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Alain Deloche - One of the best experts on this subject based on the ideXlab platform.

Eugene A. Grossi - One of the best experts on this subject based on the ideXlab platform.

  • impact of moderate functional Mitral Insufficiency in patients undergoing surgical revascularization
    Circulation, 2006
    Co-Authors: Eugene A. Grossi, Aubrey C. Galloway, Greg H. Ribakove, Gregory A Crooke, Paul L Digiorgi, Charles F Schwartz, Ulrich P Jorde, Robert M Applebaum, Juan B Grau, Stephen B. Colvin
    Abstract:

    Background-Mild and moderate functional ischemic Mitral Insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic Mitral Insufficiency at the time of isolated coronary artery bypass grafting (CABG). Methods and Results-From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate Mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expβ = 1.49; P=0.007) and mild MR (exp/3 = 1.34; P=0.033). Conclusions-Independent of ventricular function, mild and moderate functional Mitral Insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined.

  • Late results of isolated Mitral annuloplasty for "functional" ischemic Mitral Insufficiency.
    Journal of cardiac surgery, 2001
    Co-Authors: Eugene A. Grossi, Costas S. Bizekis, Angelo Lapietra, Christopher C. Derivaux, Aubrey C. Galloway, Greg H. Ribakove, Alfred T. Culliford, Rick A. Esposito, Julie Delianides, Stephen B. Colvin
    Abstract:

    BACKGROUND: Repair of functional ischemic Mitral regurgitation (MR) due to annular deformity and leaflet restriction remains a challenge for the surgeon and lacks well-documented outcomes. We investigated outcomes in the treatment of functional ischemic MR corrected by annuloplasty techniques alone. METHODS: From May 1980 to July 1999, 174 patients underwent repair for functional ischemic Mitral Insufficiency with annuloplasty alone (128 ring annuloplasty; 46 suture annuloplasty). Acute Insufficiency was present in 25 (14.4%). Concomitant procedures included CABG (n = 152; 87.4%). Patients were studied longitudinally with annual follow-up and echocardiograms. RESULTS: Overall hospital mortality was 17.8% and was increased by NYHA Class 4 (23.8% vs. 8.7%; p = 0.011), diabetes (25.0% vs. 13.6%; p = 0.059), and chronic Mitral Insufficiency (16.4% vs. 8.0%; p = 0.070). Multivariate analysis revealed age (beta = 0.099; p = 0.049) and ejection fraction < 30% (beta = 1.260; p = 0.097) as significant predictors of hospital death. Mean postoperative Mitral Insufficiency was 0.84 +/- 0.86 (scale of 0-4). NYHA Class 4 (beta = 2.33; p = 0.034) and simple suture annuloplasty (beta = 2.08; p = 0.07) were associated with increased risk of late cardiac death. Cumulative incidence of Mitral reoperation was 7.7% at 5 years. At follow-up, 89.7% of patients were in NYHA Class 1 or 2 with 83.4% having none or only mild Mitral Insufficiency. CONCLUSIONS: Ring annuloplasty is associated with a survival benefit when compared to simple suture repair in ischemic patients who require annuloplasty alone to correct the MR. Mitral reconstruction with a ring annuloplasty offers durable results in this homogeneous subset of functional ischemic MR patients. Ischemic Mitral Insufficiency is associated with significant late mortality.

  • valve repair versus replacement for Mitral Insufficiency when is a mechanical valve still indicated
    The Journal of Thoracic and Cardiovascular Surgery, 1998
    Co-Authors: Eugene A. Grossi, Aubrey C. Galloway, Greg H. Ribakove, Alfred T. Culliford, Rick A. Esposito, Julie Delianides, Jeffrey S Miller, Patricia M Buttenheim, Gregory F Baumann, Frank C Spencer
    Abstract:

    Abstract Objectives: Although many advantages of Mitral valve reconstruction have been demonstrated, whether specific subgroups of patients exist in whom mechanical valve replacement offers advantages over Mitral reconstruction remains undetermined. Methods: This study examined the late results of Mitral valve surgery in patients with Mitral Insufficiency who received either a St. Jude Medical valve ( n  = 514) or a Mitral valve reconstruction with ring annuloplasty ( n  = 725) between 1980 and 1996. Results: Overall operative mortality was 7.2% in the patients receiving a St. Jude Medical Mitral valve and 5.4% in those undergoing Mitral valve reconstruction (no significant difference); isolated mortality was 2.5% in the St. Jude Medical group and 2.2% in the valve reconstruction group (no significant difference). The follow-up interval was more than 5 years for 340 patients with a mean of 39.8 months (98.5% complete). Overall 8-year freedom from late cardiac death, reoperation, and all valve-related complications was 72.8% for the St. Jude Medical group and 64.8% for valve reconstruction group (no significant difference). For patients with isolated, nonrheumatic Mitral valve disease, 8-year freedom from late cardiac death and reoperation was better in the Mitral valve reconstruction group (88.3%) than in the St. Jude Medical valve group (86.0%; p  = 0.05). Furthermore, Cox proportional hazards regression revealed that Mitral valve reconstruction was independently associated with a lesser incidence of late cardiac death ( p  = 0.04), irrespective of preoperative New York Heart Association class. However, the St. Jude Medical valve offered better 8-year freedom from late cardiac death, reoperation, and all valve-related complications than did Mitral valve reconstruction in patients with multiple valve disease (77.0% vs 45.3%; p Conclusions: Therefore, Mitral valve reconstruction appears to be the procedure of choice for isolated, nonrheumatic disease, whereas insertion of a St. Jude Medical valve should be preferred for patients with multiple valve disease. (J Thorac Cardiovasc Surg 1998;115:389-96)

