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Mazur PK, Arghami A, Macielak SA, Nei SD, Viehman JK, King KS, Daly RC, Crestanello JA, Schaff HV, Dearani JA. Apixaban for Anticoagulation After Robotic Mitral Valve Repair. Ann Thorac Surg 2023; 115:966-973. [PMID: 35973484 DOI: 10.1016/j.athoracsur.2022.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/04/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is no consensus regarding postoperative anticoagulation after mitral valve repair (MVRep). We compared the outcomes of post-MVRep anticoagulation with apixaban compared to warfarin. METHODS We reviewed data of 666 patients who underwent isolated robotic MVRep between January 2008 and October 2019. We excluded patients who had conversion to sternotomy and those discharged without anticoagulation or on clopidogrel (n = 40). Baseline and intraoperative characteristics and antiplatelet/anticoagulation records were collected. In-hospital and post-discharge complications and overall survival were compared. RESULTS Among the 626 studied patients the median age was 58 years (interquartile range, 51-66), 71% were male, and 1% (n = 9) had atrial fibrillation. Eighty percent (n = 499) were discharged on warfarin and 20% on apixaban (n = 127). Almost all patients (126 of 127, 99%) in the apixaban group were also on aspirin at discharge, whereas in the warfarin group only 79% (n = 395) were also on aspirin at discharge. Baseline characteristics were similar, except that the apixaban group had more female patients (46 of 127, 36% vs 136 of 499, 27%, P = .047). There were no differences in in-hospital complications, including stroke. Readmission rate was higher in the apixaban group (15 of 127, 12% vs 30 of 499, 6%, P = .02), driven mostly by postoperative atrial fibrillation (6 of 127 [5%] vs 5 of 499 [1%], respectively; P = .01). There was no difference in other complications (including bleeding and thromboembolic events), or overall mortality within 3 years. Exclusion of patients who did not receive aspirin at discharge did not affect the results. CONCLUSIONS Anticoagulation with apixaban after minimally invasive robotic MVRep is safe and has similar rates of bleeding and thromboembolism compared to patients treated with warfarin.
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Affiliation(s)
- Piotr K Mazur
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | | | - Scott D Nei
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Jason K Viehman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Ahmed EA, Schaff HV, Geske JB, Lee AT, King KS, Dearani JA, Nishimura RA, Ommen SR. Optimal Management of Mitral Regurgitation Due to Ruptured Mitral Chordae Tendineae in Patients With Hypertrophic Cardiomyopathy. Semin Thorac Cardiovasc Surg 2022; 35:476-482. [PMID: 35598764 DOI: 10.1053/j.semtcvs.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
There is continued controversy regarding surgical management of patients with hypertrophic cardiomyopathy (HCM) and intrinsic mitral valve disease; some clinicians favor prosthetic replacement as this corrects left ventricular outflow tract (LVOT) obstruction and valve leakage. In this study, we investigated the management and late outcome of operation for mitral regurgitation (MR) due to ruptured chordae tendineae in patients with HCM. We analyzed 49 consecutive patients with HCM and MR due to ruptured mitral valve chordae. Echocardiograms and operative reports were reviewed to classify valve anatomy and surgical methods. Information on late outcomes was obtained from electronic medical records and follow-up surveys. The mean age of the 36 men and 13 women was 61.9 ± 12.5 years; significant resting or provoked LVOT obstruction was present at the time of surgery in 46 patients. During the index operation, mitral valve repair was performed in 45 patients, and prosthetic replacement was necessary for 4 patients. Concomitant septal myectomy was performed in 46 patients. There were no hospital deaths or deaths within 30 days of operation. Five and ten-year survival estimates (Kaplan-Meier) were 92% and 71%. During follow-up at a median of 7.9 years, 3 patients underwent reoperation for MV replacement, 5 days, 3 years, and 14 years following valve repair. Ruptured mitral chordae may result in severe mitral valve regurgitation in patients with hypertrophic cardiomyopathy. Valvuloplasty at the time of septal myectomy is safe with an acceptably low rate of recurrent MR requiring prosthetic replacement.
