Redo Mitral Valve Replacement Research Articles

Mortality and resource utilization in surgical versus transcatheter repeat mitral valve replacement: A national analysis.

Transcatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk patients requiring redo operations. This study aims to evaluate the association of TMVR with selected clinical and financial outcomes. Adults undergoing isolated redo mitral valve replacement were identified in the 2016-2020 Nationwide Readmissions Database and categorized into TMVR or SMVR cohorts. Various regression models were developed to assess the association between TMVR and in-hospital mortality, as well as additional secondary outcomes. Transseptal and transapical catheter-based approaches were also compared in relation to study endpoints. Of an estimated 7,725 patients, 2,941 (38.1%) underwent TMVR. During the study period, the proportion of TMVR for redo operations increased from 17.8% to 46.7% (nptrend<0.001). Following adjustment, TMVR was associated with similar odds of in-hospital mortality (AOR 0.82, p = 0.48), but lower odds of stroke (AOR 0.44, p = 0.001), prolonged ventilation (AOR 0.43, p<0.001), acute kidney injury (AOR 0.61, p<0.001), and reoperation (AOR 0.29, p = 0.02). TMVR was additionally correlated with shorter postoperative length of stay (pLOS; β -0.98, p<0.001) and reduced costs (β -$10,100, p = 0.002). Additional analysis demonstrated that the transseptal approach had lower adjusted mortality (AOR 0.44, p = 0.02), shorter adjusted pLOS (β -0.43, p<0.001), but higher overall costs (β $5,200, p = 0.04), compared to transapical. In this retrospective cohort study, we noted TMVR to yield similar odds of in-hospital mortality as SMVR, but fewer complications and reduced healthcare expenditures. Moreover, transseptal approaches were associated with lower adjusted mortality, shorter pLOS, but higher cost, relative to the transapical. Our findings suggest that TMVR represent a cost-effective and safe treatment modality for patients requiring redo mitral valve procedures. Nevertheless, future studies examining long-term outcomes associated with SMVR and TMVR in redo mitral valve operations, are needed.

Early and Mid-Term Outcomes of Using the Chimney Technique in Redo Mitral Valve Replacement in Patients with a Small Mitral Annulus.

The outcomes of redo mitral valve replacement (Re-MVR) in a small mitral annulus with the use of the chimney technique are not well documented. The purpose of this study is to present our early experience with this group of patients, illustrating the periop-erative complications and mortality outcomes. From 2019 to 2020, 77 consecutive patients underwent Re-MVR with the use of the chimney technique because of a small mitral annulus. To evaluate heart structural integrity and clinical outcomes, postoperative clinical data and echocardiograms were examined. The mean age was 56.7 ± 15.98 years. All patients underwent mitral valve surgery, of which 62 were mitral valve replacements, 7 mitral valve repairs, and 8 double valve replacements. The preoperative mitral valve mean gradient was 18.07 ± 9.40 mmHg, and the postoperative mitral prosthesis size was 28.51 ± 1.22 mm. The median increment of mitral size enlargement was 4 (0, 6) valve sizes. The mean mitral gradient coming out of the operating room was 10.34 ± 2.12 mmHg, and at the follow-up echocardiogram performed at 3 years after the procedure, it was 10.36 ± 1.70 mmHg. One-year survival was 93.3%, while the 4-year survival rate was 89.3%, with no reoperation. The use of the chimney technique in small mitral valve re-mitral valve replacement results in larger valve sizes. Moreover, the mean gradients over the mitral valve are acceptable both intraoperatively and over time.

Fifth-time redo mitral valve replacement via right thoracotomy under systemic hyperkalemia cardiopulmonary bypass without aortic cross-clamp

The surgical management of prosthetic valvular endocarditis (PVE) can be challenging. We report a case of a 46-year-old female patient who had a history of four cardiac operations. We chose a mitral valve replacement via right thoracotomy to enable optimal exposure of the mitral valve (MV). Because of multi-reoperations, we employed systemic hyperkalemia for cardiac arrest to protect the heart during cardiopulmonary bypass (CPB) without aortic cross-clamping. Here, we present a complex operation that performed management of CPB under hyperkalemia and the patient had a good postoperative recovery.

