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moderate ischemic mitral regurgitation

Joe Luis Pantoja, Ashley E Morgan, Eugene A Grossi, Morten O Jensen, Jonathan W Weinsaft, Robert A Levine, Liang Ge, Mark B Ratcliffe
BACKGROUND: Recurrence of mitral regurgitation (MR) after undersized mitral annuloplasty (MA) for ischemic MR is as high as 60%, with the recurrence rate likely due to continued dilation of the left ventricle (LV). To better understand the causes of recurrent MR, we studied the effect of undersized MA on strain in the LV wall. We hypothesize that the acute change in ventricular shape induced by MA will cause increased strain in regions nearest the mitral valve. METHODS: Finite element models were previously reported, based on cardiac magnetic resonance images of 5 sheep with mild to moderate ischemic MR...
October 5, 2016: Annals of Thoracic Surgery
Liangshan Wang, Bo Li, Changcheng Liu, Tianhua Rong, Yang Yu, Chengxiong Gu
OBJECTIVE: To investigate the short- and medium-term effects of combined mitral valve surgery (MVS) and coronary artery bypass grafting (CABG) versus CABG alone for patients with moderate ischemic mitral regurgitation (IMR). DESIGN: Meta-analysis of 4 randomized controlled trials (RCTs) and 5 observational studies. SETTING: Hospitals that perform cardiac surgery. PARTICIPANTS: The study included 1,256 cardiac surgery patients from 4 RCTs and 5 observational studies...
June 29, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Salvatore Campisi, Jean F Fuzellier, Benjamain Haber, Jean P Favre, Antoine Gerbay, Marco Vola
BACKGROUND: Ischemic mitral regurgitation (IMR) is a common complication of coronary artery disease and represents an independent predictor of mortality. In the IMR the pattern of mitral valve annular dilatation is asymmetrical: this can explain the long-term incidence of recurrent mitral regurgitation after surgical annular size reduction with a symmetrical ring. The aim of this study is to analyze early and mid-term results of mitral valve repair (MVR) with the CMA IMR ETlogix ring, specifically developed for the surgical correction of IMR...
November 1, 2016: International Journal of Cardiology
Daniel Hernandez-Vaquero, Rocío Díaz, Rubén Álvarez-Cabo, Carlota Vigil-Escalera, Jacobo Silva
No abstract text is available yet for this article.
July 2016: Journal of Thoracic Disease
Faruk Toktas, Senol Yavuz, Kadir K Ozsin, Umut S Sanri
OBJECTIVES: To investigate whether mitral valve repair (MVR) at the time of coronary artery bypass grafting (CABG) in patients with ischemic moderate mitral regurgitation (MR) and coronary artery disease could improve short- and mid-term postoperative outcomes.  METHODS: Between March 2013 and December 2015, 90 patients with moderate ischemic MR underwent first-time CABG in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey. Out of 90 patients, 44 (48...
August 2016: Saudi Medical Journal
Francesco Nappi, Mario Lusini, Cristiano Spadaccio, Antonio Nenna, Elvio Covino, Christophe Acar, Massimo Chello
BACKGROUND: Guidelines recommend surgery for patients with severe ischemic mitral regurgitation (MR). Nonrandomized studies suggest that subvalvular repair is associated with longer survival, but randomized studies are lacking. OBJECTIVES: This study sought to investigate the benefit of papillary muscle surgery on long-term clinical outcomes of patients with ischemic MR. METHODS: Ninety-six patients with severe ischemic MR were randomized to either undersizing restrictive mitral annuloplasty (RA) or papillary muscle approximation with undersizing restrictive mitral annuloplasty (PMA) associated with complete surgical myocardial revascularization...
May 24, 2016: Journal of the American College of Cardiology
Robert E Michler, Peter K Smith, Michael K Parides, Gorav Ailawadi, Vinod Thourani, Alan J Moskowitz, Michael A Acker, Judy W Hung, Helena L Chang, Louis P Perrault, A Marc Gillinov, Michael Argenziano, Emilia Bagiella, Jessica R Overbey, Ellen G Moquete, Lopa N Gupta, Marissa A Miller, Wendy C Taddei-Peters, Neal Jeffries, Richard D Weisel, Eric A Rose, James S Gammie, Joseph J DeRose, John D Puskas, François Dagenais, Sandra G Burks, Ismail El-Hamamsy, Carmelo A Milano, Pavan Atluri, Pierre Voisine, Patrick T O'Gara, Annetine C Gelijns
BACKGROUND: In a trial comparing coronary-artery bypass grafting (CABG) alone with CABG plus mitral-valve repair in patients with moderate ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI) or survival after 1 year. Concomitant mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation, but patients had more adverse events. We now report 2-year outcomes. METHODS: We randomly assigned 301 patients to undergo either CABG alone or the combined procedure...
