1
|
Pölzl L, Gollmann-Tepeköylü C, Nägele F, Cetin K, Spilka J, Holfeld J, Oezpeker UC, Stastny L, Graber M, Hirsch J, Engler C, Dumfarth J, Ruttmann-Ulmer E, Hangler H, Grimm M, Müller L, Höfer D, Bonaros N. Five-year outcomes of different techniques for minimally invasive mitral valve repair in Barlow's disease. Eur J Cardiothorac Surg 2024; 65:ezae213. [PMID: 38781502 PMCID: PMC11150856 DOI: 10.1093/ejcts/ezae213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/12/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Barlow's disease is a specific sub-form of mitral valve (MV) disease, characterized by diffuse excessive tissue and multi segment prolapse. The anterolateral mini-thoracotomy represents the standard access for MV regurgitation in many centres. It still remains unclear which surgical technique provides the best results. Therefore, the aim of this study was to compare operative safety and mid-term outcomes after (i) isolated annuloplasty, (ii) use of additional artificial chordae or (iii) leaflet resection in patients suffering from Barlow's disease undergoing minimally invasive MV repair. METHODS A consecutive series of patients suffering from Barlow's disease undergoing minimally invasive MV surgery between 2001 and 2020 were analysed (n = 246). Patients were grouped and analysed according to the used surgical technique. The primary outcome was a modified Mitral Valve Academic Research Consortium combined end-point of mortality, reoperation due to repair failure or reoccurrence of severe mitral regurgitation within 5 years. The secondary outcome included operative success and safety up to 30 days. RESULTS No significant difference was found between the 3 surgical techniques with regard to operative safety (P = 0.774). The primary outcome did not differ between groups (P = 0.244). Operative success was achieved in 93.5% and was lowest in the isolated annuloplasty group (77.1%). Conversion to MV replacement was increased in patients undergoing isolated annuloplasty (P < 0.001). CONCLUSIONS Isolated annuloplasty, use of additional artificial chordae and leaflet resection represent feasible techniques in Barlow patients undergoing minimally invasive MV surgery with comparable 5-year results. In view of the increased conversion rate in the annuloplasty group, the pathology should not be oversimplified.
Collapse
Affiliation(s)
- Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Kardelen Cetin
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Spilka
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ulvi C Oezpeker
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Luka Stastny
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Engler
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Herbert Hangler
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ludwig Müller
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Höfer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
2
|
Wang Z, Ma K, Zhu Y, Li S. Innovation in surgical treatment of hypertrophic obstructive cardiomyopathy in children. Cardiol Young 2024:1-10. [PMID: 38602080 DOI: 10.1017/s104795112400057x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Hypertrophic cardiomyopathy is the second most common cardiomyopathy affecting children and adolescents and is the main cause of sudden death of young athletes. The natural prognosis of children with severe hypertrophic obstructive cardiomyopathy is not optimistic, and it is not uncommon for children with hypertrophic obstructive cardiomyopathy who do not respond to medication. Surgical treatment is often the only solution. Conventional surgical methods in the past include classic or modified extended Morrow operation, classic or modified Konno operation, and Ross-Konno operation. In recent years, with the development of minimally invasive surgery, various minimally invasive surgical methods have emerged endlessly. Because the incision of minimally invasive cardiac surgery is significantly smaller than that of traditional surgery, it causes less trauma, recovers quickly after surgery, and has the advantage of no difference in surgical effect compared with traditional median sternotomy. Tally endoscopic transmitral myectomy, RTM, minimally right thoracotomy, and other surgical methods have achieved encouraging results in adults and some older children with hypertrophic obstructive cardiomyopathy. The appearance of transapical beating-heart septectomy has brought the treatment of hypertrophic obstructive cardiomyopathy from the era of cardiopulmonary bypass and cardiac arrest to a new era of minimally invasive beating-heart surgery. In the past, there were few articles about the treatment of children with hypertrophic obstructive cardiomyopathy. This article reviewed the new progress and prognosis of surgical treatment of children with hypertrophic obstructive cardiomyopathy at home and abroad.
Collapse
Affiliation(s)
- Zhangwei Wang
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Kai Ma
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Yaobin Zhu
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Shoujun Li
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| |
Collapse
|
3
|
Chiang CY, Huang JH, Chiu KM, Chen JS. Impact of Recurrent Mitral Regurgitation on Left Ventricular Mass Regression and Cardiac Events following Mitral Valve Repair. J Clin Med 2023; 13:235. [PMID: 38202242 PMCID: PMC10779914 DOI: 10.3390/jcm13010235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Mitral valve regurgitation results in volume overload, followed by left ventricular remodeling. Variation of reverse remodeling following mitral repair influences the clinical outcomes. We aimed to evaluate the association between recurrent mitral regurgitation and mass regression following mitral valve repair and the impact on major adverse cardiovascular events. METHODS A retrospective cohort study was conducted on 164 consecutive patients with severe mitral regurgitation who underwent elective mitral valve repair. Subgroups were classified based on the presence of recurrent mitral regurgitation exceeding moderate severity. The hemodynamic parameters were evaluated according to geometry, mass, and function with Doppler echocardiography before and after surgery. Cox regression analysis was performed to evaluate the association between hemodynamics and mass regression and clinical outcomes. RESULTS The results for MR indicated 110 cases with non-recurrent MR and 54 with recurrent MR, along with 31 major adverse cardiovascular events. The tracked echocardiographic results revealed less reduction in dimension and volume, along with less mass regression in the recurrent MR subgroup. Significant differences were revealed in the relative change of the LV end-diastolic volume index and relative mass regression between subgroups. The relative change in the LVEDVI was proportionally correlated with relative mass regression. Cox regression analysis identified correlations with major adverse cardiovascular events, including suture annuloplasty, recurrent mitral regurgitation, tracked LV mass, relative LV mass regression, and systolic dysfunction. CONCLUSION LV mass regression and relative change of the LV end-diastolic volume could be risk predictors of recurrent mitral regurgitation. The extent of LV mass regression is correlated with adverse cardiac events.
Collapse
Affiliation(s)
- Chih-Yao Chiang
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, National Defense Medical Center, Taipei 114201, Taiwan
| | - Jih-Hsin Huang
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
| | - Kuan-Ming Chiu
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
| | - Jer-Shen Chen
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
| |
Collapse
|
4
|
Kumagai Y, Nakajima H, Nakajima T, Yoshitake A. Systolic anterior motion due to morphology changes in constrictive pericarditis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad146. [PMID: 37756689 DOI: 10.1093/icvts/ivad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023]
Abstract
Systolic anterior motion (SAM) can be caused by multifactorial mechanisms, including structural, morphological and functional factors. We report an unusual case of a 76-year-old woman presenting with SAM associated with constrictive pericarditis. Echocardiography showed no septal hypertrophy but SAM and left ventricular outflow tract obstruction and moderate mitral regurgitation. The restoration of diastolic function after complete pericardiectomy successfully eliminated it.