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Affiliation(s)
- Eglal A Ahmed
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alexander T Lee
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Lee WJ, Kim J, Moon CH, Eom T, Son D, Lee S, Lee H, Jeong SM, Kim DH. Successful mitral repair in dogs by mitral annuloplasty using Hegar dilator: two case reports. J Vet Sci 2021; 23:e11. [PMID: 34841749 PMCID: PMC8799939 DOI: 10.4142/jvs.21192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
Mitral regurgitation (MR) is the most common heart disease in small-breed dogs. Mitral repair, which comprise artificial chorda tendineae implantation and mitral annuloplasty, has become the mainstay of treatment in the veterinary field. We report on two small dogs who underwent mitral repair surgery for MR. A Hegar dilator was used during mitral annuloplasty for accurate and reproducible surgery. In both cases, mitral regurgitant flow almost disappeared after surgery, and clinical signs improved. The treatment regimen was terminated 3 months after the surgery. We concluded that using a Hegar dilator may facilitate mitral valve repair surgery.
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Affiliation(s)
- Won-Jong Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | | | - Chang-Hwan Moon
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - TaeHeum Eom
- Helix Animal Medical Center, Seoul 05581, Korea
| | - DongJu Son
- Helix Animal Medical Center, Seoul 05581, Korea
| | - Seungmin Lee
- Department of Thoracic Surgery, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul 03312, Korea
| | - Haebeom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Seong-Mok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Dae-Hyun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea.
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Ashikhmina E, Schaff HV, Daly RC, Stulak JM, Greason KL, Michelena HI, Fatima B, Lahr BD, Dearani JA. Risk factors and progression of systolic anterior motion after mitral valve repair. J Thorac Cardiovasc Surg 2021; 162:567-577. [DOI: 10.1016/j.jtcvs.2019.12.106] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/24/2019] [Accepted: 12/19/2019] [Indexed: 11/24/2022]
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5
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Pahwa S, Stephens EH, Daly RC, Arghami A, Dearani JA. Mitral Valve Repair: How I Teach It. Ann Thorac Surg 2021; 112:363-367. [PMID: 33905734 DOI: 10.1016/j.athoracsur.2021.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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Hu X, Jiang W, Li H, Yan G, Wang Y. Timing of Valve Repair for Asymptomatic Mitral Regurgitation and Preserved Left Ventricular Function. Ann Thorac Surg 2021; 111:862-870. [DOI: 10.1016/j.athoracsur.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
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7
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Lee WJ, Kim J, Moon CH, Eom T, Son D, Lee S, Lee H, Jeong SM, Kim DH. Successful mitral repair in dogs by mitral annuloplasty using Hegar dilator: two case reports. J Vet Sci 2021. [DOI: 10.4142/jvs.2021.22.e93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Won-Jong Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | | | - Chang-Hwan Moon
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - TaeHeum Eom
- Helix Animal Medical Center, Seoul 05581, Korea
| | - DongJu Son
- Helix Animal Medical Center, Seoul 05581, Korea
| | - Seungmin Lee
- Department of Thoracic Surgery, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul 03312, Korea
| | - Haebeom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Seong-Mok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Dae-Hyun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
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Baccelli A, Lapenna E, Del Forno B, Schiavi D, Meneghin R, Giambuzzi I, Ruggeri S, Castiglioni A, Alfieri O, De Bonis M. Long-Term Results of Mitral Repair With Complete Semi-Rigid Rings vs Posterior Flexible Bands. Ann Thorac Surg 2020; 112:756-761. [PMID: 33275928 DOI: 10.1016/j.athoracsur.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the study was to evaluate whether the type of ring used had an impact on the long-term results of mitral repair for degenerative mitral regurgitation (MR), due to posterior leaflet prolapse, treated with quadrangular or triangular resection. METHODS From January 2002 to December 2008, 1406 patients with severe MR due to posterior leaflet prolapse underwent mitral repair. Of these patients, we selected 452 consecutive patients treated with the same repair approach. Mitral annuloplasty to complete the repair was performed with a posterior flexible band (n = 260) or a complete semi-rigid ring (n = 192). The 2 groups were comparable at baseline, and their clinical and echocardiographic outcomes were compared at long-term follow-up. RESULTS Overall survival at 14 years was similar (P = .29). The cumulative incidence function of cardiac death, with noncardiac death as competing risk, showed no difference (P = .71). At 14 years, probability of recurrence of MR greater than or equal to 3+ was 1.11% in the flexible band group and 3.25% in the semi-rigid ring group (P = .073). At 14 years, probability of recurrence of MR greater than or equal to 2 was 13.49% in the band group vs 10.78% in the semi-rigid ring group (P = .897). CONCLUSIONS In patients requiring mitral valve repair for posterior leaflet prolapse, treated with the same repair approach, the type of annuloplasty ring has no impact on the incidence of cardiac death and recurrence of MR at 14 years. Whether these findings remain stable at longer follow-up should be further investigated.
