scholarly journals Valve Endocarditis, to repair or not to repair, is that really the question?

2021 ◽  
Author(s):  
Michele Di Mauro ◽  
Giorgia Bonalumi ◽  
Antonio Calafiore ◽  
Roberto Lorusso
Keyword(s):  
Mitral Valve ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Valve Repair ◽  
Total Removal ◽  
Term Survival ◽  
Mitral Repair ◽  
Short And Long Term ◽  
Wide Experience

The meta-analysis by He and collaborators [has the worth to cover, as much as possible, a gap of scientific evidence where conducting a randomized trial appears very complex for ethical and logistical reasons. The authors concluded that mitral valve repair (MVP) provide better pooled results, both early and late, with respect to mitral valve replacement (MVR). However, the superiority of MVP is driven by some single large cohort-studies where surgeons had wide experience in the field of MVP for IE. This finding is also confirmed by other studies. But if mitral repair produces such a better short- and long-term survival than replacement, why are there no clear indications from consensus and guidelines pushing surgeons toward the pursuit of a reconstructive procedure at almost any cost? We wonder but to repair or not to repair, is that really the question? The AATS consensus suggests to repair “whenever possible” but without providing more specific indications. If the two primary goals of surgery are total removal of infected tissues and reconstruction of cardiac morphology, including repair or replacement of the affected valve(s), probably MVP as to perform in case of less extensive tissue detriment by the infection. In more wide valve involvement, MVP may be the choice but only in very expert hands and in Centers with very large volume of valve repairing. This decision cannot therefore be the result of the choice of an individual but must derive from a careful multidisciplinary discussion to be held in an EndoTeam.

scholarly journals Annuloplasty ring dehiscence after mitral valve repair: incidence, localization and reoperation

2019 ◽  
Author(s):  
Thilo Noack ◽  
Philipp Kiefer ◽  
Nina Vivell ◽  
Franz Sieg ◽  
Mateo Marin-Cuartas ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mortality Rate ◽  
Survival Rates ◽  
Clinical Problem ◽  
Valve Repair ◽  
Term Survival ◽  
Annuloplasty Ring ◽  
Ring Annuloplasty ◽  
Short And Long Term

Abstract OBJECTIVES Mitral valve (MV) annuloplasty ring dehiscence with subsequent recurrent mitral regurgitation represents an unusual but challenging clinical problem. Incidence, localization and outcomes for this complication have not been well defined. METHODS From 1996 to 2016, a total of 3478 patients underwent isolated MV repair with ring annuloplasty at the Leipzig Heart Centre. Of these patients, 57 (1.6%) underwent reoperation due to annuloplasty ring dehiscence. Echocardiographic data, operative and early postoperative characteristics as well as short- and long-term survival rates after MV reoperation were analysed. RESULTS Occurrences of ring dehiscence were acute (<30 days), early (≤1 year) and late (>1 year) in 44%, 33% and 23% of patients, respectively. Localization of annuloplasty ring dehiscence was found most frequently in the P3 segment (68%), followed by the P2 (51%) and the P1 segments (47%). The 30-day mortality rate and 1- and 5-year survival rates after MV reoperation were 2%, 89% and 74%, respectively. During reoperation, MV replacement was performed in 38 (67%) and MV re-repair in 19 (33%) patients. CONCLUSIONS Annuloplasty ring dehiscence is clinically less common, localized more frequently on the posterior annulus and occurs mostly acutely or early after MV repair. MV reoperation can be performed safely in such patients.

Abstract 16046: Conventional versus Right Mini-thoracotomy versus Robotic Mitral Valve Replacement/repair; Insights From a Network Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Mitral Valve Surgery ◽  
Valve Repair ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Mini Thoracotomy