Collapse
Affiliation(s)
- Yu Kumagai
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Saitama Medical University, International Medical Center, Saitama, Japan
| |
Collapse
|
5
|
Timek TA. Commentary: Light on the long shadow of systolic anterior motion. J Thorac Cardiovasc Surg 2023; 165:92-93. [PMID: 33781597 DOI: 10.1016/j.jtcvs.2021.02.049] [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: 02/05/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Mich.
| |
Collapse
|
6
|
Systolic Anterior Motion of the Mitral Valve in the Presence of Annular Calcification. J Am Soc Echocardiogr 2022; 36:421-427. [PMID: 36529336 DOI: 10.1016/j.echo.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/19/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mitral annular calcification (MAC) has been reported as a possible cause of systolic anterior motion (SAM) of the mitral valve and dynamic left ventricular outflow tract (LVOT) obstruction. While morphologic features predisposing to SAM in other clinical settings have been described, patients with MAC+SAM have not been systematically investigated. We hypothesized that bulky calcium deposits in the mitral annulus could displace the valve toward the septum, thus promoting development of SAM. METHODS We studied 30 patients with severe MAC who had SAM with septal contact. Three comparator groups (matched for age and sex) were developed: 30 controls without MAC or SAM, 30 with severe MAC but no SAM, and 30 with SAM but no MAC. RESULTS Significant differences were found across groups for mitral valve coaptation point-septal distance (CSD), anterior mitral leaflet (AML) length, left ventricular diastolic dimension, and ejection fraction. Comparing all MAC subjects (n = 60) with controls, CSD was less (20.5 ± 4.1 vs 23.2 ± 3.7 mm, P = .003) and ejection fraction was higher (67.7% ± 7.8% vs 60.9% ± 6.4%, P < .0001) in MAC patients. Within MAC subjects AML was longer (21.9 ± 3.0 vs 17.4 ± 2.2 mm, P < .0001) and CSD was smaller (18.0 ± 2.7 vs 23.1 ± 3.6 mm, P < .0001) when SAM was present despite similar height of the calcium bar in the 2 MAC groups (12.4 ± 2.9 vs 11.1 ± 3.1 mm, P = .11). Regression analysis confirmed AML length and CSD as independent predictors of SAM. MAC+SAM patients also had more echocardiographic risk factors for SAM (acute aortomitral angle, small LVOT, long AML, small CSD, and presence of a septal bump) than MAC/no-SAM patients (3.4 ± 0.9 vs 1.8 ± 1.0, P < .0001). CONCLUSIONS Bulky MAC appears to contribute to dynamic LVOT obstruction when it accumulates in such a way that the mitral valve is displaced anteriorly toward the septum. However, other features are also associated with SAM in these patients, particularly a long AML. A combination of morphologic features and favorable hemodynamics may be needed for SAM to develop in patients with severe MAC.
Collapse
|
7
|
Usui A, Mutsuga M. Surgical Management for Systolic Anterior Motion (SAM) of the Mitral Valve in Obstructive Hypertrophic Myopathy. Ann Thorac Cardiovasc Surg 2022; 28:239-248. [PMID: 35851569 PMCID: PMC9433892 DOI: 10.5761/atcs.ra.22-00103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In patients with obstructive hypertrophic cardiomyopathy, left ventricular outflow tract (LVOT) obstruction can be created by the hypertrophic interventricular septum (IVS) as well as systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Sufficient septal myectomy is a fundamental surgical technique to treat LVOT obstruction, however, direct surgical management for SAM is another key aspect. Besides the hypertrophic IVS, mitral valve, subvalvular apparatus, and papillary muscle may play important role for SAM and several surgical techniques have been proposed to treat SAM in literature. In this review, each surgical technique is classified by the anatomical structure on which the surgical procedure is applied. The AML is the main surgical site and is applied with plication (vertical plication, resection–plication–release strategy), extension (the AML extension, transverse incision of the AML), sutured (edge-to-edge repair, anterior leaflet retention plasty), or traction (floating stitch, papillary muscle-to-anterior annulus stitches, paradoxical stitches, transposition of a directed chorda tendinea to the AML). Height reduction of the posterior mitral valve leaflet and papillary muscle reorientation are other techniques. We should understand theoretical aspects of each technique on correction of anatomical and functional abnormalities of the structure and should apply them under proper indication.
Collapse
Affiliation(s)
- Akihiko Usui
- Department of Cardiovascular Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
8
|
Morisaki A, Takahashi Y, Fujii H, Sakon Y, Murakami T, Shibata T. Outcomes of loop technique with ring annuloplasty: a > 10-year experience. Gan To Kagaku Ryoho 2022; 70:793-803. [PMID: 35349037 DOI: 10.1007/s11748-022-01804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We assessed the long-term outcomes of the loop technique with ring annuloplasty for mitral regurgitation from our > 10-year experience. METHODS We retrospectively reviewed 362 patients who underwent the loop technique with ring annuloplasty via median sternotomy or right mini-thoracotomy for mitral regurgitation. The median follow-up duration was 4.1 years (interquartile range 2.3-5.8 years). RESULTS This study involved 147 women and 215 men (median age, 66.5 years). Mitral regurgitation was caused by Barlow's disease in 27 patients. Seven patients required reoperations (recurrent regurgitation caused by technical issues, n = 3; progression of degenerative disease, n = 4). The 5- and 10-year cumulative incidences of reoperation considering death as the competing event were 1.4% and 5.4%, respectively. The 5- and 10-year postoperative cumulative incidences of moderate-to-severe recurrent mitral regurgitation were 4.7% and 13.0%, respectively. Residual regurgitation ≥ mild (hazard ratio, 6.99; 95% confidence interval, 1.520-32.12; P = .012) was an independent risk factor for reoperation. The independent risk factors for moderate-to-severe recurrent regurgitation were residual regurgitation ≥ mild (hazard ratio, 9.60; 95% confidence interval, 3.042-30.31; P < .001) and the loop-in-loop technique (hazard ratio, 3.40; 95% confidence interval, 1.058-10.90; P = .040). The median mean pressure gradient was sustained at almost 3.5 mmHg for > 7 years. CONCLUSIONS The loop technique with ring annuloplasty provided excellent results with good hemodynamics beyond the mid-term. Residual regurgitation ≥ mild and the loop-in-loop technique may not be preferable for durable outcomes.
Collapse
Affiliation(s)
- Akimasa Morisaki
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshito Sakon
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
9
|
Repair of Mitral Valves with Severe Annular Dilatation and Abundant Leaflet Tissue Using a Prosthetic Ring with a Large Anterior-Posterior Diameter. J Clin Med 2022; 11:jcm11061709. [PMID: 35330034 PMCID: PMC8955655 DOI: 10.3390/jcm11061709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
Backround: Mitral valve (MV) repair in the case of a large anterior-posterior diameter and redundant valve tissue remains challenging and favors repair with a ring that exhibits a large anterior-posterior diameter. Compared to other available rings, the Medtronic Simulus annuloplasty ring shows the largest anterior-posterior diameter. This study reports for the first time mid-term results using this annuloplasty ring. Methods: Between 11/2015 and 12/2019, a total of 378 patients underwent MV repair for degenerative mitral regurgitation using the Medtronic Simulus ring, according to the following selection criteria: large MV annuli, abundant leaflet tissue (i.e., Barlow disease), and risk for SAM. Results: Overall survival after 5 years was 90.8 ± 4.6%. Five patients required valve-related reoperations because of ring dehiscence (n = 1), progression of native valve disease (n = 2), dehiscence of quadrangular resection suture (n = 1), and endocarditis (n = 1). The cumulative incidence of valve-related reoperation at 5 years was 1.3 ± 0.5%. At latest follow-up, echocardiography demonstrated excellent valve function with no/mild MR in 299 patients (94.6%). Two patients (0.6%) had more than moderate MR. No patient developed SAM after repair. Conclusion: Repair of MV with large annuli and abundant leaflet tissue with the Medtronic Simulus annuloplasty ring shows excellent mid-term results regarding reoperation rates and recurrent MR.
Collapse
|
10
|
Nakamae K, Oshitomi T, Sassa T, Uesugi H. Surgical repair for systolic anterior motion of anterior mitral leaflet due to mitral annular calcification. Gen Thorac Cardiovasc Surg 2022; 70:398-401. [PMID: 35043386 DOI: 10.1007/s11748-021-01760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/11/2021] [Indexed: 12/01/2022]
Abstract
Systolic anterior motion of the anterior mitral leaflet with anterior displacement of the coaptation site of the bi-leaflets due to mitral annular calcification on the posterior side, causing left ventricular outflow tract obstruction, is rare. We report the case of a 72-year-old woman with exertional dyspnea due to systolic anterior motion who underwent surgical repair to decalcify the mitral annular calcification and mitral valve repair. Hence, the systolic anterior motion, mitral valve regurgitation, and symptoms improved significantly. This report illustrates the novelty of surgical technique, the indication, and the limitation of mitral valve repair for such rare cases. A proper understanding of the mechanism in each patient and enhanced techniques for decalcification of posterior mitral annular calcification are needed to treat such complex cases.
