Comparison of quality of life in patients with mitral valve replacement and mitral valve repair in Imam Ali Hospital during 2014 to 2020: a cross-sectional study.

OBJECTIVE: Mitral valve failure is one of the most common valvular heart diseases worldwide. Valve replacement and repair have an impact on the quality of life of patients. Therefore, the present study was conducted to compare the quality of life in patients with mitral valve replacement and those who underwent mitral valve repair. METHODS: In this cross-sectional study, we considered all cardiac patients with ischemic mitral insufficiency who underwent mitral valve repair and patients with a history of valve replacement in Imam Ali Hospital of Kermanshah between 2014 and 2020. Two Minnesota and general quality of life questionnaires along with a checklist for demographic variables were used for data collection. Data analysis was performed using SPSS version 21 software. RESULTS: The mean quality of life score based on the general quality of life scale in the valve repair group was 32.33 (SD = 2.29) and in the valve replacement group 32.89(SD = 2.60), (p = 0.917). Also, mean quality of life, as measured by the Minnesota MLHFQ was 60.89(SD = 17.67) in the valve repair group and 63.42 (SD = 12.13) in the valve replacement group (p = 0.308). The results showed that the average general quality of life was different in study groups regarding education. Tukey's post hoc test showed that the average general quality of life in illiterate people is significantly lower than in people with academic degrees (P-value = 0.001). CONCLUSION: The quality of life of the patients in both the valve repair and replacement groups was at an average level. There was no significant difference between the general quality of life and the Minnesota scales, suggesting that both tools can be effectively used to measure patients' quality of life. The study's findings can be valuable for monitoring patients, screening for conditions, and enhancing communication between doctors and patients.

The influence of calcium-phosphate metabolism abnormalities on the quality of life in patients with hemodynamically significant mitral regurgitation.

BACKGROUND: In recent years, studies have indicated that vitamin D [25(OH)D3] and other calcium-phosphate (Ca-P) metabolism parameters and their disturbances might be potential new factors that may influence health-related quality of life (HRQoL). The aim of our study was to assess the extent of Ca-P metabolism abnormalities in patients with significant mitral regurgitation (MR) and their effect on patients' HRQoL. METHODS: We included 99 patients with significant MR (median age, 75 years [Q1-Q3, 66.0-81.5], 35.4% females). Hemodynamically significant MR was assessed using transthoracic echocardiography (vena contracta > 3 mm, effective orifice area > 0.2 cm2, and MR volume > 30 mL/s). HRQoL was evaluated using a cardiac-specific (MacNew) tool. RESULTS: A significant negative correlation between parathormone (PTH) levels and HRQoL was demonstrated (r = - 0.242, - 0.243, and - 0.255; p = 0.018, 0.018, and 0.013 for Global Scores, and physical and social domains, respectively). Additionally, we confirmed that patients with higher NT-proBNP levels, NYHA heart failure (HF) class, and larger left ventricles had poorer HRQoL. Moreover, patients with poorer HRQoL walked a shorter distance in a 6-min walking test. CONCLUSIONS: To the best of our knowledge, this report is the first to show that Ca-P abnormalities resulted in significantly worse HRQoL, especially in the physical domain, in a population of patients with hemodynamically significant MR.

Cognitive functions and jugular venous reflux in severe mitral regurgitation: A pilot study.

Cardiac diseases with elevated central venous pressure have higher frequency of jugular venous reflux (JVR), which is associated with decreased cerebral blood flow and white matter hyperintensities. Whether patients with severe mitral-regurgitation (SMR) have poorer cognitive functions and whether JVR is involved were determined in this pilot study. Patients with SMR and age/sex-matched controls were prospectively recruited. Neuropsychological tests such as global cognitive (Mini-Mental State Examination, MMSE), verbal memory, executive, and visuospatial domains were performed. Cardiac parameters by cardiac catheterisation and echocardiography, and the frequency of JVR by colour-coded duplex ultrasonography were obtained. Forty patients with SMR and 40 controls (71.1±12.2, 38-89 years; 75% men) were included. Compared with the controls, patients with SMR had lower scores in all neuropsychological tests but only MMSE and visuospatial test scores were statistically significant after adjusting for age, sex, and educational level. We further adjusted for cardiovascular risk factors; the significance remained in the visuospatial test but diminished in MMSE. Multivariate linear regression analyses adjusted for age, sex, and educational level showed that JVR combined with high right-atrial-pressure (RAP > 50th-percentile, 12 mmHg) was significantly associated with poorer performances in both MMSE [right JVR: B coefficient(95% confidence interval,p) = -2.83(-5.46-0.20, 0.036); left JVR: -2.77(-5.52-0.02, 0.048)] and visuospatial test [right JVR: -4.52(-8.89-0.16, 0.043); left JVR: -4.56(-8.81-0.30, 0.037)], with significances that remained after further adjusting for cardiovascular risk factors. Our pilot results suggest that retrogradely-transmitted venous pressure might be involved in the mechanisms mediating the relationship between cardiac diseases and brain functions.

