1
|
Du Y, Han H, Zhang T, Shen H, Han W, Jia S, Yu Y, Guo Y, Wang Z, Liu Y, Shi D, Zhou Y. Prognosis of Elevated Mitral Valve Pressure Gradient After Transcatheter Edge-to-Edge Repair: Systematic Review and Meta-Analysis. Curr Probl Cardiol 2024; 49:102095. [PMID: 37778430 DOI: 10.1016/j.cpcardiol.2023.102095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Elevation in mitral valve pressure gradient (MVPG) after mitral valve transcatheter edge-to-edge repair (M-TEER) is common, however, evidence on its prognosis is scarce and debatable. Thus, this study aims to investigate the impact of increased MVPG after M-TEER on outcomes. Studies reporting the associations between the elevated MVPG after M-TEER and outcomes were identified in a systematic search of published literatures. Associations were pooled by meta-analysis using a random-effects model. The primary outcome was the composite of all-cause mortality and heart failure (HF) hospitalization. Seven observational studies with 2,730 patients (mean age, 77.7 ± 9.3 years; male, 64.4%; functional mitral regurgitation [MR], 65.2%) were eligible for the present analysis. M-TEER was performed entirely using the MitraClip system (Abbott), followed by 29.7% of patients having increased MVPG. Elevated postprocedural MVPG was not associated with a higher risk of the primary outcome, compared to low MVPG [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.95-1.58; p = 0.12; I2 = 53.5%). However, the prognosis of elevated MVPG was observed in degenerative MR patients (HR = 1.37; 95% CI 1.03-1.84; p = 0.03; I2 = 0%), whereas not in functional MR patients. Patients with low MVPG + high residual MR had a higher risk of the primary outcome than those with high MVPG + low residual MR after M-TEER (HR = 1.50; 95% CI 1.10-2.03; p = 0.01; I2 = 13%). In conclusion, elevated MVPG seems to predict adverse outcomes mainly in patients with degenerative MR. Future studies are needed to prove these findings.
Collapse
Affiliation(s)
- Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Tianhao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Wei Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yi Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yonghe Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yuyang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China.
| |
Collapse
|
2
|
Wagner CM, Fu W, Hawkins RB, Romano MA, Ailawadi G, Bolling SF. Alfieri versus conventional repair for bileaflet mitral valve prolapse. JTCVS OPEN 2023; 16:242-249. [PMID: 38204703 PMCID: PMC10775110 DOI: 10.1016/j.xjon.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 01/12/2024]
Abstract
Objective Mitral valve repair for bileaflet prolapse can be complex, involving multiple chords or resection. The Alfieri technique for bileaflet disease is simple but may be associated with mitral stenosis or recurrent mitral regurgitation. Outcomes of patients with bileaflet prolapse undergoing mitral valve repair using the Alfieri versus conventional chord/resection techniques were compared. Methods Adults undergoing mitral valve repair for bileaflet prolapse for degenerative disease from 2017 to 2023 were stratified by repair technique. Outcomes including operative mortality and echocardiogram data were compared. Time to event analysis was used to characterize freedom from recurrent mitral regurgitation (moderate or greater mitral regurgitation). Results Among 188 patients with bileaflet prolapse, 37% (70) were repaired with the Alfieri and the remaining patients were repaired with chords/resection. Compared with chords/resection, patients undergoing the Alfieri had shorter cardiopulmonary bypass and crossclamp times. Operative mortality (0% [0/70] vs 2% [2/118], P = .27) was similar between both techniques. The mean mitral gradient was low and similar for the Alfieri versus chords/resection (3 vs 3, P = .34). Development of recurrent mitral regurgitation at 2 years, incorporating the competing risk of death and mitral reintervention, was 4.3% (95% CI, 1.5%-9.3%) for the Alfieri technique and 5.8% (95% CI, 2.2%-11.8%) for chord/resection (P = .83). Conclusions Both the Alfieri and chord/resection techniques had low rates of recurrent mitral regurgitation at 2 years. The mitral valve gradient was low and similar regardless of technique; thus, those who received the Alfieri technique did not have an increased rate of mitral stenosis. The Alfieri may be an underused technique for bileaflet prolapse.
Collapse
Affiliation(s)
- Catherine M. Wagner
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
- National Clinician Scholar's Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich
| | - Whitney Fu
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Robert B. Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Matthew A. Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Steven F. Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| |
Collapse
|
3
|
Yajima S, Zhu Y, Stark CJ, Wilkerson RJ, Park MH, Stefan E, Woo YJ. Chordal force profile after neochordal repair of anterior mitral valve prolapse: An ex vivo study. JTCVS OPEN 2023; 15:164-172. [PMID: 37808060 PMCID: PMC10556825 DOI: 10.1016/j.xjon.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 10/10/2023]
Abstract
Objective This study aimed to biomechanically evaluate the force profiles on the anterior primary and secondary chordae after neochord repair for anterior valve prolapse with varied degrees of residual mitral regurgitation using an ex vivo heart simulator. Methods The experiment used 8 healthy porcine mitral valves. Chordal forces were measured using fiber Bragg grating sensors on primary and secondary chordae from A2 segments. The anterior valve prolapse model was generated by excising 2 primary chordae at the A2 segment. Neochord repair was performed with 2 pairs of neochords. Varying neochord lengths simulated postrepair residual mitral regurgitation with regurgitant fraction at >30% (moderate), 10% to 30% (mild), and <10% (perfect repair). Results Regurgitant fractions of baseline, moderate, mild, and perfect repair were 4.7% ± 0.8%, 35.8% ± 2.1%, 19.8% ± 2.0%, and 6.0% ± 0.7%, respectively (P < .001). Moderate had a greater peak force of the anterior primary chordae (0.43 ± 0.06 N) than those of baseline (0.19 ± 0.04 N; P = .011), mild (0.23 ± 0.05 N; P = .041), and perfect repair (0.21 ± 0.03 N; P = .006). In addition, moderate had a greater peak force of the anterior secondary chordae (1.67 ± 0.17 N) than those of baseline (0.64 ± 0.13 N; P = .003), mild (0.84 ± 0.24 N; P = .019), and perfect repair (0.68 ± 0.14 N; P = .001). No significant differences in peak and average forces on both primary and secondary anterior chordae were observed between the baseline and perfect repair as well as the mild and perfect repair. Conclusions Moderate residual mitral regurgitation after neochord repair was associated with increased anterior primary and secondary chordae forces in our ex vivo anterior valve prolapse model. This difference in chordal force profile may influence long-term repair durability, providing biomechanical evidence in support of obtaining minimal regurgitation when repairing mitral anterior valve prolapse.
Collapse
Affiliation(s)
- Shin Yajima
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Bioengineering, Stanford University, Stanford, Calif
| | - Charles J. Stark
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | | | - Matthew H. Park
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Elde Stefan
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Bioengineering, Stanford University, Stanford, Calif
| |
Collapse
|
4
|
Hungerford S, Bart N, Song N, Jansz P, Dahle G, Duncan A, Hayward C, Muller D. Thirty-day and one-year outcomes following transcatheter mitral valve edge-to-edge repair versus transapical mitral valve replacement in patients with left ventricular dysfunction. ASIAINTERVENTION 2023; 9:78-86. [PMID: 36936096 PMCID: PMC10020820 DOI: 10.4244/aij-d-22-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/25/2022] [Indexed: 03/16/2023]
Abstract
Background A comparison of 30-day and 1-year clinical outcomes in patients with pre-existing left ventricular (LV) dysfunction undergoing transcatheter mitral valve edge-to-edge repair (TEER) or transcatheter transapical mitral valve replacement (TMVR) has not previously been reported. Aims We aimed to compare 30-day and 1-year rates of all-cause and cardiovascular mortality as well as rehospitalisation for heart failure (HFH). Methods All patients with severe (≥3+) symptomatic mitral regurgitation (MR) and an LV ejection fraction ≤50% who underwent TEER or TMVR over a 5-year period were evaluated. Results Ninety-six patients (50 TEER, age 80±9 years, 70% secondary MR and 46 TMVR, age 72±9 years, 91% secondary MR) were studied. Baseline demographic and transthoracic echocardiogram characteristics were well-matched, with the exception of age (TEER 80±9 vs TMVR 72±9; p=0.01). Successful device implantation occurred in 96% of TEER patients and 97.8% of TMVR patients. Ninety-two percent of TEER patients had ≤2+MR predischarge, whilst no TMVR patient had ≥1+MR (p<0.01). No significant difference in the combined endpoint of 30-day all-cause mortality or HFH was observed (p>0.05). At 1 year, freedom from all-cause mortality and HFH was 79.2% across the entire study population but was significantly higher in patients undergoing TEER (TEER: n=45 [90%] hazard ratio 11.26, 95% confidence interval [CI]: 10.59-11.93 vs TMVR: n=39 [67.4%] 95% CI: 10.09-11.33; p=0.008). Conclusions Despite comparable rates of successful device implantation, MR reduction, and 30-day all-cause mortality/HFH, TEER patients had lower all-cause mortality and HFH rates at 1 year.
Collapse
Affiliation(s)
- Sara Hungerford
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nicole Bart
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Ning Song
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Paul Jansz
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Oslo University, Oslo, Norway
| | - Alison Duncan
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Christopher Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - David Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| |
Collapse
|
5
|
Mastro F, Angelini A, D'Onofrio A, Gerosa G. A journey from resect to respect to restore: aiming at optimal physiological surgical mitral valve repair. J Cardiovasc Med (Hagerstown) 2023; 24:1-11. [PMID: 36484280 DOI: 10.2459/jcm.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The concept of 'repairing' a degenerated mitral valve in order to restore the native competence means achieving the best physiological result coupled with the least invasive approach: this represents an interesting challenge for cardiac surgeons. The evolution of cardiac surgery through the years has involved techniques and technologies in every field of interest. From 'resect', to 'respect', to 'restore': the micro-invasive approach based on Neochord implant implies a transapical beating heart surgery which is based on the concept of implanting artificial chordae, preserving the physiological dynamics of the mitral annulus and avoiding the disadvantages of cardiopulmonary bypass and cardioplegic arrest of the heart.
Collapse
Affiliation(s)
- Florinda Mastro
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| |
Collapse
|
6
|
Lapenna E, Alfieri O, Nisi T, De Bonis M. Mitral regurgitation in hypertrophic obstructive cardiomyopathy: The role of the edge‐to‐edge technique. J Card Surg 2022; 37:3336-3341. [DOI: 10.1111/jocs.15826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital Vita‐Salute San Raffaele University Milan Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital Vita‐Salute San Raffaele University Milan Italy
| | - Teodora Nisi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital Vita‐Salute San Raffaele University Milan Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital Vita‐Salute San Raffaele University Milan Italy
| |
Collapse
|
7
|
Zhu D, Wang S, Taramasso M, Pan X. Transcatheter mitral edge-to-edge repair: past, present, and the future. Sci Bull (Beijing) 2022; 67:1728-1731. [PMID: 36546055 DOI: 10.1016/j.scib.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Da Zhu
- Department of Structure Heart Center, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China
| | - Shouzheng Wang
- Department of Structure Heart Center, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China; Department of Structure Heart Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | | | - Xiangbin Pan
- Department of Structure Heart Center, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China; Department of Structure Heart Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| |
Collapse
|
8
|
Koell B, Ludwig S, Weimann J, Waldschmidt L, Hildebrandt A, Schofer N, Schirmer J, Westermann D, Reichenspurner H, Blankenberg S, Conradi L, Lubos E, Kalbacher D. Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair. JACC Cardiovasc Interv 2022; 15:922-934. [PMID: 35512916 DOI: 10.1016/j.jcin.2021.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/18/2021] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the adverse impact of elevated postprocedural mitral valve pressure gradient (MPG) on outcome in a real-world population of patients with severe mitral regurgitation (MR) who underwent transcatheter mitral valve edge-to-edge repair (TEER). BACKGROUND TEER has become a routine treatment alternative for patients with severe MR at high surgical risk. The consequences of elevated MPG after TEER have been subject to controversial debates. METHODS All consecutive patients undergoing TEER for either severe degenerative MR (DMR) or functional MR (FMR) at a high-volume center between September 2008 and January 2020 were prospectively included and followed periodically. Postprocedural MPG by discharge transthoracic echocardiography was considered elevated at ≥5 mm Hg. The primary combined endpoint was death or heart failure rehospitalization after 5 years. RESULTS A total of 713 patients undergoing TEER (DMR, n = 265; FMR, n = 445) were included. Elevated postprocedural MPG was present in 37.0% of those with DMR (n = 98) and 22.0% of those with FMR (n = 98). In contrast to patients with FMR, 6-minute walk distance did not improve in patients with DMR with elevated MPG. Kaplan-Meier analyses did not demonstrate significant differences for the primary endpoint in patients with DMR (low vs elevated MPG, 67.3% vs 74.4%; P = 0.06) and those with FMR (78.6% vs 74.8%; P = 0.54). After adjustment, elevated MPG was an independent predictor of the primary endpoint in patients with DMR (HR: 1.59; 95% CI: 1.03-2.45; P = 0.034) but not in those with FMR (HR: 0.87; 95% CI: 0.63-1.22; P = 0.43). CONCLUSIONS Elevated postprocedural MPG is an independent predictor of adverse clinical and functional outcomes in patients with DMR but not in those with FMR.
Collapse
Affiliation(s)
- Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Annabel Hildebrandt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Hermann Reichenspurner
- DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
| |
Collapse
|
9
|
Saccocci M, Colli A. Actual perspective on off-pump transapical artificial chord implantation. J Card Surg 2022; 37:1250-1253. [PMID: 35182401 PMCID: PMC9303263 DOI: 10.1111/jocs.16330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
Mitral valve repair (MVR) is undisputedly associated with better clinical and functional outcomes than any other type of valve substitute. Conventional mitral valve surgery in dedicated high-volume centers can assure excellent results in terms of mortality and freedom from mitral regurgitation (MR) recurrence but requires cardiopulmonary bypass (CPB) and cardioplegic heart arrest. Trying to replicate the percentage of success of surgical MVR is the aim of all new transcatheter mitral dedicated devices. In particular, transapical beating-heart mitral valve repair by artificial chordae implantation with transesophageal echocardiography guidance is an expanding field. The safety and feasibility of the procedure have already been largely demonstrated with Neochord and more recently with Harpoon systems. Wang et al. present the outcomes of the first-in-human experience using a novel artificial chordae implantation device, the Mitralstitch system. Despite a quite small cohort of only 10 patients treated, 1-year results are satisfying and comparable with the early experience with former devices (4 patients with moderate or more MR recurrence). The comparison with surgical MVR is still unfavorable and requires further studies and significant procedure improvement. However, the device permits the treatment of anterior and posterior leaflets prolapse and performs quite easily edge-to-edge reparation. It will be interesting to evaluate longer follow-up in larger cohorts of patients as well as the possibility to shift to the transfemoral approach.