  • operative therapy for Mitral Insufficiency from coronary artery disease
    Seminars in Thoracic and Cardiovascular Surgery, 1995
    Co-Authors: Aubrey C. Galloway, Eugene A. Grossi, Frank C Spencer, S B Colvin
    Abstract:

    This report reviews the results of combined coronary bypass and Carpentier-type Mitral valve reconstruction in 115 patients with ischemic Mitral Insufficiency. Overall operative mortality was 15.7%. Factors that increased operative risk in the overall valve repair population of 638 patients included ischemic etiology, previous cardiac surgery, NYHA functional classification, and age. Variables predicting increased risk of late cardiac death were ischemic etiology, concomitant procedures, and pulmonary hypertension. Late survival was diminished in ischemic patients, but 10-year freedom from reoperation was 93%, suggesting excellent durability after repair for ischemic Mitral Insufficiency. These results are compared with published reports of operative treatment for Mitral Insufficiency from coronary artery disease. Guidelines for use of coronary bypass alone versus coronary bypass in association with valve repair or replacement are developed. In most patients with moderate to severe Mitral Insufficiency secondary to coronary artery disease, the valvular pathology must be corrected, and valve repair with ring annuloplasty is the preferred method. Preoperative planning based on transesophageal echocardiography and cardiac catheterization data is essential for proper operative strategy, and attention to cardioplegia delivery and techniques to minimize reperfusion injury are necessary for optimal results. With these guidelines, late results are excellent after operative treatment for ischemic Mitral Insufficiency.

Aubrey C. Galloway - One of the best experts on this subject based on the ideXlab platform.

  • impact of moderate functional Mitral Insufficiency in patients undergoing surgical revascularization
    Circulation, 2006
    Co-Authors: Eugene A. Grossi, Aubrey C. Galloway, Greg H. Ribakove, Gregory A Crooke, Paul L Digiorgi, Charles F Schwartz, Ulrich P Jorde, Robert M Applebaum, Juan B Grau, Stephen B. Colvin
    Abstract:

    Background-Mild and moderate functional ischemic Mitral Insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic Mitral Insufficiency at the time of isolated coronary artery bypass grafting (CABG). Methods and Results-From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate Mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expβ = 1.49; P=0.007) and mild MR (exp/3 = 1.34; P=0.033). Conclusions-Independent of ventricular function, mild and moderate functional Mitral Insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined.

  • Late results of isolated Mitral annuloplasty for "functional" ischemic Mitral Insufficiency.
    Journal of cardiac surgery, 2001
    Co-Authors: Eugene A. Grossi, Costas S. Bizekis, Angelo Lapietra, Christopher C. Derivaux, Aubrey C. Galloway, Greg H. Ribakove, Alfred T. Culliford, Rick A. Esposito, Julie Delianides, Stephen B. Colvin
    Abstract:

    BACKGROUND: Repair of functional ischemic Mitral regurgitation (MR) due to annular deformity and leaflet restriction remains a challenge for the surgeon and lacks well-documented outcomes. We investigated outcomes in the treatment of functional ischemic MR corrected by annuloplasty techniques alone. METHODS: From May 1980 to July 1999, 174 patients underwent repair for functional ischemic Mitral Insufficiency with annuloplasty alone (128 ring annuloplasty; 46 suture annuloplasty). Acute Insufficiency was present in 25 (14.4%). Concomitant procedures included CABG (n = 152; 87.4%). Patients were studied longitudinally with annual follow-up and echocardiograms. RESULTS: Overall hospital mortality was 17.8% and was increased by NYHA Class 4 (23.8% vs. 8.7%; p = 0.011), diabetes (25.0% vs. 13.6%; p = 0.059), and chronic Mitral Insufficiency (16.4% vs. 8.0%; p = 0.070). Multivariate analysis revealed age (beta = 0.099; p = 0.049) and ejection fraction < 30% (beta = 1.260; p = 0.097) as significant predictors of hospital death. Mean postoperative Mitral Insufficiency was 0.84 +/- 0.86 (scale of 0-4). NYHA Class 4 (beta = 2.33; p = 0.034) and simple suture annuloplasty (beta = 2.08; p = 0.07) were associated with increased risk of late cardiac death. Cumulative incidence of Mitral reoperation was 7.7% at 5 years. At follow-up, 89.7% of patients were in NYHA Class 1 or 2 with 83.4% having none or only mild Mitral Insufficiency. CONCLUSIONS: Ring annuloplasty is associated with a survival benefit when compared to simple suture repair in ischemic patients who require annuloplasty alone to correct the MR. Mitral reconstruction with a ring annuloplasty offers durable results in this homogeneous subset of functional ischemic MR patients. Ischemic Mitral Insufficiency is associated with significant late mortality.

