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New Advances in Mitral Valve Diseases Management

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (1 May 2023) | Viewed by 10054

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Special Issue Editors

Dr. Cristina Barbero

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Guest Editor

Department of Cardiovascular and Thoracic Surgery, University of Turin, Città della Salute e della Scienza, San Giovanni Battista Hospital “Molinette,” Turin, Italy
Interests: mitral valve surgery; minimally invasive surgery; heart transplant

Dr. Andrea Costamagna

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Guest Editor

Division of Anaesthesia and Critical Care Medicine, Department of Surgical Sciences, University of Turin, Torino, Italy
Interests: point-of-care ultrasound; lung transplantation; ECLS; organ donation; MCS devices

Dr. Fabrizio D’Ascenzo

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Division of Cardiology, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
Interests: heart failure; cardiovascular medicine; echocardiography; myocardial infarction; atrial fibrillation; cardiac function

Special Issue Information

Dear Colleagues,

Mitral valve disease, the focus of this Special Issue, is one of the most common valve disorders and carries a significant burden in terms of mortality and morbidity.

The increasing incidence of this disease in the general population, as result of global aging, and the recent advances in research and technologies have provided deeper insights into mechanisms and factors that significantly play a role in the prognosis of these patients, such as the precise disease mechanisms, the early diagnosis with several imaging modalities, the risk stratification, the optimal timing for intervention, and the type of procedure to offer.

Surgery is definitely the gold standard for the treatment of significant mitral valve disease. In recent years, minimally invasive techniques have shown exciting early and long-term outcomes, and new micro-invasive procedures, such as percutaneous mitral valve repair or replacement, are rising. Furthermore, the roles of the cardiac anesthesiologist/intensivist and of the cardiologist in the peri-operative management of this challenging patient cohort are evolving and are becoming crucial elements in obtaining optimal results.

This Special Issue will thus focus on innovative and out-of-the-box research on mitral valve disease management as well as ground-breaking points of view regarding topics that are yet to be consolidated.

Thus, we are pleased to invite colleagues to submit their original research and communications, as well as systematic reviews and meta-analyses, on the topics listed below. Case series and case reports will only be considered if of impressive and peculiar interest.

New elements and tools in diagnosis of mitral valve diseases;
Prognostic scores and biomarkers;
Preoperative optimization (analgesia, medications, multiorgan function, blood management, functional status, nutrition);
Minimally invasive mitral valve surgery;
Trans-catheter mitral valve repair/replacement;
ERACS and anesthetic choices;
Rehabilitation.

Dr. Cristina Barbero
Dr. Andrea Costamagna
Dr. Fabrizio D’Ascenzo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

mitral valve
perioperative care
ERACS
prognostic scores
blood management
biomarkers
point of care
minimally invasive surgery
micro-invasive surgery

Published Papers (7 papers)

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Research

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13 pages, 506 KiB

Open AccessArticle

Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience

by Laura Giroletti, Valentina Brembilla, Ascanio Graniero, Giovanni Albano, Nicola Villari, Claudio Roscitano, Matteo Parrinello, Valentina Grazioli, Ettore Lanzarone and Alfonso Agnino

Medicina 2023, 59(9), 1568; https://doi.org/10.3390/medicina59091568 - 29 Aug 2023

Cited by 2 | Viewed by 952

Abstract

Background and objective Renewed interest in robot-assisted cardiac procedures has been demonstrated by several studies. However, concerns have been raised about the need for a long and complex learning curve. In addition, the COVID-19 pandemic in 2020 might have affected the learning curve of these procedures. In this study, we investigated the impact of COVID-19 on the learning curve of robotic-assisted mitral valve surgery (RAMVS). The aim was to understand whether or not the benefits of RAMVS are compromised by its learning curve. Materials and Methods Between May 2019 and March 2023, 149 patients underwent RAMVS using the Da Vinci^® X Surgical System at the Humanitas Gavazzeni Hospital, Bergamo, Italy. The selection of patients enrolled in the study was not influenced by case complexity. Regression models were used to formalize the learning curves, where preoperative data along with date of surgery and presence of COVID-19 were treated as the input covariates, while intraoperative and postoperative data were analyzed as output variables. Results The age of patients was 59.1 ± 13.3 years, and 70.5% were male. In total, 38.2% of the patients were operated on during the COVID-19 pandemic. The statistical analysis showed the positive impact of the learning curve on the trend of postoperative parameters, progressively reducing times and other key indicators. Focusing on the COVID-19 pandemic, statistical analysis did not recognize an impact on postoperative outcomes, although it became clear that variables not directly related to the intervention, especially ICU hours, were strongly influenced by hospital logistics during COVID-19. Conclusions Understanding the learning curve of robotic surgical procedures is essential to ensure their effectiveness and benefits. The learning curve involves not only surgeons but also other health care providers, and establishing a stable team in the early stage, as in our case, is important to shorten the duration. In fact, an exogenous factor such as the COVID-19 pandemic did not affect the robotic program despite the fact that the pandemic occurred early in the program. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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11 pages, 1068 KiB

Open AccessArticle

Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis

by Cristina Barbero, Marco Pocar, Dario Brenna, Barbara Parrella, Sara Baldarelli, Valentina Aloi, Andrea Costamagna, Anna Chiara Trompeo, Alessandro Vairo, Gianluca Alunni, Stefano Salizzoni and Mauro Rinaldi

Medicina 2023, 59(8), 1435; https://doi.org/10.3390/medicina59081435 - 8 Aug 2023

Viewed by 1363

Abstract

Background. Minimally invasive surgery via right mini-thoracotomy has become the standard of care for the treatment of mitral valve disease worldwide, particularly at high-volume centers. In recent years, the spectrum of indications has progressively shifted and extended to fragile and higher-risk patients, also addressing more complex mitral valve disease and ultimately including patients with native or prosthetic infective endocarditis. The rationale for the adoption of the minimally invasive approach is to minimize surgical trauma, promote an earlier postoperative recovery, and reduce the incidence of surgical wound infection and other nosocomial infections. The aim of this retrospective observational study is to evaluate the effectiveness and the early and late outcome in patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Methods. Prospectively collected data regarding minimally invasive surgery in patients with mitral valve infective endocarditis were entered into a dedicated database for the period between January 2007 and December 2022 and retrospectively analyzed. All comers during the study period underwent a preoperative evaluation based on their clinical history and anatomy for the allocation to the most appropriate surgical strategy. The selection of the mini-thoracotomy approach was primarily driven by a thorough transthoracic and especially transesophageal echocardiographic evaluation, coupled with total body and vascular imaging. Results. During the study period, 92 patients underwent right mini-thoracotomy to treat native (80/92, 87%) or prosthetic (12/92, 13%) mitral valve endocarditis at our institution, representing 5% of the patients undergoing minimally invasive mitral surgery. Twenty-six (28%) patients had undergone previous cardiac operations, whereas 18 (20%) presented preoperatively with complications related to endocarditis, most commonly systemic embolization. Sixty-nine and twenty-three patients, respectively, underwent early surgery (75%) or were operated on after the completion of the targeted antibiotic treatment (25%). A conservative procedure was feasible in 16/80 (20%) patients with native valve endocarditis. Conversion to standard sternotomy was necessary in a single case (1.1%). No cases of intraoperative iatrogenic aortic dissection were reported. Four patients died perioperatively, accounting for a thirty-day mortality of 4.4%. The causes of death were refractory heart or multiorgan failure and/or septic shock. A new onset stroke was observed postoperatively in one case (1.1%). Overall actuarial survival rate at 1 and 5 years after operation was 90.8% and 80.4%, whereas freedom from mitral valve reoperation at 1 and 5 years was 96.3% and 93.2%, respectively. Conclusions. This present study shows good early and long-term results in higher-risk patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Total body, vascular, and echocardiographic screening represent the key points to select the optimal approach and allow for the extension of indications for minimally invasive surgery to sicker patients, including active endocarditis and sepsis. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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10 pages, 868 KiB

Open AccessArticle

Virtually Wall-Less versus Standard Thin-Wall Venous Cannula in the Minimally Invasive Mitral Valve Surgery: Single-Center Experience

by Fabrizio Ceresa, Liborio Francesco Mammana, Aurora Leonardi, Augusto Palermo and Francesco Patanè

Medicina 2023, 59(7), 1221; https://doi.org/10.3390/medicina59071221 - 29 Jun 2023

