This research was motivated by the need to develop positive feminist discourses about women who are infertile and who pursue medical interventions to achieve motherhood. This study analysed how 19 women who wanted children but who could not easily have them constructed their desire for children, motherhood and their infertility. Reasons for wanting children included motherhood as ‘natural instinct’, as ‘a stage in the development of a relationship’ and as ‘social expectation’. These were used to construct motherhood as physical, psychological and social completeness and fulfilment for women. Consequently, infertility was experienced as guilt, inadequacy and failure, reinforced by the language used to describe infertility. Women also discussed their desire for children in terms of reproductive decision-making, emphasizing notions of agency, becoming a parent as a stage in a relationship and infertility as a disruption of life plans. Our analysis argues for a broader definition of motherhood and a wider variety of culturally sanctioned roles for women.
Background
This study analyzed the effects on long‐term outcome of residual mitral regurgitation (
MR
) and mean mitral valve pressure gradient (
MVPG
) after percutaneous edge‐to‐edge mitral valve repair using the MitraClip system.
Methods and Results
Two hundred fifty‐five patients who underwent percutaneous edge‐to‐edge mitral valve repair were analyzed. Kaplan–Meier and Cox regression analyses were performed to evaluate the impact of residual
MR
and
MVPG
on clinical outcome. A combined clinical end point (all‐cause mortality,
MV
surgery, redo procedure, implantation of a left ventricular assist device) was used. After percutaneous edge‐to‐edge mitral valve repair, mean
MVPG
increased from 1.6±1.0 to 3.1±1.5 mm Hg (
P
<0.001). Reduction of
MR
severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual
MR
was predictive of the combined end point while elevated
MVPG
>4.4 mm Hg was not according to Kaplan–Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional
MR
separately to account for these different entities. In the cohort with degenerative
MR
, elevated
MVPG
was associated with increased occurrence of the primary end point, whereas this was not observed in the cohort with functional
MR
.
Conclusions
MVPG
>4.4 mm Hg after MitraClip implantation was predictive of clinical outcome in the patient cohort with degenerative
MR
. In the patient cohort with functional
MR
,
MVPG
>4.4 mm Hg was not associated with increased clinical events.
This study demonstrates mechanical approximation of both mitral valve annulus edges with improved mitral valve annular coaptation by PMVR using the MitraClip® system, which correlates with residual MR in patients with MR.
BackgroundPercutaneous edge‐to‐edge mitral valve repair (PMVR) has become an established treatment option for mitral regurgitation in patients not eligible for surgical repair. Currently, most procedures are performed under general anesthesia (GA). An increasing number of centers, however, are performing the procedure under deep sedation (DS). Here, we compared patients undergoing PMVR with GA or DS.Methods and ResultsA total of 271 consecutive patients underwent PMVR at our institution between May 2014 and December 2016. Seventy‐two procedures were performed under GA and 199 procedures under DS. We observed that in the DS group, doses of propofol (743±228 mg for GA versus 369±230 mg for DS, P<0.001) and norepinephrine (1.1±1.6 mg for GA versus 0.2±0.3 mg for DS, P<0.001) were significantly lower. Procedure time, fluoroscopy time, and dose area product were significantly higher in the GA group. There was no significant difference between GA and DS with respect to overall bleeding complications, postinterventional pneumonia (4% for GA versus 5% for DS), or C‐reactive protein levels (361±351 nmol/L for GA versus 278±239 nmol/L for DS). Significantly fewer patients with DS needed a postinterventional stay in the intensive care unit (96% for GA versus 19% for DS, P<0.001). Importantly, there was no significant difference between DS and GA regarding intrahospital or 6‐month mortality.Conclusions
DS for PMVR is safe and feasible. No disadvantages with respect to procedural outcome or complications in comparison to GA were observed. Applying DS may simplify the PMVR procedure.
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