May 19, 2016: New England Journal of Medicine
Christos G Mihos, Orlando Santana
Approximately 30% to 50% of patients will develop ischemic mitral regurgitation (MR) after a myocardial infarction, which is a result of progressive left ventricular remodeling and dysfunction of the subvalvular apparatus, and portends a poor long-term prognosis. Surgical treatment is centered on mitral valve repair utilizing a restrictive annuloplasty, or valve replacement with preservation of the subvalvular apparatus. In the recent Cardiothoracic Surgical Trials Network (CSTN) study, patients with severe ischemic MR were randomized to mitral valve repair with a restrictive annuloplasty versus chordal-sparing valve replacement, and concomitant coronary artery bypass grafting, if indicated...
January 2016: Journal of Thoracic Disease
Liang Ge, Yife Wu, Mehrdad Soleimani, Michael Khazalpour, Kiyoaki Takaba, Mehrzad Tartibi, Zhihong Zhang, Gabriel Acevedo-Bolton, David A Saloner, Arthur W Wallace, Rakesh Mishra, Eugene A Grossi, Julius M Guccione, Mark B Ratcliffe
BACKGROUND: Chronic ischemic mitral regurgitation (CIMR) is associated with poor outcome. Left ventricular (LV) strain after posterolateral myocardial infarction (MI) may drive LV remodeling. Although moderate CIMR has been previously shown to affect LV remodeling, the effect of CIMR on LV strain after posterolateral MI remains unknown. We tested the hypothesis that moderate CIMR alters LV strain after posterolateral MI. METHODS: Posterolateral MI was created in 10 sheep...
May 2016: Annals of Thoracic Surgery
Saurav Chatterjee, Byomesh Tripathi, Hafeez Ul Hassan Virk, Mohammed Ahmed, Chirag Bavishi, Parasuram Krishnamoorthy, Partha Sardar, Jay Giri, Karan Omidvari, Joanna Chikwe
Mitral regurgitation (MR) is one of the common complications in myocardial infarction (MI) patients. Almost half of the post MI patients have MR (ischemic MR)(17) which is moderate to severe (grade II-IV). Whether there is a mortality benefit of performing mitral valve repair (MVR) along with coronary artery bypass grafting (CABG) in patients with post MI moderate MR remains inconclusive. Literature search was done from PubMed, Google scholar, Ovid, and Medline databases. Studies which included post MI patients with moderate ischemic MR and reported mortality outcomes of performing CABG and MVR were chosen for the systematic review...
March 2016: Current Cardiology Reports
Gabriel Loor, Andres Schuster, Vincent Cruz, Aldo Rafael, William J Stewart, James Diaz, Kenneth McCurry
BACKGROUND: The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis (Edwards Lifesciences, Irvine, CA) is a low-profile version of the earlier Perimount valve that uses the ThermaFix process for enhanced calcium removal. The Magna valve has been in use since 2008, yet no publication, until now, has verified its intermediate-term safety and efficacy. METHODS: From 2008 through 2011 (our 4-year study period), 70 Magna valves were implanted in the mitral position at a single institution (the Cleveland Clinic)...
2016: Journal of Cardiothoracic Surgery
Norbert Klein, Dietrich Pfeiffer, Steven Goldberg, Maika Klein
BACKGROUND AND AIMS: One option for interventional treatment of secondary mitral regurgitation is the placement of an indirect mitral annuloplasty device (Carillon Mitral Contour System) cinching the mitral annulus to facilitate coaptation of the mitral leaflets. The aim of this study is to evaluate the implantation success and hemodynamic results. METHODS AND RESULTS: Seventeen consecutive patients (11 females, 6 males) suffering from moderate to severe secondary mitral regurgitation (40% ischemic, 59% non-ischemic) received a Carillon Mitral Contour System device, which was evaluated prospectively in a single-center setting...
March 2016: Journal of Invasive Cardiology
Francesco Nappi, Antonio Nenna, Cristiano Spadaccio, Mario Lusini, Massimo Chello, Massimiliano Fraldi, Christophe Acar
BACKGROUND: In patients with ischemic mitral regurgitation, leaflet prolapse requires an accurate evaluation since surgical approach depends on valvular and subvalvular characteristics. This study aims to describe a cohort of patients over a long-term follow up, analyzing survival, reoperation and predictive factors of surgical outcomes. METHODS AND RESULTS: From March 1994 to June 2011, 75 patients with ischemic mitral regurgitation and leaflet prolapse underwent surgical myocardial revascularization and mitral valve repair (90...