Collapse
Affiliation(s)
- Kosuke Nakamae
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan.
| | - Takashi Oshitomi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan
| | - Toshiharu Sassa
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan
| | - Hideyuki Uesugi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, Kumamoto, 861-4193, Japan
| |
Collapse
|
11
|
Burns DJ, Suri RM, Gillinov AM. Targeted triangular resection for repair of degenerative mitral valve disease. JTCVS Tech 2021; 10:47-52. [PMID: 34977704 PMCID: PMC8691865 DOI: 10.1016/j.xjtc.2021.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
|
12
|
Kagawa S, Abe Y, Matsumura Y, Nomura N, Shimeno K, Naruko T, Murakami T, Takahashi Y, Shibata T, Yoshiyama M. The Impact of Aorto-Mitral Angle on New-Onset Atrial Arrhythmia after Mitral Valve Repair in Patients with Mitral Regurgitation. Int Heart J 2021; 62:1273-1279. [PMID: 34789640 DOI: 10.1536/ihj.21-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this study, we hypothesized that post-operative aorto-mitral angle might be associated to the occurrence of post-operative atrial arrhythmia (AA), including atrial fibrillation and atrial tachycardia, after mitral valve repair in patients with mitral regurgitation (MR). Thus, this present study aims to determine the effects of post-operative aorto-mitral angle on new-onset AA after mitral valve repair with mitral annuloplasty for the treatment of MR.In total, 172 patients without any history of AA underwent mitral valve repair with mitral annuloplasty in our institution between 2008 and 2017. Patient information, including medical records and echocardiographic data, were retrospectively studied.As per our findings, AA occurred in 15 (8.7%) patients during the follow-up period (median, 35.7 months; range, 0.5-132 months). The patients with AA were noted to have a longer cardiopulmonary bypass time and a smaller aorto-mitral angle at post-operative TTE than the others (119 ± 6° versus 125 ± 10°, P = 0.003). No significant difference was noted in the degree of post-operative residual MR or functional MS between the groups. In a multivariate Cox proportional hazards analysis, the longer cardiopulmonary bypass time and the smaller post-operative aorto-mitral angle were independent predictors of the occurrence of AA during the follow-up period (odds ratio per 10 minutes 1.11; 95% CI 1.02-1.22, P = 0.019: odds ratio 0.91; 95% CI 0.85-0.98, P = 0.012).A small aorto-mitral angle at post-operative TTE was determined to be a predictor of new-onset AA after a mitral valve repair for treating MR.
Collapse
Affiliation(s)
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | | | - Nanaka Nomura
- Department of Cardiology, Osaka City General Hospital
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital
| | | | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City General Hospital
| | | | | | | |
Collapse
|
13
|
Morcous S, Kumar R, Patel M, Liang Y. Hypoxemia secondary to acute mitral regurgitation induced by systolic anterior motion of the mitral valve during lung transplantation. J Clin Anesth 2021; 75:110520. [PMID: 34798702 DOI: 10.1016/j.jclinane.2021.110520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Shaker Morcous
- Department of Anesthesiology (S.M., R.K., Y.L.), Department of Advanced Cardiopulmonary Therapies and Transplantation (M.P.), McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Rishi Kumar
- Department of Anesthesiology (S.M., R.K., Y.L.), Department of Advanced Cardiopulmonary Therapies and Transplantation (M.P.), McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Manish Patel
- Department of Anesthesiology (S.M., R.K., Y.L.), Department of Advanced Cardiopulmonary Therapies and Transplantation (M.P.), McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Yafen Liang
- Department of Anesthesiology (S.M., R.K., Y.L.), Department of Advanced Cardiopulmonary Therapies and Transplantation (M.P.), McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX, United States of America.
| |
Collapse
|
14
|
Ishizu K, Isotani A, Shirai S, Ando K. Percutaneous mitral valve edge-to-edge repair for late systolic anterior motion after surgical mitral valve repair: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab216. [PMID: 34738052 PMCID: PMC8564687 DOI: 10.1093/ehjcr/ytab216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/12/2021] [Accepted: 05/14/2021] [Indexed: 11/14/2022]
Abstract
Background Late post-operative systolic anterior motion (SAM) is a rare but challenging issue. The feasibility of percutaneous mitral valve edge-to-edge repair (PMVR) using the MitraClip to treat late refractory SAM after surgical mitral valve repair has rarely been reported in the literature. Case summary An 88-year-old woman with a history of mitral valve repair for a P2 prolapse 14 years before, presented with signs of congestive heart failure. Transoesophageal echocardiogram (TOE) demonstrated significant SAM of the anterior mitral leaflet, resulting in the detachment from the posterior mitral leaflet in mid-to-late systole and severe mitral regurgitation (MR). The heart team decided to perform PMVR using the MitraClip to simultaneously address the issues of SAM and MR, considering the patient's high surgical risk. TOE after the clip deployment at the medial edge of the mitral valve, where the most severe SAM was detected, confirmed resolution of SAM with marked reduction of MR. The patient was discharged home with good haemodynamic compensation. Discussion Post-operative SAM typically occurs immediately after the reparative surgery and resolves with conservative treatment; however, persistent SAM requiring repeat surgery remains a serious concern. As an alternative strategy, the MitraClip has some advantages, including low procedural risk, immediately observable results, and the ability to relocate the clip. Meanwhile, the greater risk of post-procedural mitral stenosis, particularly in patients undergoing mitral repair, should be taken into account. In our case, the clip deployment at the medial edge of the valve could minimize the progression of mitral stenosis with a satisfactory reduction of MR.
Collapse
Affiliation(s)
- Kenichi Ishizu
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| | - Akihiro Isotani
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| |
Collapse
|
15
|
Xiao M, Nie C, Wang J, Zhu C, Sun X, Zhu Z, Wang H, Wang S. Left ventricular basal muscle bundle in hypertrophic cardiomyopathy: insights into the mechanism of left ventricular outflow tract obstruction. Eur Heart J Cardiovasc Imaging 2021; 23:1018-1026. [PMID: 34718482 DOI: 10.1093/ehjci/jeab200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/18/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS Many factors cause left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM). Previous studies reported that left ventricular basal muscle bundle (BMB) may be associated with LVOTO. We aimed to evaluate the role of BMB in LVOTO by echocardiography. METHODS AND RESULTS Two hundred fifty-six patients diagnosed with HCM were recruited. The morphologic characteristics of left ventricular outflow tract (LVOT) were analysed. BMB was detected in 178 (69.5%) patients by echocardiography. Patients were separated by a resting or provocative LVOT gradient ≥30 mmHg or not. Compared to patients without LVOTO, patients with LVOTO had a significantly thicker basal septum, elongated anterior mitral leaflet (AML), shorter distance between the AML-free margin and the septum or BMB (M-sept/bundle), larger angle between the plane of the mitral valvular orifice and the ascending aorta (MV-AO angle), and higher prevalence of BMB (P < 0.05). According to multivariate analysis, the independent predictors of LVOTO were the presence of BMB, a large basal septum thickness, a short M-sept/bundle, a large MV-AO angle, and a large AML [odds ratio (95% confidence interval): 5.207 (1.381-19.633), 1.386(1.141-1.683), 0.615(0.499-0.756), 1.113(1.054-1.176), and 1.343(1.076-1.677), respectively, P < 0.05]. Of the 256 included patients, 139 underwent surgical myectomy. The transthoracic echocardiography, compared with surgical specimen, showed: sensitivity 98.3%, specificity 82.3%, positive predictive value 97.6%, negative predictive value 87.5%, and accuracy 96.4% to detect BMB. CONCLUSIONS BMB is common in HCM. BMB is a risk factor for LVOTO.
Collapse
Affiliation(s)
- Minghu Xiao
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Changrong Nie
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Jingjin Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Changsheng Zhu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Xin Sun
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Zhenhui Zhu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
| |
Collapse
|
16
|
Hashmi FH. Enlargement of left ventricular outflow tract using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach for the treatment of hypertrophic obstructive cardiomyopathy. J Card Surg 2021; 36:4203-4204. [PMID: 34453351 DOI: 10.1111/jocs.15951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Fayyaz H Hashmi
- Johns Hopkins Cardiothoracic Surgery, Suburban Hospital, Bethesda, Maryland, USA
| |
Collapse
|
17
|
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]
|
18
|
Wang H, Song H, Yang Y, Wu Z, Hu R, Chen J, Guo J, Wang Y, Jia D, Cao S, Zhou Q, Guo R. Hemodynamic testing using three-dimensional printing and computational fluid dynamics preoperatively may provide more information in mitral repair than traditional image dataset. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:632. [PMID: 33987330 PMCID: PMC8106081 DOI: 10.21037/atm-20-7960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Mitral valve repair (MVR) has been considered superior to mitral replacement for degenerative MV disease and even rheumatic diseases. However, the repair rate varies widely depending on the medical center and the surgeons’ experience. The aim of our study was to apply three-dimensional printing (3DP) and computational fluid dynamics (CFD) in surgical simulation to provide reference for surgical decision-making, especially for inexperienced surgeons. Methods Our study included retrospective and prospective cohorts. We first enrolled the retrospective cohort of 35 patients who were prepared to have MVR, aiming at exploring the feasibility of surgical simulation using 3DP and CFD. Three-dimensional transesophageal echocardiography (3D-TEE) and computed tomography angiography (CTA) were performed for all patients, and imaging data were fused to construct a 3D digital model. Next, the model was used to make the 3DP dynamic model and for CFD analysis. Mitral repair was simulated in both the 3DP dynamic model and CFD to predict surgical outcomes (grade of regurgitation and vena contracta width) and possible complications (systolic anterior motion, left ventricular outflow tract obstruction). Second, a prospective cohort of 20 patients was studied with 10 patients placed in a 3DP-guided group and 10 in an image-guided group. Rate of transformation to mitral replacement, surgery time, surgical outcomes, and surgical complications were compared between groups. Results Of the 35 patients retrospectively enrolled, 14 underwent MVR and 21 were transferred to mitral replacement. Surgical simulation for the 14 MVR patients showed high consistency with in vivo results. The result of surgical simulation for the 21 patients transferred to mitral replacement showed that 7 might have benefited from MVR. In the prospective cohort, the rate of transformation to mitral replacement and surgery time in the 3DP-guided group were significantly lower than those in the image-guided group. Conclusions 3DP and CFD models based on image data can be used for in vitro surgical simulation. These emerging technologies are now changing traditional models of diagnosis and treatment, and the role of imaging data will no longer be limited to diagnosis but will contribute more to assisting surgeons in choosing treatment strategies.
Collapse
Affiliation(s)
- Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiyong Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rui Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Juan Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ruiqiang Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
19
|
Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease. Clin Res Cardiol 2021; 110:1881-1889. [PMID: 33792775 PMCID: PMC8639536 DOI: 10.1007/s00392-021-01844-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022]
Abstract
Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.
Collapse
|
20
|
Ram E, Schwammenthal E, Kuperstein R, Jamal T, Nahum E, Sternik L, Raanani E. Secondary chordal resection with septal myectomy for treatment of symptomatic obstructive hypertrophic cardiomyopathy. Eur J Cardiothorac Surg 2021; 60:699-707. [PMID: 33693690 DOI: 10.1093/ejcts/ezab116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/09/2021] [Accepted: 01/31/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Left ventricular outflow tract obstruction causes symptoms of heart failure in most patients with hypertrophic cardiomyopathy. Resection of the secondary mitral valve (MV) chordae has recently been shown to move the MV apparatus posteriorly, thereby eradicating the outflow gradient. The aim of this study was to evaluate whether secondary chordal resection concomitant to septal myectomy improves outcomes. METHODS Between 2005 and 2020, a total of 165 patients underwent septal myectomy without MV repair or replacement in our Medical Center. Secondary MV chordal resection was performed in 60 patients, and their outcomes were compared with those of the remaining 105 patients who did not undergo chordal resection (controls). Mean age was 61 ± 13 and 58 ± 16 years, respectively (P = 0.205). RESULTS There were no in-hospital deaths throughout the entire cohort. Of those patients who underwent secondary chordal resection, New York Heart Association functional class decreased from 3 (interquartile range 2-3) preoperatively to 1 (interquartile range 1-2) postoperatively (P < 0.001), and resting outflow gradient decreased from 91 ± 39 mmHg to 13 ± 8 mmHg (86% change, P < 0.001). Compared with controls, patients who underwent secondary chordal resection had a significant lower resting outflow gradient at follow-up (14 ± 7 mmHg vs 21 ± 15 mmHg, P = 0.002). The rate of moderate or more than moderate mitral regurgitation at 5 years was 2% in the secondary chordal resection group and 5% in the controls (hazard ratio 1.05, confidence interval 0.11-10.32; P = 0.965). CONCLUSIONS In this observational study, we report that secondary chordal resection concomitant to septal myectomy for left ventricular outflow tract obstruction is safe, relieves heart failure symptoms and reduces left ventricular outflow tract gradient in appropriately selected patients.
Collapse
Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Schwammenthal
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Rafael Kuperstein
- Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Tamer Jamal
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Nahum
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel.,Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
21
|
Morita S, Takahashi S, Pernot M, Leroux L, Labrousse L. Open heart mitral valve replacement using the Edwards-Sapien 3 for severe mitral annular calcification prevents left ventricular outflow tract obstruction. Clin Case Rep 2021; 9:1424-1427. [PMID: 33768859 PMCID: PMC7981714 DOI: 10.1002/ccr3.3796] [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: 07/07/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022] Open
Abstract
Open heart transcatheter mitral valve implantation using the Edwards-Sapien 3 for mitral annular calcification is a safe procedure, because surgeons do not have to decalcify. And also, surgeons can resect the anterior mitral leaflet to prevent left ventricular outflow tract obstruction and deploy the valve under direct visualization.
Collapse
Affiliation(s)
- Shohei Morita
- Department of Cardiovascular SurgeryHiroshima University HospitalHiroshimaJapan
| | - Shinya Takahashi
- Department of Cardiovascular SurgeryHiroshima University HospitalHiroshimaJapan
| | - Mathieu Pernot
- Medico‐Surgical Department of ValvulopathiesHaut Leveque HospitalBordeauxFrance
| | - Lionel Leroux
- Medico‐Surgical Department of ValvulopathiesHaut Leveque HospitalBordeauxFrance
| | - Louis Labrousse
- Medico‐Surgical Department of ValvulopathiesHaut Leveque HospitalBordeauxFrance
| |
Collapse
|
22
|
Yu S, Peffley S, Fabbro M, Mohammed AN. A Narrative Review of the 2020 Guidelines for Use of Transesophageal Echocardiography to Assist with Surgical Decision- Making by the Cardiac Anesthesiologist in the Operating Room. J Cardiothorac Vasc Anesth 2021; 36:258-274. [PMID: 33744115 DOI: 10.1053/j.jvca.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/25/2023]
Abstract
Transesophageal echocardiography (TEE) has become an integral part in helping to diagnose, manage, and assess interventions in the cardiac operating room. Multiple guidelines have been created by the American Society of Echocardiography for performing a TEE examination for different cardiac pathologies. The operating room can provide unique challenges when performing a TEE examination, which include hemodynamic instability, time constraints, and use of general anesthesia. The Guideline for the use of TEE to assist in surgical decision- making in the operating room recently was published to provide a starting protocol for conducting a TEE examination for different cardiac surgeries and for using the information obtained to interpret and to communicate findings to the surgical team. This present narrative review focuses and expands upon the relevant portions for the cardiac anesthesiologist.
