The Experts below are selected from a list of 14811 Experts worldwide ranked by ideXlab platform
A Moritz - One of the best experts on this subject based on the ideXlab platform.
-
propensity matched comparison of two different access modes for minimally invasive Mitral Valve Surgery
Seminars in Thoracic and Cardiovascular Surgery, 2020Co-Authors: Medhat Radwan, Dimitra Bon, Laura Dressen, Thomas Walther, Alexandra Miscovic, A Moritz, Nestoras PapadopoulosAbstract:Mitral Valve Surgery is being performed routinely using minimally invasive operative techniques. We aimed comparing perioperative and long-term outcomes of minimally invasive Mitral Valve Surgery using two different surgical approaches, partial upper sternotomy (PUS) versus right anterolateral minithoracotomy (RAT). From January 1998 through December 2015 1006 patients underwent Mitral Valve Surgery using a minimally invasive access in our institution. Logistic regression analysis was used to identify covariates among 18 patient variables including the type of Mitral Valve Surgery. Using the significant regression coefficients, each patient's propensity score was calculated, allowing selectively matched subgroups of 243 patients each. Results are based on the matched cohorts between the two groups. The PUS approach was performed by eight surgeons whereas the RAT approach by two. PUS led to slightly longer duration of the cross-clamp time (100±28 vs. 88±26minutes, p
-
minimally invasive port access versus conventional Mitral Valve Surgery prospective randomized study
The Annals of Thoracic Surgery, 2005Co-Authors: Selami Dogan, Tayfun Aybek, Petar Risteski, Farooq Detho, Andrea Rapp, Gerhard Wimmergreinecker, A MoritzAbstract:Background We compared the port access Mitral Valve Surgery with the conventional procedure through median sternotomy in a prospective randomized study. Methods Forty elective patients with Mitral Valve disease were prospectively randomized to undergo minimally invasive (group I) or conventional (group II) Mitral Valve operation. The patients of group I had limited access through right small anterior thoracotomy and a femorofemoral cardiopulmonary bypass system using the endoclamp technique. To assess the efficiency and safety of the procedure, intraoperative and postoperative clinical data and markers of myocardial, cerebral, and lower limb ischemia were collected. Pulmonary function tests were performed to compare the preservation of pulmonary function. Neuropsychological tests were conducted for quantification of neurological and cognitive disorders. Results Mitral Valve reconstructions were performed in 28 patients (70%) in both groups. Intraoperative procedure-associated problems were experienced in 9 patients (45%) in group I, and 6 of them (30%) had to be converted to direct transthoracic aortic clamping. Markers of myocardial and cerebral damage as well as pulmonary and neuropsychological tests did not show statistically significant difference between groups. Conclusions The minimally invasive port access technique for Mitral Valve Surgery can be done with similar clinical safety as procedures through median sternotomy. The problems with endoclamping have forced us to change our practice to the more simple and economic transthoracic aortic clamping technique.
Donald D Glower - One of the best experts on this subject based on the ideXlab platform.
-
right minithoracotomy versus median sternotomy for Mitral Valve Surgery a propensity matched study
The Annals of Thoracic Surgery, 2015Co-Authors: Paul Tang, Mark Staffordsmith, Mark W Onaitis, Jeffrey G Gaca, Carmelo A Milano, Donald D GlowerAbstract:Background The efficacy of conventional median sternotomy versus a right minithoracotomy (RT) approach to Mitral Valve Surgery was evaluated in a single high-volume institution. Methods A retrospective analysis of a single institution's experience was performed using propensity matching of 1,694 patients who underwent Mitral Valve Surgery during a 15-year period. Patients who had procedures that were not usually performed through an RT approach were excluded. Using 1:1 propensity score matching, we obtained 215 matched patients in each group for outcomes analysis. Results There was no difference in the median year of operation between the two groups (2002 versus 2001; p = 0.142). The RT approach was not a predictor of postoperative mortality. Predictors of mortality included increasing age, diabetes, smoking, preoperative dialysis, lung disease, advanced congestive heart failure class, and peripheral vascular disease. The RT approach was associated with less new-onset atrial fibrillation (8% versus 16%; p = 0.018), pneumonia (1% versus 5%; p = 0.049), respiratory failure (3% versus 8%; p = 0.036), and acute renal failure (2% versus 7%; p = 0.006), lower chest tube output (350 versus 840 mL; p p = 0.001). Conclusions Right minithoracotomy compared with median sternotomy for Mitral Valve Surgery was associated with less postoperative atrial fibrillation, respiratory complications, acute renal failure, chest tube output, and use of packed red blood cells. Given study limitations, the RT approach for Mitral Valve Surgery may have advantages over median sternotomy in selected patients.
