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1.
Methodist Debakey Cardiovasc J ; 15(2): 149-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384379

RESUMO

Patients with advanced valvular disease may be at high or prohibitive risk for surgical management. We describe a patient with previous mitral and tricuspid valve repair and recurrent admissions for New York Heart Association Class IV heart failure symptoms due to severe mitral stenosis and severe tricuspid regurgitation. Due to her comorbidities and two previous sternotomies, the patient was at high risk for surgery. We performed a simultaneous transfemoral mitral and tricuspid valve-in-ring implantation. This is the first report of its kind using a Sapien 3 valve (Edwards Lifesciences).


Assuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Cateterismo Cardíaco/métodos , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/etiologia , Estenose da Valva Mitral/fisiopatologia , Desenho de Prótese , Recuperação de Função Fisiológica , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/fisiopatologia
2.
Kyobu Geka ; 72(6): 459-462, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31268021

RESUMO

A 45-year-old man diagnosed with severe mitral regurgitation was admitted to our hospital for surgical treatment. Preoperative computed tomographic imaging revealed a persistent left superior vena cava. At operation, cardiopulmonary bypass was established with ascending aortic and bicaval cannulation. In addition to 2 venous cannulas, we directly cannulated to the left superior vena cava for sufficient venous drainage. Mitral valve plasty consisted of triangular resection of P2 segment was performed through the right side left atriotomy. Postoperative course was uneventful and echocardiography 3 months after the operation showed trivial mitral regurgitation. Precise preoperative evaluation concerning the persistent left superior vena cava should be mandatory for appropriate management of cardiopulmonary bypass.


Assuntos
Cardiopatias Congênitas , Insuficiência da Valva Mitral , Ponte Cardiopulmonar , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Veia Cava Superior
3.
Kyobu Geka ; 72(5): 334-337, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31268028

RESUMO

Recently, mitral valve repair has been the mainstream of the operation for the treatment of mitral valve regurgitation. In particular, chorda reconstruction with artificial chordae is useful for the anterior leaflet. However, there has been no established method determining the length of chordae. In this report, we performed mitral valve repair using Memo 3D ReChord ring which enables to decide the length of chordae more easily. It is based on the concept of folding leaflet technique by Garcia et al. We used this ring in 7 patients (of which 2 were reoperation) in our institution. There was no postoperative death nor complication. Postoperative transthoracic echocardiography showed class 0~ Ⅰ mitral valve regurgitation in each case at discharge. This ring helps to make the repair more reproducible and we consider that it enables to decide the length of chordae more easily even in reoperative cases.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência da Valva Mitral , Prolapso da Valva Mitral , Cordas Tendinosas , Humanos , Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Resultado do Tratamento
4.
Pan Afr Med J ; 32: 178, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312292

RESUMO

Mitral valve aneurysm is a rare abnormality whose pathophysiology is poorly understood. It is defined as a bulge of the mitral valve leaflet toward the left atrium. Aneurysm in the posterior leaflet is exceptional. We report the case of a 26-year old man, who had been followed up for rheumatic aortic regurgitation for 4-years, hospitalized for febrile syndrome associated with episodes of left heart failure. Transthoracic echocardiographic examination (TTE) and transesophageal echocardiography (TEE) showed aortic valve vegetations with wide aneurysm of the small mitral valve associated with severe mitral valve regurgitation. The patient underwent mitral and aortic valve replacement with simple postoperative outcome. Clinical suspicion associated with suitable preoperative imaging and early surgical treatment are essential to recognize and treat this rare complication of infectious endocard.


