Commissuroplasty as a Main Operative Technique in Rheumatic Mitral Valve Repair: Surgical Experiences and Mid-Term Results

Luo, Tiange; Xu, Meng; Yan, Zhiguo; Zhan, Yu-Fei; Popal, Mohammad Sharif

doi:10.1016/j.hlc.2019.05.189

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…Interestingly, satisfactory follow-up results have been reported at our centre (13) and other cardiac centres (7,12). The majority of patients in these reports underwent successful valve repair at our centre with the SCORE procedure and without the use of other techniques (13,20). However, the performance of other repair techniques has also been reported (21).…”

Section: Patients Is Considered the Key To Achieving A High Repairmentioning

confidence: 57%

“…Three problems concern cardiac surgeons regarding this topic (14,15): long-term follow-up results (8,16), repair technique (13,17), and pathological features that can indicate the requirements for repair (18,19). Interestingly, satisfactory follow-up results have been reported at our centre (13) and other cardiac centres (7,12).…”

Section: Patients Is Considered the Key To Achieving A High Repairmentioning

confidence: 80%

“…Our cardiac centre was the first in China to perform rheumatic MVP (13), and it is still regularly performed here. Indeed, more than 150 such surgeries were performed annually at our centre in the last 2 years.…”

Section: Discussionmentioning

confidence: 99%

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Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy

Luo¹,

Xu²

2021

J Thorac Dis

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Background: There is a lack of established pathological indications for rheumatic valve repair. Therefore, we summarized the pathological classifications of rheumatic heart diseases and their correlations with the surgical strategies. Methods: This observational study enrolled patients with rheumatic heart diseases who underwent mitral valve repair (MVP) or replacement at our centre between January 2017 and January 2019. Mitral leaflet, mitral commissural, and sub-valvular apparatus were classified into three grades from mild to severe, according to their degree of pathological damage. Based on certain principles and the grade of mitral leaflet, mitral commissural, and sub-valvular apparatus damage, three pathological types were identified (types I to III), based on which all patients were classified. The features of each pathological type were summarised.Differences between the three pathological types were analysed using chi-square test of tendency. These data were used to propose a clinico-pathological classification of rheumatic mitral valve damage in Chinese patients. Results: Of 398 patients, 284 (70%) underwent MVP for rheumatic mitral valve diseases. There were 58 type I (15%) patients in the study, all of whom underwent repair (repair rate, 100%). Preoperative moderateto-severe regurgitation with mild pathological lesions was observed in 64% of these patients. In 260 type II (65%) patients, the repair rate was 76% (197/260); preoperative moderate-to-severe stenosis was observed in 88% of these patients. In 80 type III (20%) patients, the repair rate was 36% (29/80); the preoperative rates of extremely severe stenosis and moderate-to-severe regurgitation in these patients were 50% and 40%, respectively. Several preoperative parameters show the change in trend with the increase in the pathological classification severity. Conclusions: Our clinico-pathological classification of rheumatic mitral valve damage is applicable to MVP. Considering that the classification principles are based on the possibility of mitral repair, it provides a phased and achievable target ratio for MVP and a principle of screening patients who should undergo rheumatic MVP.

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Section: Patients Is Considered the Key To Achieving A High Repairmentioning

confidence: 57%

Section: Patients Is Considered the Key To Achieving A High Repairmentioning

confidence: 80%

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Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy

Luo¹,

Xu²

2021

J Thorac Dis

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“…Although there were significant differences in ejection fraction between the groups, which considered to be caused by extracorporeal circulation's affection, they were still in the normal interval. Serious MR is treated as a risk of procedure failure in both PBMV and rMVP, with a chance of 1.4% to 9.4% (22,23) and 2.6% to 3.2% (12,24) respectively. However, whether PBMV or rMVP could be used on a patient or not based on multiple factors, including the patient's condition, their choice, and the surgeon's skill.…”

Section: Discussionmentioning

confidence: 99%

Surgical rheumatic mitral valve repair compared with percutaneous balloon mitral valvuloplasty in mitral stenosis in current era: a propensity score matching study

