scholarly journals Posterior leaflet preservation during mitral valve replacement for rheumatic mitral stenosis

2006 ◽  
Vol 53 (1) ◽  
pp. 13-17 ◽  
Author(s):  
P.L. Djukic ◽  
B.B. Obrenovic-Kircanski ◽  
M.R. Vranes ◽  
M.J. Kocica ◽  
A.Dj. Mikic ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Stenosis ◽  
Posterior Leaflet ◽  
Rheumatic Mitral Stenosis ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B

Mitral valve replacement with posterior leaflet preservation was shown beneficial for postoperative left vetricular (LV) performance in patients with mitral regurgitation. Some authors find it beneficial even for the long term LV function. We investigated a long term effect of this technique in patients with rheumatic mitral stenosis. We studied 20 patents with mitral valve replacement due to rheumatic mitral stenosis, in the period from January 1988. to December 1989. In group A (10 patients) both leaflets and coresponding chordal excision was performed, while in group B (10 patients) the posterior leaflet was preserved. In all patients a Carbomedics valve was inserted. We compared clinical pre and postoperative status, as well as hemodynamic characteristics of the valve and left ventricle in both groups. Control echocardiographyc analysis included: maximal (PG) and mean (MG) gradients; effective valve area (AREA); telediastolic (TDV) and telesystolic (TSV) LV volume; stroke volume (SV); ejection fraction (EF); fractional shortening (FS) and segmental LV motion. The mean size of inserted valve was 26.6 in group A and 27.2 in group B. Hemodynamic data: PG (10.12 vs 11.1); MG (3.57 vs 3.87); AREA (2.35 vs 2.30); TDV 126.0 vs 114.5); TSV (42.2 vs 36.62); SV (83.7 vs 77.75); EF (63.66 vs 67.12); FS (32.66 vs 38.25) Diaphragmal segmental hypokinesis was evident in one patient from group A and in two patients from group B. In patients with rheumatic stenosis, posterior leaflet preservation did not have increased beneficial effect on left ventricular performance during long-term follow-up. An adequate posterior leaflet preservation does not change hemodynamic valvular characteristics even after long-term follow-up.

scholarly journals Video-assisted Minimally Invasive Mitral Valve Surgery versus Conventional Mitral Surgery in Rheumatic Patients

2020 ◽  
Author(s):  
Ayman Badawy ◽  
Mohamed Alaa Nady ◽  
Mohamed Ahmed Khalil Salama Ayyad ◽  
Ahmed Elminshawy
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Invasive Approach ◽  
Video Assisted ◽  
Group A ◽  
Group B

Background: Minimally invasive mitral valve surgery became an attractive option because of its cosmetic advantages over the conventional approach. The superiority of the minimally invasive approach regarding other aspects is still debatable. The aim of our study was to determine the potential benefits of minimally invasive mitral valve replacement with intraoperative video assistance over conventional surgery. Methods: This is a single-center prospective cohort study that included 60 patients with rheumatic heart disease who underwent mitral valve replacement. Patients were divided into two groups: group (A) included patients who had conventional sternotomy (n= 30), and group (B) included patients who had video-assisted minimally invasive mitral valve replacement (n= 30). Intraoperative and postoperative outcomes were compared between both groups. Results: Mortality occurred in one patient in the group (A). Cardiopulmonary bypass time was 118.93 ± 29.84 minutes vs. 64.73 ± 19.16 minutes in group B and A respectively (p< 0.001), and ischemic time was 102.27 ± 30.03 minutes vs. 53.67± 18.46 minutes in group B and A respectively (P < 0.001). Ventilation time was 2.77± 2.27 vs. 6.28 ± 4.48 hours in group B and A respectively (p< 0.001) and blood transfusion was 0.50 ± 0.63 vs. 2.83 ± 1.34 units in group B and A respectively (p< 0.001).  ICU stay was 1.73 ± 0.64 days in the group (B) vs. 4.47 ± 0.94 days in group A (p< 0.001). Postoperative bleeding was 353.33 ± 146.77 ml in the group (B) vs. 841.67 ± 302.03 ml in group A (p <0.001). No conversion to full sternotomy was reported in group B. In group (B), two cases (6.6%) required re-exploration for bleeding vs. four cases (13.2%) in group (A) (p=0.67). The hospital stay was 6.13 ± 1.59 days in the group (B) vs. 13.27 ± 7.62 days in group A (p< 0.001). Four cases (13.3%) developed mediastinitis in group A and in the group (B), there was one case of acute right lower limb embolic ischemia. Conclusion: Video-assisted minimally invasive mitral operations could be a safe alternative to conventional sternotomy with the potential of lesser morbidity and earlier hospital discharge.

scholarly journals Long-term follow-up of mitral valve replacement with Starr-Edwards prosthesis.

