be challenging but is essential to the success of the procedure, as even mild residual mitral regurgitation can portend poor patient outcomes. In addition to determining the severity of residual regurgitation, the anesthesiologist must elucidate the mechanism of disease in order to inform appropriate re-intervention measures. Finally, there are unique complications of mitral valve surgery for the anesthesiologist to understand and assess by echocardiography. This review describes a systematic pathway for a comprehensive intraoperative assessment of the mitral valve following surgical repair.

Effects of valve repair on long-term patient outcomes after mitral valve surgery

2011 ◽  
pp. 195-209 ◽  
Author(s):  
M.A. Daneshmand ◽  
J.G. Gaca ◽  
J.S. Rankin ◽  
C.A. Milano ◽  
D.D. Glower ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Patient Outcomes ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair

scholarly journals Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease

2021 ◽  
Author(s):  
Gloria Faerber ◽  
Sophie Tkebuchava ◽  
Mahmoud Diab ◽  
Christian Schulze ◽  
Michael Bauer ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Wide Spectrum ◽  
Mitral Valve Surgery ◽  
Valve Repair ◽  
Prolapse Repair ◽  
Repair Rate ◽  
Barlow’S Disease ◽  
Increased Risk

Abstract Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.

scholarly journals Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

2018 ◽  
Vol 26 (11) ◽  
pp. 552-561 ◽  
Author(s):  
R. Jansen ◽  
B. R. van Klarenbosch ◽  
M. J. Cramer ◽  
R. C. A. Meijer ◽  
P. H. M. Westendorp ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair

Redo mitral valve surgery following prior mitral valve repair

2018 ◽  
Author(s):  
Arman Kilic ◽  
Mark R. Helmers ◽  
Jason J. Han ◽  
Rahul Kanade ◽  
Michael A. Acker ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair

scholarly journals Microinvasive Mitral Valve Surgery: A New Frontier to Tackle Mitral Regurgitation

2021 ◽  
Author(s):  
Solomon Seifu ◽  
Eduardo de Marchena
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Repair System ◽  
Valve Repair ◽  
Mitral Repair ◽  
New Frontier ◽  
Clinical Benefits

Microinvasive, catheter-based mitral valve repair of severe mitral regurgitation utilizes less invasive approaches with less procedural morbidity and mortality. The procedural steps and clinical benefits of the transcatheter transapical mitral valve annuloplasty (AMEND mitral repair implant) and transcatheter transapical chordal repair systems (Neochord DS 1000 device and Harpoon Mitral Valve Repair System) are reviewed in this manuscript.

The age-adjusted Charlson comorbidity index in minimally invasive mitral valve surgery

2019 ◽  
Vol 56 (6) ◽  
pp. 1124-1130 ◽  
Author(s):  
Jan-Philipp Minol ◽  
Vanessa Dimitrova ◽  
Georgi Petrov ◽  
Robert Langner ◽  
Udo Boeken ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Adverse Events ◽  
Minimally Invasive ◽  
Predictive Value ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair ◽  
Comorbidity Index ◽  
Sts Score ◽  
Perioperative Course

Abstract OBJECTIVES Mitral valve repair is the preferred method used to address mitral valve regurgitation, whereas transcatheter mitral valve repair is recommended for high-risk patients. We evaluated the risk-predictive value of the age-adjusted Charlson comorbidity index (aa-CCI) in the setting of minimally invasive mitral valve surgery. METHODS The perioperative course and 1-year follow-up of 537 patients who underwent isolated or combined minimally invasive mitral valve surgery were evaluated for 1-year mortality as the primary end point and other adverse events. The predictive values of the EuroSCORE II and STS score were compared to that of the aa-CCI by a comparative analysis of receiver operating characteristic curves. Restricted cubic splines were applied to find optimal aa-CCI cut-off values for the increased likelihood of experiencing the predefined adverse end points. Consequently, the perioperative course and postoperative outcome of the aa-CCI ≥8 patients and the remainder of the sample were analysed. RESULTS The predictive value of the aa-CCI does not significantly differ from those of the EuroSCORE II or STS score. Patients with an aa-CCI ≥8 were identified as a subgroup with a significant increase of mortality and other adverse events. CONCLUSIONS The aa-CCI displays a suitable predictive ability for patients undergoing minimally invasive mitral valve surgery. In particular, multimorbid or frail patients may benefit from the extension of the objectively assessed parameters, in addition to the STS score or EuroSCORE II. Patients with an aa-CCI ≥8 have a very high surgical risk and should receive very careful attention.

scholarly journals Can We Predict Failure of Mitral Valve Repair?

