Rheumatic mitral valve repair or replacement in the valve-in-valve era
| العنوان: | Rheumatic mitral valve repair or replacement in the valve-in-valve era |
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| المؤلفون: | Alexander A. Brescia, Tessa M.F. Watt, Shannon L. Murray, Liza M. Rosenbloom, Kellianne C. Kleeman, Haley Allgeyer, Joseph Eid, Matthew A. Romano, Steven F. Bolling, Curtis S. Bergquist, Aaron M. Williams |
| المصدر: | The Journal of Thoracic and Cardiovascular Surgery. 163:591-602.e1 |
| بيانات النشر: | Elsevier BV, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Adult, Male, Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Mitral Valve Annuloplasty, Time Factors, medicine.medical_treatment, 030204 cardiovascular system & hematology, Risk Assessment, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Mitral valve, Humans, Mitral Valve Stenosis, Medicine, cardiovascular diseases, Aged, Retrospective Studies, Aged, 80 and over, Heart Valve Prosthesis Implantation, Mitral regurgitation, Mitral valve repair, Tricuspid valve, Ejection fraction, business.industry, Hemodynamics, Rheumatic Heart Disease, Mitral valve replacement, Mitral Valve Insufficiency, Atrial fibrillation, Recovery of Function, Middle Aged, medicine.disease, Surgery, Stenosis, Treatment Outcome, medicine.anatomical_structure, 030228 respiratory system, cardiovascular system, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business |
| الوصف: | For degenerative mitral disease, repair is superior to replacement; however, the best operative strategy for rheumatic mitral disease remains unclear. We evaluated the association between decision-making in choosing repair versus replacement and outcomes across 2 decades of rheumatic mitral surgery.Patients undergoing isolated, first-time rheumatic mitral surgery were identified. Era 1 (1997-2008) and Era 2 (2009-2018) were distinguished by intraoperative assessment of anterior leaflet mobility/calcification (Era 2) in deciding between mitral repair versus replacement. Primary outcome was a composite of death, reoperation, and severe valve dysfunction.Among 180 patients, age was 59 ± 14 years, and ejection fraction was 58% ± 10%. A higher proportion in Era 1 (n = 56) compared with Era 2 (n = 124) had preoperative atrial fibrillation (68% vs 46%; P = .006); the groups were otherwise similar. Primary indication was mitral stenosis in 69% (124 out of 180; pure = 35, mixed = 89) and did not differ by era (P = .67). During Era 1, 70% (39 out of 56) underwent repair, compared with 33% (41 out of 124) during Era 2 (P .001). Freedom from death, reoperation, or severe valve dysfunction at 5 years was higher in Era 2 (72% ± 9%) than Era 1 (54% ± 13%; P = .04). Five-year survival was higher in Era 2 than Era 1, but did not differ between repair versus replacement. Five-year cumulative incidence of reoperation with death as a competing risk did not differ by era, but was higher after repair than replacement.Careful assessment of anterior leaflet mobility/calcification to determine mitral repair or replacement was associated with improved outcomes. This decision-making strategy may alter the threshold for rheumatic mitral replacement in the current valve-in-valve era. |
| تدمد: | 0022-5223 1997-2008 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dc0af858ad83266bff8e3725de27e34b https://doi.org/10.1016/j.jtcvs.2020.04.118 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....dc0af858ad83266bff8e3725de27e34b |
| قاعدة البيانات: | OpenAIRE |
Full Text via ClinicalKey | تدمد: | 00225223 19972008 |
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