Association of Transcatheter Mitral Valve Repair With Quality of Life Outcomes at 30 Days and 1 Year: Analysis of the Transcatheter Valve Therapy Registry.

Importance: Improvements in symptoms, functional capacity, and quality of life are among the key goals of edge-to-edge transcatheter mitral valve repair (TMVR) for mitral regurgitation. Objective: To examine health status outcomes among patients undergoing TMVR in clinical practice and the factors associated with improvement. Design, Setting, and Participants: This cohort study used the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, which contains data on patients with severe mitral regurgitation treated with TMVR from 2013 through 2017 in 217 US hospitals. Main Outcomes and Measures: Change in disease-specific health status (Kansas City Cardiomyopathy Questionnaire-Overall Summary score [KCCQ-OS]; range 0-100 points, with higher scores indicating better health status) at 30 days and 1 year after TMVR. We also examined factors associated with health status at 30 days after TMVR, by means of multivariable linear regression using a generalized estimating equations approach to account for clustering of patients within sites. Results: The KCCQ data were available in 81.2% at baseline, 69.3% of survivors at 30 days, and 47.4% of survivors at 1 year. Among 4226 patients who underwent TMVR, survived 30 days, and completed the KCCQ at baseline and follow-up, the KCCQ-OS increased from 41.9 before TMVR to 66.7 at 30 days (mean change 24.8 [95% CI, 24.0-25.6] points; P < .001), representing a large clinical improvement. The KCCQ scores remained stable from 30 days to 1 year after TMVR, with no further significant increase or decline. On multivariable analysis, atrial fibrillation (-2.2 [95% CI, -3.7 to -0.6] points; P = .01), permanent pacemaker (-2.1 [95% CI, -3.7 to -0.4] points; P = .01), severe lung disease (-3.9 [95% CI, -6.2 to -1.5] points; P = .001), home oxygen (-2.7 [95% CI, -4.9 to -0.4] points; P = .02), and lower KCCQ scores at baseline (3.9 points for each 10-point increase [95% CI, 3.6-4.2]; P < .001) were independently associated with lower 30-day KCCQ-OS scores. In-hospital renal failure was uncommon but was also associated with significant reductions in 30-day KCCQ-OS scores (-7.3 [95% CI -13.3 to -1.2] points). In estimates calculated with inverse probability weighting, after 1 year after TMVR, 54.2% (95% CI 52.2%-56.1%) of patients were alive and well; 23.0% had died, 21.9% had persistently poor health status (KCCQ-OS <60 points), 5.5% had a health status decline from baseline, and 4.6% had both poor health status and health status decline. Conclusions and Relevance: In a national cohort of US patients undergoing edge-to-edge TMVR in clinical practice, health status was impaired prior to the procedure, improved within 30 days, and remained stable through 1 year among surviving patients with available data. While long-term mortality remains high, most surviving patients demonstrate improvements in symptoms, functional status, and quality of life, with only modest differences by patient-level factors.

Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review.

BACKGROUND: Estimating the quantitative effect of transcatheter mitral valve repair on functional parameters and quality of life is important for individual treatment decision-making. METHODS: We combined data from a prospective monocentric cohort study (N = 215) with data from a systematic literature review (PubMed search term "mitraclip", till 30.04.2016) on patients undergoing MitraClip with at least mortality after discharge reported as an outcome. Effects on functional parameters were reported as range of mean change. RESULTS: 36 observational studies and 1 randomized controlled trial were identified. Due to substantial heterogeneity of effect estimates (I 2-heterogeneity >75%) and inadequate quality of studies with a lack of comparison group in 97.4% and lack of an independent assessment of outcomes in 86.8%, no pooled estimates were calculated. All studies reported improvements of mean New York Heart Association (NYHA) class (0.5-1.9 classes), Short-Form (SF)-12/36 scores (4.4-9.2 for physical component score, 2.6-8.9 for mental component score), 6-min walk distance [(6MWD) 2-336 m] and Minnesota Living with Heart failure questionnaire (MLWHFQ) score (-7 to -18 points), with improvements regarded as clinically relevant in 20 of 29 studies for NYHA class, in all of 7 studies for SF12/36, in 9 of 15 studies for 6MWD and in all of 8 studies for MLWHFQ. CONCLUSION: MitraClip therapy provides improvements in physical capacity, physical and mental functioning and disease-specific quality of life in the majority of patients. However, more comparative and high-quality studies are required for understanding the heterogeneity of results, which is crucial for optimal patient selection.