Assuntos
Endocardite/complicações , Aneurisma Cardíaco/etiologia , Insuficiência da Valva Mitral/etiologia , Valva Mitral/diagnóstico por imagem , Adulto , Insuficiência da Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia
5.
Int Heart J ; 60(4): 796-804, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308329

RESUMO

The benefits of concomitant mitral valve procedure (MVP) for treating moderate chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) have not been clearly established. This study aimed to determine the incidence of moderate or more residual mitral regurgitation (MR) following CABG plus MVP for moderate chronic IMR, and to evaluate the impacts of concomitant MVP vs. CABG alone on clinical outcomes based on propensity-matched data.All eligible patients were entered into either the MVP group (CABG plus MVP, n = 184) or CABG group (CABG alone, n = 162). Moderate or more residual MR rate was investigated, and in-hospital and follow-up outcomes between the groups were compared after matching.Moderate or more residual MR rate was 11.4% at 1 year and 22.9% at 2 years after CABG plus MVP, respectively. Patients in the MVP group as compared with the CABG group had significantly lower moderate or more residual MR rates at various postoperative time points (all P < 0.001). Grouping was not an independent risk factor for in-hospital adverse events in multivariate logistic regression analysis. Also, grouping was a significant variable related to moderate or more residual MR rate and NYHA class III-IV at the latest follow-up in Cox regression analysis (HR = 0.391, 95% CI 0.114-0.628; HR = 0.419, 95% CI 0.233-0.819, respectively).Concomitant MVP as compared with CABG alone for treating moderate chronic IMR was associated with a reduction in moderate or more residual MR rate and an improvement in NYHA functional status, with no increase in in-hospital adverse events or follow-up death.


Assuntos
Ponte de Artéria Coronária/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , China/epidemiologia , Doença Crônica , Angiografia Coronária , Ecocardiografia Doppler , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
6.
J Cardiothorac Surg ; 14(1): 106, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31186038

RESUMO

BACKGROUND: Partial atrioventricular canal defects (PAVC) are preferred to be repaired when diagnosed and before an operation would interfere with school. There were rare previous studies about partial atrioventricular canal defect operations in adult patients. In this single-center retrospective study, we mean to review the mid-term follow-up outcomes of late diagnosed and repaired partial atrioventricular canal defects in adult patients. METHODS: 46 adult partial atrioventricular canal defect patients who underwent operation in West China Medical Center from 2009 to 2017 were included. Required data were obtained from operation notes, patient charts and the outpatient records. RESULTS: Among 46 patients, 10(21.7%)were male and mean age at operation was 37.6 ± 12.4 years. 11 patients had prior arrythmia, including 8 atrial fibrillations, 2 atrioventricular blocks and 1 left bundle branch block. There were 41 patients with tricuspid valve regurgitation and 22 underwent tricuspid valvuloplasty. All the patients had mitral regurgitation. 6 patients with valve incrassation and shrinkage underwent mitral valve replacement, and the rest underwent mitral repair surgery. There was one early death post operation and no more mortalities in the following follow-up years. According to the follow-up outcomes, heart function of the patients recovered significantly, dilation of atriums and ventricles, except for left atriums, were reversed to a large extent and all but one patients' tricuspid valve regurgitations were reduced to mild and below. 4(8.7%) patients underwent reoperation and the main reasons were arrythmia and recurrent severe mitral valve regurgitation. CONCLUSION: Partial atrioventricular canal defect repair in adult patients can achieve good results. Compared with the results of patients underwent operations in preschool years, though delayed surgery timing seems to bring more preoperative complications and influences heart function, the mortality and reoperation rate are excellent.


Assuntos
Comunicação Interventricular/cirurgia , Adulto , Arritmias Cardíacas/complicações , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , China , Diagnóstico Tardio , Feminino , Seguimentos , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Complicações Pós-Operatórias , Reoperação , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/cirurgia
7.
J Cardiothorac Surg ; 14(1): 108, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196216

RESUMO

BACKGROUND: Mitral valve repair with the use of an annuloplasty ring is the procedure of choice in patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP). The mitral annular size, shape and motion may vary substantially among patients and thus, commercially available rings may not be suitable for each individual patient. METHODS: A "personalized ring" (PR) was easily constructed in the operating room using a Dacron sheet and titanium ligating clips to custom fit to each individual mitral annulus shape and size. There were 127 patients with severe MR due to FMV/MVP that underwent mitral valve repair surgery; 58 patients received a PR and 69 patients received a commercial Carpentier-Edwards Physio II ring. The patient records were retrospectively analysed. RESULTS: There were no surgical deaths. In-hospital length-of-stay and blood transfusions were not statistically different between the two groups. Mitral valve area was greater (p < 0.05) in the PR group (3.78 ± 0.22) compared to the Physio II ring group (3.13 ± 0.21). Mitral annular area changed from systole to diastole by 14.35% ± 3.28% in the PR group and did not change in the Physio II ring group (p < 0.05). Systolic anterior motion (SAM) of the mitral valve occurred in 2 patients with the Physio II ring and no patients with the PR. Up to 8 years follow-up, all patients in both groups were alive with NYHA functional class I-II symptoms and mild or less MR. CONCLUSIONS: The PR is suitable for all patients with significant MR due to FMV/MVP who require MV repair. The precise fit of the PR to the mitral annulus better preserves valve area and sphincter function of the mitral annulus, prevents SAM and provides excellent short and long-term results.


Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Desenho de Prótese , Adulto , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/fisiopatologia , Estudos Retrospectivos , Sístole
8.
EuroIntervention ; 15(6): e491-e499, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31217145

RESUMO

AIMS: We aimed to examine the effectiveness and the optimal technique for transcatheter therapy for residual mitral regurgitation (MR) after MitraClip therapy with the AMPLATZER Vascular Plug II (AVP-II). METHODS AND RESULTS: Nine patients (mean age, 78±4 years) underwent transcatheter therapy with the AVP-II for residual MR after MitraClip therapy. We examined procedural, in-hospital, and 30-day outcomes. Our technique was successful in all cases, with treatment of different types of residual MR, including paraclip, interclip, and leaflet perforation. MR grade decreased significantly from 4+ to 1+ (p<0.0001), with final residual MR being mild or none in seven patients. Mitral stenosis did not occur with plug placement. The optimal deployment technique for reduction of MR was placement with only one segment on the left atrial side of the mitral valve leaflets (n=8). During clinical follow-up (median 155 days), symptom improvement had occurred in all patients (NYHA class, baseline vs follow-up, 3.2±0.4 vs 2.3±0.8; p=0.01) with mild or no symptoms in six patients. There was no procedural mortality, major adverse event(s), device embolisation, haemolysis or need for cardiac surgery. CONCLUSIONS: For patients with residual MR after MitraClip therapy, this technique may be effective and safe, especially when deployed with only one segment on the left atrial side of the mitral leaflets.


Assuntos
Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Retratamento , Resultado do Tratamento
9.
J Cardiothorac Surg ; 14(1): 102, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174558

RESUMO

BACKGROUND: Mitral valve replacement with the total leaflet preservation technique can yield good results; however, its development is limited by patient-valve mismatch. Therefore, we compared the efficacies of the modified total leaflet preservation technique, posterior leaflet preservation technique, and no leaflet preservation technique in mitral valve replacement. METHODS: Clinical records and echocardiographic data of 180 patients who underwent mitral valve replacement for rheumatic mitral valve disease between 2009 and 2017 were analysed retrospectively to summarise the operative experience and short-term (six months) results. The patients were divided into three groups: group A (n = 62), treated with the modified total leaflet preservation technique; group B (n = 80), treated with the posterior leaflet preservation technique; and group C (n = 38), treated with the no leaflet preservation technique. RESULTS: No significant difference in the preoperative clinical data was noted between the groups (p > 0.05). The clamp and recovery times of group A were longer (p < 0.05) and shorter (p < 0.05), respectively, than those of groups B and C. The postoperative left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular ejection fraction of group A were significantly better than those of groups B and C. The incidence of low cardiac output syndrome in group A was lower than that in group C (p < 0.05). There was no postoperative left ventricular posterior wall rupture or mechanical valve dysfunction in group A. CONCLUSIONS: The short-term results of the modified total leaflet preservation technique were better than those of the other techniques. This technique is also suitable for patients with rheumatic mitral valve stenosis.