Collapse
Affiliation(s)
- Matteo Saccocci
- Unit of Cardiac Surgery-Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Andrea Colli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
10
|
Praz F, Vahanian A, Milojevic M, Beyersdorf F. Reply to García-Villarreal et al. Eur J Cardiothorac Surg 2021; 62:6459080. [PMID: 34893810 DOI: 10.1093/ejcts/ezab532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alec Vahanian
- UFR Médecine, Université de Paris, Paris, France.,LVTS INSERM U1148, GH Bichat, Paris, France
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center, University Hospital Freiburg, Freiburg, Germany.,Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| |
Collapse
|
11
|
Ali-Ghosh H, Barlow CW. Commentary: Biomechanical differences after mitral valve repair: Is it time to use the science? JTCVS Tech 2021; 10:252-253. [PMID: 34984385 PMCID: PMC8691929 DOI: 10.1016/j.xjtc.2021.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hani Ali-Ghosh
- Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Clifford William Barlow
- Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| |
Collapse
|
12
|
Nicoara A, Song P, Bollen BA, Paone G, Abernathy JJ, Taylor MA, Habib RH, Del Rio JM, Lauer RE, Nussmeier NA, Glance LG, Petty JV, Mackensen GB, Vener DF, Kertai MD. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2021 Update on Echocardiography. Ann Thorac Surg 2021; 113:13-24. [PMID: 34536378 DOI: 10.1016/j.athoracsur.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/05/2021] [Accepted: 09/07/2021] [Indexed: 11/01/2022]
Abstract
The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) is the world's premier clinical outcomes registry for adult cardiac surgery and a driving force for quality improvement in cardiac surgery. Echocardiographic data provide a wealth of hemodynamic, structural, and functional data and have been part of STS ACSD data collection since its inception. An increasing body of evidence suggests that the use of echocardiography in patients undergoing cardiac surgery has a positive impact on postoperative outcomes. In this report, we describe and summarize the type and rate of reporting of echocardiography-related variables in the STS ACSD, including the Adult Cardiac Anesthesiology Module, from July 2017 to December 2019 for the most frequently performed cardiac surgical procedures. With this review, we aim to increase awareness of the importance of collecting accurate and consistent echocardiography data in the STS ACSD and to highlight opportunities for growth and improvement.
Collapse
Affiliation(s)
- Alina Nicoara
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Pinping Song
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Bruce A Bollen
- International Heart Institute of Montana, Missoula Anesthesiology, PC, Missoula, Montana
| | - Gaetano Paone
- Department of Surgery, Emory University, Atlanta, Georgia
| | - James Jake Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mark A Taylor
- Anesthesiology Institute/Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert H Habib
- STS Research Center, The Society of Thoracic Surgeons, Chicago, Illinois
| | | | - Ryan E Lauer
- Department of Anesthesiology, Loma Linda University, Loma Linda, California
| | - Nancy A Nussmeier
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Joseph V Petty
- CHI Health Clinic Physician Enterprise Anesthesia, CHI Health Nebraska Heart, Lincoln, Nebraska
| | - G Burkhard Mackensen
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - David F Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children Hospital, Baylor College of Medicine, Houston, Texas
| | - Miklos D Kertai
- Department of Anesthesiology Vanderbilt University, Nashville, Tennessee.
| |
Collapse
|
13
|
Higuchi S, Orban M, Stolz L, Karam N, Praz F, Kalbacher D, Ludwig S, Braun D, Näbauer M, Wild MG, Neuss M, Butter C, Kassar M, Petrescu A, Pfister R, Iliadis C, Unterhuber M, Park SD, Thiele H, Baldus S, von Bardeleben RS, Schofer N, Massberg S, Windecker S, Lurz P, Hausleiter J. Impact of Residual Mitral Regurgitation on Survival After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC Cardiovasc Interv 2021; 14:1243-1253. [PMID: 33992551 DOI: 10.1016/j.jcin.2021.03.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to assess the impact of residual mitral regurgitation (resMR) on mortality with respect to left ventricular dilatation (LV-Dil) or right ventricular dysfunction (RV-Dys) in patients with secondary mitral regurgitation (SMR) who underwent mitral valve transcatheter edge-to-edge repair (TEER). BACKGROUND The presence of LV-Dil and RV-Dys correlates with advanced stages of heart failure in SMR patients, which may impact the outcome after TEER. METHODS SMR patients in a European multicenter registry were evaluated. Investigated outcomes were 2-year all-cause mortality and improvement in New York Heart Association functional class with respect to MR reduction, LV-Dil (defined as LV end-diastolic volume ≥159 ml), and RV-Dys (defined as tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio of <0.274 mm/mm Hg). RESULTS Among 809 included patients, resMR ≤1+ was achieved in 546 (67%) patients. Overall estimated 2-year mortality rate was 32%. Post-procedural resMR was significantly associated with mortality (p = 0.031). Although the improvement in New York Heart Association functional class persisted regardless of either LV-Dil or RV-Dys, the beneficial treatment effect of resMR ≤1+ on 2-year mortality was observed only in patients without LV-Dil and RV-Dys (hazard ratio: 1.75; 95% confidence interval: 1.03 to 3.00). CONCLUSIONS Achieving optimal MR reduction by TEER is associated with improved survival in SMR patients, especially if the progress in heart failure is not too advanced. In SMR patients with advanced stages of heart failure, as evidenced by LV-Dil or RV-Dys, the treatment effect of TEER on symptomatic improvement is maintained, but the survival benefit appears to be reduced.
Collapse
Affiliation(s)
- Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital, Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Sebastian Ludwig
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Universitätsklinik für Kardiologie, Inselspital, Bern, Switzerland
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital, Bern, Switzerland
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sang-Don Park
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Niklas Schofer
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany
| | | | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany.
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW To provide a critical review of the application and outcomes of surgical edge-to-edge (E2E) or Alfieri repair for mitral valvulopathy. RECENT FINDINGS The E2E repair is a surgical technique to address mitral regurgitation, particularly suited when the responsible mechanism is bileaflet prolapse combined with enlarged annular area. It can also be used for a range of mitral valve pathologies. Surgically, the technique has been employed as a bailout for unsuccessful repair including residual mitral regurgitation because of systolic anterior motion (SAM). E2E repair should be accompanied by a ring annuloplasty for long-term repair durability. The simplicity of this approach makes it an ideal strategy during minimally-invasive mitral valve repair. It may also be performed via a transaortic approach at the time of aortic valve surgery to address less-than-severe mitral regurgitation or to address residual SAM following myectomy for hypertrophic obstructive cardiomyopathy. We review the surgical indication, potential complications including risk of mitral stenosis and the long-term outcomes of E2E repair. SUMMARY The E2E surgical repair is a simple and effective surgical strategy to address a wide range of mitral regurgitation. This is an important technique in the surgical armamentarium especially in cases of minimally-invasive mitral valve surgery.
