DOCSLIB.ORG

Myocardial Protection in Minimally Invasive Mitral Valve Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Myocardial Protection in Minimally Invasive Mitral Valve Surgery Original Article Archives of Clinical Experimental Surgery Myocardial Protection in Minimally Invasive Mitral Valve Surgery: Comparison of the Cold-Blood Cardioplegia of the Bretschneider Solution and the Warm-Blood Cardioplegia of the Calafiore Protocol Inna Kammerer1, Ragi Nagib2, Gernot Hipp2, Markus Preßmar2, Mathias Hansen3, Ulrich FW Franke2 1Department of Cardiac Surgery, Academic Teaching Hospital Abstract Ludwigshafen, GERMANY 2 Department of Cardiac Surgery, Objective: Minimal invasive mitral valve surgery using right thoracotomy is becoming a safe alternative and Robert-Bosch Hospital, Stuttgart, GERMANY has an increasing impact in the clinical routine. The best strategy for myocardial protection for these patients 3Department of Anaesthesiology, is under discussion. Warm-blood cardioplegia, according to the protocol of Calafiore (group C), is well-es- Robert-Bosch Hospital, Stuttgart, tablished in coronary surgery throughout Europe, whereas the cold-crystalloid cardioplegia by Bretschneider GERMANY (Custodiol®, group B) is in worldwide use in both heart surgery and organ transplantation. Received: Jan 28, 2012 Methods: All 107 patients with proposed mitral valve surgical repair through a right lateral mini-thoracotomy Accepted: Feb 20, 2012 Arch Clin Exp Surg 2012;1: 14-21 between July 2008 and September 2009 were evaluated and randomly selected for one of the two myocardial DOI: 10.5455/aces.20120220022958 protection strategies described above. The quality of the myocardial protection was detected using the specific ischaemia markers cTNI and CK-MB on days zero, one and two following surgery. The study population rep- Corresponding author: Inna Kammerer, MD resents 80% of all patients with isolated mitral surgery from the department. Demographic, as well as operative, Department of Cardiac Surgery data did not show any differences between the groups, and the hospitalization period was 13 days for both Academic Teaching Hospital of groups. Ludwigshafen Bremserstreet, 79 Results: The totally clinical mortality rate was 5% (2 patients in group B vs. 3 patients in group C, p=0.673). D-67063 Ludwigshafen, Germany cTNI >10 µg/l levels 48 hours after the surgical procedure (p=0.055) were significantly higher in group C com- [email protected] pared to group B, calculated by ANOVA for repeated measurement using SPSS® 17.0 software. However, the need for defibrillation was higher after Bretschneider`s cardioplegia (45% vs 10%, p<0,001), and heart arrest in the Calafiore group was attained at an average of nine seconds earlier. An IABP was implanted in one patient from the Calafiore group. Conclusions: This prospective study suggests the superiority of myocardial protection using Bretschneider`s cold-crystalloid solution, compared to warm-blood cardioplegia using the Calafiore protocol in minimally in- vasive mitral valve surgery. Keywords: Myocardial protection, minimal invasive mitral valve Introduction dard sternotomy approach, and is associated with Minimal-invasive techniques for the surgical decreased pain, reduced blood loss, faster recovery, treatment of mitral valve disease have advanced superior cosmetic results and greater patient satis- over the last 15 years. The mid-term analysis did faction [1,2]. New materials and techniques enable not demonstrate any compromise in the efficacy surgeons to overcome the initial difficulties related of mitral valve repair, when compared to the stan- to surgical exposure, the approach, perfusion sys Myocardial protection in mitral valve surgery 15 tems and instruments. An accurate learning curve is necessary All of these differences might also contribute to difficulties in and is inevitable, because technical differences with respect to interpreting the results. To circumvent these potentially con- conventional surgery still remain. Cardioplegia administra- founding factors, we only included patients undergoing mini- tion can still be a problem [3]. Numerous modifications to mal invasive mitral valve surgery without any further sig tems cardioplegic solutions, after the introduction of the cardiople- and instruments. An accurate learning curve is necessary and gic principle by Melrose [4], have been applied. The multi- is inevitable, because technical differences with respect to con- tude of different methods and techniques clearly demonstrate ventional surgery still remain. Cardioplegia