Mitral Valve Repair in Patients With Advanced Heart Failure and Severe Functional Mitral Insufficiency Reverses Left Ventricular Remodeling and Improves Symptoms

Acker, Michael A.

doi:10.1161/circheartfailure.108.810200

Cited by 13 publications

(7 citation statements)

References 25 publications

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“…While patients with severe symptomatic mitral regurgitation frequently suffer from recurrent cardiac decompensation [ 1 ], accompanying left ventricular dysfunction with subsequent pulmonary and systemic congestion is even more aggravated by the present valvular dysfunction [ 14 , 15 ] Therefore, a compensated preoperative state should be aimed for in every patient scheduled for elective valvular surgery whenever possible. However, the diagnosis and quantification of incipient, not yet clinically apparent cardiac decompensation and estimation of arising procedural risk can be challenging, and may not be sufficiently represented by contemporary, frequently applied risk scores.…”

Section: Discussionmentioning

confidence: 99%

“…As mitral regurgitation (MR) inherently leads to left ventricular dilatation via increased filling pressures and refractory volume overload, chronic heart failure (CHF) is a common concomitant factor of patients referred for surgical mitral valve repair with significant impact on postprocedural outcome [ 1 , 2 , 3 , 4 ]. A well-known consequence of CHF is an increase in plasma volume triggering acute decompensation with a significant impact on the prognosis of these patients [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery

et al. 2020

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Since risk assessment prior to cardiac surgery is based on proven but partly unsatisfactory scores, the need for novel tools in preoperative risk assessment taking into account cardiac decompensation is obvious. Even subclinical chronic heart failure is accompanied by an increase in plasma volume. This increase is illustrated by means of a plasma volume score (PVS), calculated using weight, gender and hematocrit. A retrospective analysis of 187 consecutive patients with impaired left ventricular function undergoing mitral valve surgery at a single centre between 2013 and 2016 was conducted. Relative preoperative PVS was generated by subtracting the ideal from actual calculated plasma volume. The study population was divided into two cohorts using a relative PVS score > 3.1 as cut-off. Patients with PVS > 3.1 had a significantly higher need for reoperation for bleeding/tamponade (5.5% vs. 16.7%; p = 0.016) and other non-cardiac causes (9.4% vs. 21.7%; p = 0.022). In-hospital as well as 6-month, 1-year and 5-year mortality was significantly increased in PVS > 3.1 (6.3% vs. 18.3%; p = 0.013; 9.4% vs. 23.3%; p = 0.011; 11.5% vs. 23.3%; p = 0.026; 18.1% vs. 33.3%; p = 0.018). Elevated PVS above the defined cut-off used to quantify subclinical congestion was linked to significantly worse outcome after mitral valve surgery and therefore could be a useful addition to current preoperative risk stratification.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery

et al. 2020

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“…Valvular heart diseases with aortic regurgitation or mitral regurgitation are believed to develop the heart failure by increasing the workload 4 . Kim et al 5 predicted the efficacy of a left ventricular assist device on varying degree of aortic or mitral regurgitation by using a mathematical model of the cardiovascular system and found that cardiac performance in mitral regurgitation was significantly improved by implementing a left ventricular assist device whereas that in aortic regurgitation was not.…”

Section: Can a Mathematical Model Of Cardiovascular System Predict Thmentioning

confidence: 99%

A step from the physiology to the physiome

Noma

Youm

2016

Integrative Medicine Research

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“…Similarly, flexible rings also permit annular distortion and have been found to have a 4-fold greater recurrence of MR over rigid rings [68]. Full ring annuloplasty undersized by 1 to 2 sizes restores annular geometry, ensuring proper leaflet coaptation and providing proper annular reduction and minimal risk for stenosis [69,70]. Failure to downsize can result in a recurrence rate of 30 % to 40 % [69].…”

Section: Repair Vs MV Replacementmentioning

confidence: 99%

“…Full ring annuloplasty undersized by 1 to 2 sizes restores annular geometry, ensuring proper leaflet coaptation and providing proper annular reduction and minimal risk for stenosis [69,70]. Failure to downsize can result in a recurrence rate of 30 % to 40 % [69]. Saddleshaped complete rings have also reported to improve restoration of annular geometry, decrease leaflet strain, and increase durability [71].…”

Section: Repair Vs MV Replacementmentioning

confidence: 99%

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

2014

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Functional mitral regurgitation (FMR) occurs when normal or nearly normal mitral leaflets are prevented from proper coaptation by underlying left ventricular (LV) dysfunction, mitral annular dilation, or both. FMR is associated with an adverse prognosis in nonischemic or ischemic LV dysfunction. Multiple studies have confirmed that even mild FMR portends a worse prognosis, and that the risk of FMR is independent of LV volumes and other clinical risk factors. FMR can be difficult to quantitate echocardiographically because it is load dependent and can vary considerably from exam to exam. There is a systematic tendency to underestimate FMR severity by echocardiography because the regurgitant orifice in FMR is typically elliptical, but the formula for calculating regurgitant orifice area assumes circular geometry. Treatment of FMR begins with guideline-directed medical therapy (GDMT) for LV dysfunction and heart failure, including cardiac resynchronization, if indicated. Revascularization should be considered for ischemic FMR, when indicated. Finally, mitral valve surgery should be considered in patients undergoing CABG in whom moderate or greater FMR is present, and also when severe symptomatic FMR persists despite optimal GDMT and revascularization. Percutaneous options for treatment of FMR are in development but are not currently approved in the US.

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Mitral Valve Repair in Patients With Advanced Heart Failure and Severe Functional Mitral Insufficiency Reverses Left Ventricular Remodeling and Improves Symptoms

Cited by 13 publications

References 25 publications

Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery

Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery

A step from the physiology to the physiome

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

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