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Affiliation(s)
- Andrea Baccelli
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy.
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Schiavi
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Meneghin
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele University Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Schaff HV, Nguyen A. Contemporary techniques for mitral valve repair-the Mayo Clinic experience. Indian J Thorac Cardiovasc Surg 2020; 36:18-26. [PMID: 33061182 DOI: 10.1007/s12055-019-00801-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022] Open
Abstract
Mitral valve repair for patients with degenerative or functional mitral valve regurgitation improves symptoms and prognosis, and several techniques have been described. Important principles in operation are simplicity, reproducibility, and durability of repair. At Mayo Clinic, we have operated on more than 6000 patients with degenerative mitral valve disease and valve prolapse, and this review details our approach to mitral valve repair, including robotic and minimally invasive techniques. Most patients with isolated leaflet prolapse can be managed with leaflet plication or triangular resection, and chordal replacement is reserved for repair of anterior leaflet prolapse. Posterior annuloplasty with a standard-sized flexible band is used to reduce annular circumference and improve leaflet coaptation. With these methods, early risk of mortality for mitral valve repair is low in the current era (< 1%), and rate of recurrent valve leakage is 1.5 per 100 patient-years during the first year post-repair and 0.9 per 100 patient-years thereafter. This paper also briefly summarizes important considerations for patients with mitral valve regurgitation and severe calcification, perforations due to endocarditis, and rheumatic heart disease.
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Affiliation(s)
- Hartzell Vernon Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Anita Nguyen
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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10
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Okamoto H, Fujimoto Y, Teramoto C. Novel Trigone-Based Sizing Method for Mitral Ring Annuloplasty. Ann Thorac Surg 2019; 109:1385-1393. [PMID: 31586611 DOI: 10.1016/j.athoracsur.2019.08.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 07/28/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND We devised a novel trigone-based sizing method, setting the trigones at one-quarter of the annular circumference, and used it for mitral annuloplasty in patients with mitral regurgitation (MR). METHODS Between 1999 and 2017, 436 patients with degenerative (n = 192), nonischemic functional (n = 124), or ischemic (n = 120) MR underwent mitral valvuloplasty at our institution using an incomplete ring. The intertrigonal distance and prerepair and postrepair annular diameter were measured. Then the diameters predicted from body surface area, the intertrigonal distance, and the ratios of these diameters to observed data were computed. We investigated the influence of these measurements on MR recurrence, transmitral pressure gradient, and systolic anterior motion. RESULTS Initial repair was successful in 433 patients (99%), but 3 patients with systolic anterior motion and MR required conversion to valve replacement. After 1, 5, and 10 years (mean follow-up, 6.3 years), the rate of freedom from grade 2 or higher recurrent MR was 96%, 92%, and 86% in the degenerative group, 99%, 97%, and 90% in the nonischemic functional group, and 95%, 90%, and 79%, respectively, in the ischemic group (P = .052). The observed/body surface area predicted diameter ratio was negatively correlated with the mean transmitral pressure gradient (mm Hg); 12.3 - 8.2 × (ratio) (R = -0.37, P < .001), despite a smaller ratio (<0.9) not being associated with less recurrence of MR. In the degenerative group, systolic anterior motion developed in 7 of 71 patients (10%) with an observed/intertrigonal distance predicted diameter ratio of less than 0.9 (P < .001). CONCLUSIONS Our trigone-based sizing method achieved satisfactory control of MR, while avoiding functional mitral stenosis and systolic anterior motion.
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Affiliation(s)
- Hiroshi Okamoto
- Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan.
