501
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Sündermann SH, Falk V. Chirurgische Behandlung der sekundären Mitralklappeninsuffizienz. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0147-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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502
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Abstract
Severe mitral regurgitation is a common and complex disease that is associated with an adverse prognosis. For decades, surgical treatment has been the standard of care. Recently, multiple technologies for transcatheter mitral therapy have emerged, with the potential for both repair and replacement in patients with native mitral regurgitation. Transcatheter mitral technologies have potential as solutions for unmet clinical needs. Further rigorous clinical studies are needed to determine their efficacy and safety, as well as the appropriate patient candidates. These evaluations will help to define the role of transcatheter mitral therapy as a potentially exciting new strategy to improve the lives of patients with mitral regurgitation.
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503
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504
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Torii S, Romero ME, Mori H, Harari E, Kolodgie FD, Finn AV, Virmani R. The spectrum of mitral valve pathologies: relevance for surgical and structural interventions. Expert Rev Cardiovasc Ther 2017; 15:525-535. [DOI: 10.1080/14779072.2017.1348230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sho Torii
- CVPath Institute, Inc., Gaithersburg, MD, USA
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505
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Sáez de Ibarra Sánchez JI. Reparación mitral con anillos asimétricos. Técnica de referencia para tratar la insuficiencia mitral isquémica crónica. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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506
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Hernandez-Vaquero D. Insuficiencia mitral isquémica o funcional ¿a usted cómo le gusta? CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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507
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Vemulapalli S, Lippmann SJ, Krucoff M, Hernandez AF, Curtis LH, Foster E, Qasim A, Wang A, Glower DD, Feldman T, Hammill BG. Cardiovascular events and hospital resource utilization pre- and post-transcatheter mitral valve repair in high-surgical risk patients. Am Heart J 2017. [PMID: 28625371 DOI: 10.1016/j.ahj.2017.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
MitraClip is an approved therapy for mitral regurgitation (MR); however, health care resource utilization pre- and post-MitraClip remains understudied. METHODS Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued-Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction, heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US dollars, were calculated, and event rate ratios and cost ratios were estimated with multivariable modeling. RESULTS Among 403 linked patients, the mean age was 80 years, 60% were male, mean baseline left ventricular ejection fraction was 49.6%, 83.3% were New York Heart Association class III/IV, 78.2% were MR grade 3+/4+, and 63.3% had functional MR. All-cause hospitalization decreased from 1,854 to 1,435/1,000 person-years (P<.001). HF hospitalization decreased following MitraClip (749 vs 332/1000 person-years, P<.001), but bleeding increased (199 vs 298/1000 person-years, P<.001). Changes in stroke and myocardial infarction were not statistically significant. Overall mean Medicare costs per patient were similar pre- and post-MitraClip, although there was a significant decrease in mean costs among those that survived a full year after MitraClip ($18,131 [SD $25,130] vs $11,679 [SD $22,486], P=.02). CONCLUSIONS MitraClip was associated with a reduced rate of all-cause and HF hospitalizations and an increased rate of bleeding hospitalizations. One-year Medicare costs were reduced in those who survived a full year after the MitraClip procedure. Payors and providers seeking to reduce HF hospitalizations and associated Medicare costs may consider MitraClip among appropriate patients likely to survive 1 year.
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508
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Chiarito M, Pagnesi M, Martino EA, Pighi M, Scotti A, Biondi-Zoccai G, Latib A, Landoni G, Mario CD, Margonato A, Maisano F, Feldman T, Alfieri O, Colombo A, Godino C. Outcome after percutaneous edge-to-edge mitral repair for functional and degenerative mitral regurgitation: a systematic review and meta-analysis. Heart 2017; 104:306-312. [PMID: 28663365 DOI: 10.1136/heartjnl-2017-311412] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Differences in terms of safety and efficacy of percutaneous edge-to-edge mitral repair between patients with functional and degenerative mitral regurgitation (MR) are not well established. We performed a systematic review and meta-analysis to clarify these differences. METHODS PubMed, EMBASE, Google scholar database and international meeting abstracts were searched for all studies about MitraClip. Studies with <25 patients or where 1-year results were not delineated between MR aetiology were excluded. This study is registered with PROSPERO. RESULTS A total of nine studies investigating the mid-term outcome of percutaneous edge-to-edge repair in patients with functional versus degenerative MR were included in the meta-analysis (n=2615). At 1 year, there were not significant differences among groups in terms of patients with MR grade≤2 (719/1304 vs 295/504; 58% vs 54%; risk ratio (RR) 1.12; 95% CI: 0.86 to 1.47; p=0.40), while there was a significantly lower rate of mitral valve re-intervention in patients with functional MR compared with those with degenerative MR (77/1770 vs 80/818; 4% vs 10%; RR 0.60; 95% CI: 0.38 to 0.97; p=0.04). One-year mortality rate was 16% (408/2498) and similar among groups (RR 1.26; 95% CI: 0.90 to 1.77; p=0.18). Functional MR group showed significantly higher percentage of patients in New York Heart Association class III/IV (234/1480 vs 49/583; 16% vs 8%; p<0.01) and re-hospitalisation for heart failure (137/605 vs 31/220; 23% vs 14%; p=0.03). No differences were found in terms of single leaflet device attachment (25/969 vs 20/464; 3% vs 4%; p=0.81) and device embolisation (no events reported in both groups) at 1 year. CONCLUSIONS This meta-analysis suggests that percutaneous edge-to-edge repair is likely to be an efficacious and safe option in patients with both functional and degenerative MR. Large, randomised studies are ongoing and awaited to fully assess the clinical impact of the procedure in these two different MR aetiologies.