Han

Tian

et al. 2020

J Thorac Dis

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Background: Many comparative studies of percutaneous balloon mitral valvuloplasty (PBMV) and surgical mitral commissurotomy (SMC) in rheumatic mitral stenosis (MS) were done in the last few decades. With the development of valve repair techniques, various surgical rheumatic valve repair techniques have been applied in clinic, but there is a lack of comparison with PBMV. Our study was designed to compare the perioperative and mid-term outcomes of PBMV and mitral valve repair with "four-step" procedure in the treatment of rheumatic MS. Methods: Patients with MS were treated with PBMV or rheumatic mitral valve repair (rMVP) at Beijing Anzhen Hospital between January 1, 2013 and September 30, 2018 were selected. By using propensity score matching (PSM) method, we compared the changes in post-operation clinical outcomes between the two matched groups. Kaplan-Meier analyses was used for survival analysis and drawing the curve, and log-rank test were used to compare intergroup differences. Results: A total of 252 cases were enrolled after selection, 74 cases in PBMV and 178 cases in rMVP.Seventy-four pairs were matched successfully after PSM. There were 53 females in PBMV and 54 in rMVP. The mean age of two groups was 46.95±12.50 and 47.55±11.91 years respectively. There was no significantly differences in mitral valve orifice area (MVOA) (1.05±0.32 vs. 0.97±0.24 cm 2 , P=0.12) and left ventricular ejection fraction (EF) (62.36%±5.17% vs. 62.52%±4.94%, P=0.76) between two groups preoperatively.Baseline characteristics were basically balanced after PSM. In each group, there was one case transferred to surgical mitral valve replacement due to the failure of valvuloplasty before discharge. All patients survived the interventions and no severe complications were found. MVOA were significantly increased in rMVP compared with PBMV postoperatively, as well as grading of MS and tricuspid regurgitation (TR) were significantly improved in rMVP. Three cases in PBMV were lost during the follow-up. Mitral replacement was performed in 11 patients and one of them died in PBMV, while none of patients underwent reintervention in rMVP, but one patient died of pneumonia. Conclusions: For selected patients with rheumatic MS in China, our study shows that there are comparable clinical outcomes in terms of operative, mid-term mortality and complications between PBMV and surgical rMVP with "four-step" procedure. Surgical rMVP shows more advantageous in the correction of valve stenosis and the management of concomitant tricuspid valve lesions and atrial fibrillation (AF).

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“…To improve the adoption of mitral repair for rheumatic valve disease, techniques need to be made more reproducible and results followed up. This can be achieved by identifying selection criteria for repair candidates ( [91][92][93], standardizing a methodical approach to rheumatic mitral valve repair which can be taught and audited (88,94,95) and, importantly, strengthening local surgical programs in endemic areas, with expert valve repair surgeons providing technical guidance as well as mentorship on systematic follow-up and audit (90,96). Collaboration of local surgical programs, through mutual site visits, workshops, or regional meetings, can have a significant effect on the wide adoption of rheumatic valve repair and the improvement of its techniques.…”

Section: "Conduct Studies That Determine the Potential Valuementioning

confidence: 99%

The “Cairo Accord”- Towards the Eradication of RHD: An Update

Kotit

Phillips

Afifi

et al. 2021

Front. Cardiovasc. Med.

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Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in children and young adults. It continues to be prevalent in many low- and middle-income countries where it causes significant morbidity and mortality. Following the 2017 Cairo conference “Rheumatic Heart Disease: from Molecules to the Global Community,” experts from 21 countries formulated an approach for addressing the problem of RHD: “The Cairo Accord on Rheumatic Heart Disease.” The Accord attempts to set policy priorities for the eradication of acute rheumatic fever (ARF) and RHD and builds on a recent series of policy initiatives and calls to action. We present an update on the recommendations of the Cairo Accord and discuss recent progress toward the eradication of RHD, including contributions from our own Aswan Rheumatic Heart Disease Registry (ARGI).

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Commissuroplasty as a Main Operative Technique in Rheumatic Mitral Valve Repair: Surgical Experiences and Mid-Term Results

Cited by 7 publications

References 21 publications

Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy

Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy

Surgical rheumatic mitral valve repair compared with percutaneous balloon mitral valvuloplasty in mitral stenosis in current era: a propensity score matching study

The “Cairo Accord”- Towards the Eradication of RHD: An Update

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