| | - Yasuyuki Fujimoto
- Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Chikao Teramoto
- Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
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11
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Preoperative left atrial volume index is associated with postoperative outcomes in mitral valve repair for chronic mitral regurgitation. J Thorac Cardiovasc Surg 2019; 160:661-672.e5. [PMID: 31627945 DOI: 10.1016/j.jtcvs.2019.08.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess determinants of left atrial reverse remodeling after mitral valve repair and to evaluate the impact of preoperative left atrial volume on postoperative outcomes. METHODS We reviewed the records of 720 patients who underwent mitral valve repair from September 2008 to July 2015 and had preoperative measurement of left atrial volume index. We analyzed the association of preoperative left atrial volume index on early and late outcomes, and determined which baseline characteristics are associated with left atrial reverse remodeling, as measured by changes in left atrial volume index in 512 patients who had at least 1 postoperative measurement. RESULTS The median (interquartile range) preoperative left atrial volume index was 54.0 (44.0-66.0) mL/m2. Preoperative left atrial volume index, age, body mass index, and atrial fibrillation were independently associated with the degree of left atrial reverse remodeling over the follow-up period. Reverse remodeling was greatest in patients with higher baseline left atrial volume index (P < .001), but less reverse remodeling was observed in patients with advanced age (P < .001), preoperative atrial fibrillation (P < .001), and extreme values of body mass index (P = .004), although these effects were moderately attenuated when limiting the analysis to 6-month follow-up. Secondary analysis demonstrated marginally significant effects of preoperative left atrial volume index on risks of early postoperative atrial fibrillation (P = .030) and late mortality (P = .077) after adjusting for age and sex. CONCLUSIONS In patients with degenerative mitral valve regurgitation who had mitral valve repair, preoperative left atrial volume index was associated with extent of left atrial reverse remodeling, risk of early postoperative atrial fibrillation, and late mortality. The majority of reverse remodeling occurs within the first month after operation and is greatest in younger patients.
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12
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Li Y, Zhang H, Zhang H, Luo T, Wang J, Zhu Z, Han J, Li Y, Meng X. Structural analysis of the mitral valve in rheumatic and degenerative mitral valve diseases: implications for annuloplasty selection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:617-623. [PMID: 31274274 DOI: 10.23736/s0021-9509.19.10814-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mitral valve (MV) repair has been recommended for MV diseases. Good repair requires a full understanding of the three-dimensional (3D) structure of the MV, however, currently little is known about the 3D structure of the rheumatic MV. METHODS A total of 82 cases underwent 3DTEE. Of these, 41 patients with rheumatic valvular disease (RVD) were studied intraoperatively (17 had severe mitral stenosis, 8 had severe mitral regurgitation, 16 had severe mitral stenosis coupled with regurgitation). There were 19 patients with degenerative MV disease (mitral valve prolapse [MVP] with severe regurgitation) and 22 cases with normal MV served as control subjects (CS). RESULTS Compared with CS, the anteroposterior diameter, anterolateral posteromedial, annulus circumference, and annulus area of both pathological groups, i.e., the RVD and MVP groups, were understandably greater. Though the sphericity index was greater in the RVD group vis-à-vis CS, the MVP group had nearly the same sphericity index as CS. The mitral annulus of patients with RVD tended to be round. Annular unsaddling, defined as annular height to commissural width ratio (an indicator of saddle degree) less than 15%, was significantly more prevalent in the group with degenerative MV disease. Automatic dynamic analysis revealed that the parameters of annular maximum displacement and annulus area fraction (two-dimensional) were considerably decreased in the RVD group. CONCLUSIONS Annular unsaddling was significantly more prevalent in the degenerative MV disease group. The mitral annulus of patients with RVD tended to be round and stiff.
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Affiliation(s)
- Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Han Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tiange Luo
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhihui Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China -
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13
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Shoiab I, Schaff H, Saran N, Charnin J, Ritter M. Recommendations for Perioperative Management in Patients With Absent Right Superior Vena Cava. J Cardiothorac Vasc Anesth 2018; 33:1710-1713. [PMID: 30219642 DOI: 10.1053/j.jvca.2018.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Irsa Shoiab
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN.