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Affiliation(s)
- Mauro Chiarito
- Interventional Cardiology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Antonio Martino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Pighi
- Department of Cardiology, NIHR Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Andrea Scotti
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Latina, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Di Mario
- Department of Cardiology, NIHR Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Alberto Margonato
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Maisano
- Universitäts Spital Zurich, University Heart Center, Zurich, Switzerland
| | - Ted Feldman
- NorthShore University HealthSystem, Evanston, Illinois
| | - Ottavio Alfieri
- Vita-Salute San Raffaele University, Milan, Italy.,Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Cosmo Godino
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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509
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Benito-González T, Estévez-Loureiro R, Cardona JG, Prado APD, Ruiz MC, Fernández-Vázquez F. Percutaneous Treatment of Mitral and Tricuspid Regurgitation in Heart Failure. Interv Cardiol 2017. [DOI: 10.5772/intechopen.68493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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510
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Athanasopoulos LV, Casula RP, Punjabi PP, Abdullahi YS, Athanasiou T. A technical review of subvalvular techniques for repair of ischaemic mitral regurgitation and their associated echocardiographic and survival outcomes. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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511
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Fraldi M, Spadaccio C, Mihos CG, Nappi F. Analysing the reasons of failure of surgical mitral repair approaches-do we need to better think in biomechanics? J Thorac Dis 2017; 9:S661-S664. [PMID: 28740720 PMCID: PMC5505944 DOI: 10.21037/jtd.2017.06.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 11/06/2022]
Abstract
The failure of mitral valve repair procedures revealed in the outcomes of the recent randomized studies is suggesting the necessity for a better understanding of the biomechanical mechanisms underlying the failure of the surgical approaches. Use of biomechanical modelling and finite element analysis (FEA) in cardiovascular research is an important aid in this context. In our group we developed a biomechanical model taking into account all the component of the mitral valve functional unit including the valve leaflets, the annulus, the papillary muscles, the chordae tendinea and the ventricular geometry. The two-dimensional mathematical model was capable to predict some of the actual geometrical and mechanical features of the valvular and subvalvular apparatuses in physiological and pathological conditions providing the engineering quantitative relations between closing and tethering forces and the mechanisms governing the mitral valve unit function. This model might further become patient-specific by means of 3D reconstruction of clinical imaging. Images are first converted in a standard vector format (DICOM, etc.), then automatically translated in a "structural" finite element model and finally implemented in a finite element code. This allows for in silico simulations to virtually explore the effects of different surgical approaches at an early stage after the procedure, to help the operative decision processes, or to optimize the design of surgical implants.
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Affiliation(s)
- Massimiliano Fraldi
- Department of Structures for Engineering and Architecture and Interdisciplinary Research Center for Biomaterials, Università di Napoli “Federico II” Naples, Italy
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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512
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Mihos CG, Xydas S, Yucel E, Capoulade R, Williams RF, Mawad M, Garcia G, Santana O. Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies. J Thorac Dis 2017; 9:S582-S594. [PMID: 28740711 DOI: 10.21037/jtd.2017.05.56] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Combining a ring annuloplasty (Ring) with a mitral subvalvular intervention (Ring + subvalvular) in patients with secondary mitral regurgitation (MR) may improve mitral valve (MV) repair durability. However, the outcomes of this strategy compared with a Ring only, have not been clearly defined. METHODS A systematic review and meta-analysis was performed utilizing randomized controlled and propensity matched studies which compared a Ring + subvalvular versus Ring MV repair for the treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD), and the 95% confidence interval (CI) were calculated by the Mantel-Haenszel and inverse-variance methods, for clinical outcomes and echocardiographic measures of follow-up MR, left ventricular (LV) reverse remodeling, and MV apparatus geometry. RESULTS Five studies were identified, with a total of 397 patients. Baseline characteristics were similar between groups, and all patients had moderate to severe secondary MR, with the vast majority in the setting of ischemic cardiomyopathy. A Ring + subvalvular repair consisted of papillary muscle approximation (n=2), papillary muscle relocation (n=2), or secondary chordal cutting (n=1). Follow-up ranged from 10.1 (mean range =0.25-42) to 69 [interquartile range (IQR) =23-82] months. When compared with Ring only at last follow-up, a Ring + subvalvular MV repair was associated with: (I) a smaller MR grade (MD =-0.44, 95% CI -0.69 to -0.19; P=0.0005); (II) a reduced risk of moderate or greater recurrent MR (RR =0.43, 95% CI, 0.27-0.66; P=0.0002); (III) a smaller mean LV end-diastolic diameter (MD =-3.56 mm, 95% CI -5.40 to -1.73; P=0.0001) and a greater ejection fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV apparatus geometry. There were no differences in operative mortality, post-operative morbidity, or follow-up survival between surgical approaches. CONCLUSIONS When compared with Ring only, a Ring + subvalvular MV repair is associated with greater LV reverse remodeling and systolic function, less recurrence of moderate or greater MR, and an improved geometry of the MV apparatus at short and mid-term follow-up.
