Long-term results of mitral valve surgery for degenerative anterior leaflet or bileaflet prolapse: analysis of negative factors for repair, early and late failures, and survival

Coutinho, Gonçalo F.; Correia, Pedro Miguel Alves Ribeiro; Branco, Carlos; Antunes, Manuel J.

doi:10.1093/ejcts/ezv470

Cited by 46 publications

(35 citation statements)

References 23 publications

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“…In the EVER-EST II trial, 5-year data reported that patients included in the surgical group which comprised essentially patients with mitral repair, required mitral re-do surgery during the 5 years of follow-up in 9% of cases. This is higher than previously suggested in the observational studies [33][34][35]. Observational studies tend to underestimate outcomes due to lack of follow-up and underreporting.…”

Section: Limitations Of Transcatheter Plasty and The Case Of Transcatmentioning

confidence: 56%

Advances in transcatheter mitral and tricuspid therapies

Overtchouk

Piazza

Granada

et al. 2020

BMC Cardiovasc Disord

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Background: While rheumatic mitral stenosis has been effectively treated percutaneously for more than 20 years, mitral and tricuspid regurgitation treatment appear as a contemporary unmet need. The advent of transcatheter therapies offer new treatment options to often elderly and frail patients at high risk for open surgery. We aimed at providing an updated review of fast-growing domain of transcatheter mitral and tricuspid technology. Main body: We reviewed the existing literature on mitral and tricuspid transcatheter therapies. Mitraclip is becoming an established therapy for secondary mitral regurgitation in selected patients with disproportionately severe regurgitation associated with moderate left ventricle dysfunction. Evidence is less convincing for primary mitral regurgitation. Transcatheter mitral valve replacement is a promising emerging alternative to transcatheter repair, for secondary as well as primary mitral regurgitation. But further development is needed to improve delivery. Transcatheter tricuspid intervention arrives late after similar technologies have been developed for aortic and mitral valves and is currently at its infancy. This is likely due in part to previously under-recognized impact of tricuspid regurgitation on patient outcomes. Edge-to-edge repair is the most advanced transcatheter solution in development. Data on tricuspid annuloplasty and replacement is limited, and more research is warranted. Conclusion: The future appears bright for transcatheter mitral therapies, albeit their place in clinical practice is yet to be clearly defined. Tricuspid transcatheter therapies might address the unmet need of tricuspid regurgitation treatment.

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Section: Limitations Of Transcatheter Plasty and The Case Of Transcatmentioning

confidence: 56%

Advances in transcatheter mitral and tricuspid therapies

Overtchouk

Piazza

Granada

et al. 2020

BMC Cardiovasc Disord

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“…Interestingly, in the subgroup of patients with AMLP/BLP, the repair rate increased from 94.8% to 98.4% in asymptomatic or mildly symptomatic patients 24. Moreover, these patients had increased late survival in comparison to those with pre-operative NYHA class III/IV symptoms, and similar survival to the age- and sex-matched population (figure 6).…”

Section: Controversies Surrounding Mitral Valve Repairmentioning

confidence: 90%

“…We have found that the need for MVR in AMLP/BLP was influenced not only by anatomical issues but also by patient’s characteristics and by the performing surgeon’s experience (table 3). 24 …”

Section: ‘Repair-all’ Strategy In All Corners Of Mitral Valve Prolapsementioning

confidence: 99%

Mitral valve repair for degenerative mitral valve disease: surgical approach, patient selection and long-term outcomes

Coutinho

Antunes

2017

Heart

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Mitral valve repair (MVRepair) has become the procedure of choice to correct severe degenerative mitral regurgitation (MR), due to its documented superiority to valve replacement regarding long-term survival, freedom from valve-related adverse events and preservation of left ventricular (LV) function. The refinement of MVRepair techniques has rendered almost all valves (more than 95%) amenable to repair with a 15-year freedom from reoperation of 90%. The concept of 'centres of excellence for MVRepair' has emerged, encouraging referring doctors to select the most experienced institutions or individual surgeons to deal with the most complex cases, based on repair volume, appropriate peri-procedural imaging and data regarding expected outcomes (repair, mortality and durability of repair). Based on the good results, operating on asymptomatic patients with severe MR is now widely accepted, prophylactically avoiding the dire consequences of chronic MR, such as LV function deterioration/enlargement, and development of atrial fibrillation and pulmonary hypertension. In reference centres, where the repair rate is over 95% for all types of disease with <1% mortality, it has become standard practice in nearly 50%-60% of all patients submitted to MVRepair. Finally, recent advances in the surgical treatment with the purpose of reducing invasiveness and surgical trauma, through partial sternotomy or mini-thoracotomy (video-assisted with or without robotics), are now being increasingly performed in 20%-30% of centres, claiming comparable results to conventional surgery. In addition, transcatheter technology, particularly the MitraClip, is evolving and treading its way in the treatment of high-risk patients with severe MR, but the results are still short of ideal.

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“…It is superior to replacement and interventional techniques and has the potential to restore normal life expectancy. 1,2 However, repair techniques may be complex and often dependent on an artistic ability of the operating surgeon. 3,4 This art is important because the impact on survival and symptoms is related to repair success and durability.…”

Section: Torsten Doenst MD Phdmentioning

confidence: 99%