Collapse
Affiliation(s)
- Soojie Yu
- Department of Anesthesiology, University of Arizona College of Medicine, Tucson, AZ.
| | - Sultana Peffley
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| | - Michael Fabbro
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| | - Asif Neil Mohammed
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
23
|
Nicoara A, Skubas N, Swaminathan M. Of Heights, Lengths, and Distances. J Am Soc Echocardiogr 2021; 34:104. [DOI: 10.1016/j.echo.2020.08.021] [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: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 01/07/2023]
|
24
|
Morita S, Takahashi S, Pernot M, Leroux L, Labrousse L. Open-heart transseptal transcatheter mitral valve implantation with mitral annular calcification. J Cardiol Cases 2020; 22:207-209. [PMID: 33133310 PMCID: PMC7588478 DOI: 10.1016/j.jccase.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/07/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022] Open
Abstract
Mitral valve replacement (MVR) using a prosthesis of transcatheter aortic valve implantation for mitral annular calcification (MAC) is an alternative procedure which is very different from a conventional MVR and is safe. Acceptable results including mortality and morbidity have been reported. We report the case of a male patient treated with this procedure. There was a risk of left ventricular rupture due to extensive decalcification, so we performed transcatheter mitral valve implantation (TMVI). Since he had a history of surgical aortic valve replacement (AVR), we chose open-heart transseptal approach so as not to interfere with the aortic prosthesis. TMVI has a risk of an iatrogenic left ventricular outflow tract (LVOT) obstruction. Using open-heart transseptal approach, we could easily check an anterior commissure of mitral annulus to prevent LVOT obstruction. .
Collapse
Affiliation(s)
- Shohei Morita
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Mathieu Pernot
- Medico-Surgical Department of Valvulopathies, University Hospital of Bordeaux, Bordeaux, France
| | - Lionel Leroux
- Medico-Surgical Department of Valvulopathies, University Hospital of Bordeaux, Bordeaux, France
| | - Louis Labrousse
- Medico-Surgical Department of Valvulopathies, University Hospital of Bordeaux, Bordeaux, France
| |
Collapse
|
25
|
Moore RA, Gillinov AM, Burns DJ, Pettersson GB, Wierup P. Techniques for Mitral Valve Re-repair. ACTA ACUST UNITED AC 2020; 26:42-65. [PMID: 34321958 DOI: 10.1053/j.optechstcvs.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The emergence of mitral valve repair as the preferred treatment for severe mitral regurgitation (MR) caused by degenerative disease has been accompanied by an increasing number of valve repair failures seen by surgeons. Consequently, the feasibility of valve re-repair vs valve replacement at the time of reoperation has become a valid clinical consideration. In this report we explore the mechanisms of mitral valve repair failure as well as factors that meaningfully influence the likelihood of a successful re-repair. We provide illustrations of techniques for re-repair that we have used with reliable success, informed by the mechanism of repair failure. Lastly, we share our outcomes for mitral valve re-repair over the last 5 years and discuss our experience using the techniques illustrated in this report.
Collapse
Affiliation(s)
- Ryan A Moore
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel Jp Burns
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
26
|
Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). ACTA ACUST UNITED AC 2020; 67:446-480. [PMID: 32948329 DOI: 10.1016/j.redar.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
Collapse
Affiliation(s)
- P Carmona García
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Coordinadora del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SEDAR
| | - R García Fuster
- Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, España. Coordinador del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SECCE.
| | - E Mateo
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - S Badía Gamarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Trías y Pujol, Badalona, España
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España
| | - E Gutiérrez Carretero
- Servicio de Cirugía Cardiaca, Hospital, Universitario Virgen del Rocío, Sevilla, España
| | - M L Maestre
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - V Legname
- Servicio de Cirugía Cardiaca, Centro Médico Teknon, Barcelona, España
| | - G Fita
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación. Hospital Clínic, Barcelona, España
| | - M Vives
- EDAIC. PhD. Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Universitario Dr Josep Trueta de Girona, España. Representante de España en la EACTA. Co-director del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Representante del subcomité de Educación de EACTA. Co-director grupo EchoSim
| | - T Koller Bernhard
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Sánchez Pérez
- EDAIC. Sección de Cirugía Cardiaca, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR
| | - J Miralles Bagán
- Sección Cardiotorácica, Servicio Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - S Italiano
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - B Darias-Delbey
- Servicio Anestesiología y Reanimación, Proceso del Paciente, Cardioquirúrgico, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, España
| | - J M Barrio
- Sección Anestesia y Reanimación Cardiovascular, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General. Universitario Gregorio Marañón, Madrid, España
| | - J I Sáez de Ibarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - A Hernández
- Departamento de Anestesia y Cuidados Intensivos, Grupo Policlínica, Ibiza, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos, de la SEDAR Representante del subcomité de Educación de EACTA, EDAIC, Codirector grupo EchoSim
| |
Collapse
|
27
|
Correctly Estimating Systolic Anterior Motion Risk: Seeking Guidance from the Guidelines. J Am Soc Echocardiogr 2020; 34:103. [PMID: 32919853 DOI: 10.1016/j.echo.2020.08.002] [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: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 11/22/2022]
|
28
|
Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
29
|
Maslow A, Hunter C, Chen T, Gorgone M, Klick J, Atalay M, Mahmood F. The Mitral Coaptation to Ventricular Septal Space: Two- and Three-Dimensional Transesophageal Echocardiographic Assessment. J Cardiothorac Vasc Anesth 2020; 35:187-196. [PMID: 32807602 DOI: 10.1053/j.jvca.2020.07.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the dimensions and changes in the CSEPT (space between the ventricular septum and mitral coaptation point) before and after cardiopulmonary bypass (CPB) and to compare patients with and without aortic valve stenosis (AS) undergoing cardiac surgery. DESIGN Retrospective review of intraoperative transesophageal echocardiographic examinations. SETTING Single academic medical center. PARTICIPANTS The study comprised 91 elective cardiac surgical patients-30 with AS scheduled for aortic valve replacement and 61 without AS (non-AS). INTERVENTIONS Two- and 3-dimensional (2D and 3D) analysis of the CSEPT before and after CPB. MEASUREMENTS AND MAIN RESULTS Assessment of the CSEPT distances and areas was performed using 2D and 3D imaging before and after CPB. Two-dimensional measures of CSEPT distances were performed using midesophageal 5-chamber and long-axis windows. Three-dimensional measures were performed offline using multiplanar reconstruction. The CSEPT space was smaller after CPB (p < 0.01). Before and after CPB, the midesophageal 5-chamber and long-axis windows were similar to each other, and both were larger than the pre-CPB 3D CSEPT distance. Patients with AS had smaller before and after CPB distances and areas compared with non-AS patients (p < 0.05). The change in CSEPT area in AS patients was 24%. CONCLUSIONS The CSEPT space is smaller after CPB and more so for patients with AS undergoing aortic valve replacement. Two-dimensional CEPT distances vary compared with 3D CSEPT distances. Additional study using Doppler analysis will elucidate the added value of 3D assessment of the CSEPT space.
