V-17 Complete cardiac surgery for severe valvular disease (mitral stenosis, pulmoary hypertension and tricuspid regurgitation) combined with left main coronary arterial lesion and sick-sinus syndrome

Abstract Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to hemodynamic law. The range of decreased velocity before and after cardiac surgery can hypothetically reflect the effectiveness of a graft. The aim of the study is to determine if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict intraoperative myocardial infarction. Methods One hundred sixty-six (166) consecutive patients (121 men, 64±9 years old) referred for cardiac surgery, were prospectively included in the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries' proximal segments. Measurements of coronary flow velocities were performed before and after grafting in the same sites of the arteries. The maximal value of cardiac troponin I (cTnI) after CABG and the additive criteria were accounted for in the analysis as it is described in the expert consensus document for Type 5 myocardial infarction (MI) definition. Results One hundred sixty-three patients (98%) had arterial hypertension, 28 patients (17%) had diabetes mellitus, 35 patients (21%) were currently smokers. The feasibility of coronary flow assessment during cardiac operations was 95%. Before grafting, the mean velocity in the left main artery was 91±49 cm/s, in LAD 101±35 cm/s, and in LCx 117±49 cm/s. There was a significant correlation between changes in coronary flow velocities during operation and the value of cTnI (R=0.34, p<0.0001). Ten patients met the criteria for Type 5 MI. There were no differences in age, body mass index, number of coronary arteries with stenoses, frequency of prior MI, ejection fraction or coronary flow velocity before surgery in patients with and without Type 5 MI. The group of patients with Type 5 MI had an increase in native artery velocities during surgery in comparison with patients without MI, who had a significant decrease in coronary flow velocity after grafting (30±48 vs. −10±30 cm/s; p<0.0006). Increases in native coronary velocities greater than 3 cm/s predicted Type 5 MI with 81% accuracy (sensitivity 88%, specificity 70%). Conclusion Coronary flow velocity assessment during cardiac surgery could predict an elevation of cardiac troponins and Type 5 MI. Funding Acknowledgement Type of funding source: None

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Global Risk Classification and Clinical SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) Score in Patients Undergoing Percutaneous or Surgical Left Main Revascularization

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2010.10.013 ◽

2011 ◽

Vol 4 (3) ◽

pp. 287-297 ◽

Cited By ~ 93

Author(s):

Davide Capodanno ◽

Anna Caggegi ◽

Marco Miano ◽

Glauco Cincotta ◽

Fabio Dipasqua ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Surgery ◽

Coronary Intervention ◽

Risk Classification ◽

Global Risk ◽

Left Main ◽

Percutaneous Coronary

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Impact of tricuspid repair on surgical death in patients undergoing mitral valve surgery due to rheumatic disease

European Heart Journal ◽

10.1093/eurheartj/ehab724.2258 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Viana ◽

R M Vieira De Melo ◽

D N V Da Silva ◽

G P Santana ◽

M L N De Paula ◽

...

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Disease ◽

Right Heart Failure ◽

Valve Disease ◽

Surgical Mortality ◽

Tricuspid Annuloplasty ◽

The Impact ◽

Tricuspid Repair

Abstract Introduction Observational studies differ on the impact of performing tricuspid repair on surgical mortality. Some studies demonstrate increased surgical mortality related to right ventricular failure and circulatory shock, while there are other studies that evidence improvement in quality of life and signs of right heart failure in the long time. Objective To evaluate the impact on surgical mortality of concomitant tricuspid annuloplasty in patients undergoing cardiac surgery for rheumatic mitral valve disease, who have moderate to severe tricuspid regurgitation. Methods This is a prospective cohort from January 1, 2017 to December 30, 2020. All patients over 18 years of age who underwent cardiac surgery to correct rheumatic mitral valve disease with moderate to significant tricuspid regurgitation were included. The primary outcome was 30-days mortality. Results 165 patients were included, 98 (59.4%) underwent tricuspid valve annuloplasty. The mean age was 46, 5 (±12) years, the median of Euroscore II was 2,33%. The 30-days mortality was 17 (10.3%) and there was no difference between the groups submitted or not to tricuspid repair: 12 (12.2%) versus 5 (7.5%); p=0.44, respectively. In the multivariate analysis involving seven variables with a potential prediction of death in 30 days, tricuspid repair had no association with death, RR 2,4 (0,5 – 8,3); p=0.27. Conclusion In patients with rheumatic heart disease undergoing cardiac surgery for rheumatic mitral valve disease, perform tricuspid annuloplasty in individuals who had moderate to severe tricuspid insufficiency was not associated with increased surgical mortality. FUNDunding Acknowledgement Type of funding sources: None.

