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The aim is to study risk factors of mortality and reoperation of patients who underwent surgery for mitral endocard itis between 1998 and 2010, within the cardiovascular and thoracic surgery department of the "Cliniques Universitaires Saint- Luc" (Woluwe-Saint-Lambert, Belgium).Methods : Between February 1998 and December 2010, 149 patients underwent mitral valve surgery because of an infective endocarditis. Of these 149 patients,93 (62.4%) were men (average age 59 ± 14.2 years,age range 19 - 88 years) and 56 (37.6%) were women (average age 65 ± 12.9 years, age range 22 - 86 years). A mitral repair was performed in 113 patients (75.8%), 36 of whom had a replacement (24.2%). The mitral valve disease was characterized by: a vegetat ion for 105 patients (70.4%), a mitral leaflet prolapse for 48 patients { 32.2%), a mitral annular abscess for 39 patients (26.2%), a mitral leaflet perforation for 38 patients (25.5%), a mitralchordae ruptured for 26 patients (17.4%) and a partial leaflet destruction for 8 patients (5.3%). Twenty-four patients (16.1%) not only underwent mitral valve surgery but they also benefited from a simultaneous myocardial revascularization. A median follow-up of 5.3 years has been carried out (range 0 - 15.5 years) .Results :Ofthese 149 patients,20 (13.4%) prematurely died (within 30 post-operative days) and 37 died during the follow-up.The 1-,5- and 10-year survival rates of patients with mitralvalve infective endocarditis are 83 .8% (IC 95 % ± 6.6%), 75.8% (IC 95% ± 7.8%) and 59 .3% (IC 95% ± 10.4%),respectively. Significantly (p=0.0006), native mitral va lve endocarditis on which mitra valve repair was performed displays higher 1-, 5- and 10-year survival rates than the surgeries involving mitral valve replacement; with 91.2% (IC 95% ± 5.8%), 80.7% (IC 95% ± 8.3%), and 64.6% (IC 95% ± 11.6%),respectively for mitral valve repair and 46.7% (IC 95% ± 25.2%), 46.7% (IC 95% ± 25.2%), and 38.9% (IC95% ± 25.2%), respectively for mitral valve replacement. The 1-, 5- and 10-year survival rates of freedom from mitral valve reoperation of patients with mitral valve infective endocarditis are 97.9% (IC 95% ± 2.1%), 93.4% (IC 95% ± 5.1%) and 86.4% ( IC 95% ±9.1%), respectively.Conclusions : The results of the study revea led that mitral va lve repair is more efficient than mitral valve replacement . lndeed,similar outcomes can be found in different texts discussing the same tapie. Multivariate predictors of mortality for mitral valve repair cases were age : 65 years and diabetes. Réaliser une étude sur les facteurs de mortalité et de ré-opération des patients pris en charge chirurgicalement d'une endocardite mitrale au sein du service de chirurgie cardiovasculaire et thoracique des Cliniques Universitaires Saint-Luc (Woluwe-Saint- Lambert, Belgique) entre 1998 et 2010.Méthodes : Entre février 1998 et décembre 2010, 149 patients ont subi une chirurgie de la valve mitrale à cause d'une endocardite infectieuse. De ces 149 patients, 93 (62,4%) étaient des hommes (âge moyen 59 ± 14,2 ans, range 19 - 88 ans) et 56 (37,6%) des femmes (âge moyen 65 ± 12,9 ans, range 22 - 86 a ns). Une réparation valvulaire mitrale a été effectuée chez 113 patients (75,8%), les 36 autres ont eu un remplacement (24,2%).L'atteinte va lvulaire mitrale se caractérisait par : une végétation chez 105 patients (70,4%), un prolapsus de feuillet mitral pour 48 patients (32,2%), un abcès au niveau de l'anneau chez 39 patients (26,2%), une perforation de feuillet pour 38 patients (25,5%), une rupture de cordage chez 26 patients ( 17,4%) et une destruction partielle de feuillet pour 8 patients (5,3%) . Vingt-quatre patients (16,1%} ont bénéficié d'une revascularisation myocardique concomitante. Un follow-up médian de 5,3 ans a été réalisé (range 0 - 15,5 ans).Résultats : Sur les 149 patients,20 (13,4%) sont décédés de façon précoce (endéans les 30 jou rs postopératoires) et le follow-up a rapporté 37 décès tardifs. Les taux de survie globale à 1,5 et 10 ans des patients opérés d'endocardite infectieuse mitrale sont respectivement de 83,8% (IC 95% ± 6,6%}, 75,8% (IC 95% ± 7,8%) et 59,3% (IC 95% ± 10,4%) . De façon significat ive (p=0,0006), les endocardites sur va lve native opérées par réparation mitrale montrent des taux de survie à 1,5 et 10 ans supérieurs à ceux qui ont subiun remplacement mitra l avec respectivement 91,2% (IC 95% ± 5,8%), 80,7% (IC 95% ± 8,3%) et 64,6% (IC 95% ± 11,6%) pour les réparatio ns et 46,7% (IC 95% ± 25,2%), 46,7% (IC 95% ± 25,2%) et 38,9% (IC 95% ± 25,2%) pour les remplacements. Les taux de survie sans ré-opération mitrale à 1, 5 et 10 ans des patients opérés d'une endocard ite infectieuse mitrale sont de 97,9% (IC 95% ± 2,1%), 93,4% (IC 95% ± 5,1%} et 86,4% (IC 95% ± 9,1%).Conclusion : Les résultats de l'étude ont montré une supériorité significative de la réparation mitrale par rapport au remplacement. Cela correspond à ce que l'on retrouve dans la littérature. L'analyse multivariée a également mis en évidence deux facteurs de risque influençant la mortalité des réparations mitrales : l'âge 65 ans et le diabète.