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Abstract

Background and Objectives: Minimally invasive cardiac surgery (MICS) has been developing since 1996. Peripheral cannulation is required to perform MICS, and good venous drainage and a bloodless field are crucial for the success of this procedure. We assessed the benefits of using a virtually wall-less cannula in comparison with the standard thin-wall cannula in clinical practice. Materials and Methods: Between January 2021 and December 2022, we evaluated 65 elective patients, who underwent isolated minimally invasive mitral valve surgery. Both the virtually wall-less and the thin-wall cannulas were placed through a surgical cut-down. Patients’ characteristics at baseline were similar in the two groups, except for the body surface area (BSA), which was greater in the virtually wall-less group compared to the thin-wall one. In the standard group, the size of the cannula was chosen depending on the patient’s BSA, and the choice of the Smartcannula was based on their height. Results: There were no significant differences between the two groups in terms of negative pressure applied, target flow achieved, hemolysis, the need for blood transfusion, and the post-operative increases in liver and renal enzymes. However, in all the patients, the estimated target flow was achieved, thereby showing the better hemodynamic performance of the virtually wall-less cannula, since, in this group, the patients’ BSA was significantly greater compared to the thin-wall group. Ultimately, the mean cross-clamp time, as an indirect index of the effectiveness of the venous drainage, is shorter in the virtually wall-less group compared with the thin-wall group. Conclusions: The virtually wall-less cannula should be preferred in minimally invasive mitral valve surgery due to its superior performance in terms of venous drainage compared with the standard thin-wall cannula. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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12 pages, 1098 KiB

Open AccessArticle

Predictors of Outcome in Patients with Pulmonary Hypertension Undergoing Mitral and Tricuspid Valve Surgery

by Ee Phui Kew, Vincenzo Caruso, Julia Grapsa, Paolo Bosco and Gianluca Lucchese

Medicina 2023, 59(6), 1103; https://doi.org/10.3390/medicina59061103 - 7 Jun 2023

Cited by 1 | Viewed by 1346

Abstract

Background and Objectives: Pulmonary hypertension (PH) secondary to left-sided valvular heart disease is associated with poor cardiac surgical outcome compared with patients without PH. Our objective was to investigate the prognostic factors of surgical outcome in patients with PH undergoing mitral valve (MV) and tricuspid valve (TV) surgery, in order to risk stratify their management. Materials and Methods: This is a retrospective observational study on patients with PH who underwent MV and TV surgery from 2011 to 2019. The primary outcome was all-cause mortality. The secondary outcomes were post-op respiratory and renal complications, length of intensive care unit stay and length of hospital stay. Results: Seventy-six patients were included in this study. The all-cause mortality was 13% (n = 10), with mean survival of 92.6 months. Among the patients, 9.2% (n = 7) had post-op renal failure requiring renal replacement therapy and 6.6% (n = 5) had post-op respiratory failure requiring intubation. Univariate analysis demonstrated that pre-operative left ventricular ejection fraction (LVEF), peak systolic tissue velocity at the tricuspid annulus (S’) and etiology of MV disease were associated with respiratory and renal failure. Tricuspid annular plane systolic excursion (TAPSE) was associated with respiratory failure only. S’, type of operation, LVEF, urgency of surgery, and etiology of MV disease were found to be predictive of mortality. After excluding redo mitral surgery, all statistically significant findings remain unchanged, with the addition of right ventricular (RV) size being associated with respiratory failure. In the subgroup analysis of routine cases (n = 56), patients with primary mitral regurgitation who underwent mitral valve repair had better survival outcome. Conclusions: Urgency of surgery, etiology of MV disease, type of operation (replacement or repair), S’ and pre-op LVEF are prognostic indicators in this small cohort of patients with PH undergoing MV and TV surgery. A larger prospective study is warranted to validate our findings. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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12 pages, 1715 KiB

Open AccessArticle

Twenty-Year Experience with Surgery for Native and Prosthetic Mitral Valve Endocarditis

by Antonella Galeone, Jacopo Gardellini, Venanzio Di Nicola, Fabiola Perrone, Vincenzo Boschetti, Renato Di Gaetano, Francesco Onorati and Giovanni Battista Luciani

Medicina 2023, 59(6), 1060; https://doi.org/10.3390/medicina59061060 - 31 May 2023