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Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steve Xydas
- Columbia University Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy F Williams
- Columbia University Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Maurice Mawad
- Columbia University Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Guillermo Garcia
- Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
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513
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Nappi F, Spadaccio C, Chello M, Mihos CG. Papillary muscle approximation in mitral valve repair for secondary MR. J Thorac Dis 2017; 9:S635-S639. [PMID: 28740718 DOI: 10.21037/jtd.2017.06.98] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ischemic mitral regurgitation (IMR) is a complex disorder occurring after a myocardial infarction and affecting both the mitral valvular and subvalvular apparati. Several abnormalities can be detected in IMR as annular dilatation, leaflet tethering with impaired coaptation and papillary muscle (PM) displacement along a posterior, apical or lateral vectors. Treatments available include, beside myocardial revascularization, mitral-valve repair or chordal-sparing replacement. Repair is normally achieved downsizing the mitral valve annulus with a rigid or semirigid ring. However, considering the involvement of the subvalvular apparatus, techniques addressing the PM have been developed. The rationale at the basis of this strategy relies in the possibility to reduce the interpapillary muscle distance restoring the geometry of the left ventricle (LV) and ultimately resolving the leaflet tethering at the basis of IMR. Subvalvular apparatus surgical approaches include the papillary muscle approximation (PMA), surgical relocation and PM sling. Improved outcomes in terms of postoperative positive left ventricular remodeling and recurrence of mitral regurgitation have been reported, but more investigations are required to confirm the efficacy of subvalvular apparatus surgery. Application of finite element analysis to improve preoperative and intraoperative planning and achieve a correct and durable repair by means of subvalvular surgery is an exciting new avenue in IMR research.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.,University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Massimo Chello
- Department of Cardiovascular Surgery, University Campus Bio-Medico, Rome, Italy
| | - Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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514
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Mihos CG, Yucel E, Santana O. The role of papillary muscle approximation in mitral valve repair for the treatment of secondary mitral regurgitation. Eur J Cardiothorac Surg 2017; 51:1023-1030. [PMID: 28040676 DOI: 10.1093/ejcts/ezw384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/26/2016] [Indexed: 01/28/2023] Open
Abstract
Secondary mitral regurgitation (MR) is present in up to half of patients with dilated cardiomyopathy, and is associated with a poor prognosis. It primarily results from progressive left ventricular remodelling, papillary muscle displacement and tethering of the mitral valve leaflets. Mitral valve repair with an undersized ring annuloplasty is the reparative procedure of choice in the treatment of secondary MR. However, this technique is associated with a 30-60% incidence of recurrent moderate or greater MR at mid-term follow-up, which results in progressive deterioration of left ventricular function and increased morbidity. Combined mitral valve repair and papillary muscle approximation has been applied in order to address both the annular and subvalvular dysfunction that coexist in secondary MR, which include graft and suture-based techniques. Herein, we provide a systematic review of the published literature regarding the technical aspects, clinical application, and outcomes of mitral valve repair with combined ring annuloplasty and papillary muscle approximation for the treatment of secondary MR.
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Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Orlando Santana
- The Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
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515
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Alkhouli M, Alqahtani F, Aljohani S. Transcatheter mitral valve replacement: an evolution of a revolution. J Thorac Dis 2017; 9:S668-S672. [PMID: 28740722 DOI: 10.21037/jtd.2017.05.60] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Fahad Alqahtani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Sami Aljohani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
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516
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Javadikasgari H, Gillinov AM, Idrees JJ, Mihaljevic T, Suri RM, Raza S, Houghtaling PL, Svensson LG, Navia JL, Mick SL, Desai MY, Sabik JF, Blackstone EH. Valve Repair Is Superior to Replacement in Most Patients With Coexisting Degenerative Mitral Valve and Coronary Artery Diseases. Ann Thorac Surg 2017; 103:1833-1841. [DOI: 10.1016/j.athoracsur.2016.08.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 10/20/2022]
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517
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Nappi F, Spadaccio C, Mihos CG, Fraldi M. Biomechanics raises solution to avoid geometric mitral valve configuration abnormalities in ischemic mitral regurgitation. J Thorac Dis 2017; 9:S624-S628. [PMID: 28740716 PMCID: PMC5505935 DOI: 10.21037/jtd.2017.05.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/09/2017] [Indexed: 11/06/2022]
Abstract
