Preservation of the subvalvular apparatus during mitral valve replacement of rheumatic valves does not affect long-term survival

Coutinho, Gonçalo F.; Bihun, V.; Correia, Pedro; Antunes, Pedro E.; Antunes, Manuel J.

doi:10.1093/ejcts/ezu537

Cited by 17 publications

(19 citation statements)

References 20 publications

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“…Patient‐related factors which predispose to LVOT obstruction include an intrinsically small LVOT, as occurs in patients with septal hypertrophy, sigmoid‐shaped septum, or small LV cavity size. The last is especially common in the elderly and those with mitral stenosis …”

Section: Discussionmentioning

confidence: 99%

Malaligned bioprosthetic valve causing left ventricular outflow tract obstruction

et al. 2019

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Left ventricular outflow tract obstruction resulting from strut impingement upon the interventricular septum is a rare complication of bioprosthetic mitral valve insertion. Obstruction is more likely to develop when a small, high profile prosthetic valve is inserted into a patient with a small outflow tract. The likelihood of this complication may be reduced by appropriate modification of surgical technique.

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Section: Discussionmentioning

confidence: 99%

Malaligned bioprosthetic valve causing left ventricular outflow tract obstruction

et al. 2019

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“…Coutinho et al have already identified pure mitral regurgitation as one of the independent risk factors for late mortality. 28 Okita et al compared three patient groups that underwent either MVR with chordal preservation, conventional MVR or OMC due to pure mitral stenosis. 24 There were no differences between the groups in terms of mitral valve area, cardiac index, LV end-diastolic and end-systolic volume index and contractility index in the early postoperative period; However, LV EF showed a significant increase in the chordal preservation and OMC groups and a slight decrease in the conventional MVR group.…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Replacement with Papillary Muscle Resuspension in Rheumatic Mitral Valve Disease

Uzun¹,

Tekümit²,

Tataroğlu³

et al. 2016

Turkiye Klinikleri J Cardiovasc Sci

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In this study, we compared two different mitral valve replacement techniques (with and without papillary muscle resuspension via artificial chordae) in patients with rheumatic mitral valve disease; in regard to effects on left ventricular functions and sizes. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The study included 164 patients that underwent mitral valve replacement with the complete resection of the mitral valve and subvalvular apparatus due to rheumatic mitral valve disease between January 2010 and September 2015. First, the patients were classified into two different sections according to severety of mitral insufficiency. Then, those who underwent papillary muscle resuspension were compared with those who didn't in each section. R Re es su ul lt ts s: : Overall hospital mortality rate was 0.6% with 1 death. Among the patients who have significant mitral insufficiency, there was a significant difference between those with and without resuspension in respect to rates of inotrophic support taking and hospitalization duration times (59.2% versus 26.6%, p=0.033 and 10.59±5.8 versus 7.64±5.5 days , p= 0.036, respectively) in early postoperative period and ejection fractions (increased significantly in patients with resuspension from 56.23±9.1 to 59±6.5, while decreased in patients without resuspension from 58.37±9.9 to 57.07±9.1) during the mid-term postoperative period. C Co on nc cl lu us si io on n: : In the case of valve replacement in rheumatic mitral valve disease, if there is significant mitral regurgitation preoperatively, performing papillary muscle resuspension affects left ventricular systolic functions positively. So, resuspension of the papillary muscles can be considered as a favorable alternative to other valve sparing technique due to potential advantages of maintaining mitral annulopapillary muscle continuity. K Ke ey y W Wo or rd ds s: : Rheumatic heart disease; heart valve prosthesis implantation; chordae tendineae Ö ÖZ ZE ET T A Am ma aç ç: : Biz bu çalışmada romatizmal mitral kapaklı hastalarda iki farklı mitral kapak replasman tekniğini (yapay korda ile papiller kas resüspansiyonu yapılan ve yapılmayan) sol ventrikül fonksiyon ve boyutlarına etkileri bakımından karşılaştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya Ocak 2010-Eylül 2015 arasında romatizmal mitral kapak hastalığı nedeni ile mitral kapak ve subvalvuler yapılar tamamen rezeke edilerek kapak replasmanı yapılan 164 olgu dahil edildi. İlk olarak hastalar preoperatif önemli mitral yetersizlik olup olmamasına göre 2 gruba ayrıldı. Sonra her grup içinde papiller kas resüspansiyonu yapılanlar yapılmayanlar ile karşılaştırıldı. B Bu ul lg gu ul la ar r: : Total mortalite 1 ölüm ile %0,6 idi. Önemli mitral yetersizliği olan hastalardan resüspansiyon yapılan ve yapılmayanlar arasında inotropik destek ihtiyacı ve hastanede kalış süreleri bakımından anlamlı farklılık vardı (%59,2'ye karşı %26,6, p=0,033 ve 10,59±5,8'e karşı 7.64±5.5 gün, p...

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“…Apart from anecdotal reports, there are few data to guide treatment of LVOT obstruction due to bioprosthetic malposition. In symptomatic patients, treatment may require valve re‐replacement . Successful outcomes have also been reported following alcohol septal ablation .…”

Section: Lvot Obstruction Following Surgical Mitral Valve Replacementmentioning

confidence: 99%

Mechanisms, pathophysiology, and diagnostic imaging of left ventricular outflow tract obstruction following mitral valve surgery and transcatheter mitral valve replacement

et al. 2019

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Left ventricular outflow tract obstruction is a serious complication of mitral valve surgery (repair and replacement) and transcatheter mitral valve replacement. An appreciation of the various mechanisms which cause outflow obstruction in these settings is critical to avoiding this complication and to initiating appropriate treatment. This article discusses the mechanisms, pathophysiology, and imaging of left ventricular outflow tract obstruction which can arise following insertion of a variety of mitral valve prosthetics.

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Preservation of the subvalvular apparatus during mitral valve replacement of rheumatic valves does not affect long-term survival

Abstract: Patients submitted to MVR for rheumatic mitral valve disease have a poor prognosis, independently of having the subvalvular apparatus preserved. PSVA did not improve late survival in this setting.

Cited by 17 publications

References 20 publications

Malaligned bioprosthetic valve causing left ventricular outflow tract obstruction

Malaligned bioprosthetic valve causing left ventricular outflow tract obstruction

Mitral Valve Replacement with Papillary Muscle Resuspension in Rheumatic Mitral Valve Disease

Mechanisms, pathophysiology, and diagnostic imaging of left ventricular outflow tract obstruction following mitral valve surgery and transcatheter mitral valve replacement

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