Redo mitral valve replacement in an adult with severe pulmonary hypertension resulting from structural valve deterioration and left ventricular outflow tract obstruction and a history of atrioventricular septal defect repair: a case report

BackgroundPulmonary hypertension (PH)-associated with left heart disease (Nice PH classification group II) improves when the latter is treated; however, the treatment of PH concomitant with group I PH due to congenital heart disease is difficult, and the optimal pharmacotherapy is controversial. Intervention strategies for the left-sided atrioventricular valve in partial atrioventricular septal defect (AVSD) are problematic.Case presentationA 37-year-old woman who had undergone patch closure for a partial AVSD and mitral valve replacement with a rather large bioprosthesis at the juxta-annular position for mitral regurgitation 12 years earlier was referred to our institute because of severe PH. Echocardiography revealed calcification resulting in severe stenosis of the bioprosthesis and protrusion of its stent post into the left ventricular outflow tract; therefore, redo mitral valve replacement at the supra-annular position was performed using a mechanical valve. Combined group I and II PH gradually improved with meticulous postoperative medical management.ConclusionsSevere PH due to stent post protrusion and structural valve deterioration in AVSD was successfully treated with redo mitral valve replacement. The present case was complicated with group I and II PH, for which medical therapy in conjunction with surgical treatment yielded an optimal therapeutic effect.

Value of Left Ventricular Strain Imaging Echocardiography in Predicting Outcomes after Severe Mitral Valve Regurgitation Surgery

Purpose: A new indicator of measuring ventricular systolic function is myocardial strain. However, it is unclear if longitudinal strain following mitral valve surgery has any predictive utility in clinical settings. The best time of operation is usually detected through the left ventricular internal dimensions as well as the function.. So this study aimed to evaluate the utility of myocardial strain by echocardiogram with other parameters in forecasting postoperative outcomes after primary MR surgery.&#x0D; Methodology: This prospective study enrolled 514 patients (279 males and 235 females; mean age (SD) of male participants was 57.3 (12.9). Included patients had severe primary mitral valve regurgitation and were candidates for valve surgery from April 2018 to April 2022. Patients with combined valvular disease as severe mitral stenosis, redo mitral valve replacement, and previous CABG and ischemic heart disease were excluded. Global longitudinal strain (GLS) was performed. Hospital re-admission for heart failure symptoms, reoperation and mortality were followed up as Cardiac incidents.&#x0D; Findings: In median follow-up of about four years, Age, previous ischemia, concomitant CABG, left atrial size, LVEF%, atrial fibrillation and Global longitudinal strain were all predictive of heart incidents. Age, left atrial dimension, and GLS were independent predictors to heart incidents on multivariate analysis (HR: 1.386, 95% CI: 1.083-1.776; P &lt;0.004, HR: 1.003, 95% CI: 0.976-1.031; p value 0.018, HR: 1.192, 95% CI: 1.101-1.291; P &lt;0.001 respectively). All-cause mortality was linked to impaired GLS (HR: 0.003, 95% CI: 0.973-1.102; P =0.039).&#x0D; Recommendation: GLS has a substantial link to clinical outcomes and is a stronger forecaster to cardiac issues than standard measurements. Measuring pre-operative GLS among those with severe primary MR is essential for anticipating post-operative results and determining the ideal time to plan operation.