| | - Hartzell Schaff
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN
| | - Nishant Saran
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN
| | | | - Matthew Ritter
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
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14
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Bogachev-Prokophiev AV, Afanasyev AV, Zheleznev SI, Nazarov VM, Sharifulin RM, Karaskov AM. Mid-term results of mitral valve repair using flexible bands versus complete rings in patients with degenerative mitral valve disease: a prospective, randomized study. J Cardiothorac Surg 2017; 12:113. [PMID: 29237465 PMCID: PMC5729509 DOI: 10.1186/s13019-017-0679-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/28/2017] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to compare the outcomes of mitral valve repair with flexible band (FB) versus complete semirigid ring (SR) in degenerative mitral valve disease patients. Methods From September 2011 to 2014, 171 patients were randomized and underwent successful mitral valve repair using a SR (n = 85) or FB (n = 86). There were no significant between-group differences at baseline. Results There were no early mortalities. The mean follow up was 24.7 months. The 2-year survival was 96.0 ± 2.3% (95% confidence interval [CI], 88.6–98.7%) and 94.3 ± 2.8% (95% CI, 85.5–97.9%) in the SR and FB groups, respectively (p = 0.899). The left ventricle remodeling was similar between the groups. Higher transmitral peak (8.5 [3.9–17] vs. 6 [2.1–18] mmHg, p < 0.001), mean pressure gradients (3.7 [1.3–8] vs. 2.8 [0.6–6.8] mmHg, p = 0.001), and systolic pulmonary artery pressure (34.5 [20–68] vs. 29.5 [8–48] mmHg, p < 0.001) was observed in the SR group. The 2-year freedom from recurrence of significant mitral regurgitation was significantly higher in the FB group than the SR group (p = 0.002). Residual mitral regurgitation was an independent prognostic factor of recurrence of mitral regurgitation. The 3-year freedom from reoperation was significantly higher in the FB group than the SR group (p = 0.044). Conclusion Patients with degenerative mitral valve disease may benefit from valve repair with FBs. Residual mitral regurgitation before discharge is an independent risk factor of late insufficiency recurrence. Trial registration ClinicalTrials.gov NCT03278574, retrospectively registered on 06.09.2017. Electronic supplementary material The online version of this article (10.1186/s13019-017-0679-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandr V Bogachev-Prokophiev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya street, Novosibirsk, Russian Federation, 630055
| | - Alexandr V Afanasyev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya street, Novosibirsk, Russian Federation, 630055.
| | - Sergei I Zheleznev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya street, Novosibirsk, Russian Federation, 630055
| | - Vladimir M Nazarov
- Heart Valves Surgery Department, Meshalkin National Medical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya street, Novosibirsk, Russian Federation, 630055
| | - Ravil M Sharifulin
- Heart Valves Surgery Department, Meshalkin National Medical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya street, Novosibirsk, Russian Federation, 630055
| | - Alexandr M Karaskov
- Heart Valves Surgery Department, Meshalkin National Medical Research Center Ministry of Health Russian Federation, 15 Rechkunovskaya street, Novosibirsk, Russian Federation, 630055
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Umesue M, Baba H, Kimura S. Immediate and mid-term result of restrictive mitral annuloplasty using a small semi-rigid ring. Gen Thorac Cardiovasc Surg 2016; 64:260-6. [PMID: 26884082 DOI: 10.1007/s11748-016-0631-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Though annuloplasty using a properly sized ring has been advocated in degenerative mitral regurgitation, restrictive annuloplasty using a down-sized ring is widely used in ischemic mitral regurgitation. We investigated the outcome of restrictive annuloplasty using a small (24- or 26-mm) ring in mitral regurgitation irrespective of the etiology. METHODS Nineteen patients underwent a restrictive annuloplasty using a 24-mm (n = 8) or 26-mm (n = 11) semi-rigid ring. The etiology included degenerative in 13 patients, ischemic in 3, endocarditis in 2, and congenital in 1. Body surface area of the patients implanted with the 24-mm ring was 1.40 ± 0.16 and 1.60 ± 0.18 m(2) for the 26-mm ring. Fifteen patients had 3+ or 4+ mitral regurgitation preoperatively. RESULTS Two patients were converted to valve replacement for residual mitral regurgitation during the operation. One operative mortality associated with infection was observed. Echocardiogram at 29.4 ± 14.2 months postoperatively demonstrated mitral valve area of 2.0 ± 0.6 cm(2) for 24-mm ring and 2.2 ± 0.5 cm(2) for 26-mm ring with indexed mitral valve area of 1.4 ± 0.4 cm(2)/m(2) for both groups, and no mitral regurgitation more than 2+. Transmitral mean pressure gradient on rest was 4.7 ± 2.1 mmHg at last follow up. New York Heart Association class improved from 2.2 ± 0.7 to 1.2 ± 0.2 after the operation. No late death or reoperation was observed during the follow-up of 31.0 ± 15.0 months. CONCLUSIONS Restrictive mitral annuloplasty using a small ring provided acceptable early and midterm results in patients with body surface area around 1.5 cm(2) without Barlow pathology. Restrictive annuloplasty may be another technical aspect to avoid valve replacement.
