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Mitral valve surgery

Gaby Aphram, Laurent De Kerchove, Stefano Mastrobuoni, Emiliano Navarra, Silvia Solari, Saadallah Tamer, Jerome Baert, Alain Poncelet, Jean Rubay, Parla Astarci, Philippe Noirhomme, Gebrine El Khoury
OBJECTIVES: Mitral valve (MV) repair is the gold standard for treatment of degenerative mitral regurgitation. A variety of surgical techniques allow surgeons to achieve a high rate of MV repair even with MV diseases of other aetiologies. However, a certain number of repairs fail over time. The aim of this study was to review our single-centre experience of MV re-repair and analyse the mode of repair failure, re-repair safety and efficiency in relation to the initial aetiology. METHODS: Between 1997 and 2015, 91 patients underwent redo MV re-repair...
March 14, 2018: European Journal of Cardio-thoracic Surgery
Felix Kreidel, Hannes Alessandrini, Peter Wohlmuth, Michael Schmoeckel, Stephan Geidel
OBJECTIVE: To assess the results of catheter-based and surgical reintervention in primary mitral regurgitation (PMR) after failed MitraClip therapy. METHODS: We report on 21 consecutive symptomatic patients with PMR (median age 78 years) who underwent either repeat MitraClip therapy (n=7) or mitral valve surgery (n=14) after failure of the index procedure with 1-2 MitraClip implantations. At the time of reinterventions, 193 [IQR: 32 to 622] days after index procedure, patients had recurrent or persistent grade 3 MR...
March 12, 2018: Seminars in Thoracic and Cardiovascular Surgery
Hsiu-An Lee, Chun-Yu Lin, Yung-Chang Chen, Shao-Wei Chen, Yu-Yun Nan, Kuo-Sheng Liu, Meng-Yu Wu, Yu-Sheng Chang, Jaw-Ji Chu, Pyng-Jing Lin, Feng-Chun Tsai
The feasibility and durability of mitral valve (MV) repair in active infective endocarditis (IE) has been reported, but proper management of perioperative neurological complications and surgical timing remains uncertain and may crucially affect the outcome.In this single-center retrospective observational study, patients who underwent isolated MV surgery for active native IE in our institution between August 2005 and August 2015 were reviewed and analyzed. Patients who were operated on for healed IE or who required combined procedures were excluded from this study...
March 2018: Medicine (Baltimore)
Volha Dziadzko, Marie-Annick Clavel, Mikhail Dziadzko, Jose R Medina-Inojosa, Hector Michelena, Joseph Maalouf, Vuyisile Nkomo, Prabin Thapa, Maurice Enriquez-Sarano
BACKGROUND: Mitral regurgitation is the most common valve disease worldwide but whether the community-wide prevalence, poor patient outcomes, and low rates of surgical treatment justify costly development of new therapeutic interventions remains uncertain. Therefore, we did an observational cohort study to assess the clinical characteristics, outcomes, and degree of undertreatment of mitral regurgitation in a community setting. METHODS: We used data from Mayo Clinic electronic health records and the Rochester Epidemiology Project to identify all cases of moderate or severe isolated single-valvular mitral regurgitation (with no other severe left-sided valvular disease or previous mitral surgery) diagnosed during a 10-year period in the community setting in Olmsted County (MN, USA)...
March 10, 2018: Lancet
Shinya Higuchi, Iwao Matsunaga, Kiyokazu Koga, Eiichi Teshima, Atsuhiro Nakashima, Ryuji Tominaga, Tsuyoshi Ito
In almost every type of artificial valve, structural failure has been described. We are reporting on a case of a sudden leaflet escape of an Edwards TEKNA mitral valve prosthesis 12 years after implantation. The patient had a sudden onset of dyspnea and severe pulmonary edema with subsequent cardiogenic shock. An emergency mitral replacement was successfully performed. A multi-detector computed tomography scanning and three-dimensional imaging showed two fragments that had embolized in the terminal aorta and the left common iliac artery...
