scholarly journals The effect of mitral valve replacement on atrial fibrillation behaviour

2019 ◽  
Vol 6 (4) ◽  
pp. 1159
Author(s):  
Megavath Motilal ◽  
Vijaya Rama Raju Nadakuditi ◽  
Alla Gopala Krishna Gokhale ◽  
Sudhakar Koneru ◽  
Manoj Kumar Moharana ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Surgery ◽  
Ventricular Rate ◽  
History Of ◽  
Atrial Rhythm

Background: Atrial fibrillation (AF) persisting after mitral valve surgery reduces survival due to heart failure and thrombo-embolisms and impairs quality of life. Restoration of the sinus rhythm might lead to a lower incidence of thrombo-embolism and valve-related complications in the postoperative period.Methods: This non-randomized prospective study was carried out between period April 2015 to December 2018 in the Department of Cardiothoracic and Vascular Surgery, Government General hospital, Guntur, Andhra Pradesh, India. A total of 80 patients underwent mitral valve replacement during the study period. 50 patients out of these were with atrial fibrillation and were part of this study, who underwent mitral valve replacement.Results: All fifty patients were in atrial fibrillation based on clinical examination and the echocardiogram. 13 patients preoperatively were in atrial fibrillation with fast ventricular rate. These patients were placed on antiarrhythmic drugs to control the ventricular rate prior to mitral valve replacement. After surgery twenty out of fifty (40%) patients reverted to NSR and maintained the same rhythm till the 6 months of follow-up. Twenty-nine (58%) patients continued in atrial fibrillation after surgery.Conclusions: The results of the present study showed that preoperative atrial rhythm strongly determines postoperative rhythm. In view of the promising results of combined mitral valve and anti-atrial fibrillation surgery, the inescapable conclusion is that the anti-arrhythmic procedure should be offered routinely to all patients with a history of preoperative AF.

Incidence and predictors of mismatch after mechanical mitral valve replacement

2019 ◽  
Vol 27 (7) ◽  
pp. 535-541
Author(s):  
Ashraf AH El Midany ◽  
Ezzeldin A Mostafa ◽  
Tamer Hikal ◽  
Mostafa G Elbarbary ◽  
Ayman Doghish ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Patient Prosthesis Mismatch

Background Patient-prosthesis mismatch after mitral valve replacement has an unfavorable postoperative hemodynamic outcome, which underlines the importance of identifying and preventing prosthesis- and patient-related risk factors. This study was conducted to determine the incidence and identify possible predictors of patient-prosthesis mismatch. Methods A prospective study was conducted on 715 patients with a mean age of 42 ± 11 years who underwent mechanical mitral valve replacement between 2013 and 2017. The effective orifice area of the prostheses was estimated by the continuity equation, and a mismatch was defined as an effective orifice area index ≤1.2 cm2·m−2. The mean clinical and echocardiographic follow-up was 26.74 ± 11.58 months. Multivariate regression analysis was performed to identify predictors of patient-prosthesis mismatch. Results Patient-prosthesis mismatch was detected in 382 (53.4%) patients. A small mechanical prosthesis (<27 mm) was inserted in 54.3%. Mortality during follow-up was 9% (65 patients). Patient-prosthesis mismatch was identified in patients with preoperative rheumatic mitral valve pathology, associated tricuspid regurgitation, higher New York Heart Association class, preoperative atrial fibrillation, mitral stenosis, and small preoperative left ventricular dimensions. Multivariate analysis identified mitral stenosis, preoperative atrial fibrillation, and small postoperative left ventricular end-diastolic dimension as risk factors for patient-prosthesis mismatch. Conclusion Patient-prosthesis mismatch is a common sequela after mechanical mitral valve replacement. Identification of predictors of patient-prosthesis mismatch can help so that a preoperative strategy can be implemented to avoid its occurrence.