Modifiable and nonmodifiable risk factors in redo mitral surgery

Highlights. In the present study, we conducted a retrospective analysis redo mitral valve replacement due to prosthesis failure. Predictors of adverse events and death have been analyzed. The quality of obtained predictors was verified using ROC analysis.Aim. To analyze predictors of adverse events and death in redo mitral procedure for treating mitral bioprostheses failure.Methods. The retrospective registry study of catamnesis of patients undergoing treatment for mitral valve prosthesis dysfunction was carried out. The age and gender of patients, medical history, underlying and comorbid diseases, features of primary replacement and reoperation, durability of the primary prosthesis, adverse events and death after redo mitral valve replacement and others (more than 30 factors) were taken into account. Stepwise logistic regression was used for statistical processing. The quality of obtained predictors was verified using ROC analysis.Results. The results of the study have revealed that there are modifiable risk factors such as cardiopulmonary bypass time, ischemia time, and nonmodifiable risk factors like reoperation, baseline severity of the patient's condition, complications of median resternotomy, concomitant interventions on aortic valve during reoperation. Moreover, treating atrial fibrillation during primary replacement proved to have an overall protective effect.Conclusion. Тhe only modifiable factors that can be influenced during redo mitral valve replacement due to biological prosthesis failure are cardiopulmonary bypass duration and aortic cross-clamping time.

Infant Mitral Valve Replacement: Current State of the Art.

Mitral valve replacement (MVR) in the very young is an imposing clinical challenge. Early and late mortality risk is substantial, severe adverse events are common, and redo mitral valve replacement is inevitable. Therapeutic options are limited. In the older infant with an annulus of 17mm or larger, mechanical MVR is associated with low risk of mortality and predictable durability. For the very young with annular hypoplasia, bovine jugular vein conduit MVR appears to offer equivalent or better early outcomes with the possibility of subsequent valve expansion, potentially prolonging the interval to redo MVR. Experience with cylinder MVR and other forms of surgeon-manufactured MVR is quite limited, and there is currently no information on late outcomes or durability.

Surgery Follows Function: Redo Mitral Valve Replacement After Cardioband Implantation

Surgery Follows Function: Redo Mitral Valve Replacement After Cardioband Implantation

A Case of Commando Procedure for Paravalvular Leakage after Redo Aortic Valve Replacement and Mitral Valve Replacement

A Case of Commando Procedure for Paravalvular Leakage after Redo Aortic Valve Replacement and Mitral Valve Replacement

Emergency operation of redo second and third mitral valve regurgitation in a patient with a history of the mitral valve prosthesis, coronary artery bypass graft surgery, and moderate aortic regurgitation: a case presentation

Redo cardiac surgery is usually more complex than initial surgery and has a higher risk of mortality due to the risks associated with sternotomy.&#x0D; Thoracotomy is a procedure through which easy access to the heart and valves is possible, taking less time. There is no need to release the adhesions of the previous operation. In addition, there is no possibility of heart rupture and unstable hemodynamics in the second CABG operation.&#x0D; Safe peripheral Cardiopulmonary bypass (CPB) access and right thoracotomy are preferred in patients with unstable hemodynamics with a history of CABG and mitral valve replacement (MVR) surgery.&#x0D; A 60 -year old man with a history of prosthetic MVR, CABG, and right-hand paresis due to cerebrovascular accident (CVA) was referred to Madani Hospital in Tabriz, Iran (2020). Transthoracic echocardiography (TTE) revealed signs of severe dysfunction of the prosthetic mitral valve (PMV). Whereas, on anticoagulation, a left ventricular ejection fraction (LVEF) was about 40%, and the patient had mild to moderate aortic regurgitation (AI). The patient underwent an emergency redo MVR operation using the thoracotomy techniques and coronary intervention (hybrid procedure). After two weeks, TTE showed a decreased mobility of one PMV leaflet, and the patient did not respond to full anticoagulation. Therefore, the third surgery was performed.

Transcatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry

ObjectivesDegeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration. MethodsData provided by 10 German heart centers underwent propensity score-matched retrospective analysis. The primary endpoint was 30-day/midterm mortality. Perioperative outcome was assessed according to the Mitral Valve Academic Research Consortium criteria. Further, the influence of moderate or greater tricuspid regurgitation (TR) on 30-day/midterm mortality was analyzed. ResultsBetween 2014 and 2019, 273 patients (79 transcatheter mitral valve-in-valve [TM-ViV] and 194 redo mitral valve replacement [Re-MVR]) underwent repeat procedure for mitral prosthesis/ring degeneration. Propensity score matching distinguished 79 patient pairs. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II-predicted risk was 15.7 ± 13.7% in the TM-ViV group and 15.0% ± 12.7% in the Re-MVR group (P = .5336). TM-ViV patients were older (74.73 vs 72.2 years; P = .0030) and had higher incidence of atrial fibrillation (54 vs 40 patients; P = .0233). Severe TR incidence was similar (17.95% in TM-ViV vs 14.10%; P = .1741). Sixty-eight TM-ViV patients previously underwent mitral valve replacement, whereas 41 Re-MVR patients underwent valve repair (P < .0001). Stenosis was the leading degeneration mechanism in 42 TM-ViV versus 22 Re-MVR patients (P < .0005). The 30-day/midterm mortality did not differ between groups. Moderate or greater TR was a predictor of total (odds ratio [OR], 4.36; P = .0011), 30-day (OR, 3.76; P = .0180), and midterm mortality (OR, 4.30; P = .0378), irrespective of group. ConclusionsIn both groups, observed mortality was less than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day, and midterm mortality in both groups.

Redo Mitral Valve Replacement Using St. Jude Medical Mechanical Prosthesis via Transseptal Approach in a Patient with Degenerated Mitral Epic Bioprosthesis: A Video Presentation

AbstractA 58-year-old male patient with degenerated St. Jude Epic mitral bioprosthesis underwent successful mitral valve replacement using 29 mm St. Jude Medical mechanical prosthesis. Case history presented here to prevent organ injury via a transeptal approach for a degenerated epic bioprosthesis.

Left atrial dissection due to massive atrioventricular separation following a redo mitral valve replacement.

Left atrial dissection due to massive atrioventricular separation following a redo mitral valve replacement.

On-X mitral valve leaflet embolization presenting as acute pulmonary oedema

BackgroundStructural valve failure in the form of leaflet fracture and embolization is an uncommon complication. Severe valve regurgitation with pulmonary oedema in a patient with a history of a prosthetic cardiac valve requires urgent diagnosis. An echocardiogram is essential in identifying the cause of valve failure.Case presentationWe report a case of a 21-year-old male patient who presented with acute pulmonary oedema due to fracture and embolization of a leaflet of an On-X mitral valve four years post-implant. He underwent an emergency redo mitral valve replacement with a good outcome.ConclusionsStructural valve failure with leaflet fracture and embolization is an extremely rare complication and may be fatal. Good clinical acumen is required for prompt diagnosis in any patient who presents with a circulatory collapse in the presence of a history of previous cardiac surgery. Once the diagnosis is made, the patient should undergo emergency redo valve replacement surgery.

Redo surgery for noninfective isolated mitral valve disease: Initial outcome and further follow-up compared to primary surgery.

Isolated redo-mitral valve replacement(iMVR) is underreported and often mixed up with endocarditis in the present literature. The present study compares first with redo iMVR in noninfective mitral disease. A total of 3821 mitral valve procedures were analyzed. The study was restricted to isolated and noninfective mitral valve replacements done by sternotomy. Finally, 402 patients are included, consisting of 102 redo- and 300 first surgeries. The mean patient's age was 65.9 ± 10.4 years; the mean EuroSCORE II was 3.0 ± 2.2%. Median follow-up was 221 days, ranging up to 9.9 years with a total of 367 patient-years. Redo's had higher EuroSCORE II (5.1 ± 2.9% vs. 2.3 ± 1.4%; p < .01), more atrial fibrillation (31.1% vs. 46.1%;p = .01), chronic obstructive pulmonary disease (7.3% vs. 17.6%;p = .05), coronary artery disease (7.3% vs. 17.6%;p = .03) and more frequently reduced ejection fraction < 30% (3.0% vs.11.8%;p = .02). Main outcomes showed comparable 30-days mortality (first: 4.1%, redo: 6.9%; p = .813). Postoperative morbidity of the redo's was associated with increased postoperative bleeding (p < .01) resulting in increased transfusions of packed red blood cells and fresh frozen plasma (each p < .01), more re-explorations (p < .01) and longer primary intensive care unitstay (p < .01). Postoperative occurrence of stroke, respiratory or renal failure, and myocardial infarction as well as hospital stay differed not significantly. Estimated 5-years survival was 65.5 ± 12.3% for all patients with no significant differences between the groups. Multivariate logistic regression respiratory failure as relevant for hospital (odds ratio [OR]: 12.3 [1.1-158]; p = .029) and stroke (OR: 4.8 [1.1-12.3]; p = .021) as relevant for long-term mortality. iMVR fornoninfective reasons is infrequent and rare. Compared to primary surgery, redo's suffer mainly from bleeding-associated morbidity. This does not translate into prolonged hospital stay or inferior immediate or long-term outcomes. Redo mitral valve replacement can be performed at no significantly increased surgical risk compared with first surgery and the results are particularly not limited by the surgery itself.

