Mitral Valve Replacement Research Articles

Intraoperative conduction system mapping during reoperative mitral valve replacement

Intraoperative conduction system mapping during reoperative mitral valve replacement

Left Ventricular Fibrosis by Cardiac Magnetic Resonance Tissue Characterization in Chronic Mitral Regurgitation Patients.

Background: Left ventricular remodeling in chronic mitral regurgitation (MR) encompasses two types of myocardial fibrosis: replacement fibrosis, identified by late gadolinium enhancement (LGE), and diffuse interstitial fibrosis, assessed by pre- and postcontrast T1 mapping techniques. These may explain irreversible LV dysfunction after MR correction. We aimed to assess the presence of myocardial fibrosis in patients with moderate and severe MR with no criteria for surgery versus mild MR controls. Methods: We enrolled 137 patients with chronic primary MR and 130 controls; all underwent cardiac magnetic resonance, and were followed up in a median of 2.9 years to assess mortality and the need for mitral valve replacement. Results: Patients in the study group displayed significantly higher degrees of LGE (28.4% vs 7.69%, p < 0.05), higher native T1 values (1167 ± 58.5 versus 971 ± 51.4 (p < 0.05)), and higher extracellular volumes compared to controls (32.3% ± 3.5 versus 23.9 ± 2.2, (p < 0.05)). The composite outcome occurred in 28 patients in the study group (20.4%), and significantly higher with LGE+ (78.5%). Replacement fibrosis (HR = 1.83, 95% CI, p < 0.01) and interstitial fibrosis (HR = 1.61, 95% CI, p < 0.01) were independent predictors for the composite outcome. Conclusions: Patients with moderate and severe MR with no criteria for surgery still exhibit a significant degree of both replacement and interstitial fibrosis, with prognostic implications.

Economic Disparities in Utilization and Outcomes of Structural Heart Disease Interventions in the United States

BackgroundDisparities in access to care cause negative health consequences for underserved populations. Economic disparities in structural heart disease (SHD) interventions are not well characterized. ObjectivesThe objective of this study was to evaluate economic disparities in the utilization and outcomes of SHD interventions in the United States. MethodsWe queried the National Inpatient Sample (2016-2020) to examine economic disparities in the utilization, in-hospital outcomes, length of stay, and cost of SHD interventions among patients ≥65 years of age. Outcomes were determined using logistic regression models. ResultsA total of 401,005 weighted hospitalizations for transcatheter aortic valve replacement, left atrial appendage occlusion, transcatheter mitral valve repair, and transcatheter mitral valve replacement were included. Utilization rates (number of procedures performed per 100,000 hospitalizations) were higher in patients with high income compared with medium and low income for transcatheter aortic valve replacement (559 vs 456 vs 338), left atrial appendage occlusion (148 vs 136 vs 99), transcatheter mitral valve repair (65 vs 54 vs 41), and transcatheter mitral valve replacement (7.7 vs 6.7 vs 1.2) (all P < 0.01). Low- and medium-income patients had distinctive demographic and clinical risk profiles compared with high-income patients. There were no significant differences in the adjusted in-hospital mortality, key complications, or length of stay between high-, medium-, and low-income patients following any of the 4 SHD interventions. High-income patients incurred a modestly higher cost with any of the 4 SHD interventions compared with medium- and low-income patients. ConclusionsEconomic disparities exist in the utilization of SHD interventions in the United States. Nonetheless, adjusted in-hospital outcomes were comparable among high-, medium-, and low-income patients. Multifaceted implementation strategies are needed to attenuate these utilization disparities.

COMPARATIVE ANALYSIS OF MITRAL VALVE REPAIR AND REPLACEMENT USING BIOLOGICAL PROSTHESIS IN ELDERLY PATIENTS (PSM method)

COMPARATIVE ANALYSIS OF MITRAL VALVE REPAIR AND REPLACEMENT USING BIOLOGICAL PROSTHESIS IN ELDERLY PATIENTS (PSM method)

Giant mobile thrombus in left atrium

Giant mobile left atrial thrombus has a rare occurrence. Rheumatic mitral valve stenosis (RMVS), which is frequently seen in developing countries, atrial fibrillation, and left atrial dilatation contribute to faster and higher volume thrombus formation. A 46-year-old female suffering from dyspnea was admitted to the cardiology outpatient. Transthoracic and transesophagial echocardiography confirmed rheumatic mitral stenosis with 3.5x 2.5 cm mobile circulating thrombus in left atrium. The patient underwent successful surgical thrombus removal, prostetic mitral valve replacement, and surgical ligation of the left appendage.

The Role of Microbes in Surgical Decision Making for Infective Endocarditis: Mitral Valve Repair or Replacement?

The benefits of mitral repair versus replacement for endocarditis are inconclusive. This study compares outcomes of patients with infective endocarditis undergoing mitral valve repair versus replacement and investigates the impact of microbial etiology. All 251 patients undergoing mitral valve surgery for active endocarditis between 2010 and 2023 were enrolled, 180 (71.7%) replacement and 71 (28.3%) repair. To adjust for imbalances, inverse probability of treatment weighting was applied and 187 patients were obtained. The analysis between groups, following the application of inverse probability of treatment weighting, showed no statistically significant differences across all considered outcomes. Early and late death was observed respectively in 6 (8.5%) and 11 (15.5%) patients in the repair group versus 24 (13.3%) and 45 (25.0%) in the replacement group without statistical significance (p = 0.221 and p = 0.446). Relapse occurred in six patients (8.5%) in the repair group after a median time of 4.0 months and in six (3.3%) in the replacement after 6.9 months (p = 0.071). Surgical strategy in mitral endocarditis has no effect on major postoperative complications, mortality, or medium/long-term survival. Staphylococcus aureus and Coagulase-negative Staphylococci represent a risk for early mortality and relapse. However, mitral valve repair for endocarditis can be pursued when it ensures the complete eradication of all infected tissue, particularly in cases caused by Streptococcus infection, in young patients, and after a minimum of 18 days of antibiotic therapy.

Non-vitamin K versus vitamin K antagonist oral anticoagulants in surgical mitral valve repair or bioprosthetic valve replacement in the first three months after surgery

Introduction and ObjectivesOral anticoagulation (OAC) with non-vitamin K antagonist oral anticoagulants (NOACs) after surgical mitral valve repair (MVR) or bioprosthetic valve replacement (BVR) in mitral position remains a controversial topic among the cardiovascular community, in particular in the early postoperative period. This study aimed to evaluate the efficacy and safety of NOACs in the first three months after MVR or mitral BVR compared to vitamin K antagonists (VKAs). MethodsThis was a single-center retrospective study with prospectively collected peri-intervention outcomes between 2020 and 2021. Records were retrieved and all participants were contacted by telephone. Patients were divided into groups according to OAC strategy. The primary outcome was a composite of death, rehospitalization, myocardial infarction, stroke or transient ischemic attack, systemic embolism, mitral thrombosis, or bleeding during the first three months after surgery. ResultsA total of 148 patients were enrolled, with a mean age of 65.5±12.2 years, 56.8% male. On discharge, 98 (66.2%) patients were on VKAs and 50 (33.8%) were on DOACs for at least three months. The primary outcome occurred in 22 (22.4%) patients in the VKA group and in three (6%) in the NOAC group (p=0.012), mainly driven by more bleeding events in the former. Independent predictors of the primary outcome were smoking (p=0.028) and OAC with VKAs at discharge, the latter predicting three times more events (p=0.046, OR 3.72, 95% CI 1.02–13.5). ConclusionsNOACs were associated with fewer events, supporting their efficacy and safety during the first three months after surgical MVR or mitral BVR.

Early Feasibility Study with the SATURN Transapical Mitral Valve Replacement Device

PurposeTo report the outcomes of the early feasibility study of transapical transcatheter mitral valve replacement (TMVR) with the SATURN System (InnovHeart, Milano, Italy) to treat patients with severe functional mitral regurgitation. DescriptionFive high surgical risk patients underwent transapical transcatheter mitral valve replacement with the SATURN System at a single center. One-year follow-up is complete for all patients. EvaluationThe valve was implanted successfully in all patients without any major adverse events. All patients were alive at the last follow-up. Kansas City Cardiomyopathy Questionnaire improved from a median of 63.5 (interquartile range, 19.6) at baseline to 99.0 (interquartile range, 21.6) at 1 year. Echocardiographic follow-up demonstrates stable valve function, no transvalvular or paravalvular mitral regurgitation, and absence of left ventricular outflow tract obstruction. ConclusionsAt 1 year after transapical SATURN transcatheter mitral valve replacement, all patients are alive with quality of life improvement and favorable device hemodynamics. These initial results are promising and larger scale studies with continued follow-up are required to further elucidate the efficacy and safety of this novel technology.