Background: Benefits and risks of minimally invasive cardiac surgery (MICS) through right mini-thoracotomy and robotic surgery for mitral valve are not fully understood. We conducted a network meta-analysis comparing the perioperative and long-term outcomes of mitral valve surgery via conventional sternotomy, MICS and robot. Methods: MEDLINE and EMBASE were searched through March 15th, 2020 to identify randomized controlled trials (RCTs) and propensity-score matched (PSM) trials that investigated perioperative and long-term outcomes after mitral surgery via conventional sternotomy, MICS and robot. Subanalyses were conducted by restricting trials, in which mitral valve repair was tried first for all patients. Results: Our systematic literature search identified 2 RCTs and 21 PSM trials. MICS was related to significant decrease in PM ([RR] [95% confidence interval [CI] =0.56 [0.40-0.78]] and SSI (RR [95%CI] =0.53 [0.33-0.85) compared to conventional sternatomy. Re-exploration for bleeding was significantly higher in robot compared to sternotomy (RR [95% CI] =1.56 [1.03-2.37]), and transfusion was higher in sternotomy compared to MICS (RR [95%CI] =1.63 [1.27-2.08]). No significant differences were observed in perioperative mortality, MI, stroke, and LCOS among there procedures. Similarly, there were no significant differences in long-term survival and mitral valve reoperation. Suanalyses by restricting trials in which mitral valve repair tried first for all patients showed MICS was related to significant increase in mitral valve reoperation compared to conventional sternotomy (hazard ratio [95%CI] =7.33 [1.54-34.97]) (Figure). Conclusion: Our network meta-analysis demonstrated similar long-term survival and mitral valve reoperation. However, MICS was related to significant increase in mitral valve reoperation after mitral valve repair compared to conventional sternotomy.

Repair Options for Mitral Regurgitation

2011 ◽  
Vol 7 (2) ◽  
pp. 131
Author(s):  
Ottavio Alfieri ◽  
Michele De Bonis ◽  
◽  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Surgical Techniques ◽  
Long Term Results ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Term Survival ◽  
Mitral Repair

Mitral valve repair is the treatment of choice for severe degenerative mitral regurgitation providing better freedom from cardiac events, quality of life and long-term survival compared with mitral valve replacement. Increasing numbers of asymptomatic patients are therefore referred for mitral repair. With refinements of the surgical techniques, long-term results have further improved in the last decade. Certainly experience is crucial in determining the likelihood of success and patients with a mitral valve deemed reparable should be referred to centers with high volume and extensive experience in this field. In this article the current role of mitral valve repair in degenerative mitral regurgitation (MR) will be outlined. Moreover some important concepts regarding indication and techniques of mitral repair in the more challenging setting of secondary (functional) mitral regurgitation will be presented and discussed.

scholarly journals Long-Term Outcomes of Right Minithoracotomy Versus Hemisternotomy for Mitral Valve Repair

2020 ◽  
Vol 15 (1) ◽  
pp. 74-80
Author(s):  
Edward Percy ◽  
Sameer A. Hirji ◽  
Farhang Yazdchi ◽  
Siobhan McGurk ◽  
Spencer Kiehm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Repair ◽  
Observation Time ◽  
Valve Repair ◽  
Term Survival ◽  
Long Term Survival ◽  
Mitral Repair ◽  
Total Observation

Objective Minimally invasive mitral valve repair has been increasingly adopted. Right minithoracotomy (RT) and lower hemisternotomy (HS) have each been associated with improved short-term outcomes; however, these approaches have not been directly compared to each other. The aim of this study was to compare long-term survival and durability of 2 minimally invasive approaches to mitral repair. Methods We retrospectively identified all isolated mitral repairs performed via RT or HS between October 1997 and June 2018; 100 RT cases and 719 HS cases were included. Outcomes of interest were postoperative complications, long-term survival, and freedom from mitral reoperation. A Cox proportional hazard model was used to compare RT and HS to a reference cohort of full-sternotomy cases. Total observation time was 9,901 patient-years and mean follow-up time was 12.2 years. Results Mean age was 58±12 years in the RT group and 56±13 years in the HS group ( P = 0.2). The RT group had longer bypass (143 minutes vs. 112 minutes; P < 0.001) and cross-clamp times (99 minutes vs. 78 minutes; P < 0.001) compared with the HS group. There were no differences in operative mortality or 30-day outcomes. Survival at 5, 10, and 15 years was 99% (96-100), 92% (85-100), and 69% (30-100) in the RT group and 98% (97-99), 92% (90-94), and 89% (86-92) for HS ( P < 0.9). There were no differences in risk-adjusted survival between RT, HS and full sternotomy. No long-term mitral reoperations occurred in the RT group and 8 (1%) occurred in the HS group ( P < 0.50). Conclusions Minimally invasive mitral valve repair can be performed safely through RT or HS with excellent survival and durability at 15 years.

scholarly journals MITRAL VALVE REPAIR FOR MITRAL REGURGITATION IN THE ELDERLY: YES, WE HAVE TO, BUT LOOK AT THE ETIOLOGIES!

