Primary Care Follow Up Post Mitral Valve Surgery at Ambulatory Clinic

Background. Atrial fibrillation surgical radiofrequency ablation (AFSA) during mitral valve surgery (MVS) has almost completely superseded the Cox-Maze procedure for the treatment of atrial fibrillation. Methods. We retrospectively analyzed 100 patients who underwent MVS + AFSA in our institution from January 2008 to June 2017. We compared the effectiveness of AFSA in patients who underwent LAA exclusion to those who did not. Moreover, we analyzed the role of preoperative AF duration (≤ or >1 year) and medial-lateral left atrial dimensions (ML-LAD) (≤ or >6 cm). The efficacy endpoint was freedom from AF at discharge and at 2-year follow-up. The safety endpoints were need of a permanent pacemaker (PMK), surgical re-exploration, occurrence of stroke, and left circumflex artery or esophageal lesions. Results. Overall, the rate of AF freedom was 69% at discharge and 80% at 2-year follow-up. LAA exclusion did not influence AF freedom at 2-year follow-up, and 84.6% of patients who underwent LAA exclusion were in the sinus rythm (SR) at 2 year compared to 75% of those who did not receive LAA exclusion free from AF as well ( p = 0.230 ). AF duration ≤1 or >1 year did not influence sinus rhythm (SR) maintenance (85.7% vs. 75.8%; p = 0.224 ), and in these two groups, LAA exclusion did not change the efficacy of AFSA. ML-LAD ≤ 6 cm was associated with better results in terms of SR maintenance. A statistically significant association between LAA exclusion and SR maintenance at 2-year follow-up ( p = 0.017 ) was found among patients with ML-LAD ≤ 6 cm. Complications included 7 cases of PMK implantation, 2 cases of surgical re-exploration, and 1 case of stroke. No circumflex artery or esophageal lesions occurred after surgical procedures. Conclusions. In our experience, AFSA during isolated MVS resulted in good outcomes in terms of SR maintenance and incidence of complications. AF duration ≤ 1 year did not influence results, while patients with ML-LAD ≤ 6 cm had significantly better results regarding SR at follow-up. In patients with ML-LAD ≤ 6 cm, LAA exclusion significantly increased the success rate of SR maintenance at 2-year follow-up.

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The Use of Rapid Deployment Valves in Combined Aortic and Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000373 ◽

2017 ◽

Vol 12 (3) ◽

pp. 201-206 ◽

Cited By ~ 2

Author(s):

Markus Schlömicher ◽

Matthias Bechtel ◽

Zulfugar Taghiyev ◽

Yazan Al-Jabery ◽

Peter Lukas Haldenwang ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Repair ◽

The Mean ◽

Mitral Disease ◽

Rapid Deployment

Objective Patients undergoing multiple valve surgery represent a high-risk group who could potentially benefit from a reduction of cross-clamp and cardiopulmonary bypass times because prolonged bypass and cross-clamp times are considered independent risk factors for increased morbidity and mortality after cardiac surgery. Methods Between July 2013 and November 2014, 16 patients underwent rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system in the setting of concomitant mitral disease. Fifteen patients showed mitral regurgitation, whereas one patient had severe mitral stenosis. Fourteen patients received mitral valve repair and two patients received biological mitral valve replacement. Tricuspid valve repair was performed additionally in two patients. The mean ± SD age was 72.8 ± 8.4 years, and the mean ± SD logistic EuroSCORE II is 8.7% ± 3.4%. Results Within a 30-day perioperative period, no patient was lost (n = 0). The mean ± SD follow-up time was 11 ± 2 months. At 1 year, the overall survival was 81% (n = 13). A mean ± SD transaortic gradient of 10.7 ± 2.3 mm Hg and a mean ± SD effective orifice area of 1.7 ± 0.3 cm2 were measured echocardiographically. No higher-grade paravalvular leak (aortic insufficiency > 1+) occurred. Eight patients (61%) had no residual mitral regurgitation, four patients (30%) showed trivial regurgitation (1/4), and one patient (7.3%) had moderate mitral regurgitation (2/4). No interference of the subannular stent frame with the reconstructed valve or the biological mitral prosthesis was seen. Conclusions Rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system in combined aortic and mitral valve surgery can be performed safely with reproducible results. One-year follow-up data of this small series shows encouraging results potentially justifying the extension of the indication for rapid deployment valves to patients with concomitant mitral disease. Especially elderly patients undergoing multiple valve surgery may benefit from a reduction of cardiopulmonary bypass and myocardial ischemic times.

