Interventions innovantes dans le traitement des maladies valvulaires mitrales et aortiques : options de traitement actuelles et perspectives futures
Valvular heart disease is an important cause of morbidity and mortality. In western countries, mitral regurgitation and aortic stenosis are the most frequent valvular pathologies and their prevalence increases with age. With the increase in life expectancy in these countries, the prevalence of degenerative valve disease will increase with a significant burden on healthcare systems. Advances in cardiac surgery as well as new breakthroughs in interventional cardiology have considerably modified the management of patients with valvular disease, by offering minimally invasive approaches, especially for patients at high surgical risk. In this thesis, two retrospective cohort studies were carried out. The first compares the postoperative and 3 years outcomes of mitral valve surgery vs MitraClip, a transcatheter procedure, in 259 patients with severe ischemic mitral regurgitation. The second study compares the postoperative results of two minimally invasive techniques (ministernotomy and minithoracotomy) for aortic valve replacement to conventional sternotomy. In the first study, MitraClip procedure had lower postoperative and 3-year mortality rate than surgery, but it was associated with higher recurrence rate of mitral regurgitation after 3 years. The second study showed that the two minimally invasive approaches had similar intrahospital mortality rate to sternotomy. Minithoracotomy was associated with less perioperative bleeding and less pain at rest than sternotomy. In conclusion, minimally invasive approaches offer an excellent alternative to conventional surgery in the treatment of valvular disease. The clinical benefits are more highlighted when patients are properly selected; hence the importance of a "Heart Team" that collaborates for better patient care.
MitraClip Cardiac surgery Cardiology Mitral regurgitation Minimally invasive surgery Aortic valve replacement