scholarly journals Mitral Valve Replacement Using Subvalvular Apparatus: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 23 (3) ◽  
pp. E385-E392
Author(s):  
Wan Chin Hsieh ◽  
Anas Aboud ◽  
Brandon Michael Henry ◽  
Chung Dann Kan ◽  
Mohamed Omara ◽  
...  
Keyword(s):  
Renal Failure ◽  
Mitral Valve ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Meta Analysis ◽  
Significant Difference ◽  
Long Term Mortality

Background: To assess clinical outcomes among participants undergoing mitral valve replacement with preservation of subvalvular apparatus. Methods: Electronic databases, including PubMed, Embase, Science Direct, World of Science, Scopus, Biosis, SciElo and Cochrane library, were probed using an extensive search strategy. Studies that reported at least one clinical outcome, such as morbidity, mortality, early 30-day mortality, myocardial failure, survival, late cerebrovascular events, length of stay, or major operative complications (stroke, prolonged ventilation, and reoperation for bleeding, renal failure, and sternal infection) were considered for inclusion. Data was extracted and pooled into a meta-analysis in RevMan (version 5.3) using a random-effects model. Results: A total of 21 studies with 5,106 participants (age range: 27.3-69.2 years) were included in this meta-analysis. Preservation of the subvalvular apparatus during MVR significantly reduces the risk of long-term mortality (OR: 0.46; 95% CI: 0.33-0.64), but not early mortality (OR: 0.76; 95% CI: 0.12-4.93). No significant difference ejection fraction was observed (SMD: 0.10; 95% CI: -0.44-0.64). Similarly, there was no significant difference in the risk of stroke, renal failure, and pneumonia between C-MVR and in the control group. Conclusion: MVR with the preservation of subvalvular apparatus improves clinical outcomes, such as long-term mortality, hospital length of stay, pneumonia, and bleeding. There is no significant difference in the risk of stroke, renal failure, or ICU length of stay. However, there is very limited data available with respect to bleeding, sepsis, and nosocomial infections.

Abstract 2286: Short- and Long-Term Survival of Mitral Valve Repair Versus Mitral Valve Replacement in Patients with Functional Mitral Regurgitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Julien Magne ◽  
Mario Senechal ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
Jean G Dumesnil ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Term Survival ◽  
Long Term Mortality

Mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR) when compared to mitral valve replacement (MVR). However, there is an important controversy about the type of surgical treatment that should be used in patients with functional MR (FMR). The aim of this study was to compare MVRp (i.e. restrictive annuloplasty) and MVR in patients with FMR. Pre- and operative demographic and clinical data of 392 patients (64% of male, mean age: 65±10 years) with FMR who underwent mitral surgery between 1992 and 2007 were prospectively collected in a computerized database. MVRp was performed in 52% of patients (n=204) and MVR in 48% (n=188). Compared to patients undergoing MVRp, those with MVR were significantly more frequently symptomatic (77% vs. 59%, p=0.0002), had lower left ventricular ejection fraction (LVEF) (40±15%, vs. 46±15%, p=0.0003) and had higher prevalence of pulmonary hypertension (36% vs. 24%, p=0.01) preoperatively. However, there was no significant difference between the 2 groups with regards to age, gender, MR severity, diabetes, obesity, systemic hypertension and atrial fibrillation (p>0.3). Although operative mortality was significantly lower after MVRp compared to MVR (9% vs. 17%, p=0.02), long-term survival was not statistically different between procedures (6 years: 74±4% vs. 72±4%; 12 years: 54±5% vs. 52±7%; p=0.58). After adjusting for other risk factors, the type of procedure (MVRp vs. MVR) did not come out as an independent predictor of either operative (Odds-ratio=1.7, 95% confidence interval [CI]: 0.8 –3.8, p=0.15) or long-term mortality (Hazard-ratio [HR]=1.1, 95%CI: 0.9 –1.4, p=0.29). The independent predictors of long-term mortality were age (HR= 1.04, 95%CI: 1.01–1.07, p=0.003), NYHA class ≥III (HR=1.4, 95%CI: 1.1–2, p=0.02) and LVEF (HR=1.02, 95%CI: 1.01–1.04, p=0.0009). As opposed to what has been reported in patients with organic MR, there is no evidence that MVRp provides any benefit in terms of survival compared to MVR in patients with FMR. These findings suggest that MVRp is not an optimal surgical treatment for FMR and provide an impetus toward the development of new surgical approaches for these patients.