207 Intraoperative ablation in patients with atrial fibrillation subjected to mitral valve replacement. Two years follow-up

EP Europace ◽  
2005 ◽  
Vol 7 (Supplement_1) ◽  
pp. 40-40
Author(s):  
K. Bartczak ◽  
R. Jaszewski ◽  
J. Zaslonka ◽  
M. Banach ◽  
A. Kosmider
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement

scholarly journals Positive Outcomes of Comprehensive Exercise Program on Restoration of Functional Level and Quality of Life in a Patient with Rheumatic Heart Disease Undergone Mitral Valve Replacement: A Case Report

2021 ◽  
pp. 379-384
Author(s):  
Leksha Atul Patel ◽  
Vaishnavi Dilip Yadav ◽  
Moli Jai Jain ◽  
Om C. Wadhokar
Keyword(s):  
Quality Of Life ◽  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Exercise Program ◽  
Rheumatic Heart

Heart disease due to valvular anomaly has increased prevalence along with increasing age. Rheumatic heart disease is a condition in which the heart valves have been permanently damaged post rheumatic fever. The operative management including reparation or substitution with prosthetic valve is the main therapy. Still becoming question mark either rehabilitation program is beneficence for the patient undergoing valvular surgery. We report a patient with severe mitral valve regurgitation, moderate mitral stenosis, moderate tricuspid regurgitation, and severe pulmonary artery hypertension secondary to Rheumatic Heart Disease. He underwent Mitral valve replacement surgery and advised post-operative physiotherapy which comprises 2 weeks of phase I cardiac rehabilitation, a home exercise program after discharge, and follow-up after 2 weeks. During follow up patient has a high level of independence, improvement in quality of life, and early return to work.

scholarly journals Mitral valve surgery after a failed MitraClip procedure

2020 ◽  
Author(s):  
Francesco Melillo ◽  
Luca Baldetti ◽  
Alessandro Beneduce ◽  
Eustachio Agricola ◽  
Alberto Margonato ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Surgical Intervention ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Repair

Abstract OBJECTIVES Among patients undergoing transcatheter mitral valve repair with the MitraClip device, a relevant proportion (2–6%) requires open mitral valve surgery within 1 year after unsuccessful clip implantation. The goal of this review is to pool data from different reports to provide a comprehensive overview of mitral valve surgery outcomes after the MitraClip procedure and estimate in-hospital and follow-up mortality. METHODS All published clinical studies reporting on surgical intervention for a failed MitraClip procedure were evaluated for inclusion in this meta-analysis. The primary study outcome was in-hospital mortality. Secondary outcomes were in-hospital adverse events and follow-up mortality. Pooled estimate rates and 95% confidence intervals (CIs) of study outcomes were calculated using a DerSimionian–Laird binary random-effects model. To assess heterogeneity across studies, we used the Cochrane Q statistic to compute I2 values. RESULTS Overall, 20 reports were included, comprising 172 patients. Mean age was 70.5 years (95% CI 67.2–73.7 years). The underlying mitral valve disease was functional mitral regurgitation in 50% and degenerative mitral regurgitation in 49% of cases. The indication for surgery was persistent or recurrent mitral regurgitation (grade &gt;2) in 93% of patients, whereas 6% of patients presented with mitral stenosis. At the time of the operation, 80% of patients presented in New York Heart Association functional class III–IV. Despite favourable intraoperative results, in-hospital mortality was 15%. The rate of periprocedural cerebrovascular accidents was 6%. At a mean follow-up of 12 months, all-cause death was 26.5%. Mitral valve replacement was most commonly required because the possibility of valve repair was jeopardized, likely due to severe valve injury after clip implantation. CONCLUSIONS Surgical intervention after failed transcatheter mitral valve intervention is burdened by high in-hospital and 1-year mortality, which reflects reflecting the high-risk baseline profile of the patients. Mitral valve replacement is usually required due to leaflet injury.

scholarly journals Comparison of the Surgical Effect and the Long-term Clinical Outcomes Between Robotic and Sternotomy Mitral Valve Replacement

2020 ◽  
Author(s):  
Haizhi Zhao ◽  
Changqing Gao ◽  
Ming Yang ◽  
Yao Wang ◽  
Wenbin Kang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Perioperative Complications ◽  
Mitral Valve Surgery ◽  
Blood Product Transfusion ◽  
Volume Blood