March 13, 2018: General Thoracic and Cardiovascular Surgery
Sigita Glaveckaite, Egle Uzdavinyte-Gateliene, Zaneta Petrulioniene, Darius Palionis, Nomeda Valeviciene, Gintaras Kalinauskas, Pranas Serpytis, Aleksandras Laucevicius
OBJECTIVES: We aimed to evaluate (i) the effectiveness of combined surgery (coronary artery bypass grafting with restrictive mitral valve annuloplasty) and (ii) the late gadolinium enhancement cardiovascular magnetic resonance-based predictors of ischaemic mitral regurgitation (IMR) recurrence. METHODS: The prospective analysis included 40 patients with multivessel coronary artery disease, IMR >II° and left ventricular (LV) dysfunction undergoing combined surgery...
March 9, 2018: Interactive Cardiovascular and Thoracic Surgery
Jonathan Rilinger, Claudia Heilmann, Ulrich Beitinger, Christoph B Olivier, Philipp Diehl, Friedhelm Beyersdorf, Matthias Siepe
BACKGROUND: Ischemic mitral regurgitation (IMR) is a frequent complication of coronary artery heart disease and is associated with increased mortality. Controversies exists whether patients with moderate IMR may benefit from a combined procedure with coronary artery bypass grafting (CABG) and treatment of mitral regurgitation. METHODS: 451 patients with moderate IMR (grade 2) receiving either CABG alone (CABG only) or additional mitral valve repair or replacement (CABG+MV) were included in this observational single-centre study...
March 12, 2018: Journal of Cardiovascular Surgery
Juan Manuel Monteagudo Ruiz, Maurizio Galderisi, Agostino Buonauro, Luigi Badano, Patrizia Aruta, Martin J Swaans, Laura Sanchis, Antti Saraste, Mark Monaghan, Konstantinos C Theodoropoulos, Michael Papitsas, Noah Liel-Cohen, Sergio Kobal, Mojca Bervar, Boštjan Berlot, Gerasimos Filippatos, Ignatios Ikonomidis, Spyridon Katsanos, Felix C Tanner, Daniela Cassani, Francesco F Faletra, Laura A Leo, Amparo Martinez, Javier Matabuena, Antonio Grande-Trillo, David Alonso-Rodriguez, Dolores Mesa, Teresa Gonzalez-Alujas, Marta Sitges, Fernando Carrasco-Chinchilla, Chi Hion Li, Covadonga Fernandez-Golfin, José Luis Zamorano
Aims: To determine the prevalence of mitral regurgitation (MR) in a large cohort of consecutive patients undergoing clinically indicated echocardiography and to examine the distribution of primary and secondary MR. Methods and results: All patients undergoing an echocardiographic study in 19 European centres within a 3-month period were prospectively included. MR assessment was performed as recommended by the European Association of Cardiovascular Imaging (EACVI)...
February 23, 2018: European Heart Journal Cardiovascular Imaging
Gerald Paul Fitzgerald, John Joseph Coughlan, Zahir Satti, Samer Arnous
A 23-year-old Asian student presented to our service with a 1-month history of fever, weight loss of 10 kg, night sweats, fatigue and general malaise. He was previously well with no significant medical or family history. He had a low-grade pyrexia and cardiac auscultation revealed a diastolic murmur consistent with 'tumour plop'. He had no sequelae of endocarditis. He had low-grade pyrexia of 37.7°C, and ECG showed sinus tachycardia at 130 bpm. He had raised inflammatory markers and was started on broad spectrum antibiotics...