scholarly journals Comparison of the Surgical Effect and the Long-term Clinical Outcomes Between Robotic and Sternotomy Mitral Valve Replacement

2020 ◽  
Author(s):  
Haizhi Zhao ◽  
Changqing Gao ◽  
Ming Yang ◽  
Yao Wang ◽  
Wenbin Kang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Perioperative Complications ◽  
Mitral Valve Surgery ◽  
Blood Product Transfusion ◽  
Volume Blood

Abstract BackgroundRobot-assisted mitral valve surgery has been increasingly used by surgeons to achieve better results. This study was to assess the safety and effectiveness of totally endoscopic robotic mitral valve replacement (TE-MVR) and to provide evidence that it is a reasonable surgical choice by analyzing the clinical experience, surgical efficacy, and follow-up outcomes of this procedure.MethodBetween October 2008 and October 2015, 47 patients underwent da Vinci TE-MVR. From March 2002 to June 2014, 293 patients underwent conventional sternotomy mitral valve replacement (CS-MVR), of whom 47 patients were selected to match the TE-MVR group (1:1). We performed a retrospective study by collecting perioperative data and assessed TE-MVR efficacy by comparing clinical outcomes and echocardiography with CS-MVR in a 10-year follow-up period.ResultsAll cases were conducted successfully. No operative deaths were observed, and the complications were not significantly different between the groups. The cardiopulmonary bypass time (122.02±25.45 min) and aortic cross-clamping time (85.68±20.70 min) were longer in TE-MVR group (P<0.001). The perioperative complications are similar in two groups, but the drainage volume, blood product transfusion, ICU stay and postsurgical hospital stay are better in robotic group (P<0.001). During the follow-up period, 42 patients (89.4%) in TE-MVR group and 40 patients (87.0%) in CS-MVR group were followed. Long-term event-free survival is similar in both groups. ConclusionRobotic MVR is a feasible, effective and safe minimally-invasive alternative to sternotomy MVR, and the long-term clinical and echocardiographic results are comparable to sternotomy MVR in selected patients.

scholarly journals Long-term outcome in a case of translocated mitral valve replacement for massive mitral annular calcification

2017 ◽  
Vol 5 (4) ◽  
pp. 454-457
Author(s):  
Go Kataoka ◽  
Kiyoharu Nakano ◽  
Ryota Asano ◽  
Atsuhiko Sato ◽  
Wataru Tatsuishi
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Annular Calcification ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Annular Calcification

Pulmonary Autograft Mitral Valve Replacement (Ross II): Long-Term Follow-Up of a US Center

2018 ◽  
Vol 9 (6) ◽  
pp. 645-650
Author(s):  
David Blitzer ◽  
Jeremy L. Herrmann ◽  
John W. Brown
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Sudden Cardiac Arrest ◽  
Right Heart Failure ◽  
Atrioventricular Canal ◽  
Pulmonary Autograft ◽  
Atrioventricular Canal Defect

Background: Mitral valve replacement (MVR) with a pulmonary autograft (Ross II) may be a useful technique for pediatric and young adult patients who wish to avoid anticoagulation. Our aim was to evaluate the long-term outcomes of the Ross II procedure at our institution. Methods: Patients undergoing the Ross II procedure between June 2002 and April 2008 were included. Preoperative diagnoses included rheumatic disease (n = 5), congenital mitral valve (MV) pathology (partial atrioventricular canal defect [n = 2], complete atrioventricular canal defect [n = 1], Shone's complex [n = 1]), and myocarditis (n = 1). Results: Ten patients (eight females and two males) between 7 months and 46 years were included. Mean age at surgery was 25.2 ± 15.7 years. There were no in-hospital deaths. Mean follow-up was 11.7 ± 5.2 years. There were three late deaths at 11 months, 5 years, and 11 years, respectively. Causes of death included right heart failure, sepsis, and sudden cardiac arrest. Three patients required subsequent mechanical MVR a median of two years after the Ross II procedure (range: 1-4 years). There was no mortality with reoperation. Echocardiographic follow-up demonstrated mean MV gradients ranging from 2.2 to 9.6 mm Hg. Two patients had greater than mild MV regurgitation postoperatively, and all others had minimal mitral regurgitation or less. Two patients developed moderate MV stenosis. Conclusions: The Ross II procedure is an option for select older children and young adults desiring a durable tissue MVR to avoid long-term anticoagulation.

Abstract 12022: Long-Term Clinical Outcomes of Everolimus-Eluting Stents versus Sirolimus-Eluting Stents: Systematic Review and a Meta-Analysis of 14 Randomized Control Trials, Focused on Stent Thrombosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
TOSHIAKI TOYOTA ◽  
Hiroki Shiomi ◽  
Takeshi Morimoto ◽  
Takeshi Kimura
Keyword(s):  
Clinical Outcomes ◽  
Stent Thrombosis ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Target Lesion ◽  
Pooled Analysis ◽  
Significant Difference ◽  
Artery Disease

Background: We sought to compare the long-term clinical outcomes between everolimus-eluting stent (EES) and sirolimus-eluting stents (SES) with a meta-analysis method. The long-term clinical outcomes, especially stent thrombosis (ST), after EES versus SES implantation has not been clearly defined among trials directly comparing the 2 types of stents. Methods: We searched PubMed, Cochrane database, and ClinicalTrials.gov. for trials comparing outcomes between EES (Xience V/Promus) and SES (Cypher select/Cypher select plus) in patients with native coronary artery disease using randomized controlled trial (RCT) design. We selected the article reporting the longest follow-up outcomes from each RCT. The outcome measure was all-cause death, myocardial infarction (MI), definite ST, and target-lesion revascularization (TLR). ST was further classified as those occurring early (<=30 days), late (30-365 days), or very late (<365 days). Results: We identified 14 RCT comparing EES and SES including 2 trials reporting the longest follow-up outcomes as a pooled analysis. We analyzed 13,434 randomly assigned patients with the weighted follow-up period of 2.1 years (Follow-up <=1-year: 7 trials, and 3191 patients; >1-year: 7 trials, and 10243 patients). EES as compared to SES was associated with significantly lower risks for overall ST, and early ST (pooled odds ratio (OR) 0.49, 95% confidence interval (CI) 0.30-0.81, P=0.01, and OR 0.42, 95% CI 0.18-0.99, P=0.046, respectively), while there was no significant difference in the risk for late ST and very late ST (OR 0.49, 95% CI 0.17-1.43, P=0.19, and OR 0.66, 95% CI 0.23-1.85, P=0.43, respectively). EES as compared to SES was also associated with significantly lower risks for TLR (OR 0.84, 95% CI 0.71-0.99, P=0.04). There was no significant difference in the risk for all-cause death, and MI between EES and SES. (OR 0.91, 95% CI 0.78-1.07, P=0.11, and OR 0.92, 95% CI 0.75-1.13, P=0.44, respectively). Conclusions: In the current meta-analysis of 14 RCT directly comparing EES with SES, implantation of EES as compared to SES implantation was associated with significantly lower risk for definite ST and TLR.