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Affiliation(s)
- Masayoshi Umesue
- Department of Cardiovascular Surgery, Matsuyama Red Cross Hospital, Bunkyouchou 1, Matsuyama, Ehime, 790-8524, Japan.
| | - Hironori Baba
- Department of Cardiovascular Surgery, Matsuyama Red Cross Hospital, Bunkyouchou 1, Matsuyama, Ehime, 790-8524, Japan
| | - Satoshi Kimura
- Department of Cardiovascular Surgery, Matsuyama Red Cross Hospital, Bunkyouchou 1, Matsuyama, Ehime, 790-8524, Japan
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Mitral valve gradient after valve repair of degenerative regurgitation with restrictive annuloplasty. J Thorac Cardiovasc Surg 2016; 151:106-9. [DOI: 10.1016/j.jtcvs.2015.08.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/03/2015] [Accepted: 08/22/2015] [Indexed: 11/23/2022]
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Kim JH, Kim KH, Choi JB, Kuh JH. Posterior mitral annuloplasty for enhancing mitral leaflet coaptation: using a strip designed for placement in the posterior annulus. J Cardiothorac Surg 2015; 10:164. [PMID: 26563309 PMCID: PMC4643521 DOI: 10.1186/s13019-015-0350-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 10/28/2015] [Indexed: 12/02/2022] Open
Abstract
Background In patients with mitral valve regurgitation (MR), posterior mitral annuloplasty (PMA) was performed for mitral valve repair using a strip designed for placement in the posterior annulus, sparing the anterior annulus and anterior half of the commissures. Methods Between September 2009 and October 2013, we performed PMA using a novel strip in 74 consecutive patients with MR greater than 3+. Procedures associated with mitral valve repairs were performed in 41 patients (56.9 %), including new chord placement for leaflet prolapse (n=30), patch valvuloplasty for posterior chord rupture (n=4), and posterior leaflet augmentation (n=15). All patients were analyzed by serial echocardiographic follow-up, and preoperative and postoperative computed tomography was performed in 10 randomly selected patients. Results Hospital death occurred in two patients (2.7 %), and 72 survived patients were completely followed up. At a mean follow-up of 37.2 ± 15.0 months, the MR grade was zero or 1+ in 64 patients (88.9 %), 2+ in 7 patients (9.7 %), and 3+ in one patient (1.4 %). The mean indexed valve area and mean valve gradient were 1.7 ± 0.4 cm2/m2 and 3.5 ± 1.2 mmHg, respectively. The mean leaflet coaptation height in early systole was 12.8 ± 3.5 mm. During the cardiac cycle, the repaired valves exhibited dynamic changes of 19.5 ± 9.3 % in the septo-lateral dimensions. No early conversions to valve replacements or late reoperations occurred. None of the patients with remnant or recurrent MR experienced hemolysis. Conclusions PMA using a novel strip showed a sufficient coaptation height secondary to reduction of the septo-lateral annular dimensions and dynamic changes in the dimensions. It can be expected to be an alternative mitral annuloplasty technique with satisfactory results.
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Affiliation(s)
- Jong Hun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. .,Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, 561-712, Republic of Korea.
| | - Kyung Hwa Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea.
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. .,Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, 561-712, Republic of Korea.
| | - Ja Hong Kuh
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, 20 Geonji-Ro, Deokjin-Gu, Jeonju, Chonbuk, 561-712, Republic of Korea. .,Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Chonbuk, 561-712, Republic of Korea.
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Calleja A, Poulin F, Woo A, Meineri M, Jedrzkiewicz S, Vannan MA, Rakowski H, David T, Tsang W, Thavendiranathan P. Quantitative Modeling of the Mitral Valve by Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Mitral Valve Repair: Correlation with Intraoperative Surgical Technique. J Am Soc Echocardiogr 2015; 28:1083-92. [DOI: 10.1016/j.echo.2015.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Indexed: 01/23/2023]
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Wan S, Lee APW, Jin CN, Wong RHL, Chan HHM, Ng CSH, Wan IYP, Underwood MJ. The choice of mitral annuloplastic ring-beyond "surgeon's preference". Ann Cardiothorac Surg 2015; 4:261-5. [PMID: 26309828 DOI: 10.3978/j.issn.2225-319x.2015.01.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 12/15/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Song Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex P W Lee
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Chun-Na Jin
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Randolph H L Wong
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Herman H M Chan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Innes Y P Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- 1 Division of Cardiothoracic Surgery, Department of Surgery, 2 Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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David TE. Patch Augmentation of Mitral Valve Leaflet in Ischemic Mitral Regurgitation. Semin Thorac Cardiovasc Surg 2015; 27:95-6. [PMID: 26686430 DOI: 10.1053/j.semtcvs.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Tirone E David
- Division of Cardiovascular Surgery of the Peter Munk Cardiac Centre at Toronto General Hospital and University of Toronto.