-
the everest ii trial design and rationale for a randomized study of the eValve mitraclip system compared with Mitral Valve Surgery for Mitral regurgitation
American Heart Journal, 2010Co-Authors: Laura Mauri, Pallav Garg, Joseph M Massaro, Elyse Foster, Donald D Glower, Paul Mehoudar, Ferolyn T Powell, Jan Komtebedde, Elizabeth McdermottAbstract:Background Mitral Valve Surgery is the standard of care for patients with symptomatic Mitral regurgitation (MR) or asymptomatic MR with evidence of left ventricular dysfunction or dilation. Whether an endovascular approach to repair can offer comparable effectiveness with improved safety remains to be determined in randomized trials. Study Design The EVEREST II Trial is a multicenter, randomized controlled trial to evaluate the benefits and risks of endovascular Mitral Valve repair using the MitraClip device compared with open Mitral Valve Surgery (control) in patients with moderate or severe MR. Using a 2:1 randomization ratio, the trial is enrolling up to 186 MitraClip-treated subjects and 93 control subjects. Trial end points include a primary efficacy end point: the proportion of patients free from death, Surgery for Valve dysfunction, and with moderate-severe (3+) or severe (4+) MR at 12 months; the primary safety end point includes the proportion of patients with death, myocardial infarction, reoperation, nonelective cardiovascular Surgery, stroke, renal failure, deep would infection, ventilation >48 hours, gastrointestinal complication, new permanent atrial fibrillation, septicemia, or transfusion of ≥2 U at 30 days or hospital discharge, whichever is longer. Conclusions This randomized controlled trial is designed to evaluate the performance of endovascular Mitral repair in comparison to open Mitral Valve Surgery in patients with significant MR.
-
Mitral Valve Surgery and acute renal injury port access versus median sternotomy
The Annals of Thoracic Surgery, 2003Co-Authors: Brian J Mccreath, Donald D Glower, Madhav Swaminathan, John V Booth, Barbara Phillipsbute, Sophia T H Chew, Mark StaffordsmithAbstract:Abstract Background Many outcomes and complications of minimally invasive and conventional cardiac Surgery await comparison. Patients undergoing Mitral Valve Surgery commonly sustain renal injury. Using peak postoperative fractional change of serum creatinine as a marker of renal injury, we tested the hypothesis that Mitral Valve Surgery with port access minithoracotomy (Port) and conventional Surgery with a median sternotomy (MS) incision are associated with different degrees of acute renal injury. Methods We evaluated data from all isolated Mitral Valve operations by a single surgeon between 1990 and 2000 (MS = 90, Port=227). We also performed a secondary analysis of Mitral Valve surgeries performed by both MS and Port approaches in a concurrent period from 1996 to 2002 (MS = 93, Port=240). Univariable and multivariable tests were used to determine the association of surgical technique with peak postoperative creatinine (Cr max Post) and peak postoperative fractional change in creatinine (%ΔCr); p less than 0.05 was considered significant. Results In our analysis that accounted for the date of Surgery, we observed a highly significant independent association between surgical approach and %ΔCr, indicating a greater risk of acute renal injury in the MS group (F value 13.33; p = 0.0003). Similar findings were noted in the secondary (time-concurrent) analysis of %ΔCr (F value 12.65; p = 0.0176). Conclusions We present retrospective evidence of reduced acute renal injury associated with the port access technique in Mitral Valve Surgery patients. Our findings suggest that a port access minithoracotomy approach to Mitral Valve Surgery may be preferable to conventional methods for patients with high renal risk.
Marc A Gillinov - One of the best experts on this subject based on the ideXlab platform.
-
early results of robotically assisted Mitral Valve Surgery analysis of the first 1000 cases
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Marc A Gillinov, Jose L Navia, Tomislav Mihaljevic, Hoda Javadikasgari, Rakesh M Suri, Stephanie Mick, Milind Y Desai, Johannes Bonatti, Mitra Khosravi, Jay J IdreesAbstract:Abstract Objective The study objective was to assess the technical and process improvement and clinical outcomes of robotic Mitral Valve Surgery by examining the first 1000 cases performed in a tertiary care center. Methods We reviewed the first 1000 patients (mean age, 56 ± 10 years) undergoing robotic primary Mitral Valve Surgery, including concomitant procedures (n = 185), from January 2006 to November 2013. Mitral Valve disease cause was degenerative (n = 960, 96%), endocarditis (n = 26, 2.6%), rheumatic (n = 10, 1.0%), ischemic (n = 3, 0.3%), and fibroelastoma (n = 1, 0.1%). All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. Results Mitral Valve repair was attempted in 997 patients (2 planned replacements and 1 resection of fibroelastoma), 992 (99.5%) of whom underwent Valve repair, and 5 (0.5%) of whom underwent Valve replacement. Intraoperative postrepair echocardiography showed that 99.7% of patients receiving repair (989/992) left the operating room with no or mild Mitral regurgitation, and predischarge echocardiography showed that Mitral regurgitation remained mild or less in 97.9% of patients (915/935). There was 1 hospital death (0.1%), and 14 patients (1.4%) experienced a stroke; stroke risk declined from 2% in the first 500 patients to 0.8% in the second 500 patients. Over the course of the experience, myocardial ischemic and cardiopulmonary bypass times ( P P = .003), and intensive care unit and postoperative lengths of stay ( P Conclusions Robotic Mitral Valve Surgery is associated with a high likelihood of Valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency.
