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Clinical Updates on Heart Valve Repair or Replacement Surgery

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Dr. Mariusz Kowalewski

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1. Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str, 02-507 Warsaw, Poland
2. Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), 6229 HX Maastricht, The Netherlands
Interests: coronary revascularization; neuroprotection; surgical ablation; minimally invasive cardiac surgery
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Dear Colleagues,

Valve repairs, rather than replacements, have gained wide attention and are being increasingly adopted whenever such an approach is safe and feasible. In selected cases, valve surgeries are increasingly being performed with minimally invasive techniques that earlier were associated with limited surgical incision only. Nowadays, “minimally invasive” includes thoracoscopic, transcatheter, robotic, etc. Valve surgeries are performed faster, maintaining the durability of repairs and safety of the sternotomy approach. At the same time, they allow patients’ early recovery, more effective rehabilitation, and lower morbidity; in some higher risk individuals, these benefits may translate to lower mortality as well.

In this Special Issue, you are invited to share your experience with advancements in the field of valvular surgery, with a particular focus on:

Diagnosis and planning: preoperative and intraoperative imaging;
Training in minimally invasive valve surgery;
Novel techniques including transcatheter-, robotic-, beating heart-, minimized ECC, and hybrid approaches to both isolated and combined valve surgery;
Procedural workflow and procedural challenges;
Tackling “hostile” anatomy in a minimally invasive setting;
Minimally invasive surgery for complex valve scenarios;
Postoperative care, safety, and patients’ outcomes.

Dr. Mariusz Kowalewski
Guest Editor

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Research

12 pages, 894 KiB

Open AccessArticle

Comparative Analysis of Long-Term Outcomes in Valve-Sparing Aortic Root Reimplantation: Full Sternotomy versus Mini-Sternotomy Approach

by Jakub Staromłyński, Adam Kowalówka, Radosław Gocoł, Damian Hudziak, Małgorzata Żurawska, Wojciech Nowak, Michał Pasierski, Wojciech Sarnowski, Radosław Smoczyński, Maciej Bartczak, Jakub Brączkowski, Sabina Sadecka, Dominik Drobiński, Marek Deja, Piotr Szymański, Piotr Suwalski and Mariusz Kowalewski

J. Clin. Med. 2024, 13(9), 2692; https://doi.org/10.3390/jcm13092692 - 3 May 2024

Viewed by 1531

Abstract

Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively (p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter (p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality (p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome. Full article

(This article belongs to the Special Issue Clinical Updates on Heart Valve Repair or Replacement Surgery)

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11 pages, 2245 KiB

Open AccessArticle

A Comparative Study of 1-Year Postprocedural Outcomes in Transcatheter Mitral Valve Repair in Advanced Primary Mitral Regurgitation: PASCAL vs. MitraClip

by Felix Rudolph, Johannes Kirchner, Maria Ivannikova, Vera Fortmeier, Tanja Katharina Rudolph, Kai Peter Friedrichs, Volker Rudolph and Muhammed Gerçek

J. Clin. Med. 2024, 13(2), 484; https://doi.org/10.3390/jcm13020484 - 16 Jan 2024

Cited by 1 | Viewed by 1695

Abstract

Both the MitraClip and PASCAL systems offer transcatheter edge-to-edge repair (TEER) solutions for mitral regurgitation. Evidence indicates a lower technical success rate for TEER in complex degenerative mitral regurgitation (DMR) cases. We conducted a retrospective analysis of patients who underwent transcatheter edge-to-edge therapy for primary mitral regurgitation with advanced anatomy, defined as mitral regurgitation effective regurgitant orifice area (MR-EROA) ≥0.40 cm² or large flail gap (≥5 mm) or width (≥7 mm) or Barlow’s disease, that completed follow-up after 1 year. Our criteria were met by 27 patients treated with PASCAL and 18 with MitraClip. All patients exhibited a significant, equivalent short-term reduction in MR-EROA, mitral regurgitation vena contracta diameter (MR-VCD), regurgitant volume, and clinical status. At 1 year follow-up, reductions in MR-VCD, regurgitant volume, and MR-EROA remained significant for both groups without significant differences between groups. MR-Grade ≤ 1+ was achieved in 18 (66.7%) and 10 (55.6%) patients, respectively. At follow-up, no difference in hospitalization for cardiac decompensation was observed. Overall death was similar in both groups. Our study suggests that both the PASCAL and MitraClip systems significantly reduce mitral regurgitation even in advanced degenerative diseases. Within our limited data, we found no evidence of inferior performance of the PASCAL system. Full article

(This article belongs to the Special Issue Clinical Updates on Heart Valve Repair or Replacement Surgery)

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