Assuntos
Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Tratamentos com Preservação do Órgão/métodos , Cardiopatia Reumática/cirurgia , Adulto , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/fisiopatologia , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/fisiopatologia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
10.
Medicine (Baltimore) ; 98(24): e15897, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192923

RESUMO

RATIONALE: Hemophilia A (HA) is an X-linked recessive disorder caused by clotting factor VIII (FVIII) deficiency. There is limited data on the use of replacement therapy in cardiac surgery. Since no international guideline for anticoagulation in such patient exists, careful thought should be taken to design an individualized anticoagulation strategy. PATIENT CONCERNS: We report a 54-year-old male with severe HA with FVIII activity of 0.8% when he was first diagnosed, who underwent successful mitral valve repair and coronary artery bypass graft with FVIII replacement perioperatively. DIAGNOSES: Transthoracic echocardiography and coronary angiography confirmed the HA patient with the diagnosis of severe mitral valve regurgitation and left anterior descending artery stenosis. INTERVENTIONS: Before surgery, a bolus of 1000 IU FVIII was injected, which obtained an FVIII of 80%. After induction, a 3750 IU bolus of FVIII was injected and subsequent FVIII level reached 135%. Mitral valve repair and coronary artery bypass graft with FVIII replacement were performed. After the surgery, a repeat FVIII activity level was 50.6%. The 400 mL of autologous blood and 700 mL of cardiopulmonary bypass (CPB) machine blood was returned to the patient as well as 4 units of fresh frozen plasma with an additional bolus of 1000 IU FVIII. 100 mg aspirin per day alone was given after surgery. OUTCOMES: The patient recovered uneventfully and 1-year follow-up showed no complications. LESSONS: The anticoagulant or antiplatelet regimen of HA patient following surgery should be individualized based on the evaluation of the risk factors for bleeding and thrombosis and the lowest FVIII activity ever recorded after FVIII replacement therapy.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Fator VIII/administração & dosagem , Hemofilia A/tratamento farmacológico , Insuficiência da Valva Mitral/cirurgia , Ponte de Artéria Coronária , Fator VIII/uso terapêutico , Implante de Prótese de Valva Cardíaca , Hemofilia A/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Resultado do Tratamento
17.
Isr Med Assoc J ; 5(21): 308-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140220

RESUMO

BACKGROUND: The MitraClip procedure is becoming an acceptable alternative for high-risk patients with mitral regurgitation (MR) due to functional (FMR) or degenerative (DMR) disease and suitable mitral anatomy. OBJECTIVES: To evaluate the results of MitraClip at our institute in carefully selected patients. METHODS: We conducted a retrospective analysis of medical records and echocardiography data from January 2012 to December 2017. RESULTS: A total of 39 MitraClip procedures in 37 patients (aged 75 ± 12 years, 9 women) was performed. Twenty-four patients presented with FMR, 12 with DMR, and 1 with combined pathology. One-day post-procedure MR was moderate to low in 86.1% of patients, with immediate device success in 88.8%. MR at 1 year was moderate to low in 79% at 1 year. Survival at 1 year was 86% and at 2 years 69.4%. Peri-procedural (< 1 week) death and MitraClip failure occurred in one and three patients, respectively. New York Heart Association score improved to class 1 or 2 in 37% of patients at 1 year vs. one patient at baseline. Post-procedural systolic pulmonary pressure was reduced from 53 (range 48-65) to 43 (range 36-52) mmHg at 1 month with a subsequent plateau at follow-up, to 41 (34-57) mmHg at 6 months, and to 47 (38-50) at 12 months. CONCLUSIONS: MitraClip in severe MR resulted in modest improvement in functional status and pulmonary pressure with a small risk of immediate procedural complications. Outcomes are encouraging considering the natural course of MR and the risks of surgical intervention.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Valva Mitral , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia/métodos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Avaliação de Resultados (Cuidados de Saúde) , Desempenho Físico Funcional , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Desenho de Prótese , Pressão Propulsora Pulmonar , Risco Ajustado , Índice de Gravidade de Doença , Análise de Sobrevida
18.
Rev Med Suisse ; 15(652): 1067-1071, 2019 May 22.
Artigo em Francês | MEDLINE | ID: mdl-31116521

RESUMO

Secondary mitral regurgitation is a frequent valvulopathy due to left ventricle remodeling. Although, its poor prognostic has been established, surgical interventions have shown no substantial benefits in terms of mortality benefit. MitraClip represents a transcatheter alternative. Two randomized trials - MITRA-FR and COAPT comparing the clipping versus optimal medical therapy- have confirmed the feasibility of this intervention in patients with secondary mitral regurgitation. MITRA-FR did not show any significant benefit for the MitraClip group with respect to the composite endpoint (all-cause mortality and rehospitalization for heart failure) at 12 months. On the other hand, COAPT showed a clear superiority of MitraClip in terms of mortality and rehospitalization rates, compared to the conservative treatment alone at 24 months.


