Failed MitraClip therapy: surgical revision in high-risk patients

Background: MitraClip implantation is a valid interventional option that offers acceptable short-term results. Surgery after failed MitraClip procedures remains challenging in high-risk patients. The data on these cases are limited by the small sample numbers. Aim: The aim of our study is to show, that mitral valve surgery could be possible and more advantageous, even in high-risk patients. Methods: Between 2010 and 2016, nine patients underwent mitral valve surgery after failed MitraClip therapy at our institution. Results: The patients’ ages ranged from 19 to 75 years (mean: 61.2 ± 19.6 years). The median interval between the MitraClip intervention and surgical revision was 45 days (range: 0 to 1087 days). In eight of nine patients, the MitraClip intervention was initially successful and the mitral regurgitation was reduced. Only one patient had undergone cardiac surgery previously. Intra-operatively, leaflet perforation or rupture, MitraClip detachment, and chordal or papillary muscle rupture were potentially the causes of recurrent mitral regurgitation. There were three early deaths. One year after surgery, the six remaining patients were alive. Conclusions: Mitral valve surgery can be successfully performed after failed MitraClip therapy in high-risk patients. The initial indication for MitraClip therapy should be considered carefully for possible surgical repair

Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach: a retrospective propensity-score matched analysis

Background Minimally invasive mitral valve surgery (MVS) via right mini-thoracotomy has recently attracted a lot of attention. Minimally invasive MVS shows postoperative results that are comparable to those of conventional MVS through the median sternotomy as per various earlier studies. Methods Between 2000 and 2016, a total of 669 isolated mitral valve procedures for isolated mitral valve regurgitation were performed. A propensity score-matched analysis was generated for the elimination of the differences in relevant preoperative risk factors between the cohorts and included 227 patient pairs. Only degenerative mitral valve regurgitation was included. The aim of our study was to examine if the minimally MVS is superior to the conventional approach through sternotomy based on a retrospective propensity-matched analysis. The primary endpoints were early mortality and long-term survival. The secondary endpoints included postoperative complications. Results The in-hospital mortality rate was significantly higher within the conventional sternotomy cohort (3.1%, n = 7 vs 0.4%, n = 1 for the minimally invasive cohort; p = 0.032). The incidence of stroke and exploration for bleeding was comparable. In contrast, the necessity for dialysis was significantly lower in the minimally invasive cohort (p = 0.044). Postoperative pain was not significantly lower in the minimally invasive MVS cohort (p = 0.862). While patients who underwent minimally invasive MVS experienced longer bypass and cross-clamp times, their lengths of stay in the intensive care unit and in the hospital, did not differ from the conventionally operated collective (p = 0.779 and p = 0.516), respectively. The mitral valve repair rate of 81.1% in the minimally invasive cohort was significantly superior to that of the conventional approach, which was 46.3% (p < 0.0001). The one-, five-, and 10-year survival rates were significantly higher in the minimally invasive cohort compared to the conventional approach (96%, 90%, and 84% vs. 89%, 85%, and 70%; log rank p = 0.004). Conclusion Despite prolonged cardiopulmonary bypass and cross-clamping times, the minimally invasive MVS may be considered a safe approach that is equivalent to standard median sternotomy with lower early mortality and superior long-term survival

Surgical Treatment of Cardiac Metastases: Analysis of a 13-Year Single-Center Experience