Analysis of the Perioperative Course of Cardiac Surgery Patients with Coronary Artery Disease and Heart Valve Dysfunction

The aim. To analyze the perioperative course of cardiac surgery patients with coronary artery disease (CAD) and heart valve dysfunction. Materials and methods. Retrospective analysis of 41 consecutive cardiac surgery patients (mean age 61.6 ± 7.8 years) with CAD and heart valve dysfunction who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. All the patients underwent standard clinical and laboratory examinations, coronary angiography, on-pump cardiosurgical intervention. Results. The patients were divided into three subgroups: patients with post-infarction left ventricular aneurysm (LVA) combined with insufficiency of atrioventricular valves, n = 15 (36.6%); those with ischemic mitral insufficiency (MI), n = 11 (26.8%); and patients with CAD combined with aortic valve disease, n = 15 (36.6%). During echocardiographic study, decreased left ventricular ejection fraction was found in patients with LVA and with ischemic MI: 33 ± 6.4% and 39.4 ± 7.8%, respectively, and in patients with aortic valve disease, left ventricular ejection fraction averaged 48.2 ± 9.9% (p &lt; 0.0001). According to the EuroSCORE II scale, the average risk was 11.8 ± 7.3%. All the patients were discussed by the heart team to choose the optimal method of cardiosurgical correction. In order to reduce the ischemic time, off-pump coronary bypass surgery was performed at the first stage, and the second stage was on-pump correction of valvular dysfunction. The average number of grafts was 2.8 ± 1.4, but the largest number of grafts was in the subgroup of ischemic MI: 4 ± 0.9 (p &lt; 0.005). Mitral valve replacement in patients with LVA was performed through LVA in 12 patients. Acute heart failure, acute renal failure often developed in patients after correction of ischemic MI (p &lt; 0.005). On the 1st day after the operation, there was an increase in average glucose values from 6.6 ± 2.8 to 10.3 ± 2.9 mmol/L (p &lt; 0.0001), a decrease in glomerular filtration rate from 72.1 ± 15.3 to 57 ± 18.8 mL/min/1.73 m2 (p = 0.0001), the above indicators returned to the initial level at discharge (p &lt; 0.0001). Conclusions. Off-pump myocardial revascularization in patients with CAD and dysfunction of the heart valves can significantly reduce the ischemic time. The method of mitral valve replacement through LVA developed in the department allowed to reduce the perfusion time (p = 0.0023) and the duration of the operation (p &lt; 0.005). Preoperative discussion of examination data of patients by the heart team, thorough preparation for cardiac surgery, timely response to changes in laboratory parameters with correction of drug treatment avoid complications.

Long-term outcomes of isolated mechanical versus bioprosthetic mitral valve replacement in different age groups of propensity-matched patients.

Prothesis choice in isolated mitral valve replacement for patients aged 75 years or younger remains debated as most studies comparing prothesis type have included large proportions of combined operations and benefits are influenced by concomitant procedures. This study compared long-term outcomes of isolated mechanical versus bioprosthetic mitral valves in different age groups of propensity-matched populations. This is a retrospective, multicentre, propensity-matched observational study. Baseline characteristics, operative details and long-term outcomes (mortality and freedom from surgical/transcatheter reintervention) were collected. Totally, 1536 isolated mitral valve replacements (806 mechanical, 730 bioprosthetic) were performed between 2000 and 2017. Over 90% of eligible patients successfully underwent propensity matching, yielding 226 each of mechanical and bioprosthetic valves in patients aged <65 years and 171 each of bioprosthetic and mechanical valves in patients aged 65-75 years with median follow-up of 13 years (maximum 20 years). In matched patients <65 years, 10-year survival was superior with mechanical valves versus bioprosthetic valves (78.2% vs 69.8%, P = 0.029), as was 10-year freedom from reintervention (96.2% vs 81.3%, P < 0.001). For matched patients between 65 and 75 years, there were no differences between mechanical and bioprosthetic valves in 10-year survival (64.6% vs 60.8%, P = 0.86) or 10-year freedom from reintervention (94.0% vs 97.2%, P = 0.23). Rates of post-operative stroke, gastrointestinal bleeding, renal failure and permanent pacemaker insertion were similar. In patients requiring isolated mitral valve replacement, mechanical valves confer significantly better long-term survival and freedom from reintervention for patients <65 years, while no benefit is observed at age 65-75 years compared to bioprosthetic valves.

The Fate of Mitral Valve Surgery in the Pediatric Age: A 25-Year Single-Center Experience.