administration the persistent inadequacy of all of them, because none have can still be a problem [3]. Numerous modifications to car- shown a satisfactory solution for all ischaemia-related effects. dioplegic solutions, after the introduction of the cardioplegic The large variety of application techniques and cardiople- principle by Melrose [4], have been applied. The multitude of gic solutions do not allow the homogeneous complaint of different methods and techniques clearly demonstrate the per- the effectiveness of myocardial protection, especially in long sistent inadequacy of all of them, because none have shown a ischaemia cardiac procedures in patients without coronary satisfactory solution for all ischaemia-related effects. The large disease nowadays [5]. Improvements in intra-operative myo- variety of application techniques and cardioplegic solutions cardial protection amended post-ischaemic haemodynamic do not allow the homogeneous complaint of the effectiveness function, as well as attenuated the prevalence of perioperative of myocardial protection, especially in long ischaemia cardiac infarction, and decreased mortality [6]. procedures in patients without coronary disease nowadays The clinical outcomes resulting from different techniques [5]. Improvements in intra-operative myocardial protection of surgical procedures with different myocardial protection amended post-ischaemic haemodynamic function, as well as have been compared in most studies by analyzing the mortal- attenuated the prevalence of perioperative infarction, and de- ity or the rate of myocardial infarctions [7,8]. A further disput- creased mortality [6]. able point in the discussion about cardioplegia was the neu- The clinical outcomes resulting from different techniques rological factor: a prospective randomization by Martin [9] of surgical procedures with different myocardial protection (about cold blood and crystalloid solutions in 1001 CABG have been compared in most studies by analyzing the mortal- patients had to be stopped intercessionally for cold-crystalloid ity or the rate of myocardial infarctions [7,8]. A further disput- cardioplegia. The efficiency of myocardial support during a able point in the discussion about cardioplegia was the neu- long ischaemia time (> 90 minutes) is, in view of molecular, rological factor: a prospective randomization by Martin [9] enzymatic and morphologic elements, difficult to evaluate. (about cold blood and crystalloid solutions in 1001 CABG The ischaemic cardiac marker of cellular alteration, cardiac patients had to be stopped intercessionally for cold-crystalloid Troponin-I (cTNI), has been used in a large number of stud- cardioplegia. The efficiency of myocardial support during a ies [10-12] of coronary occlusion disease without the results long ischaemia time (> 90 minutes) is, in view of molecular, of valve replacement surgery. enzymatic and morphologic elements, difficult to evaluate. The ischaemic cardiac marker of cellular alteration, cardiac In our institute we apply two different cardioplegic prin- Troponin-I (cTNI), has been used in a large number of stud- ciples in conventional cardiac surgery that require more than ies [10-12] of coronary occlusion disease without the results 90 minutes of aortic cross-clamp time with a single dose of of valve replacement surgery. cold-crystalloid histidine-triptophan-ketoglutarate solution (HTK) by Bretschneider; during relatively short procedures In our institute we apply two different cardioplegic prin- of cardiac surgery, cardioplegia was performed using a warm- ciples in conventional cardiac surgery that require more than blood potassium solution via repeated application of the Cala- 90 minutes of aortic cross-clamp time with a single dose of fiore regime every 20 minutes. In most of the descriptions cold-crystalloid histidine-triptophan-ketoglutarate solution found in the literature, patients with a heterogeneous disease (HTK) by Bretschneider; during relatively short procedures profile were included, such as patients with coronary artery of cardiac surgery, cardioplegia was performed using a warm- disease with different degrees of myocardial ischaemia and blood potassium solution via repeated application of the stenosis graduation, or with a retrospective design of the study. Calafiore regime every 20 minutes. In most of the descrip- DOI:10.5455/aces.20120220022958 www.aces.scopemed.org 16 Kammerer I et al tions found in the literature, patients with a heterogeneous subjected to minimal invasive mitral valve surgery. Patients disease profile were included, such as patients with coronary with comorbid cardiac disease, such as aortic valve disease or artery disease with different degrees of myocardial ischaemia coronary artery disease, and emergency cases were excluded. and stenosis graduation, or with a retrospective design of the All the patients consented to participate in the present study. study. All of these differences might also contribute to difficul- The MV surgery (repair or replacement) was done using ties in interpreting the results. To circumvent these potentially confounding factors, we only included patients
