scholarly journals Short-Term and Long-Term Survival After Revascularization with or without Mitral Valve Surgery of Patients with Ischemic Mitral Valve Regurgitation: A Meta-Analysis

2015 ◽  
Vol 21 ◽  
pp. 3784-3791 ◽  
Author(s):  
Hua Zhang ◽  
Yili Liu ◽  
Shaodong Qiu ◽  
Weixiang Liang ◽  
Lan Jiang
Keyword(s):  
Mitral Valve ◽  
Meta Analysis ◽  
Mitral Valve Regurgitation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Regurgitation ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival

Abstract 16046: Conventional versus Right Mini-thoracotomy versus Robotic Mitral Valve Replacement/repair; Insights From a Network Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Mitral Valve Surgery ◽  
Valve Repair ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Mini Thoracotomy

Background: Benefits and risks of minimally invasive cardiac surgery (MICS) through right mini-thoracotomy and robotic surgery for mitral valve are not fully understood. We conducted a network meta-analysis comparing the perioperative and long-term outcomes of mitral valve surgery via conventional sternotomy, MICS and robot. Methods: MEDLINE and EMBASE were searched through March 15th, 2020 to identify randomized controlled trials (RCTs) and propensity-score matched (PSM) trials that investigated perioperative and long-term outcomes after mitral surgery via conventional sternotomy, MICS and robot. Subanalyses were conducted by restricting trials, in which mitral valve repair was tried first for all patients. Results: Our systematic literature search identified 2 RCTs and 21 PSM trials. MICS was related to significant decrease in PM ([RR] [95% confidence interval [CI] =0.56 [0.40-0.78]] and SSI (RR [95%CI] =0.53 [0.33-0.85) compared to conventional sternatomy. Re-exploration for bleeding was significantly higher in robot compared to sternotomy (RR [95% CI] =1.56 [1.03-2.37]), and transfusion was higher in sternotomy compared to MICS (RR [95%CI] =1.63 [1.27-2.08]). No significant differences were observed in perioperative mortality, MI, stroke, and LCOS among there procedures. Similarly, there were no significant differences in long-term survival and mitral valve reoperation. Suanalyses by restricting trials in which mitral valve repair tried first for all patients showed MICS was related to significant increase in mitral valve reoperation compared to conventional sternotomy (hazard ratio [95%CI] =7.33 [1.54-34.97]) (Figure). Conclusion: Our network meta-analysis demonstrated similar long-term survival and mitral valve reoperation. However, MICS was related to significant increase in mitral valve reoperation after mitral valve repair compared to conventional sternotomy.

Permanent pacemaker implantation following mitral valve surgery: a retrospective cohort study of risk factors and long-term outcomes

2021 ◽  
Author(s):  
Mark R Helmers ◽  
Max Shin ◽  
Amit Iyengar ◽  
Gabriel R Arguelles ◽  
Jarvis Mays ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Permanent Pacemaker ◽  
Valve Surgery ◽  
Term Survival ◽  
Long Term Survival ◽  
Valvular Surgery

Abstract OBJECTIVES Conduction disturbances requiring permanent pacemaker (PPM) implantation remain a complication following valvular surgery. PPMs confer the risk of infection, tricuspid valve regurgitation and pacing-induced cardiomyopathy. Literature examining PPM placement in mitral valve surgery (MVS) is limited. METHODS Our institutional mitral valve (MV) database was retrospectively reviewed for adult patients undergoing surgery from 2011 to 2019. Patients with preoperative PPM were excluded. Patients were stratified by the receipt of PPM following their index operations. Multivariable logistic regression was performed to determine patient and operative risk factors for PPM. Subgroup analysis was performed on patients who underwent isolated MVS. Kaplan–Meier analysis and a multivariable Cox proportional hazards model were utilized to assess the association between PPM implantation and long-term survival. RESULTS A total of 3391 (2991 non-PPM and 400 PPM) patients met the study criteria. Significant predictors of PPM included increased decade of age (odds ratio: 1.23; 95% confidence interval: 1.12–1.35), concomitant aortic (1.44; 1.10–1.90) and tricuspid valve procedures (2.21; 1.64–2.97) and prior history of myocardial infarction (1.48; 1.07–1.86). In the isolated MV repair population, annuloplasty with ring prosthesis was associated with PPM (3.09; 1.19–8.02). Patients in the replacement population did not have significant identifiable risk factors. There was no survival difference found, and postoperative PPM placement was not found to be an independent predictor of mortality. CONCLUSIONS Our primary aim was to elucidate predictors for PPM implantation in MVS and found increasing age and concomitant procedures to be risk factors. Receipt of PPM is associated with worse long-term survival but does not independently predict survival. Among patients undergoing isolated MV repair, use of an annuloplasty ring confers a higher risk of PPM compared to an annuloplasty band.

