Every day mitral valve reconstruction: What has changed over the last 15 years?

Farnoosh Motazedian; Roya Ostovar; Martin Hartrumpf; Filip Schröter; Johannes M. Albes

doi:10.1371/journal.pone.0269537

Peer Review History

Original SubmissionNovember 5, 2021
18 Feb 2022 Decision Letter - Alessandro Leone, Editor PONE-D-21-35308Everyday mitral valve reconstruction. What has changed over the last 15 years?PLOS ONE Dear Dr. Albes Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ==============================Please ensure that your decision is justified on PLOS ONE’s publication criteria and not, for example, on novelty or perceived impact. For Lab, Study and Registered Report Protocols: These article types are not expected to include results but may include pilot data. ============================== Please submit your revised manuscript by 4/3/2022 . If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Alessandro Leone, MD Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please update your submission to use the PLOS LaTeX template. The template and more information on our requirements for LaTeX submissions can be found at http://journals.plos.org/plosone/s/latex. 3. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information 4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear the authors of the manuscript entitled "Everyday mitral valve reconstruction. What has changed over the last 15 years?" Thank you for writing this retrospective study which evaluates the change in the paradigm of mitral valve reconstruction over a three periods of time I valued the way you presented this study and the results and discussion parts I think this study provided outcomes after mitral valve reconstruction and also provided the changes in the method of surgical techniques utilized One major issue which I believe is adding the mitral valve pathologies in these patients, which I think is very related to the outcomes studied Otherwise I have no concerns Thank you Reviewer #2: This paper describes the evolution of mitral valve repair over many year. The evolution peroid was divided into three phases. I have the following notice: 1. In the results in line 100-102 the was a decrease in MVR in P3. Can you explain it please? 2. Only 13 minimally invasive MVR? 3. Some of the abbreviation are known German abbreviation used with English meaning like MIC (minimal invasive Chirurgie) for minimally invasive. Could you please correct this? 4. From line 200 to 203: you wrote. (These particular changes 201 comprised wider rings with multi-layer fabric to allow for better stitching and more secure 202 anchoring. Stiff or moderately flexible rings appeared to stabilize the annulus significantly 203 better than highly flexible ones so that the use of the latter did not play a role in this study). Can you please give an evidence or a reference to this sentence.! In general, the paper proves the thought of cardiac surgeons the use of artificial chordae is dominating the field of mitral surgery. The only unexplainable finding is he very low number of minimally invasive procedure which could be a center decision to avoid such an approach but with still no explanation. This nice collection needs some improvement before publication beside a language editing. Best regards ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Salah Eldien Altarabsheh Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0269537.r001
Revision 1
15 Mar 2022 Author Response Dear Reviewers, Thank you for your thoughtful comments and suggestions, which we would like to respond to as follows: Reviewer #1: Mitral valve pathologies are indeed important. I am sure you know from your own experience that it is somewhat problematic to determine the exact underlying pathology in a retrospective study with an almost historical cohort going back to 2004, with few meaningful echocardiographic findings properly documented or with not much in the surgeon's protocol or in the letter from the referring hospital. Thus, pathologies were not the primary focus of interest in this retrospective study. However, on your advice, we reviewed all the data still available and obtained as much information as possible. In the end, we were able to distinguish quite well between primary and secondary nature of the origin of mitral valve regurgitation by considering the morphology as primary origin if the valve leaflets and other aspects directly affected the valve apparatus or as secondary origin if the valves were tethered and/or the annulus was asymmetrically distorted. In the remaining cases, whose pathological origin was still unclear, we assumed that it was a secondary condition if bypass surgery was performed at the same time. Indeed, our results show differences between patients with measures on the valves themselves (resection, reconstruction, repair) and those with concomitant bypass surgery. In this way, we were able to investigate, at least indirectly, the importance of the type of mitral valve regurgitation (primary or secondary origin) on outcome. We included mitral valve pathologies in Table 1 and referred to them in the Patients and Methods section (lines 72-5) and in the Results (line 107), Discussion (245-9), and Limitations (lines 291-3). We also cited the 2021 ESC guidelines, which contain the current mitral valve pathology systematics [5]. Reviewer #2: 1. The slight decrease between period 2 and 3 was indeed apparent. After noticing a steep increase in repair from period 1 to period 2 possibly owing to the experience gained with repair strategies in the early years in our institution a slight decrease of the proportion of repair maneuvers was noted declining from 48% to 41%. This shift was not due to a more restrictive policy regarding repair surgery but was instead non-intentional and can be explained by a higher morbidity of the patients resulting in a higher proportion of patients with complex redo-surgery or endocarditis. We explained the slight decrease of the proportion of mitral valve repair and added a respective statement in the Discussion (lines 239-44). 2. Only 13 minimally invasive mitral valve repairs were performed mainly in period 2. The true minimally invasive approach was not favored in our hospital until recently because of the lack of center-wide expertise performed by multiple surgeons. So, you are correct. This was a center decision at the time, which has now been changed after several experienced surgeons had been trained in the meantime with minimally invasive mitral valve repair with left mini-thoracotomy at other institutions with high experience and volume. We added a respective statement in the discussion (lines 250-2) 3. We have erased the term MIC in tables, legends, and figure 2 and replaced it by MIS-MVR. 4. We added respective literature evidence regarding our statement: These particular changes comprised wider rings with multi-layer fabric to allow for better stitching and more secure anchoring. Stiff or moderately flexible rings appeared to stabilize the annulus significantly better than highly flexible ones [10,11]. Thank you again for your valuable comments. Johannes M. Albes, MD, PhD, MBA Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0269537.r002
24 May 2022 Decision Letter - Chengming Fan, Editor Everyday mitral valve reconstruction. What has changed over the last 15 years? PONE-D-21-35308R1 Dear Dr.Johannes Prof. Dr. Albes, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Chengming Fan, MD, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear the authors I want to thank you for taking into consideration for my as well as the reviewer's comments which are all meant to improve the quality of the manuscript I have no concerns about the manuscript in its current status Reviewer #2: no comment more needed to be added. the authors has adressed all our concerns in the revised version of the paper ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Salah Eldien Altarabsheh Reviewer #2: No https://doi.org/10.1371/journal.pone.0269537.r003
Formally Accepted
20 Jun 2022 Acceptance Letter - Chengming Fan, Editor PONE-D-21-35308R1 Every day mitral valve reconstruction: What has changed over the last 15 years? Dear Dr. Albes: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Chengming Fan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0269537.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .