scholarly journals Išeminės kilmės mitralinio vožtuvo nesandarumo korekcija: ankstyvieji ir vėlyvieji rezultatai

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Eglė Gatelienė ◽  
Giedrius Uždavinys ◽  
Loreta Ivaškevičienė ◽  
Irena Butkuvienė ◽  
Giedrė Šemetienė ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Reoperation Rate ◽  
Functional Class ◽  
Mitral Insufficiency ◽  
Valve Repair ◽  
Nyha Functional Class ◽  
Vilnius University ◽  
One Year

Eglė Gatelienė1, Giedrius Uždavinys2, Loreta Ivaškevičienė2, Irena Butkuvienė2, Giedrė Šemetienė1, Giedrė Nogienė21 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g, 2, LT-08661 Vilnius2 Vilniaus universiteto Širdies chirurgijos centrasEl paštas: [email protected]; [email protected] Įvadas / tikslas Darbo tikslas – įvertinti ligonių išgyvenimą, funkcinės būklės pokyčius po išeminio mitralinio vožtuvo nesandarumo chirurginės korekcijos. Nustatyti atsinaujinusio reikšmingo mitralinio vožtuvo nesandarumo dažnį, kartotinių operacijų skaičių. Ligoniai ir metodai Išanalizuoti 70 ligonių, sirgusių koronarine širdies liga esant reikšmingam išeminės kilmės mitralinio vožtuvo nesandarumui, duomenys. Vilniaus širdies chirurgijos centre 2000–2006 metais atliktos kombinuotos aortokoronarinių jungčių suformavimo ir mitralinio vožtuvo plastinių procedūrų operacijos. Vertinti bendrieji klinikiniai duomenys, Niujorko širdies asociacijos funkcinė klasė, kairiojo skilvelio išmetimo frakcija, mitralinio nesandarumo chirurginės korekcijos metodai, echokardiografinio tyrimo duomenys prieš ir po operacijos. Rezultatai Išgyvenimas po vienų, dvejų ir šešerių metų – atitinkamai 65%, 61% ir 50%. Didelis operacinis ir pooperacinis mirštamumas – 21,4% aiškinamas labai sunkia ligonių priešoperacine būkle. Šešerių metų laikotarpiu mirštamumas nedidelis – 7,2%. Neatsižvelgiant į taikytą chirurginio mitralinio vožtuvo plastikos metodą, reikšmingas mitralinio vožtuvo nesandarumo pokytis: nuo 2,83 ± 0,38 iki 0,87 ± 0,34 (p < 0,001) ankstyvuoju laikotarpiu, nuo 2,83 ± 0,38 iki 1,03 ± 0,59 (p < 0,001) vėlyvuoju periodu. Reikšmingai mažėjo Niujorko širdies asociacijos funkcinė klasė – nuo 3,73 ± 0,51 iki 2,27 ± 1,12 (p < 0,001). Kairiojo skilvelio išstūmimo frakcija didėjo nuo 29,28 ± 9,27% iki 32,03 ± 11,36%, (p < 0,01). Ankstyvuoju periodu atsinaujinęs reikšmingas mitralinio vožtuvo nesandarumas nustatytas 12,7%. Atliktos trys (5,5%) pakartotinės operacijos. Ateityje būtina įvertinti tuos rizikos veiksnius, kurie lėmė atsinaujinusį išeminį mitralinį nesandarumą, ir išsiaiškinti, ar mitralinio vožtuvo plastikos tipas lemia vožtuvo nesandarumo atsinaujinimo dažnį. Išvados Išeminio mitralinio vožtuvo plastinės procedūros (valvuloplastikos ar / ir anuloplastikos, neimplantuojant sintetinio žiedo) – veiksmingas chirurginio gydymo metodas. Tiek vožtuvo nesandarumas (p < 0,001), tiek funkcinė klasė (p < 0,001), tiek kairiojo skilvelio išstūmimo frakcija (p < 0,01) pakito statistiškai patikimai. Nors operacinis (8,6%) ir ankstyvasis pooperacinis mirštamumas (12,8%) didelis, tačiau vėlyvieji šių procedūrų rezultatai geri. Atsinaujinęs mitralinio vožtuvo nesandarumas (12,7%), pakartotinių operacijų skaičius (5,4%) – priimtini. Išgyvenimas po vienų, dvejų, šešerių metų – 65%, 61%, 50%. Pagrindiniai žodžiai: koronarinė širdies liga, išeminis mitralinis nesandarumas, mitralinio vožtuvo plastika, mitralinio vožtuvo žiedo plastika Mitral valve repair for ischemic mitral insufficiency: early and late results Eglė Gatelienė1, Giedrius Uždavinys2, Loreta Ivaškevičienė2, Irena Butkuvienė2, Giedrė Šemetienė1, Giedrė Nogienė21 Cardiac Surgery Centre of Vilnius University Hospital „Santariškių klinikos“,Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Cardiac Surgery Centre of Vilnius UniversityE-mail: [email protected]; [email protected] Objective The aim of the study was to evaluate the patients’ (pts) survival and functional status changes after ischemic mitral insufficiency (IMI) repair; to determine residual mitral regurgitation (MR) and reoperation rate. Patients and methods The study group consisted of 70 pts who underwent mitral valve (MV) repair for IMI with concomitant coronary artery bypass grafting (CABG) at Vilnius University Cardiac Surgery Centre between 2000 and 2006. We analysed general clinical data, NYHA functional class, LVEF, mitral valve repair procedures, data of echocardiography before and after the operation. Results The one-year survival was 65%, two-year survival 61%, and 6-year survival 50%. In-hospital mortality was high (21.4%) due to the poor preoperative status. Late mortality was rather low – 7.2 % in 6 years. Regardless of the mitral valve repair technique, a significant reduction of MR: early – from 2.83 ± 0.38 to 0.87 ± 0.34 (p < 0,001) and late – from 2.83 ± 0.38 to 1.03 ± 0.59 (p < 0.001) – was observed. The NYHA functional class changed from 3.73 ± 0.51 to 2.27 ± 1.12 (p < 0.001), the LVEF – from 29.28 ± 9.27% to 32.03 ± 11.36% (p < 0.01). In our series we had 12.7% (7 pts) of residual MR after repair and 5.5% (3 pts) of reoperations. Conclusions Ring-free mitral valve repair is an effective method of treatment for ischemic mitral insufficiency: the patients’ postoperative status improved significantly in terms of MR, NYHA functional class, LVEF. One-year survival was 65%, two-year survival 61%, and 6-year survival 50%. Residual MR after repair (12.7%) and reoperation rate (5.5%) were acceptable. Key words: ischemic heart disease, ischemic mitral insufficiency, mitral valve repair