Viewed by 1103

Abstract

Background and Objectives: To evaluate the early and long-term results of surgical treatment of isolated mitral native and prosthetic valve infective endocarditis. Materials and Methods: All patients undergoing mitral valve repair or replacement for infective endocarditis at our institution between January 2001 and December 2021 were included in the study. The preoperative and postoperative characteristics and mortality of patients were retrospectively reviewed. Results: A total of 130 patients, 85 males and 45 females, with a median age of 61 ± 14 years, underwent surgery for isolated mitral valve endocarditis during the study period. There were 111 (85%) native and 19 (15%) prosthetic valve endocarditis cases. Fifty-one (39%) patients died during the follow-up, and the overall mean patient survival time was 11.8 ± 0.9 years. The mean survival time was better in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (12.3 ± 0.9 years vs. 8 ± 1.4 years; p = 0.1), but the difference was not statistically significant. Patients who underwent mitral valve repair had a better survival rate compared to patients who had mitral valve replacement (14.8 ± 1.6 vs. 11.3 ± 1 years; p = 0.06); however, the difference was not statistically significant. Patients who underwent mitral valve replacement with a mechanical prosthesis had a significantly better survival rate compared to patients who received a biological prosthesis (15.6 ± 1.6 vs. 8.2 ± 0.8 years; p < 0.001). Patients aged ≤60 years had significantly better survival compared to patients aged >60 years (17.1 ± 1.1 vs. 8.2 ± 0.9; p < 0.001). Multivariate analysis showed that the patient’s age >60 years at the time of surgery was an independent risk factor for mortality, while mitral valve repair was a protective factor. Eight (7%) patients required reintervention. Freedom from reintervention was significantly higher in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (19.3 ± 0.5 vs. 11.5 ± 1.7 years; p = 0.04). Conclusions: Surgery for mitral valve endocarditis is associated with considerable morbidity and mortality. The patient’s age at the time of surgery represents an independent risk factor for mortality. Mitral valve repair should be the preferred choice whenever possible in suitable patients affected by infective endocarditis. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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Review

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16 pages, 3029 KiB

Open AccessReview

Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery—A Review of Current Concepts and Perspectives

by Johan van der Merwe and Filip Casselman

Medicina 2023, 59(8), 1470; https://doi.org/10.3390/medicina59081470 - 16 Aug 2023

Cited by 2 | Viewed by 1199

Abstract

The devastating impact of a circumflex coronary artery (CX) injury during mitral valve (MV) surgery is well reported. Despite significant improvements in preoperative risk assessment, intraoperative diagnosis and perioperative treatment strategies of CX injury during MV surgery, recent reports re-emphasize the variability in presentation, the unpredictable mechanisms of injury and the conflicting evidence regarding perioperative management. The progressive transition from conventional sternotomy access to minimally invasive surgical and transcatheter (TC) interventions for MV disease are associated with significant learning curves and require additional single-shaft and robotic console suture manipulation skills with special attentiveness to the potential risk of CX injury. The introduction of hybrid theatres that facilitate single stage surgical and TC interventions also provides new intraoperative diagnostic and therapeutic options without transporting unstable patients for percutaneous coronary intervention (PCI) assessment. By utilizing a MeSH terms-based PubMed search, a total of 89 patients with CX injury that occurred during MV surgery was identified from 49 reports between 1967 and 2022. MV surgery was performed by conventional sternotomy (n = 76, 85.4%), endoscopic (n = 12, 13.4%) and robotic access (n = 1, 1.1%), with 35 injuries (39.3%) resulting in total CX occlusion. Rescue PCI was utilized in 40 patients (44.9%). This manuscript provides a systematic overview of all available historic and contemporary reports on CX injury during MV surgery, outlines recent refinements in CX injury mechanisms, describes current MV surgery associated CX injury prevention and diagnosis and treatment strategies and highlights important MV procedural aspects that may minimize the risk and consequences of CX injury. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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11 pages, 2681 KiB

Open AccessReview

Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation

by Gregorio Tersalvi, Lorenzo Gaiero, Michele Capriolo, Yvonne Cristoforetti, Stefano Salizzoni, Gaetano Senatore, Giovanni Pedrazzini and Luigi Biasco

Medicina 2023, 59(6), 1017; https://doi.org/10.3390/medicina59061017 - 24 May 2023

Cited by 6 | Viewed by 2048

Abstract

Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US guidelines have identified common diagnostic and therapeutic pathways that do not consider patient sex in decision-making. The aim of this review is to summarize the current evidence on sex-related differences in non-rheumatic mitral regurgitation, particularly regarding incidence, imaging modalities, surgical-derived evidence, and outcomes of transcatheter edge-to-edge repair, with the goal of informing clinicians about sex-specific challenges to consider when making treatment decisions for patients with mitral regurgitation. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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