Commentary: Enhanced open transcatheter mitral valve replacement: The ultimate hybrid approach
Notice bibliographique
Résumé
Central MessageHybrid mitral valve replacement performed by surgical teams with expertise in both open and transcatheter approaches should improve the management of technically complex disease.See Article page 25. Hybrid mitral valve replacement performed by surgical teams with expertise in both open and transcatheter approaches should improve the management of technically complex disease. See Article page 25. In symptomatic mitral valve disease with severe mitral annular calcification (MAC), mitral valve replacement is challenging, and decalcification carries a risk of serious injury to the atrioventricular groove, especially in elderly patients. In such situations, an open-heart deployment of a balloon-expandable aortic prosthesis was proposed as a safer alternative to avoid a potentially hazardous decalcification. However, this technique may have several disadvantages, including the risk of periprosthetic leakage or obstruction of the left ventricular outflow tract (LVOT). Consideration of surgical techniques to overcome these limitations is essential. Codecasa and colleagues1Codecasa R. De Cillis P. Stefàno P. Balloon-expandable prosthesis for open mitral replacement with a calcified mitral annulus.J Thorac Cardiovasc Surg Tech. 2021; 5: 25-26Google Scholar report their elegant management of a 74-year-old woman with rheumatic mitral valve disease, with severe MAC on preoperative chest computed tomography scan. They performed an open mitral implantation of a balloon-expandable aortic prosthesis, preoperatively sized to allow for slight oversizing and minimal stress to the atrioventricular groove. The anterior mitral valve leaflet was resected, and a bovine pericardial skirt was sutured to the base of the prosthesis and to the mitral annulus to prevent periprosthetic leaks. A septal myectomy was also performed to prevent obstruction of the LVOT. Apart from temporary atrioventricular block requiring external pacing, the postoperative course was uneventful and the patient was discharged 9 days after the operation. Although conventional mitral valve surgery with MAC can be performed with good results in acceptable-risk patients, severe circumferential MAC frequently presents in elderly patients and is associated with increased operative risk.2Saran N. Greason K.L. Schaff H.V. Cicek S.M. Daly R.C. Maltais S. et al.Does mitral valve calcium in patients undergoing mitral valve replacement portend worse survival?.Ann Thorac Surg. 2019; 107: 444-452Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Transcatheter techniques involving the deployment of an aortic balloon-expandable prosthesis for native mitral valve disease have drawbacks such as LVOT obstruction or periprosthetic regurgitation and have led to disappointing results in patients with MAC.3Kiefer P. Noack T. Seeburger J. Hoyer A. Linke A. Mangner N. et al.Transapical mitral valve implantation for native mitral valve stenosis using a balloon-expandable prosthesis.Ann Thorac Surg. 2017; 104: 2030-2036Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar Initially described in case reports as either a planned procedure or an intraoperative bailout maneuver, the alternative hybrid approach has been demonstrated to be a feasible and hemodynamically effective solution for severe MAC. The open hybrid approach allows for resection of the anterior mitral valve leaflet and septal myectomy, which theoretically should maximize the postoperative neo-LVOT diameter.4Russell H.M. Guerrero M.E. Salinger M.H. Manzuk M.A. Pursnani A.K. Wang D. et al.Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification.J Am Coll Cardiol. 2018; 72: 1437-1448Crossref PubMed Scopus (48) Google Scholar Nevertheless, further studies are mandatory to determine whether the long-term outcome for this technique is as promising as its short-term results. The report by Codecasa and colleagues1Codecasa R. De Cillis P. Stefàno P. Balloon-expandable prosthesis for open mitral replacement with a calcified mitral annulus.J Thorac Cardiovasc Surg Tech. 2021; 5: 25-26Google Scholar illustrates the pivotal role of a multidisciplinary management of such patients, including heart team discussion, multimodality imaging (echocardiography and computed tomography scan), and rigorous preoperative planning (eg, prosthetic valve sizing and software for neo-LVOT determination). There is little doubt as to the beneficial influence of surgeons with expertise in both surgical and transcatheter approaches for these complex patients. Balloon-expandable prosthesis for open mitral replacement with a calcified mitral annulusJTCVS TechniquesVol. 5PreviewIn presence of a heavily calcified mitral apparatus, mitral valve replacement may represent a challenging surgical intervention. The risk of injury to the atrioventricular groove is high and the success rate of its consequent repair is very low. Nevertheless, a symptomatic patient affected by severe mitral stenosis, especially when balloon commissurotomy is not indicated, should not be left untreated. Mitral decalcification represents a risky option, but an apparently simpler and safer solution can be an open-heart positioning of an inverted aortic balloon-expandable aortic prosthesis. Full-Text PDF Open Access
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,007 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».