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Annals of Thoracic and Cardiovascular... Oct 2022Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation. (Observational Study)
Observational Study
PURPOSE
Our aim was to evaluate the development of new significant mitral regurgitation and long-term survival after mitral repair surgery in functional mitral regurgitation.
METHODS
A retrospective observational analysis of the recurrence of functional mitral regurgitation (ischemic and nonischemic) and global mortality during follow-up of 176 patients who underwent mitral repair surgery between 1999 and 2018 in our center was conducted.
RESULTS
The etiology of functional mitral regurgitation was ischemic in 55.7% of cases. After surgery, mitral regurgitation was 0-I in 92.3% of cases. We conducted a long-term clinical follow-up of a mean 42.2 months and an echocardiographic follow-up of a mean 41.8 months. We observed mitral regurgitation of at least grade II in 52 patients (36.9%). Survival at 1, 3, and 5 years was 78.8%, 66.7%, and 52.3%, respectively. Predictive factors for global mortality were age (hazard ratio = 1.038, p = 0.01) and a depressed preoperative ejection fraction. After a competing risk analysis, we found the only predictive factor for the recurrence of mitral regurgitation in our series to be age (sub-hazard ratio = 1.03, 95% confidence interval = 1.01-1.06, p = 0.016).
CONCLUSION
Repair surgery for functional mitral regurgitation shows age as the only independent predictor of recurrence. Age and depressed ejection fraction were predictors of mortality.
Topics: Humans; Mitral Valve Insufficiency; Mitral Valve; Retrospective Studies; Treatment Outcome; Prognosis
PubMed: 35851568
DOI: 10.5761/atcs.oa.22-00051 -
JACC. Cardiovascular Imaging Feb 2022
Topics: Cardiomyopathies; Fibrosis; Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests
PubMed: 34656464
DOI: 10.1016/j.jcmg.2021.07.025 -
The Canadian Journal of Cardiology Sep 2014Any structural or functional impairment of the mitral valve (MV) apparatus that exhausts MV tissue redundancy available for leaflet coaptation will result in mitral... (Review)
Review
Any structural or functional impairment of the mitral valve (MV) apparatus that exhausts MV tissue redundancy available for leaflet coaptation will result in mitral regurgitation (MR). The mechanism responsible for MV malcoaptation and MR can be dysfunction or structural change of the left ventricle, the papillary muscles, the chordae tendineae, the mitral annulus, and the MV leaflets. The rationale for MV treatment depends on the MR mechanism and therefore it is essential to identify and understand normal and abnormal MV and MV apparatus function.
Topics: Chordae Tendineae; Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Rupture
PubMed: 25151282
DOI: 10.1016/j.cjca.2014.06.022 -
Minerva Cardioangiologica Feb 2003Mitral regurgitation is a common finding on echocardiography, seen to some degree in over 3/4 of the population. Pathologic mitral regurgitation is a common hospital... (Review)
Review
Mitral regurgitation is a common finding on echocardiography, seen to some degree in over 3/4 of the population. Pathologic mitral regurgitation is a common hospital diagnosis, but the percent of patients with mitral valve disease who ever require surgical correction is very small. There are many etiologies of mitral regurgitation, caused by either pathologic changes to one or more of the components of the mitral valve, including the leaflets, annulus, chordae tendineae, papillary muscles, or by abnormalities of the surrounding left ventricle and/or atrium. Mitral regurgitation can be diagnosed on physical exam or by angiography, but is best diagnosed and quantified using echocardiography. The outcome of mitral regurgitation depends on the acuity of onset of the regurgitation, as well as etiology of the mitral valve disease. Acute mitral regurgitation requires urgent mitral valve surgery. In contrast, most patients with chronic mitral regurgitation will never need corrective surgery. Currently, there is not convincing evidence that medical therapy with vasodilating medications slows the progression of mitral regurgitation. When patients with chronic mitral regurgitation develop symptoms of pathologic changes to the left ventricle, surgical treatment should be offered. Mitral valve repair is the preferred corrective surgery, and only when not possible should mitral valve replacement be performed.