Abstract BackgroundRobot-assisted mitral valve surgery has been increasingly used by surgeons to achieve better results. This study was to assess the safety and effectiveness of totally endoscopic robotic mitral valve replacement (TE-MVR) and to provide evidence that it is a reasonable surgical choice by analyzing the clinical experience, surgical efficacy, and follow-up outcomes of this procedure.MethodBetween October 2008 and October 2015, 47 patients underwent da Vinci TE-MVR. From March 2002 to June 2014, 293 patients underwent conventional sternotomy mitral valve replacement (CS-MVR), of whom 47 patients were selected to match the TE-MVR group (1:1). We performed a retrospective study by collecting perioperative data and assessed TE-MVR efficacy by comparing clinical outcomes and echocardiography with CS-MVR in a 10-year follow-up period.ResultsAll cases were conducted successfully. No operative deaths were observed, and the complications were not significantly different between the groups. The cardiopulmonary bypass time (122.02±25.45 min) and aortic cross-clamping time (85.68±20.70 min) were longer in TE-MVR group (P<0.001). The perioperative complications are similar in two groups, but the drainage volume, blood product transfusion, ICU stay and postsurgical hospital stay are better in robotic group (P<0.001). During the follow-up period, 42 patients (89.4%) in TE-MVR group and 40 patients (87.0%) in CS-MVR group were followed. Long-term event-free survival is similar in both groups. ConclusionRobotic MVR is a feasible, effective and safe minimally-invasive alternative to sternotomy MVR, and the long-term clinical and echocardiographic results are comparable to sternotomy MVR in selected patients.

Long term follow-up in quality of life after mitral valve surgery

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
I Kammerer ◽  
M Höhn ◽  
AH Kiessling ◽  
S Becker ◽  
FU Sack
Keyword(s):  
Quality Of Life ◽  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Long Term Follow Up

What Factors Should Be Considered to Improve Outcome of Mechanical Mitral Valve Replacement in Children?

2021 ◽  
Vol 12 (3) ◽  
pp. 367-374
Author(s):  
Mohamed F. Elsisy ◽  
Joseph A. Dearani ◽  
Elena Ashikhmina ◽  
Prasad Krishnan ◽  
Jason H. Anderson ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Multivariable Analysis ◽  
Permanent Pacemaker ◽  
Early Mortality ◽  
Prosthetic Valve Thrombosis ◽  
Valve Size ◽  
Valve Thrombosis

Objective: To identify risk factors for pediatric mechanical mitral valve replacement (mMVR) to improve management in this challenging population. Methods: From 1993 to 2019, 93 children underwent 119 mMVR operations (median age, 8.8 years [interquartile range [IQR]: 2.1-13.3], 54.6% females) at our institution. Twenty-six (21.8%) patients underwent mMVR at ≤2 years and 93 (78.2%) patients underwent mMVR at >2 years. Median follow-up duration was 7.6 years [IQR: 3.2-12.4]. Results: Early mortality was 9.7%, but decreased with time and was 0% in the most recent era (13.9% from 1993 to 2000, 7.3% from 2001 to 2010, 0% from 2011 to 2019, P = .04). It was higher in patients ≤2 years compared to patients >2 years (26.9% vs 2.2%, P < .01). On multivariable analysis for mitral valve reoperation, valve size <23 mm was significant with a hazard ratio of 5.38 (4.87-19.47, P = .01);. Perioperative stroke occurred in 1% and permanent pacemaker was necessary in 12%. Freedom from mitral valve reoperation was higher in patients >2 years and those with a prosthesis ≥23 mm. Median time to reoperation was 7 years (IQR: 4.5-9.1) in patients >2 years and 3.5 years (IQR: 0.6-7.1) in patients ≤2 years ( P = .0511), but was similar between prosthesis sizes ( P = .6). During follow-up period (median 7.6 years [IQR: 3.2-12.4], stroke occurred in 10%, prosthetic valve thrombosis requiring reoperation in 4%, endocarditis in 3%, and bleeding in 1%. Conclusion: Early and late outcomes of mMVR in children are improved when performed at age >2 years and with prosthesis size ≥23 mm. These factors should be considered in the timing of mMVR.

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