No abstract

The 2 lesion sets (left atrial and BA) are associated with similar 30-day mortality, survival rates, incidences of embolic events and atrioventricular conduction disturbances. In patients with persistent atrial fibrillation, concomitant surgical ablation with BA lesion set provided better freedom from atrial arrhythmia recurrence, but BA ablation was associated with a higher incidence of sinus node dysfunction and a higher rate of pacemaker implantation.

ClinicalTrials.gov: NCT02054221.

The Ross operation provides long-term survival rates that are comparable with an age- and gender-matched general population. The dilated aortic annulus is a risk factor for late autograft valve insufficiency. A cryopreserved pulmonary homograft is the best option for RVOT reconstruction. Diepoxide-treated pericardial xenografts can be an alternative to allografts in elderly patients when an allograft is not available.

For patients undergoing the Ross procedure, a combination of bicuspid aortic valves and aortic insufficiency is the main risk factor for late autograft dilatation and dysfunction.

No abstract

We evaluated the differences in mitral valve (MV) plasty (MVP) and MV replacement (MVR) with respect to death, postoperative MV dysfunction, reoperation rates and thromboembolic events (DFRE) in patients with hypertrophic obstructive cardiomyopathy and systolic anterior motion of the anterior mitral leaflet-mediated MV regurgitation (HOCM & MR). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, searching PubMed, Cochrane library and ClinicalTrials.gov for studies that evaluated DFRE in adults with HOCM & MR after MVP/MVR. We used a risk of bias assessment tool for non-randomized studies, and analyses were performed using Cochrane Review Manager 5.3.5 for I2 statistics, funnel plots and forest plot and the generic inverse variance method for hazard ratios (HRs). We developed qualitative and quantitative syntheses of 35 and 23 studies, respectively, including levels of evidence of ½/3/4/5 = 3/1/11/11/9 and ½/3/4/5 = 0/1/11/11/0, respectively, from January 1980 to August 2017. A statistically significant difference between MVP and MVR favoured MVP for the prevention of DFRE in patients with HOCM & MR, on the basis of a significant reduction of the HR for DFRE: HR = 0.68 (0.57, 0.82), I2 = 68% (P = 0.002). The findings were as follows: (i) MVP should be the first-line treatment in patients with HOCM & MR (accuracy LEVEL A) and (ii) MVR may be harmful if it is used as the first-line treatment (accuracy LEVEL A).

BackgroundWe aimed to compare the outcomes of mitral valve repair with flexible band (FB) versus complete semirigid ring (SR) in degenerative mitral valve disease patients.MethodsFrom September 2011 to 2014, 171 patients were randomized and underwent successful mitral valve repair using a SR (n = 85) or FB (n = 86). There were no significant between-group differences at baseline.ResultsThere were no early mortalities. The mean follow up was 24.7 months. The 2-year survival was 96.0 ± 2.3% (95% confidence interval [CI], 88.6–98.7%) and 94.3 ± 2.8% (95% CI, 85.5–97.9%) in the SR and FB groups, respectively (p = 0.899). The left ventricle remodeling was similar between the groups. Higher transmitral peak (8.5 [3.9–17] vs. 6 [2.1–18] mmHg, p < 0.001), mean pressure gradients (3.7 [1.3–8] vs. 2.8 [0.6–6.8] mmHg, p = 0.001), and systolic pulmonary artery pressure (34.5 [20–68] vs. 29.5 [8–48] mmHg, p < 0.001) was observed in the SR group. The 2-year freedom from recurrence of significant mitral regurgitation was significantly higher in the FB group than the SR group (p = 0.002). Residual mitral regurgitation was an independent prognostic factor of recurrence of mitral regurgitation. The 3-year freedom from reoperation was significantly higher in the FB group than the SR group (p = 0.044).ConclusionPatients with degenerative mitral valve disease may benefit from valve repair with FBs. Residual mitral regurgitation before discharge is an independent risk factor of late insufficiency recurrence.Trial registrationClinicalTrials.gov NCT03278574, retrospectively registered on 06.09.2017.Electronic supplementary materialThe online version of this article (10.1186/s13019-017-0679-0) contains supplementary material, which is available to authorized users.