Ischemic mitral regurgitation (IMR) is a form of mitral insufficiency that is characterized by papillary muscle (PM) displacement, leaflet tethering, reduced closing forces, and different degree of annular dilatation. Treatment of this condition includes mitral valve replacement or mitral valve repair with restrictive annuloplasty. Recent evidences in mitral valve repair showed that addressing only the annulus and neglecting the subvalvular apparatus provides a suboptimal operation with poor long-term results. However, the complexity of the geometrical aberrances occurring in IMR demands for more accurate analysis also involving the biomechanics underlying the failing mitral valve and subvalvular apparatus. Finite element analysis (FEA) is a powerful tool in this context and we developed a biomechanical model of mitral valve and subvalvular unit using 3D geometry of the leaflets, annulus, chordae and PM. After the application of structural properties of materials to these elements and simulation of systemic pressure loading, FEA could be used to directly determine biomechanical changes and geometry variations. We believe this approach can provide valuable information to better address the surgical treatment of IMR and answer some of the questions still pending in IMR management.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Massimiliano Fraldi
- Department of Structures for Engineering and Architecture and Interdisciplinary Research Center for Biomaterials, Università di Napoli “Federico II”, Naples, Italy
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518
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Yucel E, Santana O, Escolar E, Mihos CG. Cardioband for the treatment of secondary mitral regurgitation: a viable percutaneous option? J Thorac Dis 2017; 9:S665-S667. [PMID: 28740721 PMCID: PMC5505931 DOI: 10.21037/jtd.2017.04.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/12/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Esteban Escolar
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
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519
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Capoulade R, Piriou N, Serfaty JM, Le Tourneau T. Multimodality imaging assessment of mitral valve anatomy in planning for mitral valve repair in secondary mitral regurgitation. J Thorac Dis 2017; 9:S640-S660. [PMID: 28740719 PMCID: PMC5505945 DOI: 10.21037/jtd.2017.06.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 12/23/2022]
Abstract
Secondary mitral regurgitation (MR) is frequent valvular heart disease and conveys worse prognostic. Therapeutic surgical or percutaneous options are available in the context of severe symptomatic secondary MR, but the best approach to treat these patients remains unclear, given the lack of clear clinical evidence of benefit. A comprehensive evaluation of the mitral valve apparatus and the left ventricle (LV) has the ability to clearly define and characterize the disease, and thus determine the best option for the patient to improve its clinical outcomes, as well as quality of life and symptoms. The current report reviews the mitral valve (MV) anatomy, the underlying mechanisms associated with secondary MR, the related therapeutic options available, and finally the usefulness of a multimodality imaging approach for the planning of surgical or percutaneous mitral valve intervention.
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Affiliation(s)
- Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Nicolas Piriou
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
- Department of Nuclear Medicine, CHU Nantes, Nantes University, Nantes, France
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520
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Bogachev-Prokophiev A, Afanasyev A, Zheleznev S, Fomenko M, Sharifulin R, Kretov E, Karaskov A. Mitral valve repair or replacement in hypertrophic obstructive cardiomyopathy: a prospective randomized study†. Interact Cardiovasc Thorac Surg 2017; 25:356-362. [DOI: 10.1093/icvts/ivx152] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/21/2017] [Indexed: 01/24/2023] Open
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521
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Kuwata S, Taramasso M, Guidotti A, Nietlispach F, Maisano F. Ongoing and future directions in percutaneous treatment of mitral regurgitation. Expert Rev Cardiovasc Ther 2017; 15:441-446. [DOI: 10.1080/14779072.2017.1327349] [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] [Indexed: 10/19/2022]
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522
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Grayburn PA, Stoler RC, Mack MJ. The 2017 ACC/AHA Updated Valve Guidelines Regarding Mitral Regurgitation: The Guidelines Get it Right. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1326648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paul A. Grayburn
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX, USA
- The Heart Hospital Baylor Plano, Plano, TX, USA
| | - Robert C. Stoler
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX, USA
- The Heart Hospital Baylor Plano, Plano, TX, USA
| | - Michael J. Mack
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX, USA
- The Heart Hospital Baylor Plano, Plano, TX, USA
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Guideline evolution: Follow the data, update frequently, provide optimal evidence-based surgical therapy. J Thorac Cardiovasc Surg 2017; 153:1080-1081. [DOI: 10.1016/j.jtcvs.2017.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/04/2017] [Indexed: 11/21/2022]
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Kron IL, LaPar DJ, Acker MA, Adams DH, Ailawadi G, Bolling SF, Hung JW, Lim DS, Mack MJ, O'Gara PT, Parides MK, Puskas JD. 2016 update to The American Association for Thoracic Surgery (AATS) consensus guidelines: Ischemic mitral valve regurgitation. J Thorac Cardiovasc Surg 2017; 153:e97-e114. [DOI: 10.1016/j.jtcvs.2017.01.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 01/06/2023]
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Chamsi-Pasha MA, Little SH, Reardon MJ. The use of transcatheter mitral valve system: can we make mitral regurgitation better again? J Thorac Dis 2017; 9:1174-1177. [PMID: 28616265 DOI: 10.21037/jtd.2017.04.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mohammed A Chamsi-Pasha
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Stephen H Little