Load more

Recommended publications
  • Surgical Management of Transcatheter Heart Valves
    Corporate Medical Policy Surgical Management of Transcatheter Heart Valves File Name: surgica l_management_of_transcatheter_heart_valves Origination: 1/2011 Last CAP Review: 6/2021 Next CAP Review: 6/2022 Last Review: 6/2021 Description of Procedure or Service As the proportion of older adults increases in the U.S. population, the incidence of degenerative heart valve disease also increases. Aortic stenosis and mitra l regurgita tion are the most common valvular disorders in adults aged 70 years and older. For patients with severe valve disease, heart valve repair or replacement involving open heart surgery can improve functional status and qua lity of life. A variety of conventional mechanical and bioprosthetic heart valves are readily available. However, some individuals, due to advanced age or co-morbidities, are considered too high risk for open heart surgery. Alternatives to the open heart approach to heart valve replacement are currently being explored. Transcatheter heart valve replacement and repair are relatively new interventional procedures involving the insertion of an artificial heart valve or repair device using a catheter, rather than through open heart surgery, or surgical valve replacement (SAVR). The point of entry is typically either the femoral vein (antegrade) or femora l artery (retrograde), or directly through the myocardium via the apical region of the heart. For pulmonic and aortic valve replacement surgery, an expandable prosthetic heart valve is crimped onto a catheter and then delivered and deployed at the site of the diseased native valve. For valve repair, a small device is delivered by catheter to the mitral valve where the faulty leaflets are clipped together to reduce regurgitation.
    [Show full text]
  • Valve Repair for Mitral Insufficiency Without Stenosis Richard B
    Journal of Insurance Medicine Volume 20, No. I 1988 Mortality Abstract Valve Repair for Mitral Insufficiency Without Stenosis Richard B. Singer, M.D. Consultant Association of Life Insurance Medical Directors of America References: (1) JW Kirklin, ’WIitral Valve Repair for Mitral those with isolated MVR, with or without tricuspid an- Incompetence." Mod Concepts of CV Dis, 56:7-11 (Feb. nuloplasty. The highest perioperative rate of 11.1% was ex- 1987). perienced in the group with associated CBPS, and the rate (2) ALIMDA and Society of Actuaries, ’~¢Iedical was nearly as high when the associated surgery was aortic Risks 1987: Analysis of Mortality and Survival." In final valve replacement. preparation (1988). Despite the complete lack of age/sex information, the author Subjects Studied: A series of 210 patients diagnosed at the has provided an expected survival curve based on "an age- Medical Center of the University of Alabama at Birmingham, sex-race-matched general population," but the source tables 1967-1985 as having mitral insufficiency without stenosis, are not cited. From this curve it has been possible to derive and treated by surgical repair of the mitral valve (MVR) in- and graduate expected annual rates, q/or ~/, as shown in stead of mitral valve replacement. The largest group in the Table B. Although the derivation is reasonably accurate for series consisted of 86 patients with isolated MVR, although the first year, the reader should be cautioned that the an- a few of these also had tricuspid valve annuloplasty. The nual increase of about 8% per year in qZ may be much too remaining patients had associated cardiac surgery: 63 patients high as compared with an increase of about 1% per year with coronary bypass (CBPS); 31 patients with aortic valve found for qZ, all ages combined, from data by age group replacement (AVR); 27 patients with repair of a congenital and sex for a series of patients with mitral valve replace- cardiac defect; two patients with pericardiectomy and one ment in one of the abstracts in reference 2.
    [Show full text]
  • Positive Maternal and Foetal Outcomes After Cardiopulmonary Bypass Surgery
    Case Study: Positive maternal and foetal outcomes after cardiopulmonary bypass surgery Positive maternal and foetal outcomes after cardiopulmonary bypass surgery in a parturient with severe mitral valve disease aMokgwathi GT, MBChB aLebakeng EM, MBChB, DA(SA), MMed(Anaes) bOgunbanjo GA, MBBS, FCFP(SA), MFamMed, FACRRM, FACTM, FAFP(SA), FWACP(Fam Med) aDepartment of Anaesthesiology, University of Limpopo (Medunsa Campus) bDepartment of Family Medicine and Primary Health Care, University of Limpopo (Medunsa Campus) Correspondence to: Dr GT Mokgwathi, e-mail: [email protected] Keywords: anaesthesia, cardiac surgery, parturient, cardiopulmonary bypass surgery, mitral valve replacement Abstract This case study describes the successful management of a parturient with severe mitral stenosis and moderate mitral regurgitation who underwent cardiopulmonary bypass (CPB) surgery. A healthy baby was delivered by Caesarean section 11 days later. The effects of CPB surgery and mitral valve replacement on parturient and foetus are discussed. Peer reviewed. (Submitted: 2011-01-04, Accepted: 2011-06-16) © SASA South Afr J Anaesth Analg 2011;17(4):299-302 Introduction she was classified as New York Heart Association (NYHA) class III and World Health Organization (WHO) heart Heart disease is the primary cause of nonobstetric mortality failure stage C. Her blood pressure was 90/60 mmHg in pregnancy, occurring in 1-4 % of pregnancies1-3 and and her heart rate was 82 beats per minute and regular. accounting for 10–15 % of maternal mortality in developed She had a tapping apex beat, loud first heart sound, loud countries.1,2 Cardiac disease contributes to 40.2% of pulmonary component of the second heart sound and a maternal deaths in South Africa.4 Soma-Pillay et al noted grade 3/4 diastolic murmur heard loudest at the apex.
    [Show full text]
  • Heart Valve Disease: Mitral and Tricuspid Valves
    Heart Valve Disease: Mitral and Tricuspid Valves Heart anatomy The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen- rich blood from the lungs and pumps it to the body. The heart has four chambers and four valves that regulate blood flow. The upper chambers are called the left and right atria, and the lower chambers are called the left and right ventricles. The mitral valve is located on the left side of the heart, between the left atrium and the left ventricle. This valve has two leaflets that allow blood to flow from the lungs to the heart. The tricuspid valve is located on the right side of the heart, between the right atrium and the right ventricle. This valve has three leaflets and its function is to Cardiac Surgery-MATRIx Program -1- prevent blood from leaking back into the right atrium. What is heart valve disease? In heart valve disease, one or more of the valves in your heart does not open or close properly. Heart valve problems may include: • Regurgitation (also called insufficiency)- In this condition, the valve leaflets don't close properly, causing blood to leak backward in your heart. • Stenosis- In valve stenosis, your valve leaflets become thick or stiff, and do not open wide enough. This reduces blood flow through the valve. Blausen.com staff-Own work, CC BY 3.0 Mitral valve disease The most common problems affecting the mitral valve are the inability for the valve to completely open (stenosis) or close (regurgitation).
    [Show full text]
  • A Study on Pattern of Heart Disease and Maternal and Fetal Outcome Of
    University Heart Journal Vol. 11, No. 1, January 2015 A Study on Pattern of Heart Disease and Maternal and Fetal Outcome of Pregnancy in a Tertiary Level Hospital NAHREEN AKHTAR1 , TAJMIRA SULTANA1, SYEDA SAYEEDA2, TABASSUM PARVEEN1,FIROZA BEGUM1 1Fetomaternal Medicine Wing, Dept of Obs & Gynae, Bangabandhu Sheikh Mujib Medical University, Dhaka, 2Dept of Obs & Gynae, Bangabandhu Sheikh Mujib Medical University, Dhaka. Address for Correspondence: Dr Nahreen Akhtar Professor, Fetomaternal Medicine wing, Department of Obstetric & Gynaecology. Bangabandhu Sheikh Mujib Medical University, Dhaka. E-mail – nahreenakhtar10@g mail.com Abstract: Background: Cardiac disease is the most common cause of indirect maternal deaths and the most common cause of death overall. It complicates 1% of maternal death. Objective: Management of pregnancy in patients with valvular heart disease continues to pose a challenge to the clinician.the present study was therefore design to find the pattern of Heart Disease and to evaluate the maternal and fetal outcome of pregnancy. Method: This is a cross sectional study done during the period Jan to Dec, 2011in fetomaternal medicine wing of department of Obs & Gynae, BSMMU. All the patients admitted with heart disease in pregnancy during this study period were included in this study. This study prospectively enrolled 54 pregnant women with heart disease.All cases were followed during pregnancy , labour, delivery and in early puerperium. Results: The mean (SD±) age of the patients was 26.08 ± 3.96 ranging from 20 to 35yrs, most ( 26% ) belonged to age group 26 - 30yrs and five (9.26% ) belonged to >30years of age group. Most of the patients 21 (38.89%) were primigravid and 16(29.63%) patients were of second gravida.
    [Show full text]
  • Evolution of Risk Factors Influencing Early Mortality of the Arterial Switch
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Journal of the American College of Cardiology Vol. 33, No. 6, 1999 © 1999 by the American College of Cardiology ISSN 0735-1097/99/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00071-6 Evolution of Risk Factors Influencing Early Mortality of the Arterial Switch Operation Elizabeth D. Blume, MD,*‡ Karen Altmann, MD,*§ John E. Mayer, MD, FACC,†‡ Steven D. Colan, MD, FACC,*‡ Kimberlee Gauvreau, ScD,*‡ Tal Geva, MD, AFACC*‡ Boston, Massachusetts and New York, New York OBJECTIVES The present study was undertaken to determine the independent risk factors for early mortality in the current era after arterial switch operation (ASO). BACKGROUND Prior reports on factors affecting outcome of the ASO demonstrated that abnormal coronary arterial patterns were associated with increased risk of early mortality. As diagnostic, surgical and perioperative management techniques continue to evolve, the risk factors for the ASO may have changed. METHODS All patients who underwent the ASO at Children’s Hospital, Boston between January 1, 1992 and December 31, 1996 were included. Hospital charts, echocardiographic and cardiac catheterization data and operative reports of all patients were reviewed. Demographics and preoperative, intraoperative and postoperative variables were recorded. RESULTS Of the 223 patients included in the study (median age at ASO 5 6 days and median weight 5 3.5 kg), 26 patients had aortic arch obstruction or interruption, 12 had Taussig-Bing anomaly, 12 had multiple ventricular septal defects, 8 had right ventricular hypoplasia and 6 were premature.
    [Show full text]
  • Selecting Candidates for Transcatheter Mitral Valve Repair
    • INNOVATIONS Key Points Selecting Candidates for • Mitral valve regurgitation, or leaky mitral valve, is a common valve disorder Transcatheter Mitral Valve Repair in which the leaflets of the mitral valve fail to seal effectively, resulting in Annapoorna S. Kini, MD Samin K. Sharma, MD some blood flowing back in the left atrium every time Mitral valve regurgitation is a common valve disorder The EVEREST (Endovascular Valve Edge-to- the left ventricle contracts. that causes blood to leak backward through the Edge Repair Study) II Trial was a randomized study This condition has been mitral valve and into the left atrium as the heart comparing the transcatheter approach using traditionally addressed muscle contracts. Mitral regurgitation can originate MitraClip®—a tiny cobalt chromium clip that sutures with open heart surgery. from degenerative or structural defects due to the anterior and posterior mitral valve leaflets—with aging, infection, or congenital anomalies. In contrast, surgery in patients with moderate to severe mitral • We use the latest imaging functional mitral regurgitation occurs when coronary regurgitation who are candidates for either procedure. techniques both to ensure artery disease or events such as a heart attack change that each patient is a good After five years, the study has demonstrated that the size and shape of the heart muscle, preventing candidate for the procedure, MitraClip was associated with a similar risk of death the mitral valve from opening and closing properly. In and to monitor their progress compared with mitral valve surgery after excluding people with moderate to severe mitral regurgitation, once the device is implanted. patients who required surgery within six months.
    [Show full text]
  • Review of Diagnostic and Therapeutic Approach to Canine Myxomatous Mitral Valve Disease
    veterinary sciences Review Review of Diagnostic and Therapeutic Approach to Canine Myxomatous Mitral Valve Disease Giulio Menciotti * ID and Michele Borgarelli Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, 205 Duck Pond Dr., Blacksburg, VA 24061, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-540-2314-621 Academic Editors: Sonja Fonfara and Lynne O’Sullivan Received: 23 June 2017; Accepted: 20 September 2017; Published: 26 September 2017 Abstract: The most common heart disease that affects dogs is myxomatous mitral valve disease. In this article, we review the current diagnostic and therapeutic approaches to this disease, and we also present some of the latest technological advancements in this field. Keywords: dogs; heart; echocardiography; mitral repair 1. Introduction Among canine cardiac diseases, myxomatous mitral valve disease (MMVD) represents, by far, the most common. In general, the disease is more prevalent in small breeds than in large breeds, and some small breeds are reported to have an incidence close to 100% over a dog’s lifetime [1,2]. However, large breed dogs can be affected as well [3,4]. A heritable, genetically-determined component for the disease can be implied by the strong predilection for small breeds in general, and particularly for certain breeds (i.e., Cavalier King Charles Spaniels, Dachshund), in which the heritability of disease status and severity has been demonstrated [5–7]. However, the etiology of the myxomatous process is still unknown and under investigation. Some experimental evidence seems to support a possible role of the serotonin signaling pathway triggered by altered mechanical stimuli in the disease development [8–12].
    [Show full text]
  • Preparing for Your Transcatheter Mitral Valve Repair Procedure
    Preparing for Your Transcatheter Mitral Valve Repair Procedure What you should know about MitraClip® therapy AP2939827-US_Procedure-Patient-Brochure_5-21.indd 1 6/17/14 10:35 PM About the Transcatheter Mitral Valve Repair Procedure How Should You Prepare for Your Procedure? In the days before your procedure, it is important that you: • Take all your prescribed medications • Tell your doctor if you are taking any other medications • Make sure your doctor knows of any allergies you have • Follow all instructions given to you by your doctor or nurse What Will Happen During Your Procedure? Your procedure will most likely be performed in a specialized room at the hospital called a “cath lab.” During the procedure, you will be placed under general anesthesia to put you in a deep sleep, and a ventilator will be used to help you breathe. Your doctor will use fluoroscopy (a type of X-ray that delivers radiation to you) and echocardiography (a type of ultrasound) during the procedure to visualize your heart. On average, the time required to perform the TMVR procedure is between 3 to 4 hours. However, the length of the procedure can vary due to differences in anatomy. This pamphlet is for patients like you who have been evaluated by a team of heart doctors and selected for transcatheter mitral valve repair (or “TMVR”) with MitraClip® therapy. MitraClip® therapy is a new, approved treatment to repair your leaking mitral valve using an implanted clip. Your team of heart doctors has determined that you The MitraClip® device would benefit from having this procedure.
    [Show full text]
  • 2014 Imaging in and Around the Cath
    Imaging in and Around the Cath Lab Thomas Smith, MD FACC University of California, Davis Disclosures • I have no disclosures pernent to this presentaon. Modalies in Procedure Lab • Intracardiac Echocardiography (ICE) • Transthoracic Echocardiography (TTE) • Transesophageal Echocardiography (TEE) Key Points to Ancipate Imaging • Which chamber or valve? • General anesthesia? Primary Procedures Requiring Imaging • Exclusion of LAA thrombus – Afib/fluer ablaon – Mitral valvuloplasty • Transseptal – most procedures involving LA or LV • Valve replacement – AV, ?MV, ? PV • Valvuloplasty – Mitral or aorc • Valve repair – MitraClip – Paravalvular leak repair • Pericardiocentesis • Alcohol septal ablaon • PFO or ASD closure Transseptal Procedures – Mitral Valvuloplasty – EP Ablaons – Paravalvular Leak – Le Atrial Appendage Closure – Mitral Repair with MitraClip system SP LA Length ED H SS RA Bicaval TEE IVC SVC EV Caval flow into the RA LA IVC SVC EV RA Intracardiac Echocardiography Intracardiac Echocardiography Intracardiac echo Transesophageal Echocardiography Esophagus LAA LA Appendage – Thrombus Mitral valve repair MITRACLIP MitraClip Procedure Animaon Imaging Objecves in MitraClip • Exclude LAA thrombus. • Document preprocedure MR. • Guide crossing point for trans-septal • Guide catheters in the LA to appropriate posion. • Guide clip posioning. • Assess for safe capture of leaflets. • Post-procedure MR assessment. • Assess for complicaons. Endovascular Mitral Repair System 3D Transesophageal Echo SVC Ao Ao * * FO AV View from RA VieW from LA Transeptal
