Development of Mitral Stenosis After Mitral Valve Repair: Importance of Mitral Valve Area.

Background: The development of mitral stenosis (MS) is not uncommon after mitral valve (MV) repair for degenerative mitral regurgitation (MR), but the significance of MS in this setting has not been defined.

Methods: We prospectively studied 110 such patients who underwent supine bicycle exercise testing to assess intracardiac hemodynamics at rest and at peak exercise. B-type natriuretic peptide (BNP) levels were measured at rest and after the exercise test.

Clinical evaluation of functional mitral stenosis after mitral valve repair for degenerative disease: potential affect on surgical strategy.

Background: Mitral annuloplasty with either a partial band or complete ring is an integral part of mitral valve repair for degenerative disease. The affect of annuloplasty type on outcomes has not been well described. The objective of our study was to compare echocardiographic and functional characteristics of patients who underwent mitral repair with either a complete ring or a partial band.

Functional significance of elevated mitral gradients after repair for degenerative mitral regurgitation.

Background: We have observed that elevated mitral gradients can develop in some patients after mitral valve repair for degenerative mitral regurgitation.

Methods And Results: We screened 275 patients who had mitral valve repair involving >1 leaflet scallop between October 2001 and July 2010. Mitral valve hemodynamics were assessed at rest and at peak exercise using the cycle ergometer.

Long-term evaluation of biological versus mechanical prosthesis use at reoperative aortic valve replacement.

Objectives: Recent evidence indicated that the use of a bioprosthesis in young patients at first-time aortic valve replacement (AVR) is associated with an increased reoperation risk, but not with an increase in long-term mortality, when compared with the use of a mechanical valve. However, at reoperative AVR, follow-up data by prosthesis type have been lacking from the literature. Therefore, we examined long-term survival and valve-related complications according to the type of prosthesis used at reoperative AVR.

Reoperation of left heart valve bioprostheses according to age at implantation.

Background: Evidence supporting the use of bioprostheses for heart valve replacement in young adults is accumulating. However, reoperation data, which may help guide clinical decision making in young patients, remains poorly defined in the literature.

Methods And Results: We examined the need for reoperation in 3975 patients who underwent first-time bioprosthetic aortic valve replacement (AVR) (n=3152) or mitral valve replacement (MVR) (n=823).

Influence of the On-X mechanical prosthesis on intermediate-term major thromboembolism and hemorrhage: a prospective multicenter study.

Objectives: Long-term thromboembolic and hemorrhagic outcomes after mechanical valve replacement have been well described; however, few studies have described these outcomes after valve replacement with the On-X mechanical prosthesis (On-X Life Technologies, Inc, Austin, Tex).

Methods: Between 2003 and 2008, 737 patients underwent either aortic valve replacement (n = 400), mitral valve replacement (n = 282), or double-valve replacement (n = 55). Longitudinal performance, freedom evaluation, and risk analysis were assessed with regard to major thromboembolism and hemorrhage.

Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement.

Background: The indications for tricuspid valve repair in the setting of mitral valve disease and concomitant tricuspid regurgitation (TR) remain unclear. We examined patients undergoing mitral valve replacement (MVR) to determine the effect of TR and tricuspid valve repair on survival, functional status, and postoperative TR.

Methods: Between 1990 and 2005, 624 patients underwent MVR.

Postoperative lipid-lowering therapy and bioprosthesis structural valve deterioration: justification for a randomised trial?

Objective: Bioprosthesis structural valve deterioration (SVD) is an incompletely understood process involving the accumulation of calcium and lipids. Whether this process could be delayed with lipid-lowering therapy (LLT) is currently unknown. The purpose of this observational study was to evaluate if an association exists between early LLT and a slowing of bioprosthesis SVD, with a view to designing a prospective trial.

Enlargement of the small aortic root during aortic valve replacement: is there a benefit?

Background: Aortic root enlargement (ARE) at the time of aortic valve replacement (AVR) is an often proposed but still unproven technique to prevent prosthesis-patient mismatch. To evaluate the risks and benefits of ARE, we examined the outcomes of patients with small aortic roots who underwent AVR with or without the use of ARE.

Methods: Patients (n = 712) with small aortic roots who underwent AVR were prospectively followed (follow-up, 3,730 patient-years; mean, 5.

Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age.

Background: Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults <60 years of age who were followed for over 20 years.

Management of acute severe perioperative failure of cardiac allografts: a single-centre experience with a review of the literature.

Background: Early graft failure is associated with high mortality and is the main cause of death within the first 30 days after transplantation. The purpose of the present study was to examine the investigators' experience of severe perioperative acute graft failure and to review the literature.

Methods: Nine of 385 cardiac transplants (2.

Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double-blind, within-patient comparison.

Background: Observational studies suggest that skeletonization of the internal thoracic artery (ITA) can improve conduit flow and length and reduce deep sternal infections and postoperative pain. We performed a randomized, double-blind, within-patient comparison of skeletonized and nonskeletonized ITAs in patients undergoing coronary surgery.