Background: The aim of this study was to evaluate the natural history of patients after mitral valve intervention in the pediatric age. Methods: This is a retrospective study including all patients who underwent mitral valve surgery from 1998 to 2022. The patients' surgical reports, postoperative records, and ambulatory visits were reviewed. The endpoints of the study were survival and freedom from mitral valve reoperation. Results: Of the 70 patients included in the cohort, 61 patients (86.7%) had congenital mitral valve disease, of whom 46 patients (75.4%) had a predominantly mitral regurgitation lesion, and 15 patients (24.6%) had a predominantly mitral stenosis. In the mitral regurgitation group, all of the patients underwent valve repair with an operative mortality of one patient (2.1%), and with median follow-up of 4 years (range, 0.5-13 years), there was 4.3% mortality (n = 2) and 71.2% freedom from reoperation. In the mitral stenosis group, 11 patients underwent mitral valve repair, and 4 patients underwent valve replacement. There was an operative mortality of two patients (13.3%). With a 2-year median follow-up (range: 0.1-23 years), there were no additional mortality cases in the mitral stenosis group. All three patients who survived primary mitral valve replacement (100%) and four patients who survived a primary repair (40.0%) underwent reoperation. Conclusions: This study demonstrates encouraging outcomes for mitral valve repair. The mortality of patients with congenital mitral valve disease may also be related to a difficult postoperative course, rather than the MV lesion itself.

Study of the Main Causes of Early Postoperative Mortality after Surgical Interventions on the Mitral Valve on the Background of Infective Endocarditis

The aim. To study the structural and functional changes of the mitral valve (MV) in patients with infective endocarditis, taking into account demographic differences that may affect early postoperative mortality. Materials and methods. The study included patients (n = 107) with a history of infective endocarditis with the MV damage. All the patients underwent surgical treatment taking into account the functional lesions of the MV. The material for the analysis was the data from medical records, findings of physical, clinical and instrumental examination, and the operation report. The patients were divided into two study groups: experimental group (n = 67) with the subjects who underwent MV repair, and control group (n = 40) with those who underwent MV replacement. Results. Analysis of gender-specific length of hospital stay showed that deceased male patients were treated for significantly less time compared to those who survived: 3.5 vs. 13.4 bed days (p = 0.02, χ2= 5.12). Assessment of length of stay in the intensive care unit (ICU) showed that deceased patients of experimental group stayed in the ICU significantly longer than those who survived: 14.2 vs. 4.2 bed days (p = 0.02, χ2= 4.85). It was established that there was a significant difference in gender-specific length of stay in the ICU: in male patients of experimental group (p = 0.03, χ2= 4.55) and in women of experimental group (p = 0.02, χ2= 5.24). It was found that deceased patients from the experimental group stayed in the ICU significantly longer compared to similar patients from the control group: 14.2 vs. 4.0 bed days (p = 0.02, χ2= 5.12). Among patients who died, the frequency of urgent operations was significantly higher than in those who survived: 28.6% vs. 12.0% (p = 0.006, χ2= 7.52). The frequency of scheduled operations in control group was significantly higher than that of urgent operations: 92.5% vs. 7.5% (p = 0.04, χ2= 3.98). The incidence of severe MV insufficiency was significantly higher in female patients of the experimental group who were discharged for rehabilitation compared to those in the control group: 100.0% vs. 62.5% (p = 0.02, χ2= 5.47). Conclusions. When analyzing the structural and functional changes in the mitral valve that could cause early post-operative mortality, it was found that severe mitral insufficiency was the most common (93.5%). It was established that mitral valve damage by massive vegetations with the threat of detachment was 57.0%. It was found that mitral valve abscesses were absent in 77.6% of patients, and among deceased patients they were not detected at all. Reliable features of providing qualified care to patients with MV lesions against the background of infective endocarditis are established; these are related to the duration of inpatient treatment, stay in the ICU, and urgency of surgical interventions.

