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Flashcards in Mitral Valve studies Deck (14):

25 years of Gore-Tex Mitral Valve Repair

Tirone David
JTCS 2012
"Chordal replacement with PTFE for mitral valve repair: 25 year experience"
1986- to 2004---606 patients
Isolated Anterior 17.6%, isolated posterior 29.5%, bileaflet prolapse 52.9%
Mean follow up 10.1 years
18 years freedom from re-operation was 90.2%
Freedom from severe MR was 67.5%


Mitral Valve Surgical Procedures in the Elderly
Annals of Thoracic Surgery: 94; 5; Dec 2012: 2004

This is a strong study from Lepzig about Mitral valve surgery in patients at age 70 years and older.
2500 patients over a 10 year period. 97% had MR,

65% were mitral valve repair and rest were replacement. CABG was identified as associated with inferior short and long-term survival.

30 day mortality was 3.1% and 5 year 55.2%.

Relevant study because some centers report much higher rates of operative mortality (25% for MV). This study has good long term outcomes as well.


Mitral Valve disease: if the mitral valve is not reparable/failed repair is a bioprosthesis suiting for replacement

Jamieson WE, Vancouver groupt
Eur J Cardiothorac Surg 2009 Jan25;(1)

Examined the mitral porcine bioprosthessis (CE SAV)

1135 patients from 2982 to 2000

Examined structural valve deterioration and freedom from composites of complications

For 51-60
actual freedom from SVD @ 18 year was 56.0%
actuarial freedom SVD @ 18 years was 14.7%
for 61-70
actual freedom from SVD @ 18 year was 69.2%
actuarial freedom from SVD @ 18 year was 26.5%
For > 70
actual freedom from SVD @ 15 years was 92
actuarial freedom from SVD @ 69 %

The overall actual freedom at 15 to 18 years for > 70 age grouo was for for valve-related reoperation 94 % and valve related mortality was 87%


ISTIMIR: The Italian Study on the treatment of Ischemic Mitral Regurgitation

1006 patients with ischemic MR and impaired LV ventricular function (EF < 40%) at 13 italian centers between 1996 and 2011

29% underwent mitral valve replacement and 70.4% underwent mitral valve repair. Propensity scores and 244 pairs of patients were mattached
median f/u 46.5
Early death was 3.3% for repair and 5.3% for replacement

8 year survival was 81.6% and 79.6% for repair and replacement
Freedom from all-cause reoperation was 64% vs 80%
No improvement in LV function

suggest that mitral valve replacement is suitable for chronic IMR


What are rates of post operative MR following restrictive annuloplasty

Moderate/severe MR has been shown to be as much as 33% in pts at months and more then 70% at 5 years.

predicting who is likely to benefit from replacement or repair is tough...Some say LVEDD of > 65mm should be replaced.


Predictors of mitral regurgitation recurrence in pts with heart failure undergoing mitral valve annuloplasty

Robert Dion and a group...
Am J Cardiol 2010;1065:395-401

This study has good images for echo IMR values

Basal mitral anterior leaflet angle
Posterior mitral leaflet angle
tenting area
tenting height
coaptation length
mitral annulus
Coapatiation-to-septum distance


What outcomes from the Dion Study predicted failure of annuloplasty

Distal mitral anterior leaflet tethering
posterior leaflet tethering


5 year CorCap outcomes: Beneficial effects of CorCap cardiac support device: Five year results from Acorn Trial

107 patients---no mitral valve repair/replacement and half in each group
treatment group had signficant reductions in left ventricular end-diastolic volume as well as small increase in sphericiity index.
More patients in treatment group had improve in NHYA 1 functional class
There was no differnence in freedom from composite end point of death major cardiac procedures


What is CorCap

Passive polymer cardiac support device
a significant increase in ejection fraction and decrease of LV end-diastolic volume were observed


Adjustable Annuloplasty ring (Micardia)

The enCorSQ is an adjustable ring (leaves a wire attached to the sub that can be heated and further reduce annuloplasty)


What is EVEREST study II details

N = 279 pts (2:1 radndomization)
184 to mitra clip and 95 mitral repair
Primary composite endpoint---freedom from death, surgery for mitral dysfunction, and freedom from MR > 3+ at 12 months
Primary safety endpoint---included transfusion of >2U of Blood


What were results of EVEREST II

mitral clip 55%
Surgery 73%

safety event was 15% with mitral clip and 48% with surgery. This was because of the blood transfusion data.


April 2011 NEJM

Randomized comparison of percutaneous repair with conventional surgery for mitral regurgitation to evaluate the efficacy and safety of the percutaneous approach.

Findings: No difference between two groups in terms of mortality and morbidity for major adverse cardiac events; only difference is need for transfusion (8.8% vs 53.2%)

At 30 days
E-clip: 6% mortality, 20 % converted to mitral valve surgery; 21% with grade 3+ or 4+ MR
Surgery: 6% mortality, recurrence of 3 - 4+ MR was also 20% (poor outcome)

The conclusion that E-Clip offers "superior safety"...crazy


Mitral valve repair vs Mitral Valve Replacement

Enriquuez-Sarano et al., (Group from Mayo Clinic)
"Valve Repair Improves the Outcome of Surgery for Mitral Regurgitation"
1995- Circulation
195 pts with valve repair and 214 with replacement for organic MR.
Overall survival at 10 years was 68% with repair compared to 52% with replacement
Operative mortality 2.6% with repair vs 10% with replacement
Ejection fraction was lower with both groups but better with repair.

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