Collapse
|
15
|
Sideris K, Burri M, Prinzing A, Voss S, Krane M, Guenzinger R, Lange R, Voss B. Mitral valve repair with the edge-to-edge technique: A 20 years single-center experience. J Card Surg 2021; 36:1298-1304. [PMID: 33512725 DOI: 10.1111/jocs.15377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For tailored treatment of primary mitral regurgitation (MR), surgeons developed different repair techniques. One of them, the edge-to-edge repair has recently seen a revival, especially for Barlow's disease. METHODS This study was designed to assess the outcomes of the edge-to-edge technique in mitral valve (MV) repair. Preoperative, periprocedural, and postoperative data were prospectively collected in a dedicated database and analyzed retrospectively. RESULTS Between March 1999 and July 2019, a total of 152 patients (mean age: 60 ± 13) received an edge-to-edge repair combined with annuloplasty for degenerative MR at our institution. MR resulted from posterior leaflet prolapse in 23 patients (15.1%), anterior leaflet prolapse in 19 (12.5%), and bileaflet prolapse in 110 (72.4%). Of those who had a bileaflet prolapse, 91 (82.7%) had Barlow's disease. Follow-up was complete in 97.4% (6.4 ± 5.7 years). Echocardiographic assessment was achieved in 85.5% (5.1 ± 5.6 years). Overall survival after 10 years was 73.7 ± 5.0%. Twelve patients required valve-related reoperations due to ring dehiscence (n = 2), leaflet suture dehiscence (n = 2), progression of native valve disease (n = 6), or due to device failure (ring fracture) (n = 2). The cumulative incidence of valve-related reoperation at 10 years was 8.4 ± 3.0% (5.2 ± 4.1% in patients with Barlow's disease). At latest follow-up, echocardiography revealed excellent valve function with no or mild MR in 93 patients (88.6%). The mean gradient was 2.9 ± 1.3 mmHg at discharge and decreased to 2.4 ± 1.3 mmHg. Three patients (2.8%) had more than moderate MR. CONCLUSION Edge-to-edge MV repair is a simple method with excellent results in terms of valvular function and durability especially in patients with Barlow's disease.
Collapse
Affiliation(s)
- Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| | - Anatol Prinzing
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| | - Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| | - Markus Krane
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| | - Ralf Guenzinger
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstrasse, Munich, Germany
| |
Collapse
|
16
|
Li J, Zhao Y, Zhou T, Zhu K, Zhai J, Sun Y, Wei L, Ding W, Hong T, Lai H, Wang C. Learning curve of mitral valve repair: cumulative sum failure analysis from single high-volume center. J Thorac Dis 2020; 12:6563-6572. [PMID: 33282358 PMCID: PMC7711428 DOI: 10.21037/jtd-20-1960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Mitral valve (MV) repair has become the gold standard for treating degenerative mitral regurgitation (MR), yet the success rate of MV repair is still low in clinical practice. While studies focused on the learning process of MV repair are scarce, fully understanding the learning curve could provide valuable information for education and the quality control of MV repair, thus benefiting patients. This observational study aimed to evaluate the learning process and performances of individual surgeon for MV repair for degenerative mitral disease using data from a single high-volume center. Methods Profiles of patients who underwent MV repair for degenerative MR at our institution from January 2003 to December 2016 were analyzed retrospectively. Overall and individual learning curves for the repair rate and major adverse events were calculated using sequential probability cumulative sum failure analysis. Average learning curves for major adverse events and operative time were also analyzed, by calculating the average incidence of adverse events and operative time of all operations stratified by accumulated operation numbers of individual surgeon. Altogether, we evaluated 2,482 operations performed by 14 surgeons. Results There was an obvious learning curve for the repair rate at the institution and individual surgeon levels. Altogether, 50 to 200 operations were needed to overcome the repair rate learning curve, yet wide variation was observed among individual surgeons. The learning process for individual surgeons became faster after the turning point in the institutional learning curve appeared. No obvious learning curve was observed at the institution or individual level for major adverse events and in-hospital mortality. Conclusions The number of cases required to overcome the learning curve for repair rate is substantial, although there is marked variation among surgeons. Individuals’ learning curves accelerate as the institution accumulates experience. MV repair is safe in experienced high-volume center. Close monitoring is necessary when surgeons begin to practice new techniques.
Collapse
Affiliation(s)
- Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Zhao
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhou
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kai Zhu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junyu Zhai
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenjun Ding
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Hong
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
17
|
Lapenna E, Nisi T, Ruggeri S, Trumello C, Del Forno B, Schiavi D, Meneghin R, Castiglioni A, Alfieri O, De Bonis M. Edge-to-Edge Mitral Repair Associated With Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy. Ann Thorac Surg 2020; 110:783-789. [DOI: 10.1016/j.athoracsur.2020.03.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/08/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
|
18
|
Long-term results of the edge-to-edge repair for failed mitral valve repair as a bailout option. Gen Thorac Cardiovasc Surg 2020; 69:32-37. [PMID: 32654090 DOI: 10.1007/s11748-020-01433-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We evaluate the long-term clinical and echocardiographic outcomes of edge-to-edge (E2E) repair combined with mitral annuloplasty in our institute with degenerative mitral regurgitation (MR) up to 10 years. METHODS Twenty-six consecutive patients undergoing E2E mitral repair after failure of other conventional mitral repair technique. There were 16 (61.5%) male and the mean age was 52.2 ± 10.4 years. Mitral regurgitation was due to anterior leaflet prolapse in 12 (46.2%) patients, bileaflet prolapse in 9 (34.6%), and multiple segment posterior leaflet prolapse in 5 (19.2%). RESULTS There were no perioperative deaths. Follow-up was 100% complete. The mean length of follow-up was 8.7 ± 0.9 years (median 8.4 years, 6.8-10.1 years). Two patients required reoperation of the MV. The freedom from reoperation and ≥ Moderate MR at 10 years was 69.9 ± 11.7%. The freedom from reoperation, ≥ Moderate MR and mitral stenosis (MS) at 10 years was (59.6 ± 10.0) %. The mean transmitral pressure gradient (TMPG) was 6.1 ± 2.5 mmHg, which was significantly elevated compared with preoperative TTE (P = 0.004). The freedom from ≥ Moderate MS at 10 years was 76.9 ± 8.3%. There were no differences between patients with and without MS at follow-up regarding the echocardiographic parameters and clinical status. CONCLUSION There is a slowly progressive elevation of TMPG after E2E mitral repair, while mildly elevated TMPG can be tolerated in most patients. In appropriate patients, the E2E repair combined with annuloplasty provides an effective "bailout" choice.
Collapse
|
19
|
Comparison of Mitral Valve Replacement and Repair for Degenerative Mitral Regurgitation: a Meta-analysis and Implications for Transcatheter Mitral Procedures. Curr Cardiol Rep 2020; 22:79. [PMID: 32648008 DOI: 10.1007/s11886-020-01333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Surgical mitral valve repair is considered superior to replacement to treat primary mitral regurgitation. However, the heterogeneity of cohorts and the lack of consideration of confounding in the published literature raise potential biases. The aim of this study was to pool all available matched data comparing outcomes of mitral valve repair and replacement in the setting of primary mitral regurgitation. RECENT FINDINGS We searched Medline, Embase and the Cochrane Library Central Register of Controlled Trials to identify propensity-matched studies or reports with multivariable adjustment comparing repair and replacement in patients with primary mitral regurgitation. The primary outcome was all-cause mortality. DerSimonian and Laird random effects were used to perform the meta-analysis. Eight observational studies were selected including 4599 patients (3064 mitral repairs and 1535 replacements). Mean age ranged from 62 to 69 years, and the mean follow-up duration ranged between 3 and 9 years. Replacement was associated with an increased risk of long-term all-cause mortality compared to repair (HR of 1.68, 95% confidence interval 1.35-2.09, p < 0.001, τ2 = 0.03). Surgical era and atrial fibrillation impacted the risk of mortality but not mitral anatomy. Neither repair nor replacement impacted significantly on the risk of re-operation after mitral surgery (HR 1.18, 95% CI 0.85-1.63, p = 0.33, τ2 < 0.01). Mitral valve replacement is possibly associated with higher long-term mortality than mitral valve repair in primary mitral regurgitation but often used as a bailout option in more complex anatomy. Despite this observation, both techniques have similar risk of re-operation.