Mitral Valve Prolapse, Psychoemotional Status, and Quality of Life: Prospective Investigation in the Current Era.

OBJECTIVE: The purpose of this study is to investigate whether mitral valve prolapse is associated with the patient's psychoemotional status and health-related quality of life. METHODS: Mitral valve prolapse and mitral regurgitation were prospectively and comprehensively assessed in 281 patients (age 61 ± 13 years; 63% men); 216 patients with mitral valve prolapse were compared with 65 without mitral valve prolapse (of similar age and sex). Simultaneously, we assessed the patient's psychoemotional status (anxiety, depression, posttraumatic stress symptoms), health-related quality of life, and perceived severity of illness using validated questionnaires. RESULTS: Twenty-nine percent of the patients had either no or mild mitral regurgitation (area of effective regurgitant orifice ≤0.2), and 71% had clinically significant mitral regurgitation (moderate/severe). Stratifying patients into no/mild vs moderate/severe mitral regurgitation revealed no differences in psychoemotional status or mental health-related quality of life between patients with mitral valve prolapse vs those without mitral valve prolapse within each subgroup; no/mild mitral regurgitation and moderate/severe mitral regurgitation (all P ≥ .5). In multivariate analysis, mitral valve prolapse was not independently associated with psychoemotional status or health-related quality of life (all P ≥ .4). In addition, while objective severity of the illness was not related to psychoemotional status or health-related quality of life (all P ≥ .2), the patient's perceived severity of illness predicted in and of itself all psychoemotional (all P < .03) and quality-of-life outcomes (all P < .003). CONCLUSION: Mitral valve prolapse is not a determinant of the patient's psychoemotional status or quality of life. Psychoemotional status and health-related quality of life are determined by the patient's perception of the severity of the mitral valve disease, rather than by the presence of mitral valve prolapse.

Psychoemotional and quality of life response to mitral operations in patients with mitral regurgitation: a prospective study.

BACKGROUND: Severe mitral regurgitation (MR) is associated with frequent alteration of psychoemotional status (PES), with anxiety and stress symptoms related to health-related quality of life (HR-QOL). Yet, it is unknown whether surgical correction of MR leads to improvement or deterioration in PES and HR-QOL. METHODS: We prospectively performed comprehensive MR assessment and administered questionnaires assessing PES and HR-QOL in 131 patients (aged 60 years; 75% men) before and 6 months after operation for organic MR and compared them to 62 patients who did not undergo operation for mitral disease and 36 normal controls of similar age assessed with the same methods. RESULTS: Baseline PES was poorer preoperatively in patients undergoing mitral operation compared with patients who did not undergo mitral operation and normal controls (anxiety and posttraumatic stress [PTS]; both p < 0.01) with poorer physical HR-QOL (p < 0.01). Six months later, all these psychoemotional variables improved (all p ≤ 0.02) in the patients who underwent mitral operation, whereas no change was observed in the other 2 groups (all p > 0.1). Improvement after mitral repair resulted in postoperative normalization of emotional and physical well-being, with similar scores among all groups (all p ≥ 0.4). At 6-month follow-up, no difference in improvement in PES and HR-QOL was noted according to the surgical approach (robotic versus sternotomy, all p ≥ 0.2). CONCLUSIONS: Patients with severe organic MR present with frequent psychoemotional alterations and HR-QOL deterioration, in contrast to patients who do not undergo mitral operation and normal controls. After mitral operation, notable improvement results in normalization of emotional and physical well-being. Quantification of emotional and physical well-being provides important outcome measures in patients with organic MR and uncovers important benefits provided by surgical correction of MR.

Neurocognitive deficit and quality of life after mitral valve repair.