  • valve repair versus replacement for Mitral Insufficiency when is a mechanical valve still indicated
    The Journal of Thoracic and Cardiovascular Surgery, 1998
    Co-Authors: Eugene A. Grossi, Aubrey C. Galloway, Greg H. Ribakove, Alfred T. Culliford, Rick A. Esposito, Julie Delianides, Jeffrey S Miller, Patricia M Buttenheim, Gregory F Baumann, Frank C Spencer
    Abstract:

    Abstract Objectives: Although many advantages of Mitral valve reconstruction have been demonstrated, whether specific subgroups of patients exist in whom mechanical valve replacement offers advantages over Mitral reconstruction remains undetermined. Methods: This study examined the late results of Mitral valve surgery in patients with Mitral Insufficiency who received either a St. Jude Medical valve ( n  = 514) or a Mitral valve reconstruction with ring annuloplasty ( n  = 725) between 1980 and 1996. Results: Overall operative mortality was 7.2% in the patients receiving a St. Jude Medical Mitral valve and 5.4% in those undergoing Mitral valve reconstruction (no significant difference); isolated mortality was 2.5% in the St. Jude Medical group and 2.2% in the valve reconstruction group (no significant difference). The follow-up interval was more than 5 years for 340 patients with a mean of 39.8 months (98.5% complete). Overall 8-year freedom from late cardiac death, reoperation, and all valve-related complications was 72.8% for the St. Jude Medical group and 64.8% for valve reconstruction group (no significant difference). For patients with isolated, nonrheumatic Mitral valve disease, 8-year freedom from late cardiac death and reoperation was better in the Mitral valve reconstruction group (88.3%) than in the St. Jude Medical valve group (86.0%; p  = 0.05). Furthermore, Cox proportional hazards regression revealed that Mitral valve reconstruction was independently associated with a lesser incidence of late cardiac death ( p  = 0.04), irrespective of preoperative New York Heart Association class. However, the St. Jude Medical valve offered better 8-year freedom from late cardiac death, reoperation, and all valve-related complications than did Mitral valve reconstruction in patients with multiple valve disease (77.0% vs 45.3%; p Conclusions: Therefore, Mitral valve reconstruction appears to be the procedure of choice for isolated, nonrheumatic disease, whereas insertion of a St. Jude Medical valve should be preferred for patients with multiple valve disease. (J Thorac Cardiovasc Surg 1998;115:389-96)

  • operative therapy for Mitral Insufficiency from coronary artery disease
    Seminars in Thoracic and Cardiovascular Surgery, 1995
    Co-Authors: Aubrey C. Galloway, Eugene A. Grossi, Frank C Spencer, S B Colvin
    Abstract:

    This report reviews the results of combined coronary bypass and Carpentier-type Mitral valve reconstruction in 115 patients with ischemic Mitral Insufficiency. Overall operative mortality was 15.7%. Factors that increased operative risk in the overall valve repair population of 638 patients included ischemic etiology, previous cardiac surgery, NYHA functional classification, and age. Variables predicting increased risk of late cardiac death were ischemic etiology, concomitant procedures, and pulmonary hypertension. Late survival was diminished in ischemic patients, but 10-year freedom from reoperation was 93%, suggesting excellent durability after repair for ischemic Mitral Insufficiency. These results are compared with published reports of operative treatment for Mitral Insufficiency from coronary artery disease. Guidelines for use of coronary bypass alone versus coronary bypass in association with valve repair or replacement are developed. In most patients with moderate to severe Mitral Insufficiency secondary to coronary artery disease, the valvular pathology must be corrected, and valve repair with ring annuloplasty is the preferred method. Preoperative planning based on transesophageal echocardiography and cardiac catheterization data is essential for proper operative strategy, and attention to cardioplegia delivery and techniques to minimize reperfusion injury are necessary for optimal results. With these guidelines, late results are excellent after operative treatment for ischemic Mitral Insufficiency.

Sylvain Chauvaud - One of the best experts on this subject based on the ideXlab platform.