Patient–Prosthesis Mismatch Associated With Somatic Growth After Mechanical Mitral Valve Replacement in Small Children: Metrics for Reoperation and Outcomes

Reoperation after pediatric mitral valve replacement (MVR) is inevitable due to patient-prosthesis mismatch (PPM) associated with somatic growth. We analyzed potential metrics for PPM and outcomes of redo MVR for valve upsizing. Between 1999 and 2018, 15 children without obstructive left heart lesions other than mitral stenosis underwent initial MVR with a 16-mm ATS-Advanced Performance valve. We analyzed hemodynamic data from 28 postoperative catheterizations and concomitant echocardiograms. The median age and body weight at initial MVR were 4.9 months (25th, 75th percentile: 3.6, 6.6) and 5.9 kg (5.0, 7.3). Redo MVR was planned when patients had congestive heart failure and postcapillary pulmonary hypertension (PH) due to PPM: systolic pulmonary arterial pressure (SPAP) >35 mm Hg and pulmonary capillary wedge pressure (PCWP) >15 mm Hg on catheterization. Indexed effective orifice area (iEOA) and mean transmitral pressure gradient (TMPG) were strongly correlated with SPAP (r = -0.72, P < 0.001 and r = 0.75, P < 0.001) and PCWP (r = -082, P < 0.001 and r = 0.84, P < 0.001). Cut-off values for detecting postcapillary PH due to PPM were 1.0 cm2/m2 for iEOA and 18 mm Hg for mean TMPG. Nine patients underwent redo MVR for postcapillary PH due to PPM at a median postoperative interval of 10 years (9.2, 11.9). All the patients survived, and PH was improved one year after surgery. iEOA and mean TMPG can be metrics for PPM in children after MVR. Careful follow-up is required to confirm the improvement of preoperatively existing PH after redo MVR for valve upsizing.

Redo mitral valve replacement: Options and outcomes.

Redo mitral valve replacement: Options and outcomes.

Results of reoperative mitral valve replacement at cardiovascular center - E hospital

Overview: Mitral valve (MV) disease is the most common valvular disease; surgery is the definitive treatment when it is no longer possible for conservative treatment. The number of patients undergoing MV replacement surgery is increasing and life expectancy is increasing, leading to an inevitable increase in the number of patients having to undergo reoperative MV replacement. Redo MV replacement remains a challenge. The study aimed to evaluate the results of redo-mitral valve replacement surgery.&#x0D; Method: This is a retrospective, descriptive study of patients who underwent reoperative mitral valve replacement at cardiovascular center – E hospital, from January 2015 to December 2019.&#x0D; Results: Thirty seven patients (24 females) underwent redo-MVR with either bioprosthetic (n = 18) or mechanical valves (n = 18). Median age of patients was 53 years (range 30–78 years), and the mean additive EuroSCORE was 8.15%. Median time to re-operation was 5.37± 2.78 years for first time redo-MVR and 3 years for second-time redo-MVR. Indications included prosthetic endocarditis (n = 9), para-prosthetic leak (n = 1), structural valve degeneration (n = 12), prosthetic valve thrombosis (n = 15). In-hospital mortality was 5.41%. Mean hospital stay was 27.54± 15.93 days. Actuarial survival at 1 and 5 years was 81 ± 5% and 72 ± 6%, respectively. Multivariate analysis showed that mortality was associated with Euroscore and infectious complications.&#x0D; Conclusion: Mitral valve replacement surgery is safe and effective in improving clinical symptoms and laboratory parameters. Regular postoperative monitoring is required to reduce the risk of reoperation due to prosthetic valve thrombosis. Good infection prevention and management could reduce mortality and length of hospital stay.