Collapse
|
20
|
De Bonis M, Zancanaro E, Lapenna E, Trumello C, Ascione G, Giambuzzi I, Ruggeri S, Meneghin R, Abboud S, Agricola E, Del Forno B, Buzzatti N, Monaco F, Pappalardo F, Castiglioni A, Alfieri O. Optimal versus suboptimal mitral valve repair: late results in a matched cohort study. Eur J Cardiothorac Surg 2020; 58:328-334. [DOI: 10.1093/ejcts/ezaa103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
After mitral repair for degenerative mitral regurgitation (MR), no or mild (≤1+/4+) residual MR should remain. Occasionally patients are left with more than mild residual MR (>1+/4+) for a number of reasons. The aim of this study was to assess the late implications of such a suboptimal repair in a matched cohort study.
METHODS
From 2006 to 2013, a total of 2158 patients underwent mitral repair for degenerative MR in our institution. Fifty patients (2.3%) with residual MR >1+ at hospital discharge (study group) were matched up to 1:2 with 91 patients operated on during the same period who were discharged with MR ≤1+ (control group). The median follow-up was 8 years (interquartile range 6.3–10.1, longest 12.7 years). A comparative analysis of the outcomes in the 2 groups was performed.
RESULTS
Overall survival at 8 years was 87 ± 8% in the study group and 92 ± 3% in the control group (P = 0.23). There were 3 late deaths (6.0%) in the study group and 6 deaths (6.6%) in the control group. Freedom from reoperation was similar (P = 1.0). At 8 years the prevalence of MR ≥3+ was significantly higher in the study group (15.6% vs 2.1%, P < 0.001) as was the use of diuretics, beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers. Interestingly, even in the control group, a gradual progression of MR was observed because 13.3% of the patients had MR ≥2+ at 8 years with a significant increase over time (P < 0.001).
CONCLUSIONS
Residual MR more than mild at hospital discharge is associated with lower durability of mitral repair and the need for more medical therapy in the long term. However, even an initial optimal result does not completely arrest the progression of the degenerative process.
Collapse
Affiliation(s)
- Michele De Bonis
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edoardo Zancanaro
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Meneghin
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrin Abboud
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Division of Cardiology, Echocardiography Laboratory Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Pappalardo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Castiglioni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
21
|
Reichart D, Kalbacher D, Rübsamen N, Tigges E, Thomas C, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schäfer U, Lubos E. The impact of residual mitral regurgitation after MitraClip therapy in functional mitral regurgitation. Eur J Heart Fail 2020; 22:1840-1848. [DOI: 10.1002/ejhf.1774] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Daniel Reichart
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Daniel Kalbacher
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Nicole Rübsamen
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Eike Tigges
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Christina Thomas
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery University Heart & Vascular Center Hamburg Germany
| | | | - Stefan Blankenberg
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery University Heart & Vascular Center Hamburg Germany
| | - Ulrich Schäfer
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Edith Lubos
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| |
Collapse
|
22
|
Hesitate to approximate? J Thorac Cardiovasc Surg 2019; 159:e54-e55. [PMID: 31353102 DOI: 10.1016/j.jtcvs.2019.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/15/2019] [Indexed: 11/20/2022]
|
23
|
Rings and things: Choices in mitral valve repair. J Thorac Cardiovasc Surg 2019; 159:e54. [PMID: 31324424 DOI: 10.1016/j.jtcvs.2019.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022]
|
24
|
Kim NY, Choi JB. Small rings and edge-to-edge technique elevate transmitral gradients in mitral valve repair. J Thorac Cardiovasc Surg 2019; 159:e53. [PMID: 31256965 DOI: 10.1016/j.jtcvs.2019.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/14/2019] [Accepted: 05/26/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Nan Yeol Kim
- Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine Hospital, Iksan, Republic of Korea
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine Hospital, Iksan, Republic of Korea
| |
Collapse
|
25
|
Richens D, Boulemden A, Skinner H. Repair of degenerative mitral regurgitation: An update. Glob Cardiol Sci Pract 2019; 2019:4. [PMID: 31024946 PMCID: PMC6472690 DOI: 10.21542/gcsp.2019.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The recent development of catheter-based therapies for structural valve disease, such as mitral-TAVI, MitraClip and left atrial appendage occlusion devices, makes a review of surgery for degenerative mitral valve disease timely. In this personal perspective we discuss the evolution of mitral valve repair, the core principles involved and the evidence base behind it through the lens of a single UK-based surgical team operating for a quarter century, illustrating the techniques, outcomes and some of the pitfalls of intervention.
Collapse
Affiliation(s)
- David Richens
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - Anas Boulemden
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| | - Henry Skinner
- Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, UK
| |
Collapse
|
26
|
Patzelt J, Zhang Y, Magunia H, Ulrich M, Jorbenadze R, Droppa M, Zhang W, Lausberg H, Walker T, Rosenberger P, Seizer P, Gawaz M, Langer HF. Improved mitral valve coaptation and reduced mitral valve annular size after percutaneous mitral valve repair (PMVR) using the MitraClip system. Eur Heart J Cardiovasc Imaging 2019; 19:785-791. [PMID: 28977372 DOI: 10.1093/ehjci/jex173] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/13/2017] [Indexed: 12/24/2022] Open
Abstract
Aims Improved mitral valve leaflet coaptation with consecutive reduction of mitral regurgitation (MR) is a central goal of percutaneous mitral valve repair (PMVR) with the MitraClip® system. As influences of PMVR on mitral valve geometry have been suggested before, we examined the effect of the procedure on mitral annular size in relation to procedural outcome. Methods and results Geometry of the mitral valve annulus was evaluated in 183 patients undergoing PMVR using echocardiography before and after the procedure and at follow-up. Mitral valve annular anterior-posterior (ap) diameter decreased from 34.0 ± 4.3 to 31.3 ± 4.9 mm (P < 0.001), and medio-lateral (ml) diameter from 33.2 ± 4.8 to 32.4 ± 4.9 mm (P < 0.001). Accordingly, we observed an increase in MV leaflet coaptation after PMVR. The reduction of mitral valve ap diameter showed a significant inverse correlation with residual MR. Importantly, the reduction of mitral valve ap diameter persisted at follow-up (31.3 ± 4.9 mm post PMVR, 28.4 ± 5.3 mm at follow-up). Conclusion This study demonstrates mechanical approximation of both mitral valve annulus edges with improved mitral valve annular coaptation by PMVR using the MitraClip® system, which correlates with residual MR in patients with MR.