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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Capoulade R, Zeng X, Overbey JR, Ailawadi G, Alexander JH, Ascheim D, Bowdish M, Gelijns AC, Grayburn P, Kron IL, Levine RA, Mack MJ, Melnitchouk S, Michler RE, Mullen JC, O'Gara P, Parides MK, Smith P, Voisine P, Hung J. Impact of Left Ventricular to Mitral Valve Ring Mismatch on Recurrent Ischemic Mitral Regurgitation After Ring Annuloplasty. Circulation 2017; 134:1247-1256. [PMID: 27777294 DOI: 10.1161/circulationaha.115.021014] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/29/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND In ischemic mitral regurgitation (IMR), ring annuloplasty is associated with a significant rate of recurrent MR. Ring size is based on intertrigonal distance without consideration of left ventricular (LV) size. However, LV size is an important determinant of mitral valve (MV) leaflet tethering before and after repair. We aimed to determine whether LV-MV ring mismatch (mismatch of LV size relative to ring size) is associated with recurrent MR in patients with IMR after restrictive ring annuloplasty. METHODS Patients with moderate or severe IMR from the 2 Cardiothoracic Surgical Trials Network IMR trials who received MV repair were examined at 1 year after surgery. Baseline LV size was assessed by LV end-diastolic dimension and LV end-systolic dimension (LVESd). LV-MV ring mismatch was calculated as the ratio of LV to ring size (LV end-diastolic dimension/ring size and LVESd/ring size). RESULTS At 1 year after ring annuloplasty, 45 of 214 patients with MV repair (21%) had moderate or greater MR. In univariable logistic regression analysis, larger LVESd (P=0.02) and LVESd/ring size (P=0.007) were associated with recurrent MR. In multivariable models adjusted for age, sex, baseline LV ejection fraction, and severe IMR, only LVESd/ring size (odd ratio per 0.5 increase, 2.20; 95% confidence interval, 1.05-4.62; P=0.038) remained significantly associated with 1-year MR recurrence. CONCLUSIONS LV-MV ring size mismatch is associated with increased risk of MR recurrence. This finding may be helpful in guiding choice of ring size to prevent recurrent MR in patients undergoing MV repair and in identifying patients who may benefit from MV repair with additional subvalvular intervention or MV replacement rather than repair alone. CLINICAL TRIAL REGISTRATION URL:http://clinicaltrials.gov. Unique identifiers: NCT00806988 and NCT00807040.
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Affiliation(s)
- Romain Capoulade
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Xin Zeng
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Jessica R Overbey
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Gorav Ailawadi
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - John H Alexander
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Deborah Ascheim
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Michael Bowdish
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Annetine C Gelijns
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Paul Grayburn
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Irving L Kron
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Robert A Levine
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Michael J Mack
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Serguei Melnitchouk
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Robert E Michler
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - John C Mullen
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Patrick O'Gara
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Michael K Parides
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Peter Smith
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Pierre Voisine
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.)
| | - Judy Hung
- From Division of Cardiology (R.C., X.Z., R.A.L., J.H.) and Department of Surgery (S.M.), Massachusetts General Hospital, Boston, MA; Department of Population Health Science and Policy/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.R.O., D.A., A.C.G., M.K.P.); Department of Surgery Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA (G.A., I.L.K.); Division of Cardiology, Duke Clinical Research Institute (J.H.A.) and Department of Surgery (P.S.), Duke Medicine, Durham, NC; Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA (M.B.); Department of Cardiology, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Cardiovascular Medicine, Baylor Scott & White Health, Plano, TX (M.J.M.); Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (R.E.M.); Department of Surgery, Mackenzie Health Sciences Center, Edmonton, AB, Canada (J.C.M.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.O.); and Department of Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, QC, Canada (P.V.).
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Abstract
PURPOSE OF REVIEW With widespread adoption of transcatheter aortic valve replacement, there has been a change in the approach to management of valvular heart disease. New interest has taken hold in transcatheter therapies for valvular heart disease, as well as research into pathophysiology and progression of disease. Additionally, several key trials have further refined our understanding of surgical management of valvular heart disease. This review will elucidate recent clinical trial data leading to changes in practice. RECENT FINDINGS There have been several landmark trials expanding the indications for transcatheter aortic valve replacement. Additionally, although still early, trials are beginning to demonstrate the feasibility and safety of transcatheter mitral valves. Options for transcatheter management of right-sided valvular disease continue to evolve, and these are areas of active investigation. SUMMARY The emergence of novel therapies for valvular heart disease has expanded the management options available, allowing physicians to better individualize treatment of patients with valvular heart disease. This review will focus on the recent (within 2 years) trials in this field of interest.