BACKGROUND AND AIM OF THE STUDY: Postoperative cognitive dysfunction (POCD) is a relevant complication after cardiac surgery that affects patient outcome. The study aims was to prospectively evaluate neurocognitive functions, quality of life (QoL) and psychological distress following minimally invasive mitral valve (MV) repair. METHODS: A total of 98 consecutive patients (64 males, 34 females; mean age 53.7 +/- 10.3 years; mean logistic EuroSCORE 3.23 +/- 2.90) who underwent MV repair through a Hearthport Port-Access system was enrolled in the study. Neurocognitive evaluations were performed using the Mini-Mental State Examination, Trail-Making Test (TMT-A and -B) and digit span shortly before surgery, at hospital discharge, and at three months postoperatively. Measures of QoL (Medical Outcomes, Study Short Form, SF-36) and psychological distress (Hospital Anxiety and Depression Scale, HADS) were also undertaken. RESULTS: The large degree of POCD referred to in other studies was not observed; rather, a clear sign of improvement was observed when considering TMT-B (p <0.001) and digit span forward (p < 0.05) tests at the three-month follow up. These results also agreed with the QoL and mood state indices, which showed improvements (p < 0.05) in all SF-36 and HADS scores. No significant relationship was found between neurocognitive impairment and the cross-clamp and cardiopulmonary bypass times. CONCLUSION: The study results highlighted the low risk of neurocognitive deficits after MV repair. A substantial improvement in the patients' neurocognitive assessment and QoL, from the preoperative condition to the three-month follow up after surgery, was observed. However, the small number of patients demonstrating a clear cognitive decline made it difficult to identify causative factors for POCD.

Psycho-emotional manifestations of valvular heart diseases: prospective assessment in mitral regurgitation.

OBJECTIVE: To define the prevalence and consequences of post-traumatic stress disorder (PTSD) as an emotional response to cardiac diseases in patients with mitral regurgitation. METHODS: We prospectively enrolled 186 patients with moderate or severe organic mitral regurgitation, presenting class I (absent) or II (minimal) dyspnea, who were compared with 80 controls of similar age (38 with completely normal cardiac function; 42 with mild mitral-valve prolapse; all with no, or at most mild, mitral regurgitation). Mitral-regurgitation severity and consequences were comprehensively measured, simultaneously with PTSD, anxiety, and depression. RESULTS: PTSD prevalence was higher in mitral-regurgitation patients vs controls (23% vs 9%, P <.01). Although mitral-regurgitation objective severity (regurgitant volume 77.8 ± 28.9 vs 79.0 ± 27.5 mL, P = .8) and objective consequences (left-atrial volume 59.1 ± 20.9 vs 54.02 ± 15.6 mL, P = .1; right-ventricular systolic pressure 34.1 ± 11.4 vs 32.9 ± 7.2 mm Hg, P = .6) were similar with and without PTSD (all P ≥.1), patients with PTSD were more symptomatic (class II 74 vs 38%; fatigue 71% vs 38%, both P <.0001) and had higher anxiety and depressions scores (P <.0001). CONCLUSIONS: PTSD is prevalent in organic moderate or severe mitral-regurgitation patients but is not determined by objective mitral-regurgitation severity or consequences. PTSD is linked to anxiety and depression and to symptoms usually considered cardiac, such as dyspnea. Thus, PTSD and psycho-emotional manifestations, linked to symptoms, represent important responses to chronic-valve disease that may affect clinical outcomes.

Quality of life following percutaneous mitral valve repair with the MitraClip System.

BACKGROUND: Percutaneous valve repair with MitraClip System is an emerging alternative for high surgical risk patients with severe mitral regurgitation (MR). QoL is a critical measure of effectiveness of this procedure. We sought to evaluate quality of life (QoL) and NYHA class following this novel procedure. METHODS: The study included 39 consecutive patients who underwent mitral valve repair with the MitraClip System, both for functional (64%) and degenerative (36%) MR. All patients received the SF-12v2 questionnaire pre-procedure and at 6 months follow-up to assess the physical and mental health. RESULTS: Acute procedural success was obtained in 100%. Three patients experienced minor procedural complications. At follow-up 86% of patients had MR ≤ 1+ and 14% experienced a moderate MR. Mean pre-procedural SF-12v2 scores of our patients showed a severe impairment of perceived QoL, both for physical and mental scores; after six months a striking improvement in physical (PCS 35.44 vs 44.67, p<0.0001) and mental (MCS 38.07 vs 46.94, p<0.0001) aspect of QoL was observed. Furthermore, physical and mental status upgrading was higher in patients with functional MR. NYHA functional class improved in all patients. CONCLUSION: Our results show an early marked improvement in functional status and physical and mental health in patients underwent percutaneous mitral valve repair with the MitraClip System.

Tako-tsubo cardiomyopathy induced by emotional stress leading to severe mitral regurgitation, cardiogenic shock and cardiopulmonary arrest.

