Transient systolic anterior motion with junctional rhythm after mitral valve repair in the intensive care unit

Background: Ischemic mitral regurgitation (IMR) is associated with diminished survival prospects. Ringless edge-to-edge mitral valve repair is usually performed in association with coronary artery bypass grafting (CABG). In this report, we present our early results for ringless edge-to-edge repair and concomitant CABG.Methods: Between January 2011 and June 2012, 17 patients underwent ringless edge-to-edge mitral valve repair. The cause was ischemic in all patients. A double-orifice repair was done in all patients. Complete coronary revascularization was routinely added in all cases.Results: There were no hospital and late deaths. Low cardiac output developed in 5 patients (29.41%) and was treated with inotropic agents. Two of these patients required intraaortic balloon pump support. Atrial fibrillation and ventricular arrhythmia developed in 5 (29.41%) of the patients, and all of them converted to sinus rhythm with antiarrhythmic agents. The mean (SD) stays in the intensive care unit and the hospital were 2.83 � 1.29 days and 7.74 � 2.14 days, respectively. As of the latest follow-up, all patients were in New York Heart Association class I or II. There was no recurrent mitral valve regurgitation or valve-related complications.Conclusions: Alfieri mitral valve repair is associated with lower risks of mortality, postoperative stroke, and prolonged intensive care unit and hospital stays. Alfieri mitral valve repair and concomitant CABG surgery can be performed in patients with IMR.

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Impact of frailty on periprocedural health care utilization in patients undergoing transcatheter edge-to-edge mitral valve repair

Clinical Research in Cardiology ◽

10.1007/s00392-020-01789-5 ◽

2020 ◽

Author(s):

Christos Iliadis ◽

Leandra Schwabe ◽

Dirk Müller ◽

Stephanie Stock ◽

Stephan Baldus ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Mitral Valve ◽

Health Care Utilization ◽

Mitral Valve Repair ◽

Care Utilization ◽

Valve Repair ◽

Frail Patients ◽

Intermediate Intensive Care Unit

Abstract Background Frailty is a common characteristic of patients undergoing transcatheter mitral valve repair (TMVR). It is unclear whether the physical vulnerability of frail patients translates into increased procedural health care utilization. Methods and results Frailty was assessed using the Fried criteria in 229 patients undergoing TMVR using the MitraClip system at our institution and associations with total costs and costs by cost centers within the hospital incurred during periprocedural hospitalization were examined. Frail patients (n = 107, 47%) compared to non-frail patients showed significantly higher total costs [median/interquartile range, excluding implant costs: 7,337 € (5,911–9,814) vs 6,238 € (5,584–7,499), p = 0.001], with a difference in means of 2,317 €. Frailty was the only clinical baseline characteristic with significant association with total costs. Higher total costs in frail patients were attributable primarily to longer stay on intermediate/intensive care unit (3.8 ± 5.7 days in frail vs 2.1 ± 1.7 days in non-frail, p = 0.003), but also to costs of clinical chemistry and physiotherapy. The prolonged stay on intermediate/intensive care unit in frail patients was attributable to postprocedural complications such as bleeding, kidney injury, infections and cardiovascular instability. Conclusion Frailty is associated with a mean 32% increase of hospital costs in patients undergoing TMVR, which is primarily the result of a prolonged recovery and increased vulnerability to complications. These findings are valuable for a hospital’s total cost calculation and resource allocation planning. Since frailty is regarded a potentially reversible health state, preventive interventions may help reduce costs in frail patients. Graphic abstract

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Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519841292 ◽

2019 ◽

Vol 14 (3) ◽

pp. 281-285 ◽

Cited By ~ 1

Author(s):

Burak Onan ◽

Ersin Kadirogullari ◽

Zeynep Kahraman ◽

Onur Sen

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Da Vinci Surgical System ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Valve Repair ◽

Septal Myectomy ◽

Mitral Repair

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

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