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528
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Doenst T, Essa Y, Jacoub K, Moschovas A, Gonzalez-Lopez D, Kirov H, Diab M, Bargenda S, Faerber G. Cardiac surgery 2016 reviewed. Clin Res Cardiol 2017; 106:851-867. [PMID: 28396989 DOI: 10.1007/s00392-017-1113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 01/09/2023]
Abstract
For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term "cardiac surgery". Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Yasin Essa
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Khalil Jacoub
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - David Gonzalez-Lopez
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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529
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530
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Charles EJ, Kron IL. Data, not dogma, for ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2017; 154:137-138. [PMID: 28457538 DOI: 10.1016/j.jtcvs.2017.03.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Eric J Charles
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
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531
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Sekaran NK, Crowley AL, de Souza FR, Resende ES, Rao SV. The Role for Cardiovascular Remodeling in Cardiovascular Outcomes. Curr Atheroscler Rep 2017; 19:23. [DOI: 10.1007/s11883-017-0656-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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532
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e1159-e1195. [PMID: 28298458 DOI: 10.1161/cir.0000000000000503] [Citation(s) in RCA: 1411] [Impact Index Per Article: 201.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Robert O Bonow
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Blase A Carabello
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - John P Erwin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Lee A Fleisher
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Hani Jneid
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Michael J Mack
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Christopher J McLeod
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Patrick T O'Gara
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Vera H Rigolin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Thoralf M Sundt
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Annemarie Thompson
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
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533
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70:252-289. [PMID: 28315732 DOI: 10.1016/j.jacc.2017.03.011] [Citation(s) in RCA: 1841] [Impact Index Per Article: 263.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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534
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Chan V, Levac-Martinho O, Sohmer B, Elmistekawy E, Ruel M, Mesana TG. When Should the Mitral Valve Be Repaired or Replaced in Patients With Ischemic Mitral Regurgitation? Ann Thorac Surg 2017; 103:742-747. [DOI: 10.1016/j.athoracsur.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/24/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
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535
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Pineda AM, Gowani SA, Mihos CG, Chandra R, Santana O, Lamelas J, Beohar N. Coronary Artery Disease Complexity on the Outcomes of a Staged Approach of Pci Followed by Minimally Invasive Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrés M. Pineda
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Saqib A. Gowani
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Christos G. Mihos
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Ramesh Chandra
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Joseph Lamelas
- Department of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
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536
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Kuwata S, Taramasso M, Guidotti A, Nietlispach F, Maisano F. Evaluation of Valtech’s transcatheter mitral valve repair device. Expert Rev Med Devices 2017; 14:189-195. [DOI: 10.1080/17434440.2017.1292122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Fabian Nietlispach
- University Heart Center Zurich, Zurich University Hospital, Zurich, Switzerland
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537
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Derkx S, Nguyen V, Cimadevilla C, Verdonk C, Lepage L, Raffoul R, Nataf P, Vahanian A, Messika-Zeitoun D. Anatomical features of acute mitral valve repair dysfunction: Additional value of three-dimensional echocardiography. Arch Cardiovasc Dis 2017; 110:196-201. [PMID: 28214266 DOI: 10.1016/j.acvd.2016.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022]
Abstract
Recurrence of mitral regurgitation after mitral valve repair is correlated with unfavourable left ventricular remodelling and poor outcome. This pictorial review describes the echocardiographic features of three types of acute mitral valve repair dysfunction, and the additional value of three-dimensional echocardiography.
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Affiliation(s)
- Salomé Derkx
- Department of Cardiology, AP-HP, Bichat Hospital, 75018 Paris, France
| | - Virginia Nguyen
- Department of Cardiology, AP-HP, Bichat Hospital, 75018 Paris, France; Inserm U1148, Bichat Hospital, 75018 Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMR-S 1148, 75870 Paris, France
| | - Claire Cimadevilla
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 75018 Paris, France
| | - Constance Verdonk
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 75018 Paris, France
| | - Laurent Lepage
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 75018 Paris, France
| | - Richard Raffoul
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 75018 Paris, France
| | - Patrick Nataf
- Department of Cardiac Surgery, AP-HP, Bichat Hospital, 75018 Paris, France
| | - Alec Vahanian
- Department of Cardiology, AP-HP, Bichat Hospital, 75018 Paris, France; Inserm U1148, Bichat Hospital, 75018 Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMR-S 1148, 75870 Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, AP-HP, Bichat Hospital, 75018 Paris, France; Inserm U1148, Bichat Hospital, 75018 Paris, France; University Paris Diderot, Sorbonne Paris Cité, UMR-S 1148, 75870 Paris, France.
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538
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Mihos CG, Yucel E, Santana O. Left ventricle-mitral valve ring size mismatch: understanding the limitations of mitral valve repair for ischemic mitral regurgitation. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:19. [PMID: 28164104 DOI: 10.21037/atm.2016.12.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Orlando Santana
- The Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
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539
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Olseng MW, Olsen BF, Hetland A, Fagermoen MS, Jacobsen M. Quality of life improves in patients with chronic heart failure and Cheyne-Stokes respiration treated with adaptive servo-ventilation in a nurse-led heart failure clinic. J Clin Nurs 2017; 26:1226-1233. [PMID: 27273784 DOI: 10.1111/jocn.13416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2016] [Indexed: 02/04/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to investigate if quality of life improved in chronic heart failure patients with Cheyne-Stokes respiration treated with adaptive servo-ventilation in nurse-led heart failure clinic. BACKGROUND Cheyne-Stokes respiration is associated with decreased quality of life in patients with chronic heart failure. Adaptive servo-ventilation is introduced to treat this sleep-disordered breathing. DESIGN Randomised, controlled design. METHODS Fifty-one patients (ranging from 53-84 years), New York Heart Association III-IV and/or left ventricular ejection fraction ≤40% and Cheyne-Stokes respiration were randomised to an intervention group who received adaptive servo-ventilation or a control group. Minnesota Living with Heart Failure Questionnaire was used to assess quality of life at randomisation and after three months. Both groups were followed in the nurse-led heart failure clinic. RESULT Adaptive servo ventilation improved quality of life-scores both in a per protocol analysis and in an intention to treat analysis. Twenty-one patients dropped out of the study, nine in the control and 12 in the intervention group. CONCLUSION Use of adaptive servo-ventilation improved quality of life in chronic heart failure patients with Cheyne-Stokes respiration. However, the drop-out rate was high. RELEVANCE TO CLINICAL PRACTICE Chronic heart failure patients come regularly to the nurse-led heart failure clinic. The heart failure nurses' competency has to include knowledge of equipment to provide support and continuity of care to the patients.