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Balloon dilation of rheumatic mitral stenosis with tricuspid regurgitation in patients with recent analysis of the medium-term efficacy

Heart ◽

10.1136/heartjnl-2011-300867.598 ◽

2011 ◽

Vol 97 (Suppl 3) ◽

pp. A204-A204

Author(s):

Z. Chen ◽

L. Hong ◽

H. Wang ◽

L. Lu ◽

Q. Yin ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Mitral Stenosis ◽

Balloon Dilation ◽

Recent Analysis ◽

Medium Term ◽

Term Efficacy ◽

Rheumatic Mitral Stenosis

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Mitral Stenosis in Association with Aortic Valvular Disease

Scandinavian Journal of Thoracic and Cardiovascular Surgery ◽

10.1080/00365580.1978.11978669 ◽

1978 ◽

Vol 12 (1) ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Bengt Åberg ◽

Axel Henze ◽

Rune Jonasson ◽

Leif Bergdahl ◽

Viking Olov Björk

Keyword(s):

Mitral Stenosis ◽

Valvular Disease

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Specific diseases: valvular heart disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0641 ◽

2018 ◽

pp. 2666-2667

Author(s):

Bernard Iung ◽

Luc A. Pierard

Keyword(s):

Cardiac Surgery ◽

Aortic Stenosis ◽

Perioperative Complications ◽

Left Ventricular ◽

Valvular Disease ◽

Left Ventricular Ejection ◽

Mechanical Prosthesis ◽

Ventricular Ejection Fraction ◽

Asymptomatic Patients ◽

Mitral Commissurotomy

The evaluation of the risk of non-cardiac surgery in patients with valvular disease should take into account the type, severity, and tolerance of valvular disease, and the risk inherent to non-cardiac surgery. Aortic stenosis carries the highest risk of perioperative complications. Except for emergency non-cardiac surgery, an intervention on the aortic valve is indicated firstly in case of severe symptomatic aortic stenosis. In asymptomatic patients, low- and intermediate-risk non-cardiac surgery can be performed, while the strategy should be individualized for high-risk non-cardiac surgery. Balloon aortic valvuloplasty may be used as a bridge if non-cardiac surgery is urgent. Percutaneous mitral commissurotomy should be considered in symptomatic patients with severe mitral stenosis. In patients with severe aortic or mitral regurgitation, the risk of non-cardiac surgery is low if they are asymptomatic with preserved left ventricular ejection fraction. In patients with a mechanical prosthesis, perioperative anticoagulant therapy should be adapted to the haemorrhagic risk of intervention and to the patient- and prosthesis-related thromboembolic risk.

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Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

International Journal of Angiology ◽

10.1055/s-0039-1693457 ◽

2019 ◽

Vol 28 (04) ◽

pp. 237-244

Author(s):

Teuku Muhammad Haykal Putra ◽

Renan Sukmawan ◽

Elen Elen ◽

Celly A. Atmadikoesoemah ◽

Dwita Rian Desandri ◽

...

Keyword(s):

Cardiac Surgery ◽

Late Gadolinium Enhancement ◽

Mitral Valve ◽

Myocardial Fibrosis ◽

Mitral Stenosis ◽

Postoperative Morbidity ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Gadolinium Enhancement ◽

Rheumatic Mitral Stenosis

Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

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