  • experience with the posterior leaflet extension technique for correction of rheumatic Mitral Insufficiency in children
    Brazilian Journal of Cardiovascular Surgery, 2009
    Co-Authors: Euclides Martins Tenorio, Sylvain Chauvaud, Fernando Moraes Neto, Carlos R Moraes
    Abstract:

    OBJECTIVE: To describe the experience with the technique of posterior leaflet extension in children suffering of rheumatic Mitral regurgitation. METHODS: Between April 2002, and October 2007, 30 children, mean age 11.3 years, underwent correction of Mitral Insufficiency with the technique of posterior leaflet extension with a pericardial patch. Eight also received a Carpentier ring. Six children had aortic valve disease and were submitted to Ross operation (five cases) or valve replacement with an aortic homograft. All were in functional class III or IV (NYHA classification). RESULTS: There was one death. One child presented severe hemolysis in the postoperative period and was submitted to Mitral valve replacement. Clinical evolution in the remaining patients was good. CONCLUSIONS: Posterior leaflet extension of the Mitral valve seems to be an effective surgical technique for correction of rheumatic Mitral Insufficiency in children.

  • Posterior leaflet extension with an autologous pericardial patch in rheumatic Mitral Insufficiency.
    The Annals of thoracic surgery, 2007
    Co-Authors: Rachid Zegdi, Jean-noël Fabiani, Ziad Khabbaz, Sylvain Chauvaud, Christian Latremouille, Alain Deloche
    Abstract:

    We describe our technique of posterior leaflet extension with an autologous pericardial patch in patients suffering from rheumatic Mitral regurgitation. Several simple rules have allowed us to achieve satisfying long-term results.

  • Mitral valve repair in the extensively calcified Mitral valve annulus
    The Annals of Thoracic Surgery, 1991
    Co-Authors: Bechara El Asmar, Sylvain Chauvaud, Michael A Acker, J P Couetil, P Perier, P Dervanian, Alain Carpentier
    Abstract:

    Abstract Mitral valve replacement in patients with an extensively calcified Mitral annulus is associated with an increased risk of ventricular rupture. Until now techniques of Mitral valve repair have not been applied to patients with a heavily calcified Mitral valve annulus. We present 12 patients who underwent extensive decalcification of the annulus with subsequent Mitral valve repair between 1987 and 1990. Ages ranged from 11 to 78 years; 6 patients were in New York Heart Association functional class II, 4 were in class III, and 2 were in class IV. All patients had varying degrees of Mitral Insufficiency. There were no deaths, reoperations, or thromboembolic events. Post-operative echocardiography revealed minimal residual Mitral Insufficiency in only 2 of 12 patients. All patients are currently in New York Heart Association class I or II. We believe Mitral valve repair can be done safely on patients with an extensively calcified Mitral annulus, thus avoiding the risks of left ventricular rupture, thromboembolic events, and hemorrhagic complications associated with Mitral valve replacement.

Takeshi Hiramatsu - One of the best experts on this subject based on the ideXlab platform.

  • the long term results of commissure plication annuloplasty for congenital Mitral Insufficiency
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Hideaki Ohno, Y Imai, Masatsugu Terada, Takeshi Hiramatsu
    Abstract:

    Abstract Background . Mitral valve repair in the pediatric population remains demanding because of a diversity of apparatus anomalies and the young age of the patients. Methods . We reviewed our clinical results for Mitral valve repairs for congenital Mitral Insufficiency. Forty-nine consecutive patients aged 2 months to 34 years (mean, 4.4 years) had Mitral valve repair between June 1984 and December 1996. Forty-one patients (83.7%) had associated cardiac anomalies. The predominant pathologies for the regurgitations were chordal anomalies in 34 patients (69%), annular dilatation in 8 (16%), and leaflet anomalies in 7 (14%). Mitral valve repair included commissure plication annuloplasty in 43 patients (88%), modified DeVega in 11, cleft closure in 5, plication of the anterior leaflet in 3, triangular resection of the anterior leaflet in 2, chordal shortening in 1, and placement of artificial chordae in 1. Several combined techniques were required in 19 patients. Results . There were no early or late deaths. The follow-up period was from 6 to 166 months (mean, 88.4 months). Forty-seven patients (95.9%) were in New York Heart Association class I. The long-term echocardiographic studies showed that 2 of 30 patients without reoperation had moderate regurgitation. The actuarial freedom from reoperation was 85.6% (95% confidence limits, 72.8%, 98.4%) at 13 years. Five patients (10.2%) required valve replacement from 13 days to 75 months after the valve repair. Two patients had cerebral ischemic events as a result of cardiomegaly and atrial fibrillation. Conclusions . Valve repair for congenital Mitral Insufficiency gave adequate results in combination with commissure plication annuloplasty and other techniques with excellent long-term functional status.