February 1, 2016: International Journal of Cardiology
Benoit de Varennes, Kevin Lachapelle, Renzo Cecere, Isabel Szczepkowski, Jean Buithieu
OBJECTIVE: Surgical sutureless aortic valves have the potential for shorter procedural times and could benefit patients with increased risk. The Enable (Medtronic Inc, Minneapolis, Minn) valve is a bioprosthesis housed in a Nitinol cage allowing folding and deployment once implanted. We aimed to evaluate the early clinical and echocardiographic results with the Enable valve. METHODS: Patients with aortic stenosis, Society of Thoracic Surgeons score greater than 5...
March 2016: Journal of Thoracic and Cardiovascular Surgery
Wissam A Alajaji, Elie A Akl, Aida Farha, Wael A Jaber, Wael A AlJaroudi
AIMS: Acute ischemic mitral regurgitation (MR) is seen in patients with myocardial infarction and is associated with increased morbidity and mortality. The optimal treatment strategy of this condition however, is not well established. The aim of this manuscript is to conduct a systematic review of the medical literature to assess the relative benefits and harms of mitral valve surgery with medical therapy versus medical management alone for patients with acute ischemic MR of at least moderate severity...
2015: BMC Research Notes
Daniel Goldstein, Alan J Moskowitz, Annetine C Gelijns, Gorav Ailawadi, Michael K Parides, Louis P Perrault, Judy W Hung, Pierre Voisine, Francois Dagenais, A Marc Gillinov, Vinod Thourani, Michael Argenziano, James S Gammie, Michael Mack, Philippe Demers, Pavan Atluri, Eric A Rose, Karen O'Sullivan, Deborah L Williams, Emilia Bagiella, Robert E Michler, Richard D Weisel, Marissa A Miller, Nancy L Geller, Wendy C Taddei-Peters, Peter K Smith, Ellen Moquete, Jessica R Overbey, Irving L Kron, Patrick T O'Gara, Michael A Acker
BACKGROUND: In a randomized trial comparing mitral-valve repair with mitral-valve replacement in patients with severe ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI), survival, or adverse events at 1 year after surgery. However, patients in the repair group had significantly more recurrences of moderate or severe mitral regurgitation. We now report the 2-year outcomes of this trial. METHODS: We randomly assigned 251 patients to mitral-valve repair or replacement...
January 28, 2016: New England Journal of Medicine
Sohaib A Virk, Arunan Sriravindrarajah, Douglas Dunn, Kevin Liou, Hugh Wolfenden, Genevieve Tan, Christopher Cao
BACKGROUND: The development of ischemic mitral regurgitation (IMR) portends a poor prognosis and is associated with adverse long-term outcomes. Although both mitral valve repair (MVr) and mitral valve replacement (MVR) have been performed in the surgical management of IMR, there remains uncertainty regarding the optimal approach. The aim of the present study was to meta-analyze these two procedures, with mortality as the primary endpoint. METHODS: Seven databases were systematically searched for studies reporting peri-operative or late mortality following MVr and MVR for IMR...
September 2015: Annals of Cardiothoracic Surgery
Lidia Greszata, Janina Stępińska
Epidemiology of acquired valvular heart diseases has changed significantly over last decades. Degenerative aortic valve stenosis is the most common acquired valvular disease with high prevalence in elderly population. Another common disorder is ischemic mitral regurgitation secondary to myocardial infarction. Both above-mentioned heart disorders are not typical for women in reproductive age. Rheumatic heart valve disease has become infrequent in Polish population. Mitral stenosis, the most prevalent of rheumatic valvular disorders, affects 5% of pregnant women with heart disease and rheumatic aortic stenosis is responsible for 0...
2015: Przegla̧d Lekarski
Jahan Mohebali, Frederick Y Chen
Mitral valve repair for ischemic mitral valve regurgitation remains controversial. In moderate mitral regurgitation (MR), controversy exists whether revascularization alone will be adequate to restore native valve geometry or whether intervention on the valve (repair) should be performed concomitantly. When MR is severe, the need for valve intervention is not disputed. Rather, the controversy is whether repair versus replacement should be undertaken. In contrast to degenerative or myxomatous disease that directly affects leaflet integrity and morphology, ischemic FMR results from a distortion and dilation of native ventricular geometry that normally supports normal leaflet coaptation...
May 2015: Annals of Cardiothoracic Surgery
Brian C Gulack, Brian R Englum, Anthony W Castleberry, Mani A Daneshmand, Peter K Smith, Louis P Perrault
Ischemic mitral regurgitation (MR) is a common occurrence following myocardial infarction and its presence is associated with poor outcomes. The optimal treatment of ischemic MR is a matter of debate, especially for patients with moderate MR severity. Some authors advocate for isolated coronary artery bypass grafting (CABG) for patients with moderate MR, maintaining that reverse ventricular remodeling will reduce MR grade and its associated mortality risk, while others argue that a concomitant mitral valve repair (MVR) or replacement is superior...
May 2015: Annals of Cardiothoracic Surgery
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