Why Cardiac ERAS? ERAS in Mitral Valve Surgery, the Next Big Thing?
Marjan Jahangiri
EACTS annual meeting 2024
Symposium – New frontiers in mitral valve replacement
Jörg Kempfert
EACTS annual meeting 2024
Symposium – ERAS in mitral valve surgery: The next big thing?
Eduardo Saadi
EACTS annual meeting 2024
Symposium – New frontiers in mitral valve replacement
Ismail El-Hamamsy
EACTS annual meeting 2024
Symposium – Aortic regurgitation: Treating patients across the spectrum
Francesco Onorati
EACTS annual meeting 2024
Symposium – Aortic regurgitation: treating patients across the spectrum
Evaldas Girdauskas
EACTS annual meeting 2024
Symposium – Aortic regurgitation: treating patients across the spectrum
Prof. Patrick Myers
Aortic Highlights 2024
Francesco Onorati
Vinod Thourani
Joseph Bavaria
Tom Nguyen
Andreas Zierer
Prof. Bonaros
2023 EACTS annual meeting
Prof. Bouchard
2023 EACTS annual meeting
Dr. Vinod Thourani
2023 EACTS annual meeting
Prof. Kempfert
2023 EACTS annual meeting
Dr. Nguyen
2023 EACTS annual meeting
Dr. Joseph Bavaria
2023 EACTS annual meeting
Angela De La Fuente
EACTS annual meeting, 2023
Girdauskas E, Pausch J, Eden M, Krane M, Borger M, Walther T, Kuntze T and Falk V.
Presented at 36th European Association for Cardio-Thoracic Surgery Annual Meeting, 2022.
Key points:
- Annuloplasty combined with papillary muscle repositioning to treat type IIIb mitral regurgitation (MR) had acceptable perioperative and 1-year efficacy and safety outcomes.
Background information
- Treating type IIIb MR with annuloplasty alone is associated with a high recurrence rate.
- Combining annuloplasty with subannular repair by papillary muscle repositioning may increase the stability of mitral valve repair in this patient population.
Aims
- To evaluate the safety and efficacy of standardised subannular repair.
Type of study
- A prospective, single-arm, multicentre registry study.
Endpoints
- The primary endpoint was freedom from MR >2+ after 2 years.1
- Secondary endpoints included survival, major adverse cardiac and cerebrovascular events and reinterventions.
Methods
- The study included patients with secondary MR, left ventricular ejection fraction (LVEF) ≤50%, left ventricular end-diastolic diameter (LVEDD) ≥55 mm and tenting of the proximal or anterior mitral leaflets >10 mm.
- Patients underwent annuloplasty (with Carpentier- McCarthy-Adams IMR ETlogix) together with bilateral papillary muscle repositioning.
- Endpoint assessment was performed in echocardiography and magnetic resonance imaging CoreLabs.
Results
Patients
- The study included 94 patients from six centres (Table 1).
Table 1. Baseline characteristics.
Perioperative outcomes
- The mean cardiopulmonary bypass time was 158 ± 40 min.
- Five patients (5%) developed low cardiac output syndrome and two patients (2%) experienced stroke.
- One patient died during the hospital stay (1.4%).
- At discharge, 43 patients (49%) were free of MR, and 35 (40%) had mild and 9 (10%) moderate residual MR.
Echocardiographic results
- At 1-year, 95.8% of patients were free of MR >2+ (Kaplan-Meir analysis).
- There was improved left ventricular (LV) geometry (remodeling) and reduced tenting parameters at 1-year.
Survival
- The survival rate at 1-year was 95.5%.
Conclusion
Standardised subannular repair by papillary muscle repositioning showed acceptable perioperative and 1-year efficacy and safety outcomes in patients with functional MR, including a low MR >2 recurrence rate.
Improved LV remodeling and tenting parameters were also evident 12 months after surgery. A 2-year follow-up of the study population is currently underway.
References:
- NCT03470155. Available at: https://clinicaltrials.gov/ct2/show/ NCT03470155. [Accessed September 2022].
This document is a summary of the Girdauskas E et al. presentation, as presented at the EACTS congress and covers key information including aim, type of study, methods, results and conclusions.
The full publication is available at:
Abbreviations:
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