Morphometric study of peripheral blood in assessing the appropriateness of colloid use after mitral valve replacement

The study aimed to evaluate the morphological changes in erythrocytes following the administration of various solutions. Patients who underwent mitral valve (MV) replacement were divided into three groups: the first group received Hydroxyethylcellulose (HEC), the second received gelatin solution (4% succinylated gelatin solution), and the third received 0.9% sodium chloride solution. Blood samples were collected at 90 minutes, 24, and 48 hours post-resuscitation (ICU), and before discharge. Healthy patients' blood served as the control. The express technique of the "thick drop" (EMTD) was used to assess erythrocyte shape shifts, measuring the ratio of normal and pathological forms within 10-15 minutes using a DN-300M microscope. Before using the solutions, the pathological forms of erythrocytes were significantly higher in all groups compared to the control group. The control group had over 89.8% discocytes, while the number significantly decreased in MV patients pre-operation. Post-treatment with HEC and Gelatin solution, the number of discocytes increased slightly, whereas the third group (sodium chloride) showed no significant change. The number of echinocytes and stomatocytes varied across the groups, with the third group showing minimal improvement. The findings indicated that HEC and gelatin solution improved the ratio of discocytes to pathological forms better than sodium chloride. The most promising plasma-stimulating agents for surgical patients, particularly those with heart disease, are colloids and balanced crystalloid solutions. Their composition closely mimics blood plasma, providing optimal hemodynamic stability and tissue perfusion, thus supporting better postoperative recovery and critical care management.

Long-Term Survival Comparison of Mitral Valve Repair and Mitral Valve Replacement in Rheumatic Mitral Valve Disease: A Propensity Score Analysis

Objective: Rheumatic mitral valve disease could be treated either mitral valve repair or mitral valve replacement. The present study aimed to study 5-year survival related to mitral valve surgery using propensity score matching to reduce selection bias. Materials and Methods: Between January 2007 and December 2013, 695 patients who underwent isolated mitral valve surgery were divided into two groups and matched with propensity score. Five-year survival was analyzed to assess outcomes following mitral valve repair and mitral valve replacement. Results: Six hundred ninety-five patients were studied. After propensity matching, 267 patients in each group of mitral valve repair and mitral valve replacement, the groups had no differences in baseline characteristics. Log rank testing demonstrated no difference in unmatched group (p=0.49). After propensity-matched analysis, there was difference between 5-year survival of mitral valve repair at 89.8% (95% CI 84.9 to 93.2) and at 94.6% (95% CI 90.4 to 97.0) for mitral valve replacement with p=0.09 and hazard ratio 1.77 (95% CI 0.87 to 3.56, p=0.113). Conclusion: The authors observed non-significant lower 5-year survival rates among patients with rheumatic mitral valve diseases who underwent mitral valve repair compared to replacement. Mitral valve repair in rheumatic heart disease should remain the main selection in experienced valve centers with high quality measures.

Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) &amp;gt;20 mmHg on right heart catheterization, as described in the proceedings of the 6&amp;lt;sup&amp;gt;th&amp;lt;/sup&amp;gt; World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. &amp;lt;i&amp;gt;Case presentation&amp;lt;/i&amp;gt;: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. &amp;lt;i&amp;gt;Conclusions&amp;lt;/i&amp;gt;: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.

Impact of commissural calcification on clinical outcome of percutaneous balloon mitral valvuloplasty; a retrospective cohort study of 876 patients

BackgroundPercutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes.MethodsIn this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9–10, and Group III: score 11–12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC.ResultsA total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19–2.41, P = 0.003; and OR: 3.90, 95%CI 2.61–5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35–6.27, P = 0.007).ConclusionCommissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score ≤ 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV.

First experiences with automated annular suturing device in totally endoscopic aortic and mitral valve replacement.

To overcome some of the challenges of endoscopic minimally invasive valve surgery, an automated annular suturing device has been used in aortic and mitral valve replacement surgeries. The current study investigates early clinical outcomes of patients who received aortic or mitral valve replacement with the help of the RAM® device as first experiences in minimally invasive valve surgery. Between September 2020 and June 2023, 66 consecutive patients (mean age 61.8 ± 11 years) underwent endoscopic minimally invasive aortic or mitral valve replacement through right anterior mini-thoracotomy at 2 cardiac surgery referral centres in Germany. The RAM® device was used in all Patients. 3.5 and 5.0 sizes were used in 16.7% and 83.3% of patients, respectively. Aortic, mitral and double valve surgery was performed in 81.8%, 15.2% and 1.5% of patients, respectively. Clinical data were prospectively entered into our institutional database. Cardiopulmonary bypass time and cross-clamping time were 97.9 ± 20.9 and 66 ± 15.7 min, respectively. Intensive care unit and hospital stays were 1 [1-2] and 9 [7-13] days, respectively. No paravalvular leak and no other intraoperative complications occurred. 30-day and in-hospital mortality were zero. Conversion to sternotomy occurred in 1 (1.5%) patient due to bleeding. The usage of the RAM® device is a safe, feasible and effective approach to the endoscopic implantation of aortic or mitral valves and yield excellent early outcomes. Larger size studies are needed to evaluate the efficacy and safety of RAM® device.

