Impact of Complex Anatomy and Patient Risk Profile in Minimally Invasive Mitral Valve Surgery.

Autor:	Berretta P; Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy. Electronic address: p.berretta@icloud.com., Pitsis A; Department of Cardiac Surgery, European Interbalkan Medical Center, Thessaloniki, Greece., Bonaros N; Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria., Kempfert J; Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany., Wilbring M; Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Dresden, Germany., Stefano P; Cardiac Surgery Unit, Careggi University Hospital, Firenze, Italy., Van Praet F; Department of Cardiac Surgery, Hartcentrum OLV Aalst, Aalst, Belgium., Lamelas J; Division of Cardiothoracic Surgery, University of Miami, Miami, Florida., Malvindi PG; Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy., Gerdisch M; Franciscan Health Indianapolis, Indianapolis, Indiana., Pacini D; Department of Cardiac Surgery, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy., Yan T; Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia., Rinaldi M; Cardiac Surgery Unit, University of Turin, Turin, Italy., Salvador L; Division of Cardiac Surgery, S. Bortolo Hospital, Vicenza, Italy., Fiore A; Henri Mondor Hospital, University of Paris, Paris, France., Doenst T; Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany., Dinh NH; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam., Nguyen TC; Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas., Di Eusanio M; Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2025 Jan; Vol. 119 (1), pp. 137-144. Date of Electronic Publication: 2024 Aug 30.
DOI:	10.1016/j.athoracsur.2024.07.050
Abstrakt:	Background: We aimed to assess the impact of complex mitral valve disease and patient risk profile on operative outcomes in the large cohort of the Mini-Mitral International Registry. Methods: Patients were assigned to categories of complex degenerative mitral valve regurgitation (DMR; bileaflet or anterior mitral leaflet prolapse/flail) and simple DMR (posterior mitral leaflet prolapse/flail). Subgroup analyses was performed in low-risk (EuroSCORE II <8%) and high-risk (EuroSCORE II >8%) cohorts. A logistic regression model was applied to investigate the impact of valve anatomy and patient risk factors on valve repair rate and operative risk. Results: The study cohort consisted of 4524 patients with DMR (complex DMR, 1296; simple DMR, 3228). Valve repair rate was 87.3% and 91% in complex DMR and simple DMR, respectively. Predictors of valve replacement were anterior leaflet prolapse/flail, bileaflet flail, female sex, age, and reoperation, whereas Barlow disease was protective. Clinical results were comparable between complex DMR and simple DMR. On subgroup analyses, high-risk patients showed less satisfactory outcomes with respect to both the valve repair and operative mortality rates. Conclusions: Our findings suggest that complex DMR can be satisfactorily addressed by minimally invasive techniques. However, whereas complex disease was associated with low operative risk, anterior leaflet lesions and bileaflet flail remain negative predictors of successful valve repair. Conversely, valve repair rate was less satisfactory in high-risk patients, regardless of DMR complexity. Competing Interests: Disclosures Nikolaos Bonaros reports a relationship with Edwards Lifesciences, Medtronic, Corcym, and Abbott that includes: funding grants, speaking and lecture fees, and travel reimbursement. Jorg Kempfert reports a relationship with Edwards Lifesciences, Medtronic, Artivion, and Abbott that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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