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Affiliation(s)
| | - Brita F Olsen
- Intensive and Post Operative Unit, Østfold Hospital Trust, Grålum, Norway
| | - Arild Hetland
- Department of Medicine, Østfold Hospital Trust, Grålum, Norway
| | - May S Fagermoen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Jacobsen
- Department of Medicine, Østfold Hospital Trust, Grålum, Norway.,Norwegian University of Life Sciences, Ås, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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540
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Coronary Artery Disease Complexity on the Outcomes of a Staged Approach of PCI Followed by Minimally Invasive Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:95-101. [PMID: 28129316 DOI: 10.1097/imi.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the combined coronary artery bypass graft and valve surgery for patients with concomitant coronary artery (CAD) and valvular heart disease. We sought to evaluate the impact of the complexity of CAD, as assessed by the Syntax score, on the outcomes of the staged approach. METHODS We retrospectively evaluated 138 patients who underwent PCI and MIVS at our institution between January 2009 and June 2013. The baseline Syntax score was calculated, and the patients were divided into two groups: low risk (Syntax scores, 0-22) or intermediate-high risk (>22). RESULTS There were 125 patients with low (mean ± standard deviation, 8 ± 5) and 13 with intermediate-high (mean ± standard deviation, 26 ± 4) Syntax scores. Baseline, PCI, and operative characteristics were similar between the groups, except for an observed higher incidence of peripheral arterial disease, multivessel coronary disease, mitral valve replacement, and a higher predicted The Society of Thoracic Surgeons mortality risk score in the intermediate-high Syntax group. The short-term postoperative complications, 30-day mortality, and 3-year survival (84% vs 77%) were similar between the groups. Patients in the intermediate-high-risk group had a higher incidence of repeat target vessel revascularization during follow-up (0.8% vs 16.7%). CONCLUSIONS A staged approach of PCI followed by MIVS is a safe and feasible alternative for patients with valvular heart disease and concomitant CAD. However, it may confer an increased incidence of repeat target vessel revascularization in patients with intermediate- to high-complexity CAD.
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541
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Varelmann DJ, Muehlschlegel JD. Noteworthy Literature Published in 2016 for the Cardiothoracic Anesthesiologist. Semin Cardiothorac Vasc Anesth 2017; 21:8-16. [DOI: 10.1177/1089253216687858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical research and outcome studies dominated the publication spectrum for the cardiothoracic anesthesiologist in 2016. Echocardiography is an important tool in the armamentarium of the cardiothoracic anesthesiologist. Technology is advancing at a fast pace: A new method to quantify the regurgitant volume in mitral regurgitation has been described in an experimental model and been validated in humans. Interesting studies on key elements of our daily practice have been published: Does tranexamic acid decrease the transfusion requirements after cardiac surgery? Are patients with a postoperative cognitive deficit at risk for dementia 7.5 years after surgery? What is the best strategy for post–cardiac surgery atrial fibrillation? What is the mechanism of preconditioning with remifentanil? Large multicenter looked at the treatment strategies for moderate and severe ischemic mitral regurgitation and benefits of transcatheter aortic valve replacement versus the surgical approach. These studies may give us ideas on how to tailor treatment to optimize the patients’ outcome and to minimize the associated risks.
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Affiliation(s)
- Dirk J. Varelmann
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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542
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Kron IL, LaPar DJ, Acker MA, Adams DH, Ailawadi G, Bolling SF, Hung JW, Lim DS, Mack MJ, O'Gara PT, Parides MK, Puskas JD. 2016 update to The American Association for Thoracic Surgery consensus guidelines: Ischemic mitral valve regurgitation. J Thorac Cardiovasc Surg 2017; 153:1076-1079. [PMID: 28190606 DOI: 10.1016/j.jtcvs.2016.11.068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
| | - Damien J LaPar
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Michael A Acker
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - David H Adams
- Department of Cardiac Surgery, Mount Sinai Medical Center, New York, NY
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Judy W Hung
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - D Scott Lim
- Division of Pediatric Cardiology, Departments of Pediatrics and Medicine, University of Virginia, Charlottesville, Va
| | - Michael J Mack
- Department of Cardiovascular Surgery, Heart Hospital Baylor Plano, Baylor Health Care System, Plano, Tex
| | - Patrick T O'Gara
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Michael K Parides
- The International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John D Puskas
- Department of Cardiac Surgery, Mount Sinai Medical Center, New York, NY
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543
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Pham T, Kong F, Martin C, Wang Q, Primiano C, McKay R, Elefteriades J, Sun W. Finite Element Analysis of Patient-Specific Mitral Valve with Mitral Regurgitation. Cardiovasc Eng Technol 2017; 8:3-16. [PMID: 28070866 DOI: 10.1007/s13239-016-0291-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/29/2016] [Indexed: 12/30/2022]
Abstract
Functional mitral regurgitation (FMR) is a significant complication of left ventricular dysfunction and strongly associated with a poor prognosis. In this study, we developed a patient-specific finite element (FE) model of the mitral apparatus in a FMR patient which included: both leaflets with thickness, annulus, chordae tendineae, and chordae insertions on the leaflets and origins on the papillary muscles. The FE model incorporated human age- and gender-matched anisotropic hyperelastic material properties, and MV closure at systole was simulated. The model was validated by comparing the FE results from valve closure simulation with the in vivo geometry of the MV at systole. It was found that the FE model could not replicate the in vivo MV geometry without the application of tethering pre-tension force in the chordae at diastole. Upon applying the pre-tension force and performing model optimization by adjusting the chordal length, position, and leaflet length, a good agreement between the FE model and the in vivo model was established. Not only were the chordal forces high at both diastole and systole, but the tethering force on the anterior papillary muscle was higher than that of the posterior papillary muscle, which resulted in an asymmetrical gap with a larger orifice area at the anterolateral commissure resulting in MR. The analyses further show that high peak stress and strain were found at the chordal insertions where large chordal tethering forces were found. This study shows that the pre-tension tethering force plays an important role in accurately simulating the MV dynamics in this FMR patient, particularly in quantifying the degree of leaflet coaptation and stress distribution. Due to the complexity of the disease, the patient-specific computational modeling procedure of FMR patients presented should be further evaluated using a large patient cohort. However, this study provides useful insights into the MV biomechanics of a FMR patient, and could serve as a tool to assist in pre-operative planning for MV repair or replacement surgical or interventional procedures.