Collapse
Affiliation(s)
- Andrew Maslow
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI.
| | - Caroline Hunter
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Tzonghuei Chen
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Michelle Gorgone
- Departments of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT
| | - Michael Atalay
- Department of Radiology, Rhode Island Hospital, Providence, RI
| | - Feroze Mahmood
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
30
|
Koide M, Kyodo A, Fukui K, Irie D, Matsuo A, Akabame S. Systolic anterior motion of the posterior mitral leaflet in obstructive hypertrophic cardiomyopathy with Noonan syndrome. J Echocardiogr 2020; 19:260-262. [PMID: 32462482 DOI: 10.1007/s12574-020-00477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Masahiro Koide
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, 100, Nishinokuchi, Sayama, Kumiyama, Kyoto, 613-0034, Japan. .,Department of Cardiovascular Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
| | - Atsushi Kyodo
- Department of Cardiovascular Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.,Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Kento Fukui
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, 100, Nishinokuchi, Sayama, Kumiyama, Kyoto, 613-0034, Japan.,Department of Cardiovascular Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Daisuke Irie
- Department of Cardiovascular Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Akiko Matsuo
- Department of Cardiovascular Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Satoshi Akabame
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, 100, Nishinokuchi, Sayama, Kumiyama, Kyoto, 613-0034, Japan
| |
Collapse
|
31
|
Makhija N, Magoon R, Balakrishnan I, Das S, Malik V, Gharde P. Left ventricular outflow tract obstruction following aortic valve replacement: A review of risk factors, mechanism, and management. Ann Card Anaesth 2020; 22:1-5. [PMID: 30648672 PMCID: PMC6350428 DOI: 10.4103/aca.aca_226_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The presence of dynamic left ventricular outflow tract obstruction (LVOTO) can complicate the postoperative course of patients undergoing surgical aortic valve replacement (AVR). The phenomenon of LVOTO is a consequence of an interplay of various pathoanatomic mechanisms. The prevailing cardiovascular milieu dictates the hemodynamic significance of the resultant LVOTO in addition to the anatomical risk factors. A thorough understanding of the predisposing factors, mechanism, and hemodynamic sequel of the obstruction is pivotal in managing these cases. A comprehensive echocardiographic examination aids in risk prediction, diagnosis, severity characterization, and follow-up of management efficacy in the setting of postoperative LVOTO. The armamentarium of management modalities includes conservative (medical) and surgical options. A stepwise approach should be formulated based on the physiological and anatomical substrates predisposing to LVOTO. The index phenomenon occurs more frequently than appreciated and should be considered when the post-AVR patients exhibit hemodynamic instability unresponsive to conventional supportive measures. The present article provides an overview of various peculiarities of this under-recognized phenomenon in the context of the perioperative management of patients undergoing AVR.
Collapse
Affiliation(s)
- Neeti Makhija
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Ira Balakrishnan
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Sambhunath Das
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| | - Parag Gharde
- Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNC, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
32
|
MacKay EJ, Neuman MD, Fleisher LA, Patel PA, Gutsche JT, Augoustides JG, Desai ND, Groeneveld PW. Transesophageal Echocardiography, Mortality, and Length of Hospitalization after Cardiac Valve Surgery. J Am Soc Echocardiogr 2020; 33:756-762.e1. [PMID: 32222480 DOI: 10.1016/j.echo.2020.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite recommendations regarding the use of intraoperative transesophageal echocardiography (TEE), there is no randomized evidence to support its use in cardiac valve surgery. The purpose of this study was to compare the clinical outcomes of patients undergoing open cardiac valve repair or replacement surgery with and without transesophageal echocardiographic monitoring. The hypothesis was that transesophageal echocardiographic monitoring would be associated with lower 30-day mortality and shorter length of hospitalization. METHODS In this observational retrospective cohort study, Medicare claims were used to test the association between perioperative TEE and 30-day all-cause mortality and length of hospitalization among patients undergoing open cardiac valve repair or replacement surgery between January 1, 2010, and October 1, 2015. Baseline characteristics were defined by inpatient and outpatient claims. Medicare death records were used to ascertain 30-day mortality. Statistical analyses included regression models and propensity score matching. RESULTS A total of 219,238 patients underwent open cardiac valve surgery, of whom 85% underwent TEE. Patients who underwent TEE were significantly older and had greater comorbidities. After adjusting for patient demographics, clinical comorbidities, surgical characteristics, and hospital factors, including annual surgical volume, the TEE group had a lower adjusted odds of 30-day mortality (odds ratio, 0.77; 95% CI, 0.73 to 0.82; P < .001), with no difference in length of hospitalization (<0.01%; 95% CI, -0.61% to 0.62%; P = .99). Results were similar across all analyses, including a propensity score-matched cohort. CONCLUSIONS Transesophageal echocardiographic monitoring in cardiac valve repair or replacement surgery was associated with lower 30-day risk-adjusted mortality, without a significant increase in length of hospitalization. These findings support the use of TEE as routine practice in open cardiac valve repair or replacement surgery.
Collapse
Affiliation(s)
- Emily J MacKay
- Department of Anesthesiology & Critical Care, Philadelphia, Pennsylvania; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania; Penn Center for Perioperative Outcomes Research and Transformation, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Mark D Neuman
- Department of Anesthesiology & Critical Care, Philadelphia, Pennsylvania; Penn Center for Perioperative Outcomes Research and Transformation, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee A Fleisher
- Department of Anesthesiology & Critical Care, Philadelphia, Pennsylvania
| | - Prakash A Patel
- Department of Anesthesiology & Critical Care, Philadelphia, Pennsylvania; Penn Center for Perioperative Outcomes Research and Transformation, Philadelphia, Pennsylvania
| | - Jacob T Gutsche
- Department of Anesthesiology & Critical Care, Philadelphia, Pennsylvania
| | - John G Augoustides
- Department of Anesthesiology & Critical Care, Philadelphia, Pennsylvania
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, Philadelphia, Pennsylvania; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter W Groeneveld
- Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
33
|
Cimino S, Guarracino F, Valenti V, Frati G, Sciarretta S, Miraldi F, Agati L, Greco E. Echocardiography and Correction of Mitral Regurgitation: An Unbreakable Link. Cardiology 2019; 145:110-120. [DOI: 10.1159/000504248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/19/2019] [Indexed: 11/19/2022]
Abstract
Background: Degenerative mitral valve (MV) disease causing mitral regurgitation (MR) is the most common organic valve pathology and is classified based on leaflet motion. MV repair is indicated as the preferred technique (Class I indication) when the results are expected to be durable. Therefore, a detailed and systematic evaluation of MV apparatus is pivotal in allowing the proper surgical planning, as well as the screening for trans catheter-based treatment when surgery is not indicated. Aim: The aim of the present review is to describe the crucial role of both Transthoracic Echocardiography (TTE) and Transesophageal Echocardiography (TEE) in the decisional process and the guidance of MV repair procedures. TTE is the main investigation and the first approach used to make diagnosis of MR, to assess the severity and to describe the underlying mechanism, while TEE, especially with 3D echocardiography, has been shown to be useful for clarifying complicated valvular anatomy, assessing the surgical result and detecting complications. The surgical treatment of MR takes advantage of ultrasound evaluation of MV apparatus at any stage of the process, thus making the link between surgery and echocardiography unbreakable throughout the perioperative phase.
Collapse
|
34
|
Jain CC, Newman DB, Geske JB. Mitral Valve Disease in Hypertrophic Cardiomyopathy:Evaluation and Management. Curr Cardiol Rep 2019; 21:136. [DOI: 10.1007/s11886-019-1231-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
35
|
Sideris K, Boehm J, Voss B, Guenther T, Lange RS, Guenzinger R. Functional and Degenerative Mitral Regurgitation: One Ring Fits All? Thorac Cardiovasc Surg 2019; 68:470-477. [PMID: 31546265 DOI: 10.1055/s-0039-1696989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Three-dimensional saddle-shaped annuloplasty rings have been shown to create a larger surface of leaflet coaptation in mitral valve repair (MVR) for functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR) which may increase repair durability. For the first time, this study reports mid-term results after MVR for DMR and FMR using a rigid three-dimensional ring (Profile 3D, Medtronic). METHODS Between June 2009 and June 2012, 369 patients with DMR (n = 326) or FMR (n = 43) underwent MVR (mean age 62.3 ± 12.6 years). A total of 205 patients (55.6%) underwent isolated MVR and 164 patients (44.4%) a combined procedure. Follow-up examinations were performed in 94.9% (mean 4.9 ± 0.9 years). Echocardiographic assessment was complete in 93.2% (mean 4.3 ± 1.2 years). RESULTS The 30-day mortality was 1.5% (5/326) for DMR (1.5% for isolated and 1.6% for combined procedures) and 9.3% (4/43) for FMR (0% for isolated and 10.5% for combined procedures). Survival at 6 years was 92.1 ± 1.9% for DMR (92.9 ± 2.6% for isolated and 90.7 ± 2.7% for combined procedures) and 66.4 ± 7.9% for FMR (80.0 ± 17.9% for isolated and 63.7 ± 8.9% for combined procedures). Cumulative risk for mitral valve-related reoperation at 6 years was 0% for FMR and 7.1 ± 1.5% for DMR. At echocardiographic follow-up, one patient presented with mitral regurgitation (MR) more than moderate. The only predictor of recurrent MR after MVR for DMR was residual mild MR at discharge. CONCLUSION Repair of FMR with the three-dimensional Profile 3D annuloplasty ring shows excellent mid-term results with regard to recurrence of MR. In cases of DMR, the results are conforming to the current literature.