    [Show full text]
  • Intraoperative Transesophageal Echocardiography for Surgical Repair of Mitral Regurgitation
    STATE-OF-THE-ART REVIEW ARTICLE Intraoperative Transesophageal Echocardiography for Surgical Repair of Mitral Regurgitation David Andrew Sidebotham, MB ChB, FANZCA, Sara Jane Allen, MB ChB, FANZCA, FCICM, Ivor L. Gerber, MB ChB, MD, FRACP, FACC, and Trevor Fayers, MB ChB, FRACS, FCS(SA), Auckland, New Zealand; Brisbane, Australia Surgical repair of the mitral valve is being increasingly performed to treat severe mitral regurgitation. Transe- sophageal echocardiography is an essential tool for assessing valvular function and guiding surgical decision making during the perioperative period. A careful and systematic transesophageal echocardiographic exam- ination is necessary to ensure that appropriate information is obtained and that the correct diagnoses are ob- tained before and after repair. The purpose of this article is to provide a practical guide for perioperative echocardiographers caring for patients undergoing surgical repair of mitral regurgitation. A guide to perform- ing a systematic transesophageal echocardiographic examination of the mitral valve is provided, along with an approach to prerepair and postrepair assessment. Additionally, the anatomy and function of normal and re- gurgitant mitral valves are reviewed. (J Am Soc Echocardiogr 2014;27:345-66.) Keywords: Transesophageal echocardiography, Mitral valve repair, TEE, Intraoperative, Cardiac surgery In suitable patients, surgical repair is an excellent treatment option for 2.01; 95% confidence interval, 1.19–3.40) and in mixed patient pop- severe mitral regurgitation (MR). The procedure is associated with ulations (odds ratio, 2.39; 95% confidence interval, 1.76–3.26). low mortality and is highly durable. Among 58,370 unselected pa- However, these data are nonrandomized and subject to selection tients from the Society of Thoracic Surgeons Adult Cardiac Surgery bias.
    [Show full text]
  • Minimally Invasive Concomitant Aortic and Mitral Valve Surgery: the “Miami Method”
    Keynote Lecture Series Minimally invasive concomitant aortic and mitral valve surgery: the “Miami Method” Joseph Lamelas Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA Correspondence to: Joseph Lamelas, M.D. Chief of Cardiothoracic Surgery, Mount Sinai Medical Center, Mount Sinai Heart Institute 4300 Alton Road, Miami Beach, Florida 33140, USA. Email: [email protected]. Valve surgery via a median sternotomy has historically been the standard of care, but in the past decade various minimally invasive approaches have gained increasing acceptance. Most data available on minimally invasive valve surgery has generally involved single valve surgery. Therefore, robust data addressing surgical techniques in patients undergoing double valve surgery is lacking. For patients undergoing combined aortic and mitral valve surgery, a minimally invasive approach, performed via a right lateral thoracotomy (the “Miami Method”), is the preferred method at our institution. This method is safe and effective and leads to an enhanced recovery in our patients given the reduction in surgical trauma. The following perspective details our surgical approach, concepts and results for combined aortic and mitral valve surgery. Keywords: Minimally invasive; valve surgery; aortic valve replacement; mitral valve surgery; double valve surgery Submitted Jun 21, 2014. Accepted for publication Jul 17, 2014. doi: 10.3978/j.issn.2225-319X.2014.08.17 View this article at: http://dx.doi.org/10.3978/j.issn.2225-319X.2014.08.17 Introduction Technique for minimally invasive aortic and mitral valve surgery Minimally invasive valve surgery was first performed by Navia et al. in 1996, and by Cohn et al. in 1997 (1,2).
    [Show full text]