-
surgical ablation of atrial fibrillation during Mitral Valve Surgery
The New England Journal of Medicine, 2015Co-Authors: Marc A Gillinov, Gorav Ailawadi, Peter K Smith, Annetine C Gelijns, Michael K Parides, Joseph J Derose, Alan J Moskowitz, Pierre Voisine, Denis Bouchard, Michael J MackAbstract:More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P = 0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P = 0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to Mitral-Valve Surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.)
-
minimally invasive versus conventional Mitral Valve Surgery a propensity matched comparison
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Lars G Svensson, Marc A Gillinov, Fernando A Atik, Delos M Cosgrove, Eugene H Blackstone, Jeevanantham Rajeswaran, Gita Krishnaswamy, Ung Jin, Brian P Griffin, Jose L NaviaAbstract:Objective Less invasive approaches to Mitral Valve Surgery are increasingly used for improved cosmesis; however, few studies have investigated their effect on outcome. We sought to compare these minimally invasive approaches fairly with conventional full sternotomy by using propensity-matching methods. Methods From January 1995 to January 2004, 2124 patients underwent isolated Mitral Valve Surgery through a minimally invasive approach, and 1047 underwent isolated Mitral Valve Surgery through a conventional sternotomy. Because there were important differences in patient characteristics, a propensity score based on 42 factors was used to obtain 590 well-matched patient pairs (56% of cases). Results In-hospital mortality was similar for propensity-matched patients: 0.17% (1/590) for those undergoing minimally invasive Surgery and 0.85% (5/590) for those undergoing conventional Surgery ( P = .2). Occurrences of stroke ( P = .8), renal failure ( P > .9), myocardial infarction ( P = .7), and infection ( P = .8) were also similar. However, 24-hour mediastinal drainage was less after minimally invasive Surgery (median, 250 vs 350 mL; P P = .01). More patients undergoing minimally invasive Surgery were extubated in the operating room (18% vs 5.7%, P P Conclusion Within that portion of the spectrum of Mitral Valve Surgery in which propensity matching was possible, minimally invasive Mitral Valve Surgery had cosmetic, blood product use, respiratory, and pain advantages over conventional Surgery, and no apparent detriments. Mortality and morbidity for robotic and percutaneous procedures should be compared with these minimally invasive outcomes.
Jose L Navia - One of the best experts on this subject based on the ideXlab platform.
-
early results of robotically assisted Mitral Valve Surgery analysis of the first 1000 cases
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Marc A Gillinov, Jose L Navia, Tomislav Mihaljevic, Hoda Javadikasgari, Rakesh M Suri, Stephanie Mick, Milind Y Desai, Johannes Bonatti, Mitra Khosravi, Jay J IdreesAbstract:Abstract Objective The study objective was to assess the technical and process improvement and clinical outcomes of robotic Mitral Valve Surgery by examining the first 1000 cases performed in a tertiary care center. Methods We reviewed the first 1000 patients (mean age, 56 ± 10 years) undergoing robotic primary Mitral Valve Surgery, including concomitant procedures (n = 185), from January 2006 to November 2013. Mitral Valve disease cause was degenerative (n = 960, 96%), endocarditis (n = 26, 2.6%), rheumatic (n = 10, 1.0%), ischemic (n = 3, 0.3%), and fibroelastoma (n = 1, 0.1%). All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. Results Mitral Valve repair was attempted in 997 patients (2 planned replacements and 1 resection of fibroelastoma), 992 (99.5%) of whom underwent Valve repair, and 5 (0.5%) of whom underwent Valve replacement. Intraoperative postrepair echocardiography showed that 99.7% of patients receiving repair (989/992) left the operating room with no or mild Mitral regurgitation, and predischarge echocardiography showed that Mitral regurgitation remained mild or less in 97.9% of patients (915/935). There was 1 hospital death (0.1%), and 14 patients (1.4%) experienced a stroke; stroke risk declined from 2% in the first 500 patients to 0.8% in the second 500 patients. Over the course of the experience, myocardial ischemic and cardiopulmonary bypass times ( P P = .003), and intensive care unit and postoperative lengths of stay ( P Conclusions Robotic Mitral Valve Surgery is associated with a high likelihood of Valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency.