The use of veno-veno-arterial ECMO as a successful strategy in acute mitral regurgitation secondary to papillary muscle rupture causing cardiogenic shock and profound hypoxemia: a case report

Abstract Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare mechanical complication of acute myocardial infarction occurring in 0.05–0.26% of all cases of myocardial infarction. The only treatment is emergency mitral valve surgery with high operative mortality reaching up to 39%. The use of extracorporeal membrane oxygenator (ECMO) as a stabilization strategy and a bridge to recovery may potentially improve the outcome of such cases. Here, we report a case of acute MR presenting with cardiogenic shock and severe hypoxia that required insertion of veno-veno-arterial ECMO initially and followed by emergency mitral valve replacement. This strategy proved useful with full recovery of the patient.

Operating Room Extubation for Patients Undergoing Cardiac Surgery: A National Society of Thoracic Surgeons Database Analysis

BackgroundThe utility of operating room extubation (ORE) after cardiac surgery over fast-track extubation (FTE) within 6 hours remains contested. We hypothesized ORE would be associated with equivalent rates of morbidity and mortality, relative to FTE. MethodsPatients undergoing nonemergent cardiac surgery were identified in The Society of Thoracic Surgeons Adult Cardiac Surgery Database between July 2017 and December 2022. Only procedures with The Society of Thoracic Surgeons risk models were included. Risk-adjusted outcomes of ORE and FTE were compared by observed-to-expected ratios with 95% CIs aggregated over all procedure types, and ORE vs FTE adjusted odds ratios (ORs) specific to each procedure type using multivariable logistic regression. Analyzed outcomes were operative mortality, prolonged length of stay, composite reoperation for bleeding and reintubation, and composite morbidity and mortality. ResultsThe study population of 669,099 patients across 1069 hospitals included 36,298 ORE patients in 296 hospitals. Risk-adjusted analyses found that ORE was associated with statistically similar or better results across each of the 4 outcomes and procedure subtypes. Notably, rates of postoperative mortality were significantly lower in ORE patients undergoing coronary artery bypass grafting (OR, 0.54; 95% CI, 0.46-0.65), aortic valve replacement (OR, 0.43; 95% CI, 0.24-0.77), and mitral valve replacement (OR, 0.48; 95% CI, 0.26-0.89). ConclusionsExtubation in the OR was safe and effective in a selected patient population and may be associated with superior outcomes in coronary artery bypass, aortic valve replacement, and mitral valve replacement. These national data appear to confirm institutional experiences regarding the potential benefit of OR extubation. Further refinement of optimal populations may justify randomized investigation.

Substance Use and Outcomes of Left-sided Valve Replacement in Patients With Infective Endocarditis

BackgroundRising rates of substance use (SU) have resulted in an increasing need for left-sided valve surgery for SU-associated infective endocarditis (SU-IE). We compared outcomes, readmissions, and costs between IE patients with and without SU-IE in a national cohort. MethodsUsing the Nationwide Readmissions Database (2016-2018), we identified 10,098 patients with infective endocarditis (IE) who underwent isolated aortic or mitral valve replacement. Outcomes within the same calendar year as the index operation were compared between patients with and without SU-IE. Multivariable logistic regressions were used to identify factors associated with in-hospital mortality and 30-day and 90-day readmissions. Kaplan-Meier analysis and a Cox proportional hazards model were used to compare freedom from calendar-year readmission between the groups. ResultsOf the 10,098 patients with IE, 2145 (21%) had SU-IE. Although patients with SU-IE were younger (38 years vs 60 years; P < .001) and had fewer comorbidities (Elixhauser score: 12 vs 20; P < .001) than patients who did not have SU-IE, patients with SU-IE had longer hospital stays (25 days vs 18 days; P < .001) and costlier admissions ($84,949 vs $74,122; P < .001). Patients with SU-IE had less in-hospital mortality (3.0% vs 5.8%; P < .001) but more often died when readmitted (9.6% vs 4.6%; P < .001). Readmissions were similar at 30 days (18.5% vs 18.9%; P = .8) and 90 days (31.8% vs 29.3%; P = .2), but patients with SU-IE had more calendar-year readmissions (35.1% vs 31.0%; P < .018). ConclusionsDespite their younger age and fewer comorbidities, patients who undergo valve surgery for SU-IE use more resources and more often have calendar-year readmissions than patients with IE but without SU. Strategies are needed to expedite discharge and prevent readmission in patients with SU-IE.