Topics: Cardiac Surgical Procedures; Humans; Mitral Valve Insufficiency
PubMed: 12652258
DOI: No ID Found -
Journal of Veterinary Cardiology : the... Mar 2012In degenerative valve disease, the highly organized mitral valve leaflet matrix stratification is progressively destroyed and replaced with proteoglycan rich,... (Review)
Review
In degenerative valve disease, the highly organized mitral valve leaflet matrix stratification is progressively destroyed and replaced with proteoglycan rich, mechanically inadequate tissue. This is driven by the actions of originally quiescent valve interstitial cells that become active contractile and migratory myofibroblasts. While treatment for myxomatous mitral valve disease in humans ranges from repair to total replacement, therapies in dogs focus on treating the consequences of the resulting mitral regurgitation. The fundamental gap in our understanding is how the resident valve cells respond to altered mechanical signals to drive tissue remodeling. Despite the pathological similarities and high clinical occurrence, surprisingly little mechanistic insight has been gleaned from the dog. This review presents what is known about mitral valve mechanobiology from clinical, in vivo, and in vitro data. There are a number of experimental strategies already available to pursue this significant opportunity, but success requires the collaboration between veterinary clinicians, scientists, and engineers.
Topics: Animals; Biomechanical Phenomena; Dog Diseases; Dogs; Mitral Valve; Mitral Valve Insufficiency
PubMed: 22366572
DOI: 10.1016/j.jvc.2012.01.002 -
ESC Heart Failure Oct 2021We investigated short and mid-term safety and efficacy of the PASCAL system for percutaneous mitral valve repair (PMVr) in severe mitral regurgitation (MR) in an...
AIMS
We investigated short and mid-term safety and efficacy of the PASCAL system for percutaneous mitral valve repair (PMVr) in severe mitral regurgitation (MR) in an all-comer population.
METHODS AND RESULTS
In the first consecutive 41 patients undergoing PMVr using the PASCAL system in our centre, procedural success and safety were assessed. Efficacy in improving MR and functional class were evaluated. Median patient age was 74 years, 58.5% were male patients, and median European System for Cardiac Operative Risk Evaluation Score II was 5.1%. All patients suffered from severe MR with 59% functional MR, 29% degenerative MR, and 12% of mixed aetiology MR. The technical success rate was 90%, limited by four cases where PASCAL implantation was aborted due to a prohibitive mitral gradient. On average, 1.16 PASCAL devices per patient were implanted. All patients successfully implanted with a PASCAL device were discharged with MR grade ≤ 2 and 79% with MR grade ≤ 1. Mean follow-up was 8.7 ± 4.9 months. Ninety-seven per cent of patients remained at MR ≤ 2 at follow-up, which translated into a significantly improved New York Heart Association functional class as well as a significant reduction of systolic pulmonary artery pressure and brain natriuretic peptide levels. The procedure-related rate for major adverse events was 3%. Neither early nor late single-leaflet detachment was found. In one patient, air embolism occurred, resulting in modification of the PASCAL instructions for use.
CONCLUSIONS
Percutaneous mitral valve repair using PASCAL in a real-world, all-comer population was feasible and safe, resulting in a significant mid-term reduction of MR with persistent clinical improvement.
Topics: Aged; Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 34448541
DOI: 10.1002/ehf2.13569 -
The Journal of Thoracic and... Jun 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Tricuspid Valve Insufficiency
PubMed: 32008761
DOI: 10.1016/j.jtcvs.2019.12.053 -
Journal of the American College of... Aug 2022
Topics: Humans; Ischemia; Mitral Valve; Mitral Valve Insufficiency; Myocardial Ischemia; Ventricular Remodeling
PubMed: 35902174
DOI: 10.1016/j.jacc.2022.05.023 -
JACC. Cardiovascular Imaging Jun 2022
Topics: Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Phenotype; Predictive Value of Tests
PubMed: 35680230
DOI: 10.1016/j.jcmg.2022.03.028 -
The Journal of Invasive Cardiology Feb 2023To the best of our knowledge, this case represents the first patient with Mitraclip, Amplatzer, and TricValve devices with a profound clinical improvement and long-term...
To the best of our knowledge, this case represents the first patient with Mitraclip, Amplatzer, and TricValve devices with a profound clinical improvement and long-term follow-up. In addition, this case illustrates how the treatment of high-risk patients with polyvalvular disease has changed in the last few years.
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Cardiac Catheterization; Heart Valve Prosthesis Implantation; Treatment Outcome
PubMed: 36735872
DOI: No ID Found