scholarly journals Percutaneous edge-to-edge mitral repair in the presence of mitral annulus calcification

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Fernandez Peregrina ◽  
I P Pascual ◽  
X F Freixa ◽  
G T C Tirado-Conte ◽  
R R E Rodriguez-Estevez ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Cardiovascular Mortality ◽  
Mitral Annulus ◽  
Functional Class ◽  
High Morbidity ◽  
Valve Repair ◽  
One Year ◽  
Mitraclip System

Abstract Background Mitral annular calcification (MAC) is commonly found in patients affected with mitral regurgitation (MR) and it's associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge mitral valve repair with the MitraClip system has been stablished as a valid alternative to surgery in high risk patients with severe MR. However, its efficacy in patients affected with MAC remains uncertain as this population has been excluded from trials. Objectives To analyze the safety, efficacy and mid-term durability of the treatment of MR with the MitraClip system in patients affected with moderate or severe MAC. Methods Data was obtained from a multicenter spanish registry that prospectively included consecutive patients with MR grade ≥3 undergoing transcatheter mitral valve repair with the MitraClip system. Sixty-one patients with moderate or severe MAC were included in the “MAC” group and 791 with no-or-mild MAC were allocated in the “NoMAC” group. Results Procedural success was similar in both groups (91.8% vs 95.06%, p=0.268, in MAC and NoMAC respectively) with a very low rate of complications beside a higher residual mean gradient in the MAC group (3.0 vs 3.6mmHg, p=0.001). At one-year follow-up, 79.5% of NoMAC and 90.6% of MAC patients had MR grade ≤2 (p=0.129). Only 9 patients (1,14%), all in NoMAC group, required reintervention during follow up. Eighty percent of patients in both groups remained in NYHA functional class ≤II and a significant reduction in readmissions for heart failure was also observed (65% vs 78% respectively, p=0.145). One-year mortality was slightly higher in MAC patients (19.67% vs 11.25%, p=0.050) with no difference in cardiovascular mortality (15.25% vs 9.21%, p=0.129). Conclusions Transcatheter edge-to-edge repair with the MitraClip system in selected patients with moderate or severe MAC is safe and feasible with a mid-term durability similar to those without MAC. These patients also benefit clinically from this treatment with a sustained mid-term subjective clinical improvement and no increase in cardiovascular mortality as compared to NoMAC patients. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