Collapse
Affiliation(s)
- Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Yingying Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Miriam Ulrich
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Rezo Jorbenadze
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Michal Droppa
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Wenzhong Zhang
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Henning Lausberg
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Tobias Walker
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| |
Collapse
|
27
|
Buzzatti N, Van Hemelrijck M, Denti P, Ruggeri S, Schiavi D, Scarfò IS, Reser D, Taramasso M, Weber A, La Canna G, De Bonis M, Maisano F, Alfieri O. Transcatheter or surgical repair for degenerative mitral regurgitation in elderly patients: A propensity-weighted analysis. J Thorac Cardiovasc Surg 2019; 158:86-94.e1. [PMID: 30797588 DOI: 10.1016/j.jtcvs.2019.01.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the outcomes of MitraClip and surgical mitral repair in low-intermediate risk elderly patients affected by degenerative mitral regurgitation (DMR). METHODS We retrospectively selected patients aged ≥75 years, with Society of Thoracic Surgeons Predicted Risk Of Mortality (STS-PROM) <8%, submitted to MitraClip (n = 100) or isolated surgical repair (n = 206) for DMR at 2 centers between January 2005 and May 2017. To adjust for baseline imbalances, we used a propensity score model for average treatment effect on survival. RESULTS After weighting, MitraClip showed fewer postoperative complications (P < .05) but increased residual mitral regurgitation (MR) ≥2 (27.0% vs 2.8%, P < .001) compared with surgery. One-year survival was greater after MitraClip compared with surgery (97.6% vs 95.3%, hazard ratio [HR], 0.09; confidence interval [CI], 0.02-0.37, P = .001), whereas 5-year survival was lower (34.5% vs 82.2% respectively, HR, 4.12; CI, 2.31-7.34, P < .001). Greater STS-PROM (HR, 1.18; CI, 1.12-1.24, P < .001) and MR ≥3+ recurrence (HR, 2.18; CI, 1.07-4.48, P = .033) were associated with reduced survival. 5-year MR ≥3+ was more frequent after MitraClip compared with surgery: 36.9% versus 3.9%, odds ratio, 11.4; CI, 4.40-29.68, P < .001. CONCLUSIONS In elderly patients affected by DMR and STS-PROM <8%, the average effect of MitraClip resulted in lower acute postoperative complications and improved 1-year survival compared with surgery. However, MitraClip was associated with greater MR recurrence and reduced survival beyond 1 year. Long-term survival was impaired by patients' greater risk profile and MR recurrence. Early results are promising, but in the setting of operable patients with life expectancy beyond 1 year, the quality bar for transcatheter mitral repair needs to be raised.
Collapse
Affiliation(s)
- Nicola Buzzatti
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
| | | | - Paolo Denti
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Ruggeri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Schiavi
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Diana Reser
- Cardiac Surgery Department, Zurich University Hospital, Zurich, Switzerland
| | - Maurizio Taramasso
- Cardiac Surgery Department, Zurich University Hospital, Zurich, Switzerland
| | - Alberto Weber
- Cardiac Surgery Department, Zurich University Hospital, Zurich, Switzerland
| | - Giovanni La Canna
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maisano
- Cardiac Surgery Department, Zurich University Hospital, Zurich, Switzerland
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
28
|
Calafiore AM, Totaro A, Foschi M, Di Mauro M. Durability of mitral valve repair for degenerative mitral regurgitation: is it gold all that glitters? ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S10. [PMID: 30613586 DOI: 10.21037/atm.2018.08.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Antonio M Calafiore
- Department of Cardiac Surgery and Cardiology, Pope John Paul II Foundation, Campobasso, Italy
| | - Antonio Totaro
- Department of Cardiac Surgery and Cardiology, Pope John Paul II Foundation, Campobasso, Italy
| | | | - Michele Di Mauro
- Cardiac Surgery and Cardiology, API Madonna del Ponte, Lanciano, Italy
| |
Collapse
|
29
|
Buzzatti N, Denti P, Scarfò IS, Giambuzzi I, Schiavi D, Ruggeri S, Castiglioni A, De Bonis M, La Canna G, Alfieri O. Mid‐term outcomes (up to 5 years) of percutaneous edge‐to‐edge mitral repair in the real‐world according to regurgitation mechanism: A single‐center experience. Catheter Cardiovasc Interv 2018; 94:427-435. [DOI: 10.1002/ccd.28029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Nicola Buzzatti
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| | - Paolo Denti
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| | | | - Ilaria Giambuzzi
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| | - Davide Schiavi
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| | - Stefania Ruggeri
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| | | | - Michele De Bonis
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| | - Giovanni La Canna
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| | - Ottavio Alfieri
- Department of Cardiac SurgerySan Raffaele Scientific Institute Milan Italy
| |
Collapse
|
30
|
Secondary mitral regurgitation: percutaneous edge-to-edge repair on the cutting edge? Curr Opin Cardiol 2018; 34:185-193. [PMID: 30575648 DOI: 10.1097/hco.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Secondary mitral regurgitation commonly complicates heart failure. Although the evidence for its management is most robust for treating the underlying cardiomyopathy, treatment aimed at additionally reducing the severity of mitral regurgitation with a percutaneous edge-to-edge device, MitraClip, has recently emerged. RECENT FINDINGS Despite the use of contemporary evidence-based heart failure therapies, patients with secondary mitral regurgitation and heart failure continue to remain at high risk for adverse clinical events; in both the MITRA-FR and COAPT trials, an extremely high event rate was evident in the medically managed arms over the respective 12-24-month follow-up. Data supporting the use of MitraClip to mitigate adverse outcomes in secondary mitral regurgitation is, however, conflicting. In MITRA-FR no difference was noted between MitraClip compared with the medically managed arm for the composite of all-cause death or heart failure hospitalization at 12 months. However, in COAPT, a significant reduction in the rate of heart failure re-hospitalization over 2 years was evident with MitraClip compared with medical therapy alone. SUMMARY Recommendations exist for the use of MitraClip in patients with primary mitral regurgitation and prohibitive surgical risk. However, with the divergent results of two recent high-quality randomized trials, its role in patients with secondary mitral regurgitation remains controversial.
Collapse
|
31
|
Transcatheter Mitral Valve Intervention for Chronic Mitral Regurgitation: A Plethora of Different Technologies. Can J Cardiol 2018; 34:1200-1209. [DOI: 10.1016/j.cjca.2018.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023] Open
|
32
|
Choudhary SK, Abraham A, Bhoje A, Gharde P, Sahu M, Talwar S, Airan B. Transaortic edge-to-edge mitral valve repair for moderate secondary/functional mitral regurgitation in patients undergoing aortic root/valve intervention. J Thorac Cardiovasc Surg 2017; 154:1624-1629. [DOI: 10.1016/j.jtcvs.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/04/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
|
33
|
Leaflet repair techniques in mitral valve reconstruction. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
34
|
De Bonis M, Lapenna E, Del Forno B, Di Sanzo S, Giacomini A, Schiavi D, Vicentini L, Latib A, Pozzoli A, Pappalardo F, La Canna G, Alfieri O. Minimally invasive or conventional edge-to-edge repair for severe mitral regurgitation due to bileaflet prolapse in Barlow’s disease: does the surgical approach have an impact on the long-term results?†. Eur J Cardiothorac Surg 2017; 52:131-136. [DOI: 10.1093/ejcts/ezx032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/03/2017] [Indexed: 11/14/2022] Open
|
35
|
Bail DHL. Treatment of functional mitral regurgitation by percutaneous annuloplasty using the Carillon Mitral Contour System-Currently available data state. J Interv Cardiol 2017; 30:156-162. [PMID: 28247436 DOI: 10.1111/joic.12370] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this study is to provide a systematic review of currently available data about the percutaneous trans-coronary-venous mitral annuloplasty with the Carillon Mitral Contour System. METHOD A systematic literature search was conducted using the common medical and scientific databases. The documented parameters included among others grade of mitral regurgitation (MR), vena contracta (VC), effective regurgitant orifice area (EROA), 6 minute-walk-test (6MWT), NYHA-classification, and Quality of Life (QoL) at baseline, 30 days and in the long-term follow-up. RESULTS The exact total number of successfully implantations with available data remains unclear because so many publications are either of the same institution or study group, or they present overlapping results. Reduction of functional mitral regurgitation (FMR) was associated with significant inverse left-ventricular (LV)) remodeling, improvement in 6MWT, QoL and NYHA-class during the 12-month follow-up. In almost half of the enrolled patients, the Carillon System could not be implanted or had to be removed due to coronary compromission. Adverse advent rate (AE) ranged between 2.8-39%. CONCLUSIONS Results with regard to reduction of MR and inverse LV remodeling have been remarkable. Indication and selection criteria for suitable patients, the expected complications, and the long-term results with regard to survival and quality of life still remain unclear. The available results do not establish superiority of the Carillon Mitral Contour System and support the lack of a clear benefit. The approach with the Carillon Mitral Contour System should be limited to participants of prospective and randomized trials.