Collapse
Affiliation(s)
- Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Johannes Boehm
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Thomas Guenther
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Ruediger S Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Ralf Guenzinger
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany
| |
Collapse
|
36
|
Mantovani F, Bursi F, Di Giannuario G, Barbieri A. Echocardiographic prediction of surgical reparability in degenerative mitral regurgitation due to leaflet prolapse: a review. Expert Rev Cardiovasc Ther 2019; 17:653-662. [PMID: 31483165 DOI: 10.1080/14779072.2019.1664289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Despite current guidelines provide recommendations for the optimal management of degenerative mitral regurgitation (MR), this condition remains often undertreated with delay in surgical referral and dismal effect on outcomes. Areas covered: This review focuses on the role of echocardiography in guiding mitral valve (MV) surgical repair in degenerative MR due to leaflet prolapse. Expert opinion: A stepwise protocol-driven echocardiography shared by referring physician and surgeon may help to guide referral to surgical repair in degenerative MR. This protocol particularly is useful to identify the ideal patho-anatomy for a successful and durable repair especially when early surgery is proposed and to refer the patient to centers of excellence in case of complex anatomy. Nearly 100% repair rate can be achieved when the surgical technique is adapted to the lesions seen in each valve. Three-dimensional echocardiography predicts repair complexity may be useful and should therefore be implemented. However, the current literature is far from comprehensive deriving from small, single-center studies. Therefore, reproducibility and external validation, especially with newly developed quantitative automated software, are still needed.
Collapse
Affiliation(s)
- Francesca Mantovani
- Department of Cardiology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia , Reggio Emilia , Italy
| | - Francesca Bursi
- Department of Cardiology, Azienda Socio Sanitaria Territoriale (A.S.S.T.) SANTI PAOLO E CARLO - Presidio Ospedale San Paolo , Milano , Italy
| | | | - Andrea Barbieri
- Department of Cardiology, Azienda Ospedaliera-Universitaria di Modena , Modena , Italy
| |
Collapse
|
37
|
Khanra D, Tiwari P, Shrivastava Y, Duggal B. Systolic anterior motion: an unusual cause of late mitral valve repair failure. BMJ Case Rep 2019; 12:12/7/e231301. [PMID: 31350234 DOI: 10.1136/bcr-2019-231301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dibbendhu Khanra
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Yash Shrivastava
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhanu Duggal
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
38
|
Soeding PF, Steel A, Wong J, Hoy GA. Focused cardiac echocardiography in beach-chair position surgery: A case study. Anaesth Intensive Care 2019; 47:385-388. [PMID: 31299864 DOI: 10.1177/0310057x19863067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The haemodynamic response to the beach-chair position may be affected by the presence of left ventricular hypertrophy where remodelling of cardiac chambers can potentially lead to left ventricular outflow tract obstruction. We present a case report of severe hypotension in the beach-chair position, where focused cardiac ultrasound identified left ventricular hypertrophy and geometric features that contributed to the hypotensive response. This case illustrates that focused cardiac ultrasound has the potential to alert the clinician preoperatively to left ventricular outflow tract obstruction susceptibility during surgery in the beach-chair position, and intraoperatively to direct management should sudden decreases in blood pressure occur.
Collapse
Affiliation(s)
- Paul F Soeding
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia
| | - Amelia Steel
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - James Wong
- The University of Melbourne, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Gregory A Hoy
- Melbourne Orthopaedic Group, The Avenue Hospital, Windsor, Australia.,Monash University, Melbourne, Australia
| |
Collapse
|
39
|
Silbiger JJ, Lee S, Christia P, Perk G. Mechanisms, pathophysiology, and diagnostic imaging of left ventricular outflow tract obstruction following mitral valve surgery and transcatheter mitral valve replacement. Echocardiography 2019; 36:1165-1172. [DOI: 10.1111/echo.14370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/06/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Samantha Lee
- Icahn School of Medicine at Mount Sinai New York New York
| | | | - Gila Perk
- Icahn School of Medicine at Mount Sinai New York New York
| |
Collapse
|
40
|
Di Labbio G, Kadem L. Response to letter to the editor: 'Left ventricular flow in the presence of aortic regurgitation'. J Biomech 2019; 87:212-214. [PMID: 30871721 DOI: 10.1016/j.jbiomech.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/03/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Giuseppe Di Labbio
- Laboratory of Cardiovascular Fluid Dynamics (LCFD), Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montréal, Québec, Canada.
| | - Lyes Kadem
- Laboratory of Cardiovascular Fluid Dynamics (LCFD), Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montréal, Québec, Canada
| |
Collapse
|
41
|
Ben-Shoshan J, Wang DD, Asgar AW. Left Ventricular Outflow Tract Obstruction: A Potential Obstacle for Transcatheter Mitral Valve Therapy. Interv Cardiol Clin 2019; 8:269-278. [PMID: 31078182 DOI: 10.1016/j.iccl.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Transcatheter mitral valve replacement is the focus of much enthusiasm as the future of therapy for mitral valve disease. Despite technological advances, left ventricular outflow tract (LVOT) obstruction from the valve prosthesis remains an important issue. In this review the authors discuss the pathophysiology of LVOT obstruction in both the surgical and transcatheter experience, imaging evaluation preprocedure, outcomes to date, and therapeutic options.
Collapse
Affiliation(s)
- Jeremy Ben-Shoshan
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada; Université de Montréal, 5000 rue Belanger, Montreal, Quebec H1T1C8, Canada
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Anita W Asgar
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada; Université de Montréal, 5000 rue Belanger, Montreal, Quebec H1T1C8, Canada.
| |
Collapse
|
42
|
Richens D, Boulemden A, Skinner H. Repair of degenerative mitral regurgitation: An update. Glob Cardiol Sci Pract 2019; 2019:4. [PMID: 31024946 PMCID: PMC6472690 DOI: 10.21542/gcsp.2019.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The recent development of catheter-based therapies for structural valve disease, such as mitral-TAVI, MitraClip and left atrial appendage occlusion devices, makes a review of surgery for degenerative mitral valve disease timely. In this personal perspective we discuss the evolution of mitral valve repair, the core principles involved and the evidence base behind it through the lens of a single UK-based surgical team operating for a quarter century, illustrating the techniques, outcomes and some of the pitfalls of intervention.
Collapse
Affiliation(s)
- David Richens
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - Anas Boulemden
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - Henry Skinner
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| |
Collapse
|
43
|
Jain P, Fabbro M. ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Review of the 2017 Document for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2019; 33:274-289. [DOI: 10.1053/j.jvca.2018.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Indexed: 12/12/2022]
|
44
|
Doenst T. The art of mitral valve repair: Recreating nature or learning from it? J Thorac Cardiovasc Surg 2018; 157:941-942. [PMID: 30266390 DOI: 10.1016/j.jtcvs.2018.08.017] [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: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
| |
Collapse
|
45
|
Aggarwal N, Khanuja JS, Arora SS, Maria R. Abnormal mitral valve apparatus in a case of hypertrophic obstructive cardiomyopathy: Intraoperative transesophageal echocardiography. Ann Card Anaesth 2018; 21:315-318. [PMID: 30052226 PMCID: PMC6078019 DOI: 10.4103/aca.aca_205_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hypertrophic obstructive cardiomyopathy is a relatively common disorder that signifies asymmetric hypertrophy of interventricular septum causing obstruction of the left ventricular outflow tract (LVOT). However, more recent studies have shown that during ventricular systole, flow against an abnormal mitral valve apparatus results in drag forces on the part of the leaflets. The mitral leaflet is pushed into the LVOT to obstruct it. We present a case where intraoperative transesophageal echocardiography played a crucial role in defining the etiology of LVOT obstruction that subsequently helped in deciding the surgical plan.
