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Current Perspectives on Contemporary Rheumatic Mitral Valve Repair.

ABSTRACT: The surgical management of rheumatic mitral valve disease remains a challenge for cardiac surgeons. Durability of mitral valve repair (MVr) is likely compromised not simply due to high technical demand, but surgeon reluctance, despite boasting copious advantages over MV replacement. This comprehensive review aims to evoke a deeper understanding of MVr concepts necessary to abate these limitations and shift mindset towards a more holistic approach to repair. Details of commonly utilized techniques in contemporary MVr for rheumatic heart disease will be discussed. Of importance, the reparative procedures will be mapped to an in-depth physiological exploration of the mitral complex-dynamism and rheumatic interplay. This is further emphasized by outlining the current "aggressive" resection strategy in contemporary rheumatic MVr.

SUBMITTER: Dejsupa C

PROVIDER: S-EPMC8679173 | biostudies-literature | 2021 Nov-Dec

REPOSITORIES: biostudies-literature

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Current Perspectives on Contemporary Rheumatic Mitral Valve Repair.

Dejsupa Chaninda C Chotivatanapong Taweesak T Caputo Massimo M Vohra Hunaid A HA

Innovations (Philadelphia, Pa.) 20210903 6

The surgical management of rheumatic mitral valve disease remains a challenge for cardiac surgeons. Durability of mitral valve repair (MVr) is likely compromised not simply due to high technical demand, but surgeon reluctance, despite boasting copious advantages over MV replacement. This comprehensive review aims to evoke a deeper understanding of MVr concepts necessary to abate these limitations and shift mindset towards a more holistic approach to repair. Details of commonly utilized technique ...[more]

PMID: 34478343

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Project description:BackgroundMany 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.MethodsPatients 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.ResultsA 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 cm2, 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 re-intervention in rMVP, but one patient died of pneumonia.ConclusionsFor 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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Current Perspectives on Contemporary Rheumatic Mitral Valve Repair.

Publications

Current Perspectives on Contemporary Rheumatic Mitral Valve Repair.

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