Collapse
|
36
|
Simplified mitral valve repair in pediatric patients with connective tissue disorders. J Thorac Cardiovasc Surg 2017; 153:399-403. [DOI: 10.1016/j.jtcvs.2016.09.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/30/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022]
|
37
|
Obadia JF, Basillais N, Armoiry X, Grinberg D, Dondas A, Barthelet M, Derimay F, Rioufol G, Finet G, Pozzi M. Hypertrophic cardiomyopathy: the edge-to-edge secures the correction of the systolic anterior motion. Eur J Cardiothorac Surg 2016; 51:638-643. [DOI: 10.1093/ejcts/ezw385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/26/2016] [Indexed: 01/04/2023] Open
|
38
|
Kaneko H, Neuss M, Weissenborn J, Butter C. Impact of residual mitral regurgitation after MitraClip implantation. Int J Cardiol 2016; 227:813-819. [PMID: 27823895 DOI: 10.1016/j.ijcard.2016.10.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/20/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND MitraClip (MC) is an alternative treatment for mitral regurgitation (MR). Although residual MR is common after MC, little was known about the impact of residual MR after MC. METHODS We examined 255 consecutive patients who underwent MC. The primary endpoint was the composite endpoint including all-cause death, left ventricular (LV) assist device, and mitral valve surgery. RESULTS Procedure failure defined as unsuccessful MC implantation (n=6) and residual MR ≥3+ (n=19) was associated with worse outcomes including the primary endpoint and all-cause death than those with acute procedure success (APS) defined as residual MR 2+ (n=125) or 1+ (n=105). Among patient with APS, background characteristics including age, MR etiology, heart failure severity, and LV function were not different. Although MR grade and NT-pro BNP level at 6months after MC were higher in patients with residual MR 2+, there was no significant difference in the incidence of the primary endpoint and all-cause death. Subanalysis showed that the primary endpoint occurred more frequently in patients with MR 2+ in patients with LV ejection fraction ≤40%, chronic kidney disease, and baseline NYHA-class IV. CONCLUSION Procedure failure was associated with adverse outcomes after MC. Among patients with APS, residual MR 2+ was not significantly associated with overall worse outcomes than residual MR 1+. However, residual MR 2+ was associated with poorer prognosis in patients with impaired LV function, renal dysfunction, and severe heart failure, suggesting that the optimal endpoint of MC procedure should be individualized according to each patient's baseline characteristic.
Collapse
Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiology, Heart Center Brandenburg, Germany; Department of Cardiology, Medical School Brandenburg, Germany
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Germany; Department of Cardiology, Medical School Brandenburg, Germany
| | - Jens Weissenborn
- Department of Cardiology, Heart Center Brandenburg, Germany; Department of Cardiology, Medical School Brandenburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Germany; Department of Cardiology, Medical School Brandenburg, Germany.
| |
Collapse
|
39
|
Abdelrahman N, Chowdhury MA, Al Nooryani A, Elabbassi W. A case of dilated cardiomyopathy and severe mitral regurgitation treated using a combined percutaneous approach of MitraClip followed by CARILLON® mitral contour system. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:578-581. [PMID: 27543418 DOI: 10.1016/j.carrev.2016.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022]
Abstract
Functional mitral regurgitation (FMR) is common in severe heart failure. Medical therapy is the standard of care since the role of surgery is less established. Various trans-catheter percutaneous techniques may avoid the risks of surgery; such as edge-to-edge repair using MitraClip system (Abbott Vascular, Illinois, USA) and CARILLON® Mitral Contour System® (Model XE2; Cardiac Dimensions., Kirkland, WA, USA). We present the case of a 41-year-old man with severe dilated cardiomyopathy, NYHA IIIb, and grade 3 MR. Due to high surgical risk (logistic EuroScore 35.1) he initially underwent single MitraClip insertion with significant echocardiographic and clinical improvement (MR reduced from 3+ to 1+, NYHA classes III to II). Fifteen months later, he developed heart failure symptoms due to recurrence of severe MR and was retreated with percutaneous CARILLON® Mitral Contour System® with resolution of MR and doing well at nine-month follow-up. A combined approach of MitraClip followed by percutaneous mitral annuloplasty demonstrated clinically meaningful reduction of MR and resulted in significant symptomatic improvement for up to 6months. Follow-up for longer period is warranted to ensure sustained favorable outcome.
Collapse
Affiliation(s)
| | | | | | - Wael Elabbassi
- Cardiology Department, Al Qassimi Hospital, Sharjah, UAE.
| |
Collapse
|
40
|
Buzzatti N, De Bonis M, Denti P, Barili F, Schiavi D, Di Giannuario G, La Canna G, Alfieri O. What is a “good” result after transcatheter mitral repair? Impact of 2+ residual mitral regurgitation. J Thorac Cardiovasc Surg 2016; 151:88-96. [DOI: 10.1016/j.jtcvs.2015.09.099] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
|
41
|
da Rocha e Silva JG, Spampinato R, Misfeld M, Seeburger J, Pfanmüller B, Eifert S, Mohr FW, Borger MA. Barlow's Mitral Valve Disease: A Comparison of Neochordal (Loop) and Edge-To-Edge (Alfieri) Minimally Invasive Repair Techniques. Ann Thorac Surg 2015; 100:2127-33; discussion 2133-5. [DOI: 10.1016/j.athoracsur.2015.05.097] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/12/2015] [Accepted: 05/15/2015] [Indexed: 11/29/2022]
|
42
|
Pozzoli A, Vicentini L, De Bonis M, Di Giannuario G, La Canna G, Alfieri O. Contemporary application of the edge-to-edge repair. Ann Cardiothorac Surg 2015; 4:376-9. [PMID: 26309849 DOI: 10.3978/j.issn.2225-319x.2014.12.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/24/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Alberto Pozzoli
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Luca Vicentini
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Michele De Bonis
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Giovanni La Canna
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| |
Collapse
|
43
|
Rana BS, Calvert PA, Punjabi PP, Hildick-Smith D. Role of percutaneous mitral valve repair in the contemporary management of mitral regurgitation. Heart 2015; 101:1531-9. [PMID: 26101091 DOI: 10.1136/heartjnl-2014-306256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/01/2015] [Indexed: 11/04/2022] Open
Abstract
Percutaneous mitral valve (MV) repair has been performed in over 20,000 patients worldwide. As clinical experience in this technique grows indications for its use are being defined. Mitral regurgitation (MR) encompasses a complex heterogeneous group and its treatment is governed by determining a clear understanding of the underlying aetiology. Surgical MV repair remains the gold standard therapy for severe MR. However in select groups of high-risk surgical patients, a percutaneous approach to MV repair is establishing its role. This review gives an overview of the published data in percutaneous MV repair and its impact on the contemporary management of MR.