Assuntos
Insuficiência Cardíaca , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Insuficiência Cardíaca/etiologia , Humanos , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Prognóstico , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(17): e14969, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027050

RESUMO

To summary the impact of off-pump coronary artery bypass grafting (CABG) only on patients with moderate ischemic mitral regurgitation and survival.We retrospectively analyzed 109 patients with coronary artery disease (CAD) complicated by moderate mitral regurgitation, from January, 2008 to December, 2014, in the Department of Cardiovascular Surgery at the No. 2 Hospital of Jilin University undergoing off pump CABG only. Preoperative clinical characteristics, complications after surgery, and outcome (survivor or death) were assessed. We observed the degree of mitral valve regurgitation, left ventricular ejection fraction (LVEF), left ventricular and left atrial size, left ventricular end-diastolic volume (LVEDV) preoperative, and New York Heart Association (NYHA) functional class, postoperative 10 days before discharge, and 6 months and longer after surgery. The statistical data were processed by SPSS 19 software with computer; statistical significant difference with P < .05.Overall in-hospital mortality was 2.75% (3 patients). Patients had lower mean LVEF in the postoperative compared with the preoperative period, but all the patients had higher LVEF since 6 months than preoperative period (P < .001). Compared with the preoperative dates, postoperative valvular regurgitation, left ventricular and atrial size and LVEDV postoperative 10 days before discharge, 6 months and more longer after surgery reduced significantly (P < .001). Rapid atrial fibrillation occurred in 19 cases during perioperative and returned to normal before discharge. The symptom of angina was disappeared in all patients before discharge. The mean follow-up time was 60.16 ±â€Š17.98 months (range 36-96 months). Two patients died of major adverse cardiac events including heart failure and ventricular fibrillation. Three patients died of lung cancer, and 2 patients died of stroke during the longer follow-up.Off-pump CABG can be performed safely in patients with CAD complicated by moderate mitral regurgitation. The efficacy of CABG only is well demonstrated by the significant improvement of LVEF and NYHA functional class, and by the decrease of left ventricular and atrial size, LVEDV, and mitral regurgitation grade.


Assuntos
Ponte de Artéria Coronária , Isquemia/cirurgia , Insuficiência da Valva Mitral/cirurgia , Idoso , Feminino , Humanos , Isquemia/mortalidade , Isquemia/patologia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/patologia , Insuficiência da Valva Mitral/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Função Ventricular Esquerda
20.
J Cardiothorac Surg ; 14(1): 75, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971281

RESUMO

BACKGROUND: MitraClip implantation is a valid interventional option that offers acceptable short-term results. Surgery after failed MitraClip procedures remains challenging in high-risk patients. The data on these cases are limited by the small sample numbers. AIM: The aim of our study is to show, that mitral valve surgery could be possible and more advantageous, even in high-risk patients. METHODS: Between 2010 and 2016, nine patients underwent mitral valve surgery after failed MitraClip therapy at our institution. RESULTS: The patients' ages ranged from 19 to 75 years (mean: 61.2 ± 19.6 years). The median interval between the MitraClip intervention and surgical revision was 45 days (range: 0 to 1087 days). In eight of nine patients, the MitraClip intervention was initially successful and the  mitral regurgitation was reduced. Only one patient had undergone cardiac surgery previously. Intra-operatively, leaflet perforation or rupture, MitraClip detachment, and chordal or papillary muscle rupture were potentially the causes of recurrent mitral regurgitation. There were three early deaths. One year after surgery, the six remaining patients were alive. CONCLUSIONS: Mitral valve surgery can be successfully performed after failed MitraClip therapy in high-risk patients. The initial indication for MitraClip therapy should be considered carefully for possible surgical repair.


Assuntos
Falha de Equipamento , Implante de Prótese de Valva Cardíaca/instrumentação , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Idoso , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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