Redo mitral valve replacement for initially rheumatic heart disease: In-hospital outcomes and operative risk prediction

Background: Redo mitral valve replacement (redo-MVR) remains a challenge despite advances in surgical techniques. Little is known about the outcomes of redo-MVR in patients with rheumatic heart disease. We aimed To evaluate the in-hospital outcomes and associated risk factors for mortality and morbidity after re-operative mitral valve replacement in patients with initial rheumatic heart disease.&#x0D; Methods: This retrospective cohort study included 214 patients, 96 males (44.9%) and 118 females (55.1%), who underwent redo-MVR between January 2015 and December 2020. The mean age was 41.87±11.7 years. European Heart Surgery Risk Assessment System II (EuroSCORE II), Age, Creatinine, Ejection Fraction (ACEF) scores were used for risk stratification. The primary endpoints were in-hospital mortality, major morbidity (renal failure, prolonged ventilation, stroke, reoperation, or deep sternal wound infection), and the composite outcome of mortality and/or morbidity).&#x0D; Results: Major morbidities occurred in 31.8% of patients, and the in-hospital mortality rate was 19.6%. Predictors of mortality were New York Heart Association class (NYHA) III/IV (OR: 5.4; p˂ 0.001), cardiogenic shock (OR: 13.74, p˂0.001), low left ventricular ejection fraction (LVEF) (OR: 4.36; p= 0.01), and perioperative intra-aortic balloon pump (OR: 6.79; p= 0.01). The significant predictors of mortality and/or major morbidity were NYHA III/IV (OR: 2.39; p˂0.001), low LVEF (OR: 4.44; p= 0.001), active endocarditis (OR: 2.4; p=0.04), and perioperative IABP (OR: 3.88; p= 0.045). EuroSCORE II had better accuracy than the ACEF score to predict adverse outcomes (AUC: 0.70 [95% CI: 0.63-0.78] versus 0.58 [95% CI: 0.50-0.66], p= 0.01) .&#x0D; Conclusion: Advanced NYHA class and low LVEF could be associated with poor outcomes after redo-MVR in patients with primary surgery for rheumatic mitral valve disease. EuroSCORE II is a helpful tool for risk stratification during redo-MVR.

A South Africa tertiary centre experience with redo mitral valve replacement

Severe cardiac failure from mechanical mitral valve thrombosis due to poor warfarin control is a major cause of emergency redo mitral valve replacement (MVR) in South Africa. This study aimed to review the outcomes of redo MVR in patients presenting with mitral valve failure to a tertiary South African centre.Retrospective chart review of patients undergoing redo MVR over a 10-year period (2005-2014). Patient demographics, aetiology of valve dysfunction, preoperative clinical assessment and outcomes were analysed.Sixty-four patients had 80 mitral valve procedures. The M:F ratio was 1:2.8 and the median age was 18 (IQR 14-28.5) and 25 (IQR 18-40) at initial surgery and at redo surgery, respectively. Median interval between original and redo MVRs was 47.5 (IQR 7.5-124) months. Rheumatic valve disease was the original pathology in 58 patients (90.6%). Fifty-two patients underwent a single redo MVR and 12 patients had multiple redo MVRs. Fifty-eight (72.5%) were emergency redo procedures. Prosthetic valve thrombosis was present in 73.8%. Ten patients (15.6%) developed postoperative complications. The median hospital stay and ICU stay were 19 (IQR 12-27.5) days and 4 (IQR 3-7) days, respectively. Two patients died in the postoperative period (3.1%). The mean patient follow-up was 42 months. Three patients died during follow-up.The majority of redo MVR procedures were undertaken as an emergency with valve thrombosis being the most common aetiology. The mortality rate was 3.1% and postoperative complication rate was 15.6%.