Open Transcatheter Multivalve Replacement in Degenerated Valve Prostheses in High-Risk Patients with Endocarditis

Zhigalov, Konstantin; Rad, Arian Arjomandi; Vardanyan, Robert; Wendt, Daniel; Schmack, Bastian; Ruhparwar, Arjang; Weymann, Alexander

doi:10.21470/1678-9741-2020-0394

Cited by 1 publication

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“…The following result could be explained through a high portion of patients presenting with infective endocarditis (37.9%) and 51.7% of patients requiring at least one concomitant procedure. Both procedures initially carry higher risks when compared with isolated redo SMVR 14–18 . To present the discrepancy in the outcomes, we divided our cohort (as previously mentioned) into two groups and analyzed their separate mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…Both procedures initially carry higher risks when compared with isolated redo SMVR. [14][15][16][17][18] To present the discrepancy in the outcomes, we divided our cohort (as previously mentioned) into two groups and analyzed their separate mortality rates. Patients who underwent an isolated redo SMVR showed 30-day mortality of 10.7%, while the patients with at least one additional concomitant procedure presented with significantly higher mortality of 33%, which could be explained through the complexity of the procedure and the comorbidities of the patients.…”

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confidence: 99%

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Surgical redo mitral valve replacement in high‐risk patients: The real‐world experience

Szczechowicz

Zhigalov

Rad

et al. 2021

Journal of Cardiac Surgery

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Introduction Redo surgical mitral valve replacement (SMVR) remains the gold standard treatment in patients with a history of mitral valve surgery presenting with recurrent mitral valve pathologies. Whilst this procedure is demanding, it is an inevitable intervention for some indications, such as infective endocarditis, thrombosis, or multivalve procedures. In this study, we aim to evaluate our institutional experience with SMVR on a real‐life cohort, identifying the factors that contribute to poor surgical outcomes whilst avoiding selection bias. Methods Between March 2012 and November 2020, 58 consecutive high‐risk patients underwent a redo SMVR at our institution. The primary endpoints of this study were 30‐day and 1‐year mortality. The secondary endpoint was the development of any postoperative adverse events. We analyzed and compared the survival in patients undergoing an isolated SMVR and in those that required at least one concomitant procedure. Results The overall operative, 30‐day, and 1‐year mortality were 3.4%, 22.4%, and 25.9%, respectively. The mortality in patients undergoing isolated SMVR was significantly lower than in patients requiring concomitant procedures. The multivariable regression model showed that NYHA Class IV, infective endocarditis, and postoperative dialysis were significantly associated with 30‐day mortality. Society of Thoracic Surgeons Score, infective endocarditis, concomitant procedures, and mechanical valve implantation appeared to predict long‐term mortality. Conclusion This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.

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confidence: 99%

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confidence: 99%