Clinical Implication of Transaortic Mitral Pannus Removal During Repeat Cardiac Surgery for Patients With Mechanical Mitral Valve

Park, Byungjoon; Sung, Kiick; Park, Pyo Won

doi:10.1253/circj.cj-17-0463

Cited by 6 publications

(8 citation statements)

References 28 publications

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“…Recently, we reported our experience with transaortic mitral pannus removal during repeat cardiac surgery. 25 Subaortic pannus removal without repeat AVR is not recommended, because of incomplete hemodynamic improvement and the possibility of early recurrent subaortic stenosis. 7 The 10-year overall survival was 88%; however, the event-free survival at 10 years was only 51% because of recurrent prosthetic AS, paravalvular leakage of the mitral valve, prosthetic endocarditis, and TR progression after tricuspid valve repair.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Park

Jeong

et al. 2018

Circ J

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Background: This study aimed to evaluate the early and late clinical outcomes after repeat aortic valve replacement (AVR) for subaortic pannus in patients with mechanical valves. Methods and Results:Between 2001 and 2017, 51 patients (median age, 59 years; 42 women) with prosthetic aortic stenosis (AS) caused by pannus ingrowth underwent repeat AVR because of acute malfunction of monoleaflet valve (3 patients), severe prosthetic AS (30 patients), and moderate prosthetic AS at the time of tricuspid or mitral valve surgery (18 patients). The median follow-up duration was 100 (interquartile range, 64-138) months. Double valve replacement was performed in 45 (88%) patients. Median time interval from previous operation was 161 (interquartile range, 121-194) months. The explanted mechanical AV was monoleaflet and bileaflet in 16 (31%) and 34 (67%) patients, respectively. Concomitant procedures included 16 mitral valve replacements (14 repeat) and 36 tricuspid valve surgeries (15 replacements, 21 repairs). No hospital deaths or cases of heart block occurred. Overall survival and event-free survival rates at 10 years were 88% and 51%, respectively. Late complications included recurrent prosthetic AS (4 patients), new paravalvular leakage of the mitral valve (5 patients), and severe tricuspid regurgitation (2 patients). Conclusions:Although repeat AVR for subaortic pannus had acceptable early and late survival, recurrent prosthetic AS was frequently observed during late follow-up.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Park

Jeong

et al. 2018

Circ J

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“…Their MVPG was 5 ± 1 mmHg, compared to 11 ± 7 mmHg ( p = 0.001). Park et al ( 16 ) found that patients with MVPG <5 mmHg could not benefit from the pannus clearance. Our findings were in line with their report.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Surgical Evaluations of Reoperation After Mechanical Mitral Valve Replacement Due to Different Etiologies

Wang

Sun

et al. 2022

Front. Cardiovasc. Med.

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Background:This study aimed to evaluate the clinical and surgical characteristics of patients who required reoperation after mechanical mitral valve replacement (MVR).Methods:We retrospectively identified 204 consecutive patients who underwent reoperation after mechanical MVR between 2009 and 2018. Patients were categorized according the reason for reoperation (perivalvular leakage, thrombus formation, or pannus formation). The patients' medical and surgical records were studied carefully and the rates of in-hospital complications were calculated.Results:The mean age was 51±12 years and 44% of the patients were male. The reasons for reoperation were perivalvular leakage (117 patients), thrombus formation (35 patients), and pannus formation (52 patients). The most common positions for perivalvular leakage were at the 6–10 o'clock positions (proportions of ≥25% for each hour position). Most patients had an interval of >10 years between the original MVR and reoperation. The most common reoperation procedure was re-do MVR (157 patients), and 155 of these patients underwent concomitant cardiac procedures. There were 10 in-hospital deaths and 32 patients experienced complications. The 10-year survival rate was 82.2 ± 3.9% in general, and the group of lowest rate was patients with PVL (77.5 ± 5.2%). The independent risk factors were “male” (4.62, 95% CI 1.57–13.58, P = 0.005) and “Hb <9g/dL before redo MV operation” (3.45, 95% CI 1.13–10.49, P = 0.029).Conclusion:Perivalvular leakage was the most common reason for reoperation after mechanical MVR, with a low survival rate in long term follow-up relatively.

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“…Pannus formation was reported to occur more frequently in the aortic position and in female patients [ 18 , 19 ]. The incidence of pannus formation after mechanical MVR was reportedly below 1% [ 16 ], which is consistent with the present study (0%).…”

Section: Discussionmentioning

confidence: 99%

Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications

Uchino

Murakami

Mukohara

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives This study aimed to examine very-long-term outcomes of a mechanical valve at the mitral position. Methods This study included all patients who underwent mitral valve replacement using a mechanical valve including urgent operation at the Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, from January 1987 to December 2015. Results Five hundred and eighty three patients (277 men [47.51%]; age, 61 [54–67] years) were included in this study. The implanted valve models were as follows: SJM 221(37.91%), ATS 35(6.00%), On-X 68(11.66%), and Carbomedics 194(33.28%).The median clinical follow-up duration was 13.3 (7.4–19.6) years. The survival rates at 10, 15, 20, and 25 years were 81.42%, 69.27%, 56.34%, and 45.03%, respectively. Thromboembolism was observed in 38 patients, and the linearized ratio for each event was 0.626%/patient-year(95% confidence interval, 0.443%–0.859%). Intracranial Haemorrhage and gastrointestinal bleeding were observed in 26 and 9 patients, and the linearized ratio for each event was 0.425%/patient-year (95% confidence interval, 0.277%–0.006%) and 0.145%/patient-year (95% confidence interval, 0.067%–0.276%), respectively. Major paravalvular leak was observed in 32 patients, and the linearized ratio was 0.532%/patient-year (95% confidence interval, 0.364%–0.751%). The cumulative incidence rate of major paravalvular leak at 10, 15, 20, and 25 years were 3.7%, 5.6%, 6.4%, and 10.4%, respectively. Multivariable Cox regression analysis revealed that repeated mitral valve replacement and male gender were associated with major paravalvular leak. Conclusion Male gender and repeated mitral valve replacement were risk factors for paravalvular leak after mechanical mitral valve replacement. Paravalvular leak could have occurred regardless of postoperative period even at 25 years after implantation. Lifelong clinical follow-up is considered necessary.

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Clinical Implication of Transaortic Mitral Pannus Removal During Repeat Cardiac Surgery for Patients With Mechanical Mitral Valve

Cited by 6 publications

References 28 publications

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Clinical and Surgical Evaluations of Reoperation After Mechanical Mitral Valve Replacement Due to Different Etiologies

Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications

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