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Lawrie G. Invited commentary. Ann Thorac Surg 2014; 98:1556. [PMID: 25441781 DOI: 10.1016/j.athoracsur.2014.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/05/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Gerald Lawrie
- Houston Methodist Specialty Group, 6560 Fannin #1842, Houston, TX77030.
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Quintana E, Suri RM, Thalji NM, Daly RC, Dearani JA, Burkhart HM, Li Z, Enriquez-Sarano M, Schaff HV. Left ventricular dysfunction after mitral valve repair—the fallacy of “normal” preoperative myocardial function. J Thorac Cardiovasc Surg 2014; 148:2752-60. [DOI: 10.1016/j.jtcvs.2014.07.029] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/26/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
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Algarni KD, Suri RM, Daly RC. Robotic-assisted mitral valve repair: surgical technique. Multimed Man Cardiothorac Surg 2014; 2014:mmu022. [PMID: 25362732 DOI: 10.1093/mmcts/mmu022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Robotic-assisted mitral valve repair represents the least invasive surgical approach currently available for anatomical mitral valve repair in patients with myxomatous mitral valve disease. Standard mitral valve repair techniques utilized during conventional sternotomy/right thoracotomy are exactly replicated with the robotic instrumentation through 1-2 cm port-like incisions with superior 3D visualization. This is performed on cardiopulmonary bypass by peripheral cannulation of the femoral vessels/right internal jugular vein. The ascending aorta is occluded with a transthoracic aortic cross-clamp. Antegrade cardioplegia is delivered centrally into the aortic root through a cardioplegia vent catheter. By replicating conventional mitral valve repair done via an open sternotomy approach, the quality of mitral valve repair is ensured while providing the patients with advantages of less invasive surgery including shorter hospital stay, rapid recovery and return to normal activities, less blood transfusion, superior cosmesis and complete elimination of sternotomy-related morbidities such as deep sternal wound infection and sternal dehiscence. We reviewed the first consecutive 200 patients undergoing robotic mitral valve repair at Mayo Clinic Rochester between 24 January 2008 and 28 January 2011. Successful mitral valve repair was completed in all patients. There were no early (30-day) deaths. One patient suffered a stroke (0.5%). One patient required reoperation for bleeding (0.5%). Two patients (1%) required reoperation for recurrent mitral regurgitation. Twelve patients (6%) required transfusion of allogeneic blood products. We have noted a significant reduction in operative times and resource utilization over time.
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Affiliation(s)
- Khaled D Algarni
- King Saud University, Riyadh, Saudi Arabia Mayo Clinic, Rochester, MN, USA
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David TE, David CM, Manlhiot C. Simplici-T Annuloplasty Band for Mitral Valve Repair for Degenerative Disease. Ann Thorac Surg 2014; 98:1551-6. [DOI: 10.1016/j.athoracsur.2014.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 12/01/2022]
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Suri RM, Burkhart HM. Optimizing outcomes of robotic mitral valve repair for all prolapse anatomy: the Suri-Burkhart technique. Ann Cardiothorac Surg 2014; 2:841-5. [PMID: 24349993 DOI: 10.3978/j.issn.2225-319x.2013.10.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/11/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harold M Burkhart
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Rodrigues ES, Lynch JJ, Suri RM, Burkhart HM, Li Z, Mauermann WJ, Rehfeldt KH, Nuttall GA. Robotic Mitral Valve Repair: A Review of Anesthetic Management of the First 200 Patients. J Cardiothorac Vasc Anesth 2014; 28:64-68. [DOI: 10.1053/j.jvca.2013.05.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Indexed: 11/11/2022]
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Saxena P, Malouf JF, Click R, Suri RM. 3D Echocardiography in Cardiac Surgery. J Card Surg 2014; 29:51-54. [DOI: 10.1111/jocs.12256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pankaj Saxena
- Division of Cardiovascular Surgery; Mayo Clinic; Rochester Minnesota
| | | | - Roger Click
- Division of Cardiology; Mayo Clinic; Rochester Minnesota
| | - Rakesh M. Suri
- Division of Cardiovascular Surgery; Mayo Clinic; Rochester Minnesota
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A near 100% repair rate for mitral valve prolapse is achievable in a reference center: Implications for future guidelines. J Thorac Cardiovasc Surg 2012; 144:308-12. [DOI: 10.1016/j.jtcvs.2011.12.054] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/19/2011] [Accepted: 12/21/2011] [Indexed: 11/22/2022]