Tako-Tsubo cardiomyopathy (TTC) which is usually precipitated by profound emotional and physical stress has been widely reported in the past. In this case we report a young female patient who developed sudden dyspnea and palpitation after an profound stress (fierce argument).The patient had characteristic feature of progressive pulmonary edema. Her symptom worsened gradually leading to cardiopulmonary arrest in a few hours from the onset. After resuscitation an immediately performed echocardiography showed a severe mitral regurgitation due to rupture of antromedial papillary muscle. Left ventricular function showed akinetic mid-to-distal portion of the left ventricular chamber and hyperkinetic in basal segment. Inotrop infusion and aortic balloon pump placement was done because of unstable homodynamics. Semi-elective surgical valve replacement was performed. One year after the acute event the patient remained asymptomatic. Clinicians should recognize that Tako-Tsubo cardiomyopathy is one etiology of acute pulmonary edema with normal coronary artery finding.

Case study in heart-brain interplay: a 53-year-old woman recovering from mitral valve repair.

This article presents the case of a 53-year-old female attorney who underwent successful mitral valve repair for mitral valve prolapse. The patient's postoperative course was marked by refractory pain, fatigue, shortness of breath, refusal to ambulate, frequent episodes of tearfulness, and a postsurgical decline in ejection fraction through postoperative week 4. Her slow recovery prompted a psychiatric consult, during which she reported panic and a fear of "losing it." After respective presentations of the case from the cardiology and psychiatry perspectives, the article concludes with a moderated discussion of the case to explore insights it provides into heart-brain interactions.

Quality of life after mitral valve surgery: differences between reconstruction and replacement.

BACKGROUND AND AIMS OF THE STUDY: Quality of life (QoL) is of increasing interest in major surgical procedures. Mitral valve reconstruction (MRr) is assumed to be better tolerated than mitral valve replacement (MVR). The study aim was to assess mid-term QoL in patients undergoing isolated mitral valve surgery. METHODS: QoL was monitored in 115 consecutive patients who had isolated mitral valve surgery (62 with MVR, 53 with MRr). Mid-term survival was assessed after a mean of 37 +/- 18 months using the SF-36 health survey questionnaire. RESULTS: Patients undergoing MVR were younger (61.9 +/- 12.7 versus 64.9 +/- 12.5 years; p <0.01) and had significantly more frequently a history of left heart failure (43.5% versus 13.2%; p <0.01) than patients with MRr. No significant difference was found between the two groups when considering preoperative NYHA functional class and left ventricular function. In-hospital mortality was significant higher in MVR than in MRr patients (6.4% versus 0%; p <0.01). QoL was significantly impaired in patients with MVR in physical function (PF), role function (RF) and general health (GH) compared with patients undergoing MRr. Nevertheless, only slight impairments in two of eight aspects in MVR, and in one of eight aspects in MRr, were found compared with an age- and sex-matched standard population. Mid-term survival was similar in both groups. CONCLUSION: Outcome after MVR was excellent, though these patients had a more advanced stage of the disease preoperatively than MRr patients. Mid-term outcome and QoL was, however, similar in the two groups.

Endoscopic mitral valve repair: feasible, reproducible, and durable.

OBJECTIVE: We sought to document the feasibility, safety, and effectiveness of performing mitral valve repair using a totally endoscopic approach. METHODS: Between February 1997 and October 1, 2001, 187 patients underwent totally endoscopic mitral valve repair at our institution. The mean age was 60.7 +/- 13.1 years, and 62% were male. Median preoperative functional class and degree of mitral regurgitation were II and 4, respectively. Data collection included an institutional protocol assessing procedure-related pain, cosmesis, and functional recovery. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19 +/- 15.2 months and was 100% complete. RESULTS: Associated atrial procedures were performed in 9.1% (n = 17) of the patients. Two patients required intraoperative conversion to sternotomy. Thoracoscopic re-evaluation for suspected bleeding (n = 19) was part of our aggressive postoperative management. One patient required sternotomy for control of bleeding. Hospital mortality included 1 (0.5%) patient and was not technology related. There were 1 early and 6 late reoperations, 4 of which were due to endocarditis. No risk factors for repair failure could be detected. Freedom from mitral valve reoperation at 4 years was 93.3% +/- 2.6%. The median degree of mitral regurgitation at follow-up was 0. Ninety-three percent of the patients were highly satisfied with either no or mild postoperative pain, and 98.4% believed they had an aesthetically pleasing scar. CONCLUSIONS: Totally endoscopic mitral valve repair can be done safely with excellent results and a high degree of patient satisfaction. It is now our exclusive approach for isolated atrioventricular valve disease.