Collapse
Affiliation(s)
- Bushra S Rana
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridgeshire, UK
| | - Patrick A Calvert
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK University of Birmingham, Birmingham, UK
| | - Prakash P Punjabi
- Cardiothoracic Department, Hammersmith Hospital, Imperial College London, London, UK
| | | |
Collapse
|
44
|
Antunes MJ. MitraClip therapy and surgical edge-to-edge repair in patients with severe left ventricular dysfunction and secondary mitral regurgitation: is the solution here? Eur J Cardiothorac Surg 2015; 49:263-4. [PMID: 25769465 DOI: 10.1093/ejcts/ezv078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Manuel J Antunes
- Center of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal
| |
Collapse
|
45
|
|
46
|
BAIL DOROTHEEH. (Meta)-Analysis of Safety and Efficacy Following Edge-to-Edge Mitral Valve Repair Using the MitraClip System. J Interv Cardiol 2015; 28:69-75. [DOI: 10.1111/joic.12168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- DOROTHEE H.L. BAIL
- Competence-Center Quality Assurance; Medical Service of Statutory Healthcare Insurance; Tuebingen and Stuttgart; Germany
| |
Collapse
|
47
|
Buzzatti N, Maisano F, Latib A, Taramasso M, Denti P, La Canna G, Colombo A, Alfieri O. Comparison of outcomes of percutaneous MitraClip versus surgical repair or replacement for degenerative mitral regurgitation in octogenarians. Am J Cardiol 2015; 115:487-92. [PMID: 25529545 DOI: 10.1016/j.amjcard.2014.11.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 11/29/2022]
Abstract
Octogenarians affected by mitral regurgitation (MR) are an increasing high-risk population. MitraClip repair is emerging as a promising option for this kind of patients. In this retrospective study, the outcomes of patients aged ≥80 years, affected by isolated degenerative MR, who underwent isolated transcatheter (n = 25) or surgical (n = 35, 29 repairs and 6 replacements) mitral intervention from September 2008 to February 2014 were compared. MitraClip patients had higher mean age (84.5 ± 3.2 vs 81.9 ± 2.0 years, p <0.01), median Logistic Euroscore 19.4 (11.1 to 29.0) versus 8.4 (7.0 to 10.1) (p <0.01), median Society of Thoracic Surgeons predicted mortality 5.3 (3.5 to 6.6) versus 2.7 (2.3 to 3.9) (p <0.01), and more advanced New York Heart Association class (III to IV in 68% vs 37%, p = 0.02). At 30 days, 1 death occurred in the MitraClip group (p = 0.2). MitraClip was associated with significantly less complications (p <0.05) but more residual MR >2 (p <0.01). Two-year actuarial survival rate was 90% for MitraClip versus 97% for surgery (p <0.01). Higher Society of Thoracic Surgeons mortality was associated with reduced follow-up survival rate (p = 0.01). Two-year actuarial freedom from MR >2 was 70% versus 100%, respectively (p <0.01). New York Heart Association class and quality of life improved after MitraClip and were similar to surgical patients. Recurrent MR >2 was not significantly associated with follow-up mortality in this elderly setting. After the introduction of MitraClip, octogenarian patients with isolated degenerative MR receiving mitral treatment significantly increased (p <0.01). In conclusion, MitraClip patients, despite being older, more symptomatic, and affected by more co-morbidities showed significantly reduced postoperative complications. Two-year mortality was higher in the MitraClip group likely because of co-morbidities. Transcatheter mitral repair resulted in more octogenarians being treated compared with the past.
Collapse
Affiliation(s)
- Nicola Buzzatti
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Azeem Latib
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni La Canna
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
48
|
Abstract
Mitral regurgitation is one of the most common forms of heart valve disorder, which may result in heart failure. Due to the rapid ageing of the population, surgical repair and replacement treatments, which have represented an effective treatment in the past, are now unsuitable for about half of symptomatic patients, who are judged high-risk. Encouraged by the positive experience with transcatheter aortic valves and percutaneous reconstructive mitral treatments, a number of research groups are currently engaged in the development of minimally invasive approaches for the functional replacement of the mitral valve. The first experiences have clearly demonstrated that the approach is feasible and promising, though significant progress is still required in the prostheses design and implantation procedures before the treatment can establish as a safe and effective solution. This review analyses the devices currently at a most advanced stage of development, describing their main features and the technical solutions that they adopt in order to respond to the functional requirements of the most challenging of the heart valves.
Collapse
|
49
|
Vahanian A, Himbert D, Iung B. Unmet clinical needs in transcatheter mitral valve interventions in 2014. EUROINTERVENTION 2014; 10 Suppl U:U101-5. [PMID: 25256320 DOI: 10.4244/eijv10sua14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alec Vahanian
- Cardiology Department, Bichat Hospital, Paris, France, University Paris VII, Paris, France
| | | | | |
Collapse
|
50
|
Pragliola C, Chello M, Gaudino M, Mazza A, Cellini C, Spadaccio C, Covino E. Long-term results of an open flexible prosthetic band for mitral insufficiency. Asian Cardiovasc Thorac Ann 2014; 22:811-5. [PMID: 24585286 DOI: 10.1177/0218492314520747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND use of a prosthetic ring is an integral part of any mitral valve repair and can influence the long-term stability of the results. We evaluated the long-term results of the AnnuloFlex ring implanted as an open flexible band in patients affected by degenerative mitral disease. METHODS between 2001 and 2010, 82 patients (52 women, 30 men) with a mean age of 62 years, underwent repair of a prolapsing mitral valve with an AnnuloFlex band. One patient was reoperated on for a technical error and received a mechanical prosthesis, 3 were missing at follow-up, and the other 78 were prospectively followed up with clinical interviews and transthoracic echocardiography. RESULTS the mean follow-up was 7.0 ± 1.8 years. Six patients died; 2 deaths were considered valve-related. The overall survival estimate at 10 years was 88.6% (95% confidence interval: 76.1%-94.8%). Freedom from endocarditis was 97.1% (95% confidence interval: 89.1%-98.5%). Freedom from thrombosis or hemorrhage was 93.7% (95% confidence interval: 81.6%-97.9%). Freedom from new or increased regurgitation was 93.1% (95% confidence interval: 87.3%-97.3%). The cumulative freedom from any valve-related event was 78.6% (95% confidence interval: 69.7%-97.1%). A single case of systolic anterior motion occurred before hospital discharge. CONCLUSION the long-term results of the AnnuloFlex band are excellent and stable.
Collapse
Affiliation(s)
- Claudio Pragliola
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Chello
- Division of Cardiac Surgery, Università Campus Biomedico, Rome, Italy
| | - Mario Gaudino
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Cellini
- Department of Cardiovascular Science, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Elvio Covino
- Division of Cardiac Surgery, Università Campus Biomedico, Rome, Italy
| |
Collapse
|