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Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: Establishing the benchmark against which percutaneous interventions should be judged. J Thorac Cardiovasc Surg 2011; 142:970-9. [DOI: 10.1016/j.jtcvs.2011.07.027] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 06/10/2011] [Accepted: 07/19/2011] [Indexed: 11/24/2022]
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Suri RM, Burkhart HM, Rehfeldt KH, Enriquez-Sarano M, Daly RC, Williamson EE, Li Z, Schaff HV. Robotic mitral valve repair for all categories of leaflet prolapse: improving patient appeal and advancing standard of care. Mayo Clin Proc 2011; 86:838-44. [PMID: 21757782 PMCID: PMC3258002 DOI: 10.4065/mcp.2010.0733] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To characterize the early outcomes of robotic mitral valve (MV) repair using standard open techniques. PATIENTS AND METHODS We prospectively studied 100 patients with severe mitral regurgitation due to leaflet prolapse who underwent robot-assisted MV repair using conventional open-repair techniques between January 1, 2008, and December 31, 2009, at Mayo Clinic, Rochester, MN. RESULTS The mean age of the patients was 53.9 years; 77 patients (77%) were male. Fifty-nine patients (59%) had posterior leaflet prolapse, 38 (38%) had bileaflet disease, and 3 (3%) had isolated anterior leaflet prolapse. Median cross-clamp and bypass times decreased significantly during the course of the study (P<.001). Median postoperative ventilation time was 0 hours for the last 25 patients, with most patients extubated in the operating room. No deaths occurred. Reexploration for postoperative bleeding occurred in 1 patient (1%); 3 patients (3%) required percutaneous coronary intervention. Median hospital stay was 3 days. One patient (1%) underwent mitral reoperation for annuloplasty band dehiscence. Residual regurgitation was mild or less in all patients at dismissal and 1 month postoperatively. Significant reverse remodeling occurred by 1 month, including decreased left ventricular end-diastolic diameter (-7.2 mm; P<.001) and left ventricular end-diastolic volume (-61.0 mL;P<.001). CONCLUSION Robot-assisted MV repair using proven, conventional open-repair techniques is reproducible and safe and hastens recovery for all categories of leaflet prolapse. One month after surgery, significant regression in left ventricular size and volume is evident.
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Affiliation(s)
- Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Garrido-Olivares L, David TE, Maganti M, Wijeysundera D, Rao V. Effect of preoperative non–dialysis-dependent renal dysfunction on isolated aortic and mitral valve surgery: A propensity score analysis. J Thorac Cardiovasc Surg 2011; 142:155-61. [DOI: 10.1016/j.jtcvs.2010.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 10/26/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
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Bulging Subaortic Septum: An Important Risk Factor for Systolic Anterior Motion After Mitral Valve Repair. Ann Thorac Surg 2011; 91:1427-32. [DOI: 10.1016/j.athoracsur.2011.01.084] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 11/21/2022]
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Chandra S, Salgo IS, Sugeng L, Weinert L, Tsang W, Takeuchi M, Spencer KT, O'Connor A, Cardinale M, Settlemier S, Mor-Avi V, Lang RM. Characterization of Degenerative Mitral Valve Disease Using Morphologic Analysis of Real-Time Three-Dimensional Echocardiographic Images. Circ Cardiovasc Imaging 2011; 4:24-32. [DOI: 10.1161/circimaging.109.924332] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sonal Chandra
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Ivan S. Salgo
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Lissa Sugeng
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Lynn Weinert
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Wendy Tsang
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Masaaki Takeuchi
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Kirk T. Spencer
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Anne O'Connor
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Michael Cardinale
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Scott Settlemier
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Victor Mor-Avi
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
| | - Roberto M. Lang
- From the University of Chicago Medical Center (S.C., L.S., L.W., W.T., K.T.S., A.O., V.M.-A., R.M.L.), Chicago, Ill; Philips Healthcare (I.S.S., M.C., S.S.), Andover, Mass; and the University of Occupational and Environmental Health (M.T.), School of Medicine, Kitakyushu, Japan
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Abstract
Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a ‘best practice revolution’ in the field of degenerative mitral valve regurgitation.
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Affiliation(s)
- David H Adams
- Department of Cardiothoracic Surgery, The Mount Sinai School of Medicine, 1190 Fifth Avenue, New York, NY 10029, USA.
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