March 9, 2018: BMJ Case Reports
Paul S Pagel, Lonnie Dye, Brent T Boettcher, Julie K Freed
OBJECTIVE: Blood flow across the mitral valve during early left ventricular (LV) filling produces a 3-dimensional rotational fluid body, known as a vortex ring, that enhances LV filling efficiency. Diastolic dysfunction is common in elderly patients, but the influence of advanced age on vortex formation is unknown. The authors tested the hypothesis that advanced age is associated with a reduction in LV filling efficiency quantified using vortex formation time (VFT) in octogenarians undergoing coronary artery bypass graft (CABG) surgery...
March 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Yuka Matsunaga, Masataka Ishimura, Hazumu Nagata, Kiyoshi Uike, Tadamune Kinjo, Masayuki Ochiai, Kenichiro Yamamura, Hidetoshi Takada, Yoshihisa Tanoue, Masaki Hayakawa, Masanori Matsumoto, Toshiro Hara, Shouichi Ohga
BACKGROUND: Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by systemic or intrarenal platelet aggregation, thrombocytopenia, and red cell fragmentation. Post-operative TMA mostly occurs in adult patients with cardiovascular surgery, with the distinct pathophysiology from classical thrombotic thrombocytopenic purpura (TTP) although the exact pathophysiology remains unclear. CASE PRESENTATION: A one-month-old infant developed TMA after the initial surgery of double outlet right ventricle...
February 7, 2018: Pediatrics and Neonatology
Min-Kyung Kang, Boyoung Joung, Chi Young Shim, In Jeong Cho, Woo-In Yang, Jeonggeun Moon, Yangsoo Jang, Namsik Chung, Byung-Chul Chang, Jong-Won Ha
BACKGROUND: Atrial fibrillation (AF) can occur even after the correction of mitral valve (MV) pathology in patients who have pre-operative sinus rhythm and undergo MV surgery. However, the factors associated with the occurrence of AF after MV surgery are still unclear. The aim of this retrospective study was to investigate the factors determining the occurrence of permanent AF after MV surgery in patients with preoperative sinus rhythm who underwent MV surgery. METHODS: Four hundred and forty-two patients (mean age 46 ± 12, 190 men) who underwent MV surgery and sinus rhythm were investigated retrospectively...
March 9, 2018: Cardiovascular Ultrasound
Ginnie Abarbanell, William L Border, Brian Schlosser, Gemma Morrow, Michael Kelleman, Ritu Sachdeva
OBJECTIVE: It is unclear whether neonates with interrupted aortic arch (IAA) and a smaller left ventricular outflow tract may have improved outcomes with a Yasui operation (ventricular outflow bypass procedure) over a primary complete repair. This study sought to identify preoperative echocardiographic parameters to differentiate which neonates may have improved outcomes with a primary vs Yasui operation. DESIGN: Patient demographics, cardiac surgery type, complications, need for reoperation and/or interventional catheterization, and date of last follow-up were collected on neonates who underwent a biventricular repair for IAA from 2003 to 2014...
March 9, 2018: Congenital Heart Disease
P A MacIntyre, M Scott, R Seigne, A Clark, F Deveer, I Minchin
This prospective multicentre observational study investigated the risk of non-cardiac surgery in patients with moderate or severe aortic stenosis (AS). Patients with AS undergoing non-cardiac surgery in five New Zealand hospitals between August 2011 and September 2015 were studied. Preoperative variables were analysed for a significant association with postoperative major adverse cardiac events (MACE) and 30-day mortality. Of the 147 patients recruited, 13 (9%) died within 30 days and 33 (22%) had a MACE. Using univariate analysis, patients with severe AS had four times higher 30-day mortality than patients with moderate AS (16% versus 4%, <i>P</i>=0...
March 2018: Anaesthesia and Intensive Care
Baotong Li, Hengchao Wu, Hansong Sun, Jianping Xu, Yunhu Song, Wei Wang, Shuiyun Wang
BACKGROUND: Although it has been realized that restrictive mitral valve annuloplasty (MVA) may result in clinically significant functional mitral stenosis (MS), it still cannot be predicted. The purpose of this study was to identify risk factors for clinically significant functional MS following restrictive MVA surgery for chronic ischemic mitral regurgitation (CIMR). METHODS: 114 patients who underwent restrictive MVA with coronary artery bypass grafting (CABG) for treatment of CIMR were retrospectively reviewed...