scholarly journals Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: a retrospective propensity-score matched analysis

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4810 ◽  
Author(s):  
Sabreen Mkalaluh ◽  
Marcin Szczechowicz ◽  
Bashar Dib ◽  
Anton Sabashnikov ◽  
Gabor Szabo ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Mitral Valve Regurgitation ◽  
Mitral Valve Surgery ◽  
Early Mortality ◽  
Conventional Approach ◽  
Valve Regurgitation ◽  
Term Survival

Background Minimally invasive mitral valve surgery (MVS) via right mini-thoracotomy has recently attracted a lot of attention. Minimally invasive MVS shows postoperative results that are comparable to those of conventional MVS through the median sternotomy as per various earlier studies. Methods Between 2000 and 2016, a total of 669 isolated mitral valve procedures for isolated mitral valve regurgitation were performed. A propensity score-matched analysis was generated for the elimination of the differences in relevant preoperative risk factors between the cohorts and included 227 patient pairs. Only degenerative mitral valve regurgitation was included. The aim of our study was to examine if the minimally MVS is superior to the conventional approach through sternotomy based on a retrospective propensity-matched analysis. The primary endpoints were early mortality and long-term survival. The secondary endpoints included postoperative complications. Results The in-hospital mortality rate was significantly higher within the conventional sternotomy cohort (3.1%, n = 7 vs 0.4%, n = 1 for the minimally invasive cohort; p = 0.032). The incidence of stroke and exploration for bleeding was comparable. In contrast, the necessity for dialysis was significantly lower in the minimally invasive cohort (p = 0.044). Postoperative pain was not significantly lower in the minimally invasive MVS cohort (p = 0.862). While patients who underwent minimally invasive MVS experienced longer bypass and cross-clamp times, their lengths of stay in the intensive care unit and in the hospital, did not differ from the conventionally operated collective (p = 0.779 and p = 0.516), respectively. The mitral valve repair rate of 81.1% in the minimally invasive cohort was significantly superior to that of the conventional approach, which was 46.3% (p < 0.0001). The one-, five-, and 10-year survival rates were significantly higher in the minimally invasive cohort compared to the conventional approach (96%, 90%, and 84% vs. 89%, 85%, and 70%; log rank p = 0.004). Conclusion Despite prolonged cardiopulmonary bypass and cross-clamping times, the minimally invasive MVS may be considered a safe approach that is equivalent to standard median sternotomy with lower early mortality and superior long-term survival.

Abstract 2305: Determinants of Outcomes Following Mitral Valve Surgery in Patients with Severe Organic Mitral Regurgitation and No or Mild Symptoms

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Eric Charbonneau ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Long Term Survival ◽  
Long Term Mortality

The optimal timing of mitral valve surgery in patients with severe organic mitral regurgitation (OMR) and no or mild symptoms is highly controversial. The aim of this study was thus to determine the preoperative predictors of mortality following mitral valve surgery in patients with severe OMR and no or mild symptoms. Preoperative and operative data of 324 patients (65% of male, mean age: 65±13 years) with severe OMR and no/mild symptoms (NYHA class I and II) who underwent mitral valve surgery between 1992 and 2007 were prospectively collected in a computerized database. Mitral valve repair (MVRp) was performed in 132 (41%) and mitral valve replacement (MVR) in 187 (59%) patients. Operative mortality was low for both procedures (whole cohort: n=9, 2.7%; MVRp: n=2, 1.5%; MVR: n=7, 3.7%; p=0.34) but was significantly higher in the patients (n=167, 56%) with impaired preoperative left ventricular ejection fraction (LVEF) (<60%) (5.3% vs. 1.2%, p=0.04). Long-term survival was 93±2% at 5 years and 87±3% at 10 years. Patients with LVEF<60% had significantly reduced long-term survival compared to patients with normal LVEF (5-year: 89±4% vs. 95±5%, 10-year: 80±6% vs. 88±4%, p=0.049). Multivariate analysis identified age (Hazard-ratio [HR]= 1.03, 95% confidence interval (CI): 1–1.08, p=0.02), heart failure (HR= 1.9, 95%CI: 1.3–3, p= 0.0018), and LVEF (HR= 1.04, 95%CI: 1.01–1.07, p=0.0253) as independent predictors of long-term mortality. Furthermore, MVR was not associated with worse long-term survival on both univariate (p=0.83) and multivariate (p=0.98) analysis. Performing mitral valve surgery is safe in patients with severe OMR and no or mild symptoms. Impaired LVEF is associated with increased short- and long-term mortality, suggesting that these patients should be promptly operated before the onset of LV dysfunction.

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