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Affiliation(s)
- Thuy Pham
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Fanwei Kong
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Caitlin Martin
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Qian Wang
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | | | - Raymond McKay
- Cardiology Department of Hartford Hospital, Hartford, CT, USA
| | | | - Wei Sun
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
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544
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Beeri R, Korach A. Ischemic Mitral Regurgitation: The Value of Flexibility in the Quest for a Perfect Repair. Semin Thorac Cardiovasc Surg 2017; 28:269-270. [PMID: 28043428 DOI: 10.1053/j.semtcvs.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Ronen Beeri
- The Heart Valve Clinic, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; The Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Amit Korach
- The Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; The Cardio-Thoracic Surgery Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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545
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D'Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, McDonald D, Edwards FH, Shahian DM. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Outcomes and Quality. Ann Thorac Surg 2017; 103:18-24. [DOI: 10.1016/j.athoracsur.2016.11.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
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546
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Muller DW, Farivar RS, Jansz P, Bae R, Walters D, Clarke A, Grayburn PA, Stoler RC, Dahle G, Rein KA, Shaw M, Scalia GM, Guerrero M, Pearson P, Kapadia S, Gillinov M, Pichard A, Corso P, Popma J, Chuang M, Blanke P, Leipsic J, Sorajja P, Muller D, Jansz P, Shaw M, Conellan M, Spina R, Pedersen W, Sorajja P, Farivar RS, Bae R, Sun B, Walters D, Clarke A, Scalia G, Grayburn P, Stoler R, Hebeler R, Dahle G, Rein KA, Fiane A, Guerrero M, Pearson P, Feldman T, Salinger M, Smart S, Kapadia S, Gillinov M, Mick S, Krishnaswamy A, Pichard A, Corso P, Chuang M, Popma J, Leipsic J, Blanke P, Carroll J, George I, Missov E, Kiser A. Transcatheter Mitral Valve Replacement for Patients With Symptomatic Mitral Regurgitation. J Am Coll Cardiol 2017; 69:381-391. [DOI: 10.1016/j.jacc.2016.10.068] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
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547
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Topographic mapping of left ventricular regional contractile injury in ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2016; 154:149-158.e1. [PMID: 28109612 DOI: 10.1016/j.jtcvs.2016.11.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Restrictive leaflet tethering resulting from regional left ventricular (LV) contractile injury causes ischemic mitral regurgitation (MR). We hypothesized that 3-dimensional LV topographic mapping by MRI-based multiparametric strain analysis could characterize the regional contractile injury patterns that differentiate ischemic coronary artery disease patients who have ischemic MR from those who do not. METHODS Magnetic resonance imaging-based multiparametric strain data were calculated for 15,300 LV grid points in 100 normal volunteers. Strain parameters from ischemic MR (n = 10) and ischemic no-MR (n = 36) patients were then normalized to this normal human strain database with z score quantification of standard deviation from the normal mean. Mean multiparametric strain z scores were calculated for 18 LV subregions (basilar/mid/apical levels; 6 LV regions). Mean strain z scores for papillary muscle-related (basilar/mid levels of anterolateral, posterolateral, and posterior) and nonpapillary muscle-related (all other) subregions were compared between ischemic MR and ischemic no-MR groups. RESULTS Across all patients, contractile injury was greater in the papillary muscle-related regions compared with the nonpapillary regions (P = .007). In the papillary regions, contractile injury was greater in the ischemic MR group compared with the no-MR group (z scores, 1.91 ± 1.13 vs 1.20 ± 1.01, respectively; P < .001). Strain values in the nonpapillary muscle-related subregions were not different between the 2 groups (1.31 ± 1.04 vs 1.20 ± 1.03; P = .301). CONCLUSIONS Multiparametric strain analysis demonstrated severe normalized contractile injury in the papillary muscle-related LV subregions in patients with ischemic MR. The mean degree of normalized injury approached 2 standard deviations and was significantly worse than the levels seen in ischemic no-MR patients.
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548
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Wang S, Tang B. The putative mechanism of recurrent valve regurgitation after valve repair in ischemic mitral