Background Cardiac metastases are more common than primary malignant tumors of the heart and are usually treated surgically as a palliative approach. In this study, we reviewed our experience with the surgical treatment of patients with cardiac metastases of various types of malignant tumors. Methods Between 2003 and 2016, 10 patients underwent surgery for cardiac metastases at our institution. Results The mean age was 53.5 +/- 19 years. Female patients made up 60% ( n = 6) of the collective. The cohort included cardiac metastases of diverse origins (peripheral sarcomas, melanoma, rectal carcinoma, and hepatocellular carcinoma). The left side of the heart was more frequently affected ( n = 7). In only six patients, the primary malignancy was known at the time of cardiac surgery. The interval between the first diagnosis of the primary tumor and cardiac metastases ranged from simultaneous diagnosis to up to 19 years. At the time of the diagnosis of the cardiac metastases, seven patients already had multiple metastases: all seven patients had pulmonary metastases, and three of them additionally had hepatic, cerebral, or osseous metastases. Only four patients were symptomatic (atrial fibrillation, pericardial effusion, tachycardia with chest pain, dyspnea). There was no in-hospital death. The postoperative course was uneventful overall. The one- and two-year survival rates were similar, that is, 76%. The median follow-up time was 5.4 years. Conclusions Surgical intervention for treating cardiac metastases is associated with uneventful clinical outcome and acceptable survival in this critically ill population. Control of the primary malignancy, and maybe other metastases, determines the survival

Chirurgia zastawki płucnej i drogi odpływu z prawej komory u dorosłych: 23-letnie doświadczenie

  Background: Surgery of the pulmonary valve, right ventricular outflow tract, and pulmonary artery falls under the domain of paediatric cardiac surgery. However, 97 adult patients underwent such operations in our institution from 1993 to 2016. Aim: This study aims to analyse preoperative risk factors, intraoperative data, postoperative outcomes, and long-term survival to identify the potential predictors of mortality and high-risk patients. Methods: We divided our patient cohort into three groups in accordance with surgical indications: 17 patients with pulmonary valve endocarditis (group A), 70 patients with congenital defects involving the pulmonary valve (group B), and 10 patients who underwent pulmonary valve surgery for other indications, such as tumour or other acquired valvular disease (group C). Results: Gender distribution was comparable in all the three groups, with about 40% of the total number of patients being female. The mean age was 35.9 ± 15.7 years. Sixty (61.9%) patients had a history of cardiac surgery. Various concomitant cardiac surgical procedures were necessary in 49 (50.5%) cases. There were two (11.8%) in-hospital deaths in group A, two (2.9%) in group B, and none in group C. Within the mean follow-up time of 6.6 ±7.2 years, three (17.7%) patients in group A, two (2.9%) in group B, and four (40%) in group C died. Conclusions: Adult patients with pulmonary valve disease are often previously heart-operated and often need concomitant procedures. The operative risk in patients with pulmonary valve endocarditis is high. Surgery of congenital defects of the pulmonary valve is safe and can be performed with excellent outcomes.Wstęp: Operacyjne leczenie chorób zastawki płucnej, drogi odpływu z prawej komory oraz tętnicy płucnej jest domeną kardiochirurgii dziecięcej. W latach od 1993 do 2016 zostało w naszej klinice przeprowadzonych 97 takich zabiegów u dorosłych pacjentów. Cel: Celem pracy była analiza czynników ryzyka, danych chirurgicznych oraz krótko- i długoterminowych wyników leczenia, dzięki czemu możliwa była identyfikacja potencjalnych czynników prognostycznych oraz pacjentów obarczonych wysokim ryzykiem. Metody: Podzieliliśmy badaną kohortę na trzy grupy, według wskazań do operacji: 17 pacjentów z infekcyjnym zapaleniem wsierdzia (grupa A), 70 chorych z wrodzonymi wadami serca obejmującymi zastawkę płucną, drogę odpływu z prawej komory lub tętnicę płucną (grupa B), oraz 10 pacjentów, u których operacja w zakresie wyżej wymienionych struktur została wykonana z innych wskazań, takich jak guzy lub inne nabyte schorzenia (grupa C). Wyniki: We wszystkich trzech grupach około 40% pacjentów stanowiły kobiety. Średni wiek wynosił 35.9 ±15.7 lat. Sześćdziesięciu (61.9%) pacjentów było już wcześniej operowanych kardiochirurgicznie. W 49 (50.5%) przypadkach oprócz zabiegu na omawianych strukturach, konieczne były różne dodatkowe procedury w ramach tej samej operacji. Zaobserwowaliśmy dwa (11.8%) zgony w przebiegu pooperacyjnym w grupie A, dwa (2.9%) w grupie B i żadnego w grupie C. Podczas obserwacji trwającej średnio 6.6 ±7.2 lat, zmarło trzech (17.7%) pacjentów z grupy A, dwóch (2.9%) z grupy B oraz czterech (40%) z grupy C. Wnioski: Dorośli pacjenci operowani z powodu patologii zastawki płucnej często byli już leczeni kardiochirurgicznie i często wymagają dodatkowych procedur. Ryzyko operacyjne u chorych z infekcyjnym zapaleniem wsierdzia jest wysokie. Operacje wad wrodzonych drogi odpływu z prawej komory i zastawki płucnej są obarczone niskim ryzykiem a wyniki takiego leczenia są bardzo dobre