Endocarditis --- Endocarditis --- Heart Valve Prosthesis Implantation

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Le but de cette étude est d'analyser le pronostic vital à court et à long terme des patients ayant bénéficié d'une chirurgie de remplacement de la valve aortique (RVAo) par une prothèse mécanique. Dans un but de contrôle de qualité, nous souhaitons comparer les événements observés à ceux prédits par des scores validés pour la mortalité et les autres complications à court et à long terme. Une évaluation du pouvoir de prédiction des différents scores pour la prédiction de la mortalité à 1 an est réalisée.Matériel et méthodes : Une série consécutive de 690 patients (63 ans d'âge moyen) ayant bénéficié d'un RVAo par une prothèse mécanique de janvier 1998 à décembre 2012. L'implantation a été associée à un pontage coronarien chez 214 patients (31,0 %), à un BENTALL chez 80 patients (11,6 %), à une buse/plastie chez 14 patients (2,0 %), à une myomectomie septale chez 23 patients (3,3 %), à une endartériectomie carotidienne chez 15 patients (2,2 %), à un MAZE chez 9 patients (1,3 %) et à une fermeture d'un foramen ovale perméable chez 10 patients (1,4 %). Le devenir à court et à long terme fut analysé rétrospectivement et comparé à des scores prédictifs (l'EuroSCORE I, l'EuroSCORE II et le STS).Résultats: La mortalité opératoire est de 4,3%. Les complications post-opératoires sont : un infarctus du myocarde chez 17 patients (2,5%), un AVC chez 12 patients (1,7%), une dialyse chez 25 patients (3,6%), une implantation d'un pacemaker chez 37 patients (5,4%) et de la FA chez 279 patients (40,4%). Les complications à long terme sur une durée de 3,4 années de suivi moyen, sont : 39 événements hémorragiques (5,7%), 24 AVC (3,5%), 8 reprise de plaie sternale (1 ,2%), 6 redo (0,9%), 4 dysfonctions valvulaires (0,6%), 2 endocardites (0,3%) et 2 embolies périphérique s (0,3%). Le taux de survie global, estimé par la méthode de KAPLAN-MEIER, à 5 et 10 ans étaient respectivement de 84% et 60%. Pour la prédiction de la mortalité à 1 an, l'EuroSCORE 1 a la meilleure courbe ROC avec une AUC à 0,77.Conclusion : Le taux de mortalité observé est similaire aux valeurs prédites par l'EuroSCORE I et l'EuroSCORE Il. Les taux de complications procédurales correspondent aux valeurs prédites par le STS, sauf pour la ventilation prolongée et la réopération où nous avons obtenu un résultat inférieur, c'est-à-dire meilleur dans ce cas-ci. The purpose of this study is to analyze the short and long-term prognosis of patients who underwent aortic valve replacement surgery by a mechanical prosthesis. For quality control purposes, we wanted to compare the events observed against predicted scores validated for mortality and other short and long-term complications. An evaluation of the predictive power of the different scores for the prediction of 1-year mortality is carried out.Material and methods: A consecutive series of 690 patients (average age 63 years) having benefited an aortic valve replacement by a mechanical prosthesis from January 1998 to December 2012. The implantation was associated with coronary artery bypass grafting for 214 patients (31,0%), with a BENTALL for 80 patients (11,6%), with a Buse / plasty for 14 patients (2,0%), with a septal myomectomy for 23 patients (3,3%), with a carotid endarterectomy for 15 patients (2,2%), with a MAZE in 9 patients (1,3%) and with a closure of a patent foramen ovale for 10 patients (1,4%). The short and long term future was retrospectively analyzed and compared with predictive scores (the EuroSCORE I, II and STS).Results: Operative mortality was 4,3%. Postoperative complications were: a myocardial infarction for 17 patients (2,5%), a stroke for 12 patients (1,7%), a dialysis for 25 patients (3,6%), the implantation of a pacemaker for 37 patients (5,4%) and FA for 279 patients (40,4%). Long­ term complications over an average follow-up period of 3.4 years are: 39 bleeding events (5,7%), 24 strokes (3,5%), 8 resumption of sternal wound (1,2%), redo 6 (0,9%), 4 valvular dysfunction (0,6%), 2 endocarditis (0,3%) and 2 peripheral embolism (0,3%). The overall survival rate, estimated by the Kaplan-Meier method, to 5 and 10 years were 84% and 60% respectively. For the prediction of 1-year mortality, the EuroSCORE I has the best curve with a ROC AUC 0,77. Conclusions: The observed mo1tality rate is similar to the values predicted by the EuroSCORE 1 and II. The rates of procedural complications correspond to the values assessed by the STS, except for prolonged ventilation and reoperation where we obtained a lower (better) result.