Abstract 15741: Long Term Survival Following Transcatheter Aortic Valve Replacement: Results From a Single US High Volume Center

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ricardo O Escarcega ◽  
Rebecca Torguson ◽  
Marco A Magalhaes ◽  
Nevin C Baker ◽  
Sa’ar Minha ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Term Survival ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Long Term Mortality

Introduction: Mortality following Transcatheter aortic valve replacement (TAVR) has been reported up to 5 years. However, mortality after 5 years remains unclear. Hypothesis: We aim to determine the mortality in patients undergoing TAVR >5 years follow up. Methods: From our institution’s prospectively collected TAVR database we analyzed all patients undergoing TAVR to a maximum follow up of 8 years. We divided our population into transapical TAVR (TA-TAVR) and transfemoral TAVR (TF-TAVR) groups. A Kaplan-Meier survival analysis was conducted. Results: A total of 511 patients who underwent TAVR were included in the analysis. Patients undergoing TA-TAVR had higher rates of peripheral vascular disease compared with TF-TAVR (56% vs 29%, p<0.001) and Society of Thoracic Surgeons Score (10.9 ± 4 vs 9.2 ± 4, p<0.001). TA-TAVR was associated with higher mortality at 1 year (32% vs 21%, p=0.01). However, there was no significant difference in very-long term mortality of patients undergoing TA-TAVR vs TF-TAVR (Figure). Conclusions: Long-term mortality following TAVR surpasses 50%. While in the first 2 years TA-TAVR is associated with higher mortality rates after three years the survival rates are similar in both approaches.

Impact of sex on cardiac remodeling and long‐term outcomes, following mitral valve replacement

2020 ◽  
Author(s):  
Ryaan EL‐Andari ◽  
Sabin J. Bozso ◽  
Jimmy J.H Kang ◽  
Dana Boe ◽  
Nicholas M. Fialka ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Cardiac Remodeling ◽  
Long Term Outcomes

Immediate versus wait-and-gradual discontinuation in antipsychotic switching: A meta-analysis

2020 ◽  
Vol 34 (8) ◽  
pp. 914-919
Author(s):  
Hiroyoshi Takeuchi ◽  
Gary Remington
Keyword(s):  
Clinical Outcomes ◽  
Meta Analysis ◽  
Outcome Data ◽  
Controlled Trials ◽  
Double Blind ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Meta Analyses ◽  
Switching Strategies

Introduction: In two previous meta-analyses of randomized controlled trials (RCTs) examining antipsychotic switching strategies in patients with schizophrenia, we showed no significant differences in any clinical outcomes between immediate versus gradual and gradual versus wait-and-gradual discontinuation of the pre-switch antipsychotic. In this report, we compared immediate versus wait-and-gradual antipsychotic discontinuation. Methods: We identified five RCTs examining immediate versus wait-and-gradual discontinuation of the pre-switch antipsychotic in antipsychotic switching involving patients with schizophrenia. However, no data were available from one RCT. The following clinical outcome data were extracted and meta-analyzed: study discontinuation, psychopathology, extrapyramidal symptoms, and treatment-emergent adverse events that were reported in two or more of the studies. Results: The meta-analysis included four RCTs involving 351 patients ( n=175 for immediate and n=176 for wait-and-gradual antipsychotic discontinuation). A significant difference was found in study discontinuation due to all causes ( n=4, n=351, risk ratio=1.58, 95% confidence interval 1.15–2.17, p=0.005, I2=0%) between the immediate and wait-and-gradual antipsychotic discontinuation groups, while there was no significant difference in any other clinical outcomes. The group difference in study discontinuation due to all causes remained significant for the studies adopting immediate antipsychotic initiation but not for the studies switching to ziprasidone. Conclusion: Findings suggest that wait-and-gradual antipsychotic discontinuation may be preferable when a more cautious antipsychotic switch is needed. However, further long-term, double-blind RCTs are needed to confirm the present findings.

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