Percutaneous Mitral Valve Repair in Patients with Prior Cardiac Surgery

2012 ◽  
Vol 27 (3) ◽  
pp. 295-298 ◽  
Author(s):  
Salvatore Scandura ◽  
Gian Paolo Ussia ◽  
Anna Caggegi ◽  
Sarah Mangiafico ◽  
Valeria Cammalleri ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair

Percutaneous mitral valve repair with the MitraClip system in the elderly: One-year outcomes from the GRASP registry

2016 ◽  
Vol 224 ◽  
pp. 440-446 ◽  
Author(s):  
Salvatore Scandura ◽  
Piera Capranzano ◽  
Anna Caggegi ◽  
Carmelo Grasso ◽  
Giuseppe Ronsivalle ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
The Elderly ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
One Year ◽  
Mitraclip System

scholarly journals Very Long-Term Survival and Durability of Mitral Valve Repair for Mitral Valve Prolapse

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Dania Mohty ◽  
Thomas A. Orszulak ◽  
Hartzell V. Schaff ◽  
Jean-Francois Avierinos ◽  
Jamil A. Tajik ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Mitral Valve Prolapse ◽  
Reoperation Rate ◽  
Surgical Correction ◽  
Valve Repair ◽  
Term Survival ◽  
Long Term Survival ◽  
Leaflet Prolapse

Background Mitral regurgitation (MR) due to mitral valve prolapse (MVP) is often treatable by surgical repair. However, the very long-term (>10-year) durability of repair in both anterior leaflet prolapse (AL-MVP) and posterior leaflet prolapse (PL-MVP) is unknown. Methods and Results In 917 patients (aged 65±13 years, 68% male), surgical correction of severe isolated MR due to MVP (679 repairs and 238 replacements [MVRs]) was performed between 1980 and 1995. Survival after repair was better than survival after MVR for both PL-MVP (at 15 years, 41±5% versus 31±6%, respectively; P =0.0003) and AL-MVP (at 14 years, 42±8% versus 31±5%, respectively; P =0.003). In multivariate analysis adjusting for predictors of survival, repair was independently associated with lower mortality in PL-MVP (adjusted risk ratio [RR] 0.61, 95% CI 0.44 to 0.85; P =0.0034) and in AL-MVP (adjusted RR 0.67, 95% CI 0.47 to 0.96; P =0.028). The reoperation rate was not different after repair or MVR overall (at 19 years, 20±5% for repair versus 23±5% for MVR; P =0.4) or separately in PL-MVP ( P =0.3) or AL-MVP ( P =0.3). However, the reoperation rate was higher after repair of AL-MVP than after repair of PL-MVP (at 15 years, 28±7% versus 11±3%, respectively; P =0.0006). From the 1980s to the 1990s, the RR of reoperation after repair of AL-MVP versus PL-MVP did not change (RR 2.5 versus 2.7, respectively; P =0.58), but the absolute rate of reoperation decreased similarly in PL-MVP and AL-MVP (at 10 years, from 10±3% to 5±2% and from 24±6% to 10±2%, respectively; P =0.04). Conclusions In severe MR due to MVP, mitral valve repair compared with MVR provides improved very long-term survival after surgery for both AL-MVP and PL-MVP. Reoperation is similarly required after repair or replacement but is more frequent after repair of AL-MVP. Recent improvement in long-term durability of repair suggests that it should be the preferred mode of surgical correction of MVP whether it affects anterior or posterior leaflets and is an additional incentive for early surgery of severe MR due to MVP.

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