Collapse
Affiliation(s)
- Neelam Aggarwal
- Department of Cardiothoracic and Vascular Anesthesia, Dr. B. L. Kapur Memorial Hospital, New Delhi, India
| | - Jasbir Singh Khanuja
- Department of Cardiothoracic and Vascular Anesthesia, Dr. B. L. Kapur Memorial Hospital, New Delhi, India
| | - Sameer Saurabh Arora
- Department of Cardiothoracic and Vascular Anesthesia, Dr. B. L. Kapur Memorial Hospital, New Delhi, India
| | - Rahul Maria
- Department of Cardiothoracic and Vascular Anesthesia, Dr. B. L. Kapur Memorial Hospital, New Delhi, India
| |
Collapse
|
46
|
Prada G, Vieillard-Baron A, Martin AK, Hernandez A, Mookadam F, Ramakrishna H, Diaz-Gomez JL. Echocardiographic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. J Cardiothorac Vasc Anesth 2018; 33:1559-1583. [PMID: 30077562 DOI: 10.1053/j.jvca.2018.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 02/03/2023]
Abstract
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography. Hence, M-mode can provide clinically relevant information in echocardiography and lung ultrasound-driven approaches for diagnosis, monitoring, and interventional procedures performed by anesthesiologists and intensivists. Although M-mode is feasible, this imaging modality progressively has been abandoned in echocardiography and is often underutilized in lung ultrasound. This article aims to comprehensively illustrate contemporary applications of M-mode ultrasonography in the anesthesia and critical care medicine practice. Information presented for each clinical application will include image acquisition and interpretation, evidence-based clinical implications in the critically ill and surgical patient, and limitations. The present article focuses on echocardiography and reviews left ventricular function (mitral annular plane systolic excursion, E-point septal separation, fractional shortening, and transmitral propagation velocity); right ventricular function (tricuspid annular plane systolic excursion, subcostal echocardiographic assessment of tricuspid annulus kick, outflow tract fractional shortening, ventricular septal motion, wall thickness, and outflow tract obstruction); volume status and responsiveness (inferior vena cava and superior vena cava diameter and respiratory variability [collapsibility and distensibility indexes]); cardiac tamponade; systolic anterior motion of the mitral valve; and aortic dissection.
Collapse
Affiliation(s)
- Gabriel Prada
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin En Yvelines, France; INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ.
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
47
|
Impact of different annuloplasty rings on geometry of the mitral annulus with fibroelastic deficiency: the significance of aorto-mitral angle. Int J Cardiovasc Imaging 2018; 34:1707-1713. [PMID: 29845584 DOI: 10.1007/s10554-018-1383-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
We sought to investigate the impact of full annuloplasty rings versus C-shape bands on mitral annular geometry in the presence of fibroelastic deficiency (FED), as assessed by intraoperative three-dimensional transesophageal echocardiography (3DTEE). We retrospectively selected 65 patients who underwent mitral valve repair for severe mitral regurgitation caused by FED using full rings (the Ring group, n = 30) and C-shape bands (the Band group, n = 35). 71 controls without valvular heart disease were also included. Thorough 3DTEE inspections were performed for the entire cohort to measure morphological parameters of mitral annulus before and after surgery. Mid-term repair durability and left atrial diameter were followed up. The preoperative 3DTEE parameters, including annular diameters, area, height and aorto-mitral angle, were significantly larger in the FED groups than normal, and were comparable between two groups using different annuloplasty devices. After repair, the anterior-posterior diameter, annulus circumference and area were significantly larger in the Band group than in the Ring group. The aorto-mitral angle became comparable with normal value in the Ring group (p = 0.728), but not in the Band group (p = 0.011). Follow-up echocardiographic data showed a significant correlation between postoperative aorto-mitral angle and reduced left atrial diameter at 50.3 months after surgery (r = 0.63; p < 0.001). In conclusion, compared with C-shape bands, full rings may impose less narrowing on aorto-mitral angle, which correlates well with mid-term left atrial reverse remodeling.
Collapse
|
48
|
Sigurdsson M, McCartney SL, Maslow A. Dynamic Left Ventricular Outflow Obstruction and Systolic Anterior Motion of the Mitral Valve Complicating Surgical Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2018; 33:863-865. [PMID: 29935803 DOI: 10.1053/j.jvca.2018.05.008] [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: 05/03/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Martin Sigurdsson
- Department of Anesthesiology, Divisions of Cardiothoracic and Critical Care Anesthesiology, Duke University, Durham, NC
| | - Sharon L McCartney
- Department of Anesthesiology, Divisions of Cardiothoracic and Critical Care Anesthesiology, Duke University, Durham, NC
| | - Andrew Maslow
- Department of Anesthesiology, Warren Alpert School of Medicine at Brown University, Providence, RI
| |
Collapse
|
49
|
Ma W, Shi W, Zhang W, Wu W, Ye W, Kong Y. Management of Incomplete Initial Repair in the Treatment of Degenerative Mitral Insufficiency. Int Heart J 2018; 59:510-517. [PMID: 29743415 DOI: 10.1536/ihj.17-287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We sought to present our institutional protocol to manage incomplete initial repair of degenerative mitral regurgitation and to evaluate its mid-term outcomes. Eight hundred and fifteen patients with degenerative mitral insufficiency undergoing mitral valve repair were investigated in this study. The initial repair attempt was incomplete in 48 patients, leaving a degree of residual regurgitation > mild, and an elevated transmitral gradient or systolic anterior motion (SAM). These patients were further treated with medication or mitral valve re-repair or replacement under reinstituted cardiopulmonary bypass. Transesophageal echocardiographic reports and operational records were reviewed to identify morphological causes and establish management of incomplete initial repair. Mid-term outcomes of patients with re-repair and complete initial repair were evaluated and compared. Residual mitral regurgitation > mild was detected in 25 patients, an elevated transmitral gradient was detected in seven patients, and SAM was detected in 16 patients. The condition of eight patients with SAM was resolved with medication only. Mitral valve re-repair was performed in 23 patients and replacement was performed in 17, with comparable early mortality and morbidity. At 60.3 ± 25.5 months after surgery, late mitral stenosis and reoperation rate were significantly higher in re-repair patients than in patients with complete initial repair, despite comparable survival, left chamber reverse remodeling, and degree of residual regurgitation. Based on our institutional protocol, acceptable outcomes can be achieved for patients with incomplete initial mitral valve repair. Management should be tailored based on the characteristics of the mitral valve complex, expected repair durability, and operative risk.
Collapse
Affiliation(s)
- Wenrui Ma
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Wei Shi
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Wei Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Weihua Wu
- Department of Echocardiography, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Wei Ye
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Ye Kong
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University
| |
Collapse
|
50
|
Manabe S, Kasegawa H, Arai H, Takanashi S. Management of systolic anterior motion of the mitral valve: a mechanism-based approach. Gen Thorac Cardiovasc Surg 2018; 66:379-389. [PMID: 29616461 DOI: 10.1007/s11748-018-0915-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
Although the mechanism of systolic anterior motion (SAM) of the mitral valve is unknown, it is known to have a multifactorial pathophysiology. Echocardiographic analysis of the mitral leaflet revealed the step-wise progression of SAM, and intraventricular flow analysis revealed the contribution of drag force generated by the misled flow below the posterior leaflet. Although several diverse clinical features of SAM are already known, some key features need to be abstracted from among them to understand the regulation of SAM establishment. This paper reviews past articles that have investigated the mechanism of SAM and proposes a mechanism-based concept to provide insights for better comprehension of SAM recognition.
Collapse
Affiliation(s)
- Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital, 4-1-1, Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
| | - Hitoshi Kasegawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu, Tokyo, 183-0003, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1, Asahi-cho, Fuchu, Tokyo, 183-0003, Japan
| |
Collapse
|