How long mitral valve repair last

Conclusions: This study confirms the excellent clinical long-term results after mitral valve repair. Further studies are required to better define the possible causative role of chronic obstructive pulmonary disease and any underlying connective tissue metabolic disorder in late failures after mitral valve repair. After incision a soft tissue retractor is inserted and the intercostal space is gently spread with a retractor.

Two trocars are inserted in the thorax to allow positioning of a ventricular vent, CO2 insufflator, camera device and pericardial stay sutures. Whereas at the beginning of our experience the approach involved retrograde arterial perfusion and balloon endoclamping, the procedure has evolved to a technique with ascending aorta cannulation, long femoral venous cannula drainage, and direct transthoracic aortic clamping.

Biomedicus single stage Medtronic, Minneapolis, Minn or RAP single 2 stage cannulas Estech were inserted through the femoral vein into the right atrium and the correct position was achieved with the Seldinger technique under transesophageal echocardiographic guidance. In case of mitral and tricuspid valve surgery, a single 2 stage cannula RAP, Estech was used as it allows to drain simultaneously the superior and inferior venae cavae. The mitral valve is approached with a traditional left paraseptal atriotomy and exposed using a specially designed atrial retractor held by a mechanical harm inserted through a right parasternal port.

Mitral valve procedures were performed under a combination of direct vision and thoracoscopic assistance. The surgical steps that we were unable to perform under direct vision were performed with video assistance, such as placement of sutures on the anterior annulus of the mitral valve, or at the level of the posterior medial commissures. All patients received an accurate intraoperative transoesophageal echocardiogram before and after weaning from cardiopulmonary bypass machine.

In patients who had an attempt to repair, our policy is to replace the mitral valve if a at the hydrostatic saline test after several attempts, there is still some degrees of mitral regurgitation, b the surface of coaptation is not enough to guarantee a long durability, c at intraoperative echo, there is more than mild mitral regurgitation. Eight surgeons contributed to this series, with 2 of them MG, MS performing Cumulative survival was evaluated with the Kaplan—Meier method.

All statistical analyses were performed with SPSS Baseline characteristics are listed in Table 1. In Twenty-three patients 1.

Postoperative outcomes are reported in Table 3. For the patients that were effectively repaired, 19 1. In the remaining 76 cases, the learning curve was considered the main cause. Mitral valve replacement was performed in patients. As previously stated, 73 replacements were failed repairs.

Median follow-up time was 32 months IQR 9—59 and was At follow-up, patients were dead: 61 patients were MVR and 53 were mitral valve repair. Overall 1-, 5- and year survival were Specifically, survival after repair at 1-, 5- and years was Survival after replacement at 1-, 5- and years was In the setting of degenerative mitral valve diseased, overall 1-, 5-, and year survival was Specifically, rate of survival after mitral valve repair was Overall freedom from reoperation was After mitral valve repair, freedom from reoperation at 1-, 5- and years was Freedom from reoperation after replacement at 1-, 5- and years was Specifically, rate of freedom from reoperation after mitral valve repair was We demonstrated that MIMVS through RT is a safe procedure, associated with excellent postoperative outcomes, short hospital length of stay and outstanding long-term results.

Specifically, overall in-hospital mortality was 1. Similar results were found for the patients undergoing mitral valve repair for degenerative mitral valve disease. MIMVS has been shown to decrease postoperative complications, providing fast recovery, shorter hospital length of stay, less pain, better aesthetic appearance and consequently less use of hospital resources [ 8 ].

In , the consensus statement of international society of minimally invasive cardiothoracic surgery ISMICS concluded that MIMAVS may be an alternative to conventional mitral valve surgery, given that there was comparable short term and long term mortality, comparable in-hospital morbidity renal, pulmonary, cardiac complications, pain perception and readmissions , reduced sternal complications, transfusions, postoperative AF, duration of ventilation and ICU and hospital length of stay [ 5 ].

Similar results were described by the Society of Thoracic Surgeons of the adult cardiac surgery database as well as by several meta-analyses confirming the main points of the aforementioned consensus statement [ 4 , 6 — 8 , 14 ]. Our results are in line with the current literature; however, despite these excellent outcomes, many criticism still remain regarding MIMVS as it is technically more complex, requires a distinct learning curve prolonged cross-clamp and cardiopulmonary bypass times and is supposedly associated with higher incidence of neurological events, aortic dissection, groin complications and higher rate of mitral valve replacement instead of mitral valve repair [ 5 , 11 ].

Some authors argue that limited exposure may lead to insufficient de-airing and thus an increase risk in neurologic events [ 14 ]. We believe that our standard technique, with central cannulation and direct aortic cross-clamping is as safe as sternotomy in terms of neurological events.

It has been shown that the incidence of stroke does not seem to depend on the surgical access [ 8 , 16 ], but rather on the choice of endo-clamp and peripheral vessel cannulation [ 4 , 17 , 18 ]. Previously, we demonstrated that the use of retrograde perfusion is associated 4-fold increase in stroke and postoperative delirium when compared to anterograde perfusion. In mitral valve replacement surgery, the damaged mitral valve is replaced by an artificial prosthetic valve.

The two types of artificial valves are mechanical valves and tissue valves. The type of valve replacement chosen depends largely on the severity of the condition and the overall health of the patient. Like mitral valve repair, mitral valve replacement can be performed as a traditional, open surgery or through minimally invasive approaches, and surgery may be performed with robotic assistance. When deciding whether to repair or replace a mitral valve, a cardiac surgeon will consider many factors including overall health, other health conditions that may be present, the condition of the existing valve, and the likely benefits of surgery.

People will typically feel better as soon as their valve is repaired. It takes about two to three weeks for most people to feel well, although some healing and recovery may still continue in the following weeks and months. Our surgeons can help you decide if a mitral valve procedure is necessary for you, and if so, which type of procedure would be best. Incisions in minimally invasive heart surgery and open-heart surgery Open pop-up dialog box Close.

Incisions in minimally invasive heart surgery and open-heart surgery In minimally invasive heart surgery, surgeons access the heart through small cuts incisions in the chest, as shown in the top two images. Minimally invasive heart surgery Open pop-up dialog box Close. Minimally invasive heart surgery In one type of minimally invasive heart surgery, surgeons make small incisions in the side of your chest, between your ribs, to reach your heart.

Robot-assisted heart surgery Open pop-up dialog box Close. Robot-assisted heart surgery In robot-assisted heart surgery, a surgeon sits at a remote console and views the heart on a video monitor.

Share on: Facebook Twitter. Show references Heart disease. National Heart, Lung, and Blood Institute. Accessed March 11, Mitral regurgitation.

Merck Manual Professional Version. Mitral stenosis. Otto CM, et al. Journal of the American College of Cardiology. Felker GM, et al. Heart failure as a consequence of valvular heart disease. Elsevier; Office of Patient Education. Recovering from heart surgery: Your care at home. Mayo Clinic; Heart valve disease resources: Considerations for surgery.

American Heart Association. Mitral stenosis adult. Aldea GS. Minimally invasive aortic and mitral valve surgery. Simonato, M. Transcatheter mitral valve replacement after surgical repair or replacement: Comprehensive midterm evaluation of valve-in-valve and valve-in-ring implantation from the VIVID registry. Harb SC, et al. Mitral valve disease: A comprehensive review. Current Cardiology Reports.