2019 ◽  
Vol 8 (4) ◽  
pp. 526 ◽  
Author(s):  
Simone Gasser ◽  
Maria von Stumm ◽  
Christoph Sinning ◽  
Ulrich Schaefer ◽  
Hermann Reichenspurner ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Redo Surgery ◽  
Valve Repair

Objective: To identify echocardiographic and surgical risk factors for failure after mitral valve repair. Methods: We identified a total of 77 consecutive patients from our institutional mitral valve surgery database who required redo mitral valve surgery due to recurrence of mitral regurgitation after primary mitral valve repair. A control group of 138 patients who had a stable echocardiographic long-term result was included based on propensity score matching. Systematic analysis of echocardiographic parameters was performed before primary surgery; after mitral valve repair and prior to redo surgery. Risk factor analysis was performed using multivariate Cox regression model. Results: Redo surgery was associated with the presence of pulmonary hypertension ≥ 50 mmHg (p = 0.02), a mean transmitral gradient > 5 mmHg (p = 0.001), left ventricular ejection fraction ≤ 45% (p = 0.05) before surgery and mitral regurgitation ≥moderate at time of discharge (p = 0.002) in the whole cohort. Patients with functional mitral valve regurgitation had a higher tendency to undergo redo surgery if preoperative left ventricular end-diastolic diameter exceeded 65 mm (p = 0.043) and if postoperative tenting height exceeded 6 mm (p = 0.018). Low ejection fraction was not significantly associated with the need for redo mitral valve surgery in the functional subgroup. Conclusions: Recurrent mitral regurgitation is still a valuable problem and is associated with relevant perioperative mortality. Patients with severe mitral regurgitation should undergo early mitral valve repair surgery as long as systolic pulmonary artery pressure is low, left ventricular ejection fraction is preserved, and LVEED is deceeds 65 mm.

Minimally Invasive versus Conventional Open Mitral Valve Surgery a Meta-Analysis and Systematic Review

2011 ◽  
Vol 6 (2) ◽  
pp. 84-103 ◽  
Author(s):  
Davy C. H. Cheng ◽  
Janet Martin ◽  
Avtar Lal ◽  
Anno Diegeler ◽  
Thierry A. Folliguet ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Dissection ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Normal Activity ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair ◽  
Phrenic Nerve Palsy ◽  
Randomized Controlled

Objective This meta-analysis sought to determine whether minimally invasive mitral valve surgery (mini-MVS) improves clinical outcomes and resource utilization compared with conventional open mitral valve surgery (conv-MVS) in patients undergoing mitral valve repair or replacement. Methods A comprehensive search of MEDLINE, Cochrane Library, EMBASE, CTSnet, and databases of abstracts was undertaken to identify all randomized and nonrandomized studies up to March 2010 of mini-MVS through thoracotomy versus conv-MVS through median sternotomy for mitral valve repair or replacement. Outcomes of interest included death, stroke, myocardial infarction, aortic dissection, need for reintervention, and any other reported clinically relevant outcomes or indicator of resource utilization. Relative risk and weighted mean differences and their 95% confidence intervals were analyzed as appropriate using the random effects model. Heterogeneity was measured using the I2 statistic. Results Thirty-five studies met the inclusion criteria (two randomized controlled trials and 33 nonrandomized studies). The mortality rate after mini-MVS versus conv-MVS was similar at 30 days (1.2% vs 1.5%), 1 year (0.9% vs 1.3%), 3 years (0.5% vs 0.5%), and 9 years (0% vs 3.7%). A number of clinical outcomes were significantly improved with mini-MVS versus conv-MVS including atrial fibrillation (18% vs 22%), chest tube drainage (578 vs 871 mL), transfusions, sternal infection (0.04% vs 0.27%), time to return to normal activity, and patient scar satisfaction. However, the 30-day risk of stroke (2.1% vs 1.2%), aortic dissection/injury (0.2% vs 0%), groin infection (2% vs 0%), and phrenic nerve palsy (3% vs 0%) were significantly increased for mini-MVS versus conv-MVS. Other clinical outcomes were similar between groups. Cross-clamp time, cardiopulmonary bypass time, and procedure time were significantly increased with mini-MVS; however, ventilation time and length of stay in intensive care unit and hospital were reduced. Conclusions Current evidence suggests that mini-MVS maybe associated with decreased bleeding, blood product transfusion, atrial fibrillation, sternal wound infection, scar dissatisfaction, ventilation time, intensive care unit stay, hospital length of stay, and reduced time to return to normal activity, without detected adverse impact on long-term need for valvular reintervention and survival beyond 1 year. However, these potential benefits for mini-MVS may come with an increased risk of stroke, aortic dissection or aortic injury, phrenic nerve palsy, groin infections/complications, and increased cross-clamp, cardiopulmonary bypass, and procedure time. Available evidence is largely limited to retrospective comparisons of small cohorts comparing mini-MVS versus conv-MVS that provide only short-term outcomes. Given these limitations, randomized controlled trials with adequate power and duration of follow-up to measure clinically relevant outcomes are recommended to determine the balance of benefits and risks.

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