Methods And Results: Patients (n = 48) undergoing bilateral ITA harvest were randomized to receive 1 skeletonized and 1 nonskeletonized ITA.

Early postoperative anticoagulation after mechanical valve replacement: a Canadian survey.

Background And Aim Of The Study: The optimal approach to anticoagulation during the early postoperative period after mechanical valve replacement, by which early thromboembolism is prevented without bleeding complications, is not yet known. The study aim was to examine the practice patterns of Canadian cardiac surgeons with regard to early postoperative anticoagulation after mechanical valve implantation.

Methods: A questionnaire was sent to 100 Canadian cardiac surgeons in July 2004, and 57 responses were received.

Combined atrial fibrillation ablation with mitral valve surgery.

Background And Aim Of The Study: The study aim was to evaluate the efficacy and outcome of radiofrequency (RF) atrial fibrillation (AF) ablation in patients undergoing mitral valve (MV) surgery.

Methods: Between March 2002 and December 2004, 61 patients (mean age 65.4 +/- 10 years) underwent isolated endo-left atrial AF ablation using a unipolar RF device (Cardioblate; Medtronic, USA) in conjunction with 34 MV repairs and 27 MV replacements.

Mechanical versus bioprosthetic valve replacement in middle-aged patients.

Objective: The current trend towards decreasing the age for selection of a tissue over a mechanical prosthesis has led to a dilemma for patients aged 50-65 years. This cohort study examines the long-term outcomes of mechanical versus bioprosthetic valves in middle-aged patients.

Methods: Patients (N = 659) aged between 50 and 65 years who had first-time aortic valve replacement (AVR) and/or mitral valve replacement (MVR) with contemporary prostheses were followed prospectively after surgery.

The internal thoracic artery skeletonization study: a paired, within-patient comparison [NCT00265499].

Background: Traditional harvesting of the internal thoracic artery (ITA) for use as a conduit in coronary bypass surgery involves the dissection of a rim of tissue surrounding the artery on either side. Recent studies, primarily observational, have suggested that skeletonization of the ITA can improve conduit flow, increase length, and reduce the risk of deep sternal infection in high risk patients. Furthermore, skeletonization of the ITA can potentially preserve intercostal nerves and reduce post-operative pain and dysesthesias associated with ITA harvesting.

Early postoperative anticoagulation after mechanical valve replacement: a systematic review.

The optimal approach to early postoperative anticoagulation after mechanical valve implantation remains controversial. This review article examines the pathogenesis of thrombus formation and the different strategies for early postoperative anticoagulation. The most commonly reported anticoagulation regimens had the after estimates of early postoperative thromboembolism and hemorrhage: oral anticoagulation alone (0.

Surgical treatment of atrial fibrillation with diathermy: an in vitro study.

Objective: The utilization of diathermy (electrocautery) as an energy source in the treatment of chronic atrial fibrillation has generated positive early clinical results. Although this technology is available and affordable, it has not been well studied for this indication. The objectives of this study were: (1) to characterize atrial lesions created by diathermy, (2) to determine relationships between power setting, tissue contact time, and lesion depth and (3) to histologically compare diathermy and unipolar radiofrequency lesions.

Importance of moderate ischemic mitral regurgitation.

Background: The importance of moderate ischemic mitral regurgitation in patients presenting for coronary artery bypass grafting (CABG) is controversial. Therefore, we tracked the course of unrepaired moderate ischemic mitral regurgitation after CABG surgery alone, identified factors associated with worsening postoperative ischemic mitral regurgitation, and assessed the impact of unrepaired moderate ischemic mitral regurgitation on survival.

Methods: From 1980 to 2000, 467 patients with moderate ischemic mitral regurgitation underwent CABG alone.

Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valves.

Background: We examined factors associated with persistent or recurrent congestive heart failure after aortic valve replacement.

Methods: Patients who underwent aortic valve replacement with contemporary prostheses (n = 1563) were followed up with annual clinical assessment and echocardiography. The effect of demographic, comorbid, and valve-related variables on the composite outcome of New York Heart Association class III or IV symptoms or congestive heart failure death after surgery was evaluated with stratified log-rank tests, Cox proportional hazard models, and logistic regression.

Hemolysis after mitral valve repair: mechanisms and treatment.

Background: The objectives of this study were to determine the mechanisms of hemolysis after mitral valve repair and to determine outcomes after surgical treatment (mitral replacement or re-repair).

Methods: Between 1981 and 2002, 32 patients (mean age, 58 years) presented with hemolytic anemia after mitral valve repair for degenerative, rheumatic, or ischemic mitral regurgitation (MR). Three types of annuloplasty were used at the initial mitral valve repair: Cosgrove-Edwards, Carpentier-Edwards, and bovine pericardial (Perigard).