Benefits of Early Surgery on Clinical Outcomes After Degenerative Mitral Valve Repair

Zhou, Tianyu; Li, Jun; Lai, Hao; Zhu, Kai; Sun, Yongxin; Ding, Wenjun; Hong, Tao; Wang, Chunsheng

doi:10.1016/j.athoracsur.2018.05.011

Cited by 17 publications

(15 citation statements)

References 26 publications

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“…Therefore, in patients with LV systolic dysfunction, including a decreased ejection fraction and increased LV dimension, the effects of MV repair might be compromised. In this study, our results showed that in patients with LV systolic dysfunction, the incidence of perioperative complications was low, and thirty-day mortality was comparable to that in previous studies and our early study [8]. Previous studies have shown that the perioperative mortality rate of MV repair in degenerative MR varies from 0.2 to 1.2% [1,6,9,10].…”

Section: Discussionsupporting

confidence: 84%

“…We also found in our study that anterior leaflet prolapse and intraoperative residual mild MR were independent predictive factors for recurrent MR; however, in previous studies, patients with preserved LV systolic function constituted most of the patient cohorts. In our previous study [ 8 ], we found that recurrent MR was only 3% at 8-year during follow up for those who received early surgical intervention before the onset of guideline-based indications. Therefore, preoperative LV systolic dysfunction might be associated with recurrent MR. A dilated left ventricle with LV systolic dysfunction could lead to annular enlargement and apically displaced leaflets, which cause secondary MR.…”

Section: Discussionmentioning

confidence: 99%

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Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Zhao

Zhou

et al. 2020

J Cardiothorac Surg

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Background This study aims to evaluate the early and mid-term outcomes of mitral valve repair for degenerative mitral regurgitation (MR) in patients with left ventricular systolic dysfunction. Methods From January 2005 to December 2016, the profiles of patients with degenerative MR who underwent mitral valve repair at our institution were analyzed. Left ventricular systolic dysfunction was defined as an ejection fraction < 60% or left ventricular end-systolic dimension > 40 mm. Finally, 322 patients with left ventricular systolic dysfunction were included in this study. The prognosis of left ventricular function during follow-up was evaluated and preoperative factors associated with deteriorated left ventricular systolic function during follow-up were analyzed. Results The in-hospital mortality rate was 1.6%. The rate of eight-year overall survival, freedom from reoperation for mitral valve and freedom from recurrent MR were 96.9, 91.2 and 73.4%, respectively. Intraoperative residual mild MR (hazard ratio 4.82) and an isolated anterior leaflet lesion (hazard ratio 2.48) were independent predictive factors for recurrent MR. During follow-up, 212 patients underwent echocardiography examinations at our institution. Among them, 132 patients had improved left ventricular systolic function, and 80 patients had deteriorated left ventricular systolic. Freedom from recurrent MR was found in 75.9% of the improved left ventricular systolic function group and 56.2% of the deteriorated left ventricular systolic function group (P = 0.047). An age > 50 years (odds ratio 2.40), ejection fraction≤52% (odds ratio 2.79) and left ventricular end-systolic dimension≥45 mm (odds ratio 2.31) were independent risk factors for deteriorated left ventricular systolic function during follow-up. Conclusions Mitral valve repair could be safely performed for degenerative MR in patients with left ventricular systolic dysfunction. Intraoperative residual mild MR and an isolated anterior leaflet lesion were independent predictive factors for recurrent MR. An age > 50 years, ejection fraction≤52% and left ventricular end-systolic dimension≥45 mm were independent risk factors for deteriorated left ventricular systolic function during follow-up.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Zhao

Zhou

et al. 2020

J Cardiothorac Surg

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“…The results of degenerative MV repair at our institution have been published previously; the overall hospital mortality for degenerative MV repair is 1.8%. 5 The operative details are provided in Table 2. The CPB and crossclamp times were not significantly different in the PMR and elective IMR subgroups, and the postoperative complications were comparable.…”

Section: Resultsmentioning

confidence: 99%

“…The techniques of MV repair for primary MR at our institution have been described in a previous article. 5 In the IE patients, we fully inspected the infectious lesions on the valve and surrounding tissue. First, we removed vegetations and infection foci.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

Wang

Zhou

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Emergency or urgent surgery is often required in patients with papillary muscle rupture and active mitral valve infective endocarditis. The aim of this study was to analyze the outcomes of patients with active endocarditis who underwent emergency or urgent mitral valve repair. Methods From 2005 to 2014, 154 ischemic mitral regurgitation patients and 41 infective endocarditis patients underwent mitral valve repair in our institution; 23 had emergency operations due to papillary muscle rupture, and 18 with active infective endocarditis underwent urgent surgery. Results Cardiopulmonary bypass time (141.4 ± 43.3 versus 145.3 ± 46.5 min) and crossclamp time (77.7 ± 34.1 versus 79.2 ± 33.0 min) were similar in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, and major postoperative complications were comparable. Hospital mortality was 17.4% in the papillary muscle rupture subgroup and 8.4% in the elective ischemic mitral regurgitation subgroup. Cardiopulmonary bypass time (103.6 ± 37.0 versus 75.5 ± 20.8 min) and crossclamp time (61.7 ± 21.2 versus 45.3 ± 18.0 min) were significantly longer in infective endocarditis patients. There were no major complications or hospital deaths. Eight years postoperatively, overall survival was 94.4% and 86.5% in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, respectively ( p = 0.730). Overall survival was 100% in both infective endocarditis subgroups. Conclusion The feasibility and effectiveness of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis are satisfactory. Early and mid-term outcomes are comparable to those of elective operations.

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“…The quality of the results, at least in terms of survival, is strictly related to the presence of preoperative risk factors, as atrial fibrillation or pulmonary hypertension or reduced ejection fraction. It is indubitable that better results can be achieved when patients are operated on in an early phase, without the late consequences of the disease (13,14).…”

mentioning

confidence: 99%

Durability of mitral valve repair for degenerative mitral regurgitation: is it gold all that glitters?

Calafiore¹,

Totaro²,

Foschi

et al. 2018

Ann. Transl. Med

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Benefits of Early Surgery on Clinical Outcomes After Degenerative Mitral Valve Repair

Cited by 17 publications

References 26 publications

Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Mitral valve repair for degenerative mitral regurgitation in patients with left ventricular systolic dysfunction: early and mid-term outcomes

Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

Durability of mitral valve repair for degenerative mitral regurgitation: is it gold all that glitters?

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