Heart ◽  
1972 ◽  
Vol 34 (2) ◽  
pp. 129-133 ◽  
Author(s):  
R S Barclay ◽  
J M Reid ◽  
J G Stevenson ◽  
T M Welsh ◽  
N McSwan
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Long Term Follow Up

scholarly journals Long-term follow-up after mitral valve replacement in childhood: poor event-free survival in the young child☆

2007 ◽  
Vol 31 (5) ◽  
pp. 860-865 ◽  
Author(s):  
Wolfram Beierlein ◽  
Vera Becker ◽  
Robert Yates ◽  
Victor Tsang ◽  
Martin Elliott ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Young Child ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Event Free Survival ◽  
Free Survival ◽  
Long Term Follow Up

scholarly journals Evaluation of Safety and Efficacy of Combined Low Dose Aspirin and Warfarin Following Mechanical Heart Valve Replacement for Mitral Valve Disease

2021 ◽  
Vol 36 (1) ◽  
pp. 24-31
Author(s):  
Md Sorower Hossain ◽  
Istiaq Ahmed ◽  
Sanjay Kumar Raha ◽  
Smriti Kana Biswas ◽  
Md Kamrul Hasan
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Low Dose ◽  
Thromboembolic Events ◽  
Safety And Efficacy ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Group A ◽  
Group B

Introduction: Warfarin is recommended following mechanical valve replacement to prevent thromboembolic complications. A combination of warfarin and aspirin may further reduce thromboembolic events in these patients. This study was designed to evaluate safety and efficacy of combined low dose aspirin and warfarin therapy following mechanical mitral valve replacement. Materials and Methods: Purposively selected 99 patients who underwent mechanical mitral valve replacement were divided into two groups. Patients of Group A (n=50) received combined low dose aspirin (75mg) and warfarin. Patients of Group B (n=49) received conventional dose of warfarin alone. International normalized ratio (INR) was targeted 1.8-2.4 for group A Patients and 2.5-3.5 for group B Patients. Post-operatively INR, thromboembolic events, anti-coagulation related haemorrhage and other morbidity and mortality were registered in both groups. Result: Patients were followed up postoperatively for 9 months. The mean dose of warfarin in group A and group B was 4.36 ± 0.31 mg and 5.57±0.52 mg respectively (p<0.001). The overall mean INR of two groups of patients were statistically different (P<0.001) with low INR in group A (2.19±0.13) patients compared to group B (3.03±0.31). The thromboembolic events in group A (0.02/patient year) were lower than those in group B (0.08/Patient year). There was no statistically significant (p=0.362) difference in bleeding episodes between two groups but data indicate proportion of minor bleeding manifestations were higher in patients treated with warfarin plus aspirin group. Conclusion: Following mechanical mitral valve replacement, a combination of aspirin (75mg) and low dose warfarin with an aim to maintain INR between 1.8 and 2.4 (lower than recommended 2.5-3.5) may provide satisfactory outcomes in term of thrombosis, embolism and bleeding without increase in mortality. Bangladesh Heart Journal 2021; 36(1): 24-31

scholarly journals Evaluation of the preoperative administration of sildenafil on operative and early postoperative outcome after mitral valve replacement in patients with pulmonary hypertension

2020 ◽  
Author(s):  
Islam M Ibrahim ◽  
Ahmed L Dokhan ◽  
Rasha S Elsebaey ◽  
Mohammed G Abdellatif
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Systolic Pulmonary Artery Pressure ◽  
Preoperative Administration ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Mitral valve diseases are commonly associated with pulmonary hypertension. The aim of this study was to evaluate the effect of preoperative administration of sildenafil on the outcome after mitral valve replacement in patients with pulmonary hypertension. Methods: This prospective randomized study was carried out on 67 patients who had a mitral valve replacement and associated high systolic pulmonary artery pressure more than 50 mmHg. Patients were randomized into three groups: group A (n= 20) received preoperative sildenafil for one week, group B (n=22) received sildenafil for one month, and group C (n= 25) did not receive sildenafil. All patients had transthoracic echocardiography preoperatively, one week and one month postoperatively. Results: There was no difference in preoperative and operative variables among groups. Dobutamine support was required in 15 patients (60%) in group C vs. 6 patients (30%) in group A and 5 patients (22.5%) in group B (p= 0.012). Duration of mechanical ventilation was significantly longer in group C (389.2 ± 48.79 minutes) compared to group A and B (295.5 ± 17.01 and 281.4 ± 39.44 minutes, respectively, p<0.001). ICU stay was longer in group C (61.72 ± 13.69 hours) compared to groups A and B (53.55 ± 14.49 and 45.64 ± 13.43 hours, respectively, p=0001). The hospital stay was longer in group C (8.0 ± 1.80 days) compared to group A and B (6.05 ± 0.94 and 6.27 ± 1.24 days, respectively; p< 0.001). The transthoracic echocardiographic study one month after the operation showed that pulmonary artery systolic pressure significantly lower in groups A and B (28.30 ± 3.3 and 28.2 ± 4.98 mmHg, respectively) compared to group C (43.12 ± 4.99 mmHg) (p <0.001). There was no statistically significant difference between groups A and B regarding PASP after five days  (p= 0.287) or one month (p= 0.939). Conclusion: We found that preoperative administration of oral sildenafil in patients with pulmonary hypertension undergoing mitral valve replacement may reduce pulmonary hypertension postoperatively. We could not find a difference in the administration of sildenafil for either one week or one month preoperatively.

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