2021 ◽  
Author(s):  
Antonio Calafiore ◽  
Massimo Di Marco ◽  
Stefano Guarracini ◽  
Kostas katsavrias ◽  
Michele Di Mauro
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
The Elderly ◽  
Valve Repair ◽  
Term Survival ◽  
Acceptable Solution ◽  
Mitral Repair ◽  
Technical Ability

The meta-analysis by Di Tommaso et al demonstrated as elderly patients with mitral regurgitation (MR) undergoing mitral valve repair (MVr) had lower short-term mortality and higher long-term survival with respect to patients undergoing mitral valve replacement (MVR). The benefit of repair is such, that initial surgical strategy is advisable in the elderly even in case of mild symptoms if compared with conservative management. However, even if repair can be performed in presence of some specific etiologies, as degenerative MR or secondary MR, there are always cases where a replacement can be an acceptable solution compared to a repair with uncertain future, regardless of our believes and our technical ability. In this subset of patients, the literature does not show any improvement in outcome of transcatheter mitral repair. Mitral valve repair has to be always done, but look at the etiologies and to the consequences that what is done today can cause tomorrow.

723 TWO- VS. THREE-FIELD LYMPHADENECTOMY FOR ESOPHAGEAL CANCER. A SYSTEMATIC REVIEW AND META-ANALYSIS OF SHORT- AND LONG-TERM OUTCOMES.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Letícia Nogueira Datrino ◽  
Clara Lucato Santos ◽  
Guilherme Tavares ◽  
Luca Schiliró Tristão ◽  
Maria Carolina Andrade Serafim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Meta Analysis ◽  
Operation Time ◽  
Extended Lymphadenectomy ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term

Abstract   Nowadays, there is still no consensus about the benefits of adding neck lymphadenectomy to the traditional two-fields esophagectomy. An extended lymphadenectomy could potentially increase operation time and the risks for postoperative complications. However, extended lymphadenectomy allows resection of cervical nodes at risk for metastases, potentially increasing long-term survival rates. This study aims to estimate whether cervical prophylactic lymphadenectomy for esophageal cancer influences short- and long-term outcomes through a systematic review of literature and meta-analysis. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, and Lilacs (BVS). The inclusion criteria were: (1) studies that compare two-field vs. three-field esophagectomy; (2) adults (&gt;18 years); (3) articles that analyze short- or long-term outcomes; and (4) clinical trials or cohort studies. The results were summarized by forest plots, with effect size (ES) or risk difference (RD) and 95% CI. Results Twenty-five articles were selected, comprising 8,954 patients. Three-field lymphadenectomy was associated to higher operation time (ES: -1.51; 95%CI -1.84, −1.18) and higher blood loss (ES: -0.24; 95%CI: −0.37, −0.11). Also, neck lymphadenectomy inputs additional risk for pulmonary complications (RD: 0.03; 95%CI: 0.01, 0.05). No difference was noted for morbidity (RD: 0.01; 95%CI: −0.01, 0.03); leak (−0.02; 95%CI: −0.07, 0.03); postoperative mortality (RD: 0.00; 95%CI: −0.00, 0.01), and hospital stay (ES: -0.05; 95%CI -0.20, 0.10). Three-field lymphadenectomy allowed higher number of retrieved lymph nodes (MD: -1.51; 95%CI -1.84, −1.18), but did not increase the overall survival (HR: 1.11; 95%CI: 0.96, 1.26). Conclusion Prophylactic neck lymphadenectomy for esophageal cancer should be performed with caution once it is associated with poorer short-term outcomes compared to traditional two-field lymphadenectomy and does not improve long-term survival. Future esophageal cancer studies should determine the subgroup of patients who could benefit from prophylactic neck lymphadenectomy in long-term outcomes.

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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