-
minimally invasive versus conventional Mitral Valve Surgery a propensity matched comparison
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Lars G Svensson, Marc A Gillinov, Fernando A Atik, Delos M Cosgrove, Eugene H Blackstone, Jeevanantham Rajeswaran, Gita Krishnaswamy, Ung Jin, Brian P Griffin, Jose L NaviaAbstract:Objective Less invasive approaches to Mitral Valve Surgery are increasingly used for improved cosmesis; however, few studies have investigated their effect on outcome. We sought to compare these minimally invasive approaches fairly with conventional full sternotomy by using propensity-matching methods. Methods From January 1995 to January 2004, 2124 patients underwent isolated Mitral Valve Surgery through a minimally invasive approach, and 1047 underwent isolated Mitral Valve Surgery through a conventional sternotomy. Because there were important differences in patient characteristics, a propensity score based on 42 factors was used to obtain 590 well-matched patient pairs (56% of cases). Results In-hospital mortality was similar for propensity-matched patients: 0.17% (1/590) for those undergoing minimally invasive Surgery and 0.85% (5/590) for those undergoing conventional Surgery ( P = .2). Occurrences of stroke ( P = .8), renal failure ( P > .9), myocardial infarction ( P = .7), and infection ( P = .8) were also similar. However, 24-hour mediastinal drainage was less after minimally invasive Surgery (median, 250 vs 350 mL; P P = .01). More patients undergoing minimally invasive Surgery were extubated in the operating room (18% vs 5.7%, P P Conclusion Within that portion of the spectrum of Mitral Valve Surgery in which propensity matching was possible, minimally invasive Mitral Valve Surgery had cosmetic, blood product use, respiratory, and pain advantages over conventional Surgery, and no apparent detriments. Mortality and morbidity for robotic and percutaneous procedures should be compared with these minimally invasive outcomes.
Michael J Mack - One of the best experts on this subject based on the ideXlab platform.
-
pacemaker implantation after Mitral Valve Surgery with atrial fibrillation ablation
Journal of the American College of Cardiology, 2019Co-Authors: Joseph J Derose, Gorav Ailawadi, Michael K Parides, Donna Mancini, Helena L Chang, Michael Argenziano, Francois Dagenais, Louis P Perrault, Wendy C Taddeipeters, Michael J MackAbstract:Abstract Background The incidence of permanent pacemaker (PPM) implantation is higher following Mitral Valve Surgery (MVS) with ablation for atrial fibrillation (AF) compared with MVS alone. Objectives This study identified risk factors and outcomes associated with PPM implantation in a randomized trial that evaluated ablation for AF in patients who underwent MVS. Methods A total of 243 patients with AF and without previous PPM placement were randomly assigned to MVS alone (n = 117) or MVS + ablation (n = 126). Patients in the ablation group were further randomized to pulmonary vein isolation (PVI) (n = 62) or the biatrial maze procedure (n = 64). Using competing risk models, this study examined the association among PPM and baseline and operative risk factors, and the effect of PPM on time to discharge, readmissions, and 1-year mortality. Results Thirty-five patients received a PPM within the first year (14.4%), 29 (83%) underwent implantation during the index hospitalization. The frequency of PPM implantation was 7.7% in patients randomized to MVS alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications for PPM were similar among patients who underwent MVS with and without ablation. Ablation, multiValve Surgery, and New York Heart Association functional (NYHA) functional class III/IV were independent risk factors for PPM implantation. Length of stay post-Surgery was longer in patients who received PPMs, but it was not significant when adjusted for randomization assignment (MVS vs. ablation) and age (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p = 0.50). The need for PPM was associated with a higher risk of 1-year mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05) after adjustment for randomization assignment, age, and NYHA functional class. Conclusions AF ablation, multiValve Surgery, and NYHA functional class III/IV were associated with an increased risk for permanent pacing. PPM implantation following MVS was associated with a significant increase in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery; NCT00903370)
-
surgical ablation of atrial fibrillation during Mitral Valve Surgery
The New England Journal of Medicine, 2015Co-Authors: Marc A Gillinov, Gorav Ailawadi, Peter K Smith, Annetine C Gelijns, Michael K Parides, Joseph J Derose, Alan J Moskowitz, Pierre Voisine, Denis Bouchard, Michael J MackAbstract:More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P = 0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P = 0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to Mitral-Valve Surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.)