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1.
Asian Cardiovasc Thorac Ann ; 30(1): 74-83, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34757854

ABSTRACT

BACKGROUND: We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy. METHODS: We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution. RESULTS: The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02-11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent. CONCLUSIONS: The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.


Subject(s)
Cardiomyopathy, Hypertrophic , Heart Septum , Adult , Aged , Cardiac Pacing, Artificial , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/standards , Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/mortality , Cardiomyopathy, Hypertrophic/surgery , Clinical Competence , Heart Block/therapy , Heart Septum/diagnostic imaging , Heart Septum/surgery , Humans , Middle Aged , Mitral Valve Insufficiency/surgery , Retrospective Studies , Treatment Outcome
2.
J Cardiothorac Surg ; 12(1): 113, 2017 Dec 13.
Article in English | MEDLINE | ID: mdl-29237465

ABSTRACT

BACKGROUND: We aimed to compare the outcomes of mitral valve repair with flexible band (FB) versus complete semirigid ring (SR) in degenerative mitral valve disease patients. METHODS: From September 2011 to 2014, 171 patients were randomized and underwent successful mitral valve repair using a SR (n = 85) or FB (n = 86). There were no significant between-group differences at baseline. RESULTS: There were no early mortalities. The mean follow up was 24.7 months. The 2-year survival was 96.0 ± 2.3% (95% confidence interval [CI], 88.6-98.7%) and 94.3 ± 2.8% (95% CI, 85.5-97.9%) in the SR and FB groups, respectively (p = 0.899). The left ventricle remodeling was similar between the groups. Higher transmitral peak (8.5 [3.9-17] vs. 6 [2.1-18] mmHg, p < 0.001), mean pressure gradients (3.7 [1.3-8] vs. 2.8 [0.6-6.8] mmHg, p = 0.001), and systolic pulmonary artery pressure (34.5 [20-68] vs. 29.5 [8-48] mmHg, p < 0.001) was observed in the SR group. The 2-year freedom from recurrence of significant mitral regurgitation was significantly higher in the FB group than the SR group (p = 0.002). Residual mitral regurgitation was an independent prognostic factor of recurrence of mitral regurgitation. The 3-year freedom from reoperation was significantly higher in the FB group than the SR group (p = 0.044). CONCLUSION: Patients with degenerative mitral valve disease may benefit from valve repair with FBs. Residual mitral regurgitation before discharge is an independent risk factor of late insufficiency recurrence. TRIAL REGISTRATION: ClinicalTrials.gov NCT03278574 , retrospectively registered on 06.09.2017.


Subject(s)
Balloon Valvuloplasty/instrumentation , Heart Valve Diseases/surgery , Mitral Valve/surgery , Adult , Aged , Chronic Disease , Equipment Design , Female , Heart Valve Diseases/diagnosis , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Prospective Studies , Severity of Illness Index , Treatment Outcome , Young Adult
3.
Asian Cardiovasc Thorac Ann ; 22(1): 9-17, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24585637

ABSTRACT

BACKGROUND: Prosthesis choice is a major concern in valvular surgery. METHODS: A multicenter clinical trial was performed to assess the efficacy and safety of the CardiaMed prosthetic heart valve. The study enrolled 420 patients who underwent mitral (209) or aortic (211) valve replacement from 2003 to 2004 at 7 institutions in Russia, and who were followed up from 2006 to 2011. The mean age was 52.2 ± 10.2 years (range, 12-78 years), 47.4% were female, and 99.05% completed the study. RESULTS: The maximum observation term was 7.5 years (2188.5 patient-years); 1081.6 patient-years for aortic and 1106.9 patient-years for mitral valve replacement. The overall 7-year survival rate was 85.1% ± 3.7%; 86.1% ± 4.8% and 84.4% ± 5.4% for aortic and mitral valve replacement, respectively. The 7-year freedom from valve-related death was 93.9% ± 3.7% and 94.5% ± 3.2% for aortic and mitral valve replacement, respectively. When early mortality (<30 days) was excluded, these rates were 94.8% ± 3.1% and 93.8% ± 3.82%, respectively. Linearized valve-dependent complication rates were determined for structural valve failure (0%/patient-year overall), thrombosis (0.63%/patient-year, all for mitral valve replacement), thromboembolic complications including transient neurologic deficits (0.13%/patient-year overall, 0.5%/patient-year for aortic valve replacement, 0.8%/patient-year for mitral valve replacement), hemorrhagic bleeding (0.64%/patient-year overall, 0.55%/patient-year for aortic valve replacement, 0.09%/patient-year for mitral valve replacement), prosthetic endocarditis (0.28%/patient-year overall, 0.28%/patient-year for aortic valve replacement, 0%/patient-year for mitral valve replacement), and hemolysis (0%/patient-year overall). CONCLUSION: The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.


Subject(s)
Aortic Valve/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Mitral Valve/surgery , Adolescent , Adult , Aged , Aortic Valve/physiopathology , Child , Disease-Free Survival , Female , Heart Valve Diseases/diagnosis , Heart Valve Diseases/mortality , Heart Valve Diseases/physiopathology , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/mortality , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Mitral Valve/physiopathology , Postoperative Complications/etiology , Prosthesis Design , Risk Factors , Russia , Time Factors , Treatment Outcome , Young Adult
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