Surgical Treatment of Cardiac Tumors: Insights from an 18-Year Single-Center Analysis

Background: The aim of this study was to investigate the clinical presentation, operative data, and early and late outcomes of a large patient cohort undergoing surgical treatment for cardiac tumors in our institution. Material/Methods: A total of 181 patients underwent surgery because of suspected cardiac tumor in our institution between 1998 and 2016. In 162 cases, the diagnosis was confirmed postoperatively and these patients were included in this study. Preoperative baseline characteristics, operative data, and postoperative early and long-term outcomes were analyzed. Results: Mean age at presentation was 56.6 +/- 17.6 years, and 95 (58.6%) patients were female. There were 126 (77.8%) patients with benign cardiac tumors, while the remaining patients had malignant tumors (primary and metastasized). The mean follow-up time was 5.2 +/- 4.7 years. The most frequent histologically verified tumor type was myxoma (63%, n=102). In terms of malignant tumors, various types of sarcomas presented most primary malignant cardiac tumors (7.4%, n=12). The mean ICU length of stay was 1.7 +/- 2.2 days and overall in-hospital mortality was 3.1% (n=5). Frequent postoperative complications included mediastinal bleeding (5.8%, n=9), wound infection (1.3%, n=2), acute renal failure (5.6%, n=9), and major cerebrovascular events (n=7, 4.6%). The overall cumulative survival after cardiac tumor resection was 94% at 30 days, 85% at 1 year, 72% at 5 years, and 59% at 15 years. Conclusions: Surgical treatment of cardiac tumors is a safe and highly effective strategy associated with good early and longterm outcomes

Surgery for Cardiac Papillary Fibroelastoma: A 12-Year Single Institution Experience

Background: We reviewed our clinical experience with cardiac papillary fibroelastoma from 2005 to 2017. The objective of this study was to investigate the clinical and operative data, as well as the early survival rate and immediate postoperative complications. Material/Methods: We performed a retrospective analysis of 11 patients (eight males and three females) who underwent resection of cardiac papillary fibroelastoma in our institution. Results: Mean age at tumor diagnosis was 60 +/- 14 years. The mean dimension of the tumor was 14 +/- 11 mm. The most common symptoms were dyspnea, palpitation, and angina pectoris, while one patient had recurrent fever attacks and another patient had a transient ischemic attack. Two patients had concomitant malignant tumors (cervical and colon carcinoma) and another two had concomitant benign neoplasms (liver cyst and thyroid adenoma). Bypass and cross clamp times were 77 +/- 32 minutes and 54 +/- 18 minutes, respectively. The tumors were found predominantly on cardiac valves (n= 7). In eight cases, only tumor extirpation was performed, whereas in the other three cases, the valves had to be replaced. The mean intensive care unit length of stay was 1.1 +/- 0.3 days and there was no in-hospital mortality. All patients were alive at one-year follow-up and the survival rate was 91% in the mean follow-up period of 4.15 years. Conclusions: The surgical treatment of cardiac papillary fibroelastoma was curative and safe. Thus, potential complications such as embolization or mechanical irritation of the valves can be avoided without high surgical risk