Transcatheter Aortic Valve Replacement --- Heart Valve Prosthesis Implantation

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Percutaneous aortic valve replacement and percutaneous mitral valve repair are emerging alternatives for high-risk patients with severe valve disease. Interventional cardiologists are faced with the challenge represented by these complex procedures. This practical guide specifically deals with a comprehensive knowledge of the techniques and approach to percutaneous treatment of left side cardiac valve disease and discusses the potential complications and expected or potential morbidity from the procedure. This book aims at providing interventional cardiologists with useful tips and tricks for percutaneous treatment of mitral and aortic valves in the light of recent advances.

Aortic valve -- Transplantation. --- Balloon dilation -- Methods. --- Heart Valve Diseases -- Surgery. --- Heart valve prosthesis implantation -- Methods. --- Mitral valve -- Surgery. --- Aortic valve --- Mitral valve --- Investigative Techniques --- Therapeutics --- Heart Diseases --- Cardiac Surgical Procedures --- Prosthesis Implantation --- Cardiovascular Surgical Procedures --- Cardiovascular Diseases --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Thoracic Surgical Procedures --- Surgical Procedures, Operative --- Diseases --- Balloon Dilation --- Heart Valve Diseases --- Methods --- Catheterization --- Heart Valve Prosthesis Implantation --- Human Anatomy & Physiology --- Medicine --- Surgery & Anesthesiology --- Health & Biological Sciences --- Surgery - General and By Type --- Physiology --- Transplantation --- Surgery --- Transplantation. --- Surgery. --- Mitral valvotomy --- Mitral valvulotomy --- Valva aortae --- Medicine. --- Cardiology. --- Cardiac surgery. --- Medicine & Public Health. --- Cardiac Surgery. --- Heart valves --- Heart --- Cardiac surgery --- Open-heart surgery --- Internal medicine

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The surgical treatment of the aortic valve and root disease, organic and ischemic mitral regurgitation, and endocarditis has made great strides. Still, there is the well-known dilemma: on the one hand the need for anticoagulation in patients with mechanical valves that otherwise guarantee long-term functioning and, on the other, the unpredictable durability of biological substitutes and of valve repair procedures which, per se, do not require anticoagulation. The choice of procedure is determined by factors such as patients' age, metabolic and bleeding disorders, and bleeding preconditions, as well as such critical issues as the desire to bear children in young women. The book contains a collection of proceedings of The Berlin Heart Valve Symposium which was held in November 2008. It focuses on current surgical approaches to and evolving trends in aortic valve repair, aortic root and valve replacement with pulmonary autograft, aortic allograft, stentless and stented bioprostheses.  Further contributions will deal with recent advances in catheter-based percutaneous and transapical techniques, ablation techniques for atrial fibrillation, tissue engineering of heart valves, multi-modality imaging, and anticoagulation.

Embryonic Development. --- Fetal Diseases. --- Heart -- Diseases. --- Heart Diseases. --- Aortic Valve --- Bioprosthesis --- Heart Valve Prosthesis Implantation --- Blood Vessel Prosthesis Implantation --- Prosthesis Implantation --- Vascular Grafting --- Heart Valves --- Prostheses and Implants --- Cardiac Surgical Procedures --- Surgical Procedures, Operative --- Equipment and Supplies --- Vascular Surgical Procedures --- Cardiovascular Surgical Procedures --- Thoracic Surgical Procedures --- Heart --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Cardiovascular System --- Anatomy --- Surgery - General and By Type --- Surgery & Anesthesiology --- Health & Biological Sciences --- Aorta --- Heart valves --- Cardiovascular instruments, Implanted --- Surgery --- Implanted cardiovascular instruments --- Cardiac valves --- Valves, Heart --- Valves --- Medicine. --- Cardiology. --- Cardiac surgery. --- Medicine & Public Health. --- Cardiac Surgery. --- Biomedical engineering --- Electronics in cardiology --- Implants, Artificial --- Arteries --- Blood --- Chest --- Circulation --- Surgery. --- Internal medicine --- Cardiac surgery --- Open-heart surgery --- Diseases