March 7, 2018: Cardiology Journal
Gian Manuel Jiménez-Rodríguez, Sergio Criales-Vera, Mario Adrian Juárez-Peñaloza, Luis Alonso González-Tapia, Mariana Chaire-Hernández
We present the case of a 72-year-old woman diagnosed with rheumatic fever at the age of 6. In 1972, she was diagnosed with mitral valve insufficiency and mitral valve stenosis, then in 1974, a decision was made to perform mitral valve replacement surgery with a 32-mm Braunwald-Cutter ball cage prosthesis. An echocardiogram performed in 2014 revealed normal biventricular systolic function, mechanical prosthesis in mitral position with maximum speed of 1.9 m/s, maximum gradient of 15 mmHg, mean gradient of 6 mmHg, severe tricuspid valve insufficiency, inferior vena cava measuring 15 mm with more than 50% collapse and pulmonary artery systolic pressure of 40 mmHg...
February 2018: Oxford Medical Case Reports
Nazan Puluca, Melchior Burri, Julie Cleuziou, Markus Krane, Rüdiger Lange
OBJECTIVES: Most patients (75%) with Marfan syndrome present with aortic root dilatation that may require surgical intervention. However, associated cardiovascular disorders are not limited to the aortic root. These patients frequently require consecutive operations on the remaining thoracic aorta or the heart valves. Our intent was to characterize the spectrum of such procedures. METHODS: Data from all patients with Marfan syndrome undergoing aortic root surgery at our centre between 1988 and 2016 were analysed retrospectively...
February 28, 2018: European Journal of Cardio-thoracic Surgery
Robert Zilberszac, Andreas Gleiss, Thomas Binder, Günther Laufer, Michael Grimm, Harald Gabriel, Gerald Maurer, Raphael Rosenhek
Aims: Although concomitant mitral regurgitation (MR) and tricuspid regurgitation (TR) are frequently present in patients with aortic stenosis (AS), outcome data are scarce and treatment strategies are controversial. The aim of the present study was to assess the presentation and outcome of patients with AS and coexisting MR and TR. Methods and results: Eighty-nine consecutive patients with severe AS and at least moderate MR (72 functional and 17 degenerative) were included and followed...
March 1, 2018: European Heart Journal Cardiovascular Imaging
Robert G Nampiaparampil, Daniel G Swistel, Michael Schlame, Muhamed Saric, Mark V Sherrid
Transesophageal echocardiography is essential in guiding the surgical approach for patients with obstructive hypertrophic cardiomyopathy. Septal hypertrophy, elongated mitral valve leaflets, and abnormalities of the subvalvular apparatus are prominent features, all of which may contribute to left ventricular outflow tract obstruction. Surgery aims to alleviate the obstruction via an extended myectomy, often with an intervention on the mitral valve and subvalvular apparatus. The goal of intraoperative echocardiography is to assess the anatomic pathology and pathophysiology in order to achieve a safe intraoperative course and a successful repair...
March 2018: Journal of the American Society of Echocardiography
Xianqiu Wu, Wuli Wei, Yi He, Huajing Qin, Fenqiang Qi
BACKGROUND: To apply the cumulative sum (CUSUM) failure analysis to assess the performance of a single surgeon during mitral valve replacement via the right anterolateral minithoracotomy (RAMT) approach and to analyse the learning curve for the procedure. METHODS: A total of 100 mitral valve replacements were performed using the RAMT approach from June 2011 to April 2013 by a single surgeon with no prior experience of this technique. Patients were divided into five blocks according to the operation date...
February 14, 2018: Heart, Lung & Circulation
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