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Spirometric Changes following Open-Heart Surgery on Rheumatic Mitral Valves

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239800600106 ◽

1998 ◽

Vol 6 (1) ◽

pp. 28-33 ◽

Cited By ~ 2

Author(s):

Abha Chandra ◽

Shashi Srivastava ◽

Dronamraju Dilip

Keyword(s):

Mitral Valve ◽

Lung Function ◽

Vital Capacity ◽

Heart Surgery ◽

Open Heart Surgery ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Cardiothoracic Ratio ◽

The Mean

Evaluation of pulmonary function by spirometry in adult patients undergoing cardiac surgery is a simple test to assess pulmonary reserve that has important implications in the operative morbidity. Pulmonary function was studied preoperatively, before discharge, and at the 3-month follow-up in 22 randomly selected patients who underwent open-heart surgery for rheumatic mitral valve disease (2 reconstructions, 20 replacements). The mean preoperative cardiothoracic ratio was 0.58. Lung function was found to be impaired preoperatively in all 22 patients and the majority suffered from restrictive lung disease. Better preoperative lung function was seen in nonsmokers, patients with a cardiothoracic ratio of less than 0.50, and those with a normal pulmonary artery pressure. After mitral valve surgery, the mean pulmonary artery pressure was 20.6 ± 2.9 mm Hg, the mean mitral valve pressure gradient was 3.6 ± 2.4 mm Hg, and the mean cardiothoracic ratio was 0.52 ± 0.09. A significant deterioration was seen in the predischarge spirometric values of forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, flow rate at 25% to 75% of expired vital capacity, and maximum volume ventilation. The deterioration was greater in smokers and those who had prolonged cardiopulmonary bypass (more than 80 minutes). No correlation was found with ventilation because all patients were electively ventilated overnight. There was an overall improvement in spirometric parameters at the 3-month follow-up although the values remained lower than predicted. Spirometry was found to be useful for assessing lung function in patients undergoing mitral valve surgery and we recommended it as a routine test.

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The fate of untreated moderate rheumatic aortic valve incompetence after mitral valve surgery: A one-year follow-up study

Journal of the Egyptian Society of Cardio-Thoracic Surgery ◽

10.1016/j.jescts.2017.08.002 ◽

2017 ◽

Vol 25 (3) ◽

pp. 236-241

Author(s):

Ahmed A. Faragalla ◽

Azza Katta ◽

Hassan Ezeldien ◽

Hani A. Ibrahim

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Follow Up Study ◽

One Year

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Intermediate-Term Results of 505 Consecutive Minithoracotomy Mitral Valve Procedures

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01243895-200600130-00001 ◽

2006 ◽

Vol 1 (3) ◽

pp. 99-104 ◽

Cited By ~ 5

Author(s):

Jeffrey S. Martin ◽

R. Duane Davis ◽

Donald D. Glower

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Late Complications ◽

Mitral Valve Surgery ◽

Bacterial Endocarditis ◽

Valve Surgery ◽

Subacute Bacterial Endocarditis ◽

Term Survival ◽

Few Data

Background Patient demand for less invasive surgery and interest in avoiding sternotomy has led to the increased use of the minithoracotomy for mitral valve surgery. Although the feasibility of this approach has been established, few data are available regarding intermediate-term results. Methods A total of 505 consecutive minithoracotomy mitral valve procedures performed between 1996 and 2004 were analyzed. Procedures were mitral replacement (191/505, 38%) and repair (314/505, 62%). Concomitant cardiac procedures were performed in 78 cases (13%) (maze 36, tricuspid 29, atrial septal defect/patent foramen ovale 13) and reoperation in 92 cases (18%). Arterial cannulation was ascending aorta in 403 cases (80%), femoral in 101 cases (20%), and axillary in 1 case (< 1%). An endoluminal aortic clamp was used in 406 cases (80%), an external clamp was used in 19 cases (4%), and 80 procedures (16%) were performed with ventricular fibrillation. Robotic assistance was used in 12 cases (2%). Results Mean patient age was 58.7 years (range 18–90 years). Median follow-up was 3.1 years. Operative mortality was 4 of 505 cases (<1%). Major complications included stroke in 7 cases (1%) and reoperation for bleeding in 18 cases (4%); there were no cases of mediastinitis. Late complications included chronic aortic dissection in 1 case (<1%) and mitral reoperation in 13 cases (3%) (subacute bacterial endocarditis 6, failed repair 2, other 5). Five-year survival was (83% ± 2%) and freedom from mitral reoperation was (96% ± 1%). Follow-up echocardiograms were available in 246 of 314 cases (78%) mitral repairs and mean mitral regurgitation grade was 1 ± 1. Mitral regurgitation was grade 3–4+ in 14 of 246 cases (6%) (subacute bacterial endocarditis 4, low ejection fraction 5, other 5). Five-year freedom from 3–4+ mitral regurgitation was 89% ± 3%. Conclusions Mitral valve surgery via minithoracotomy can be performed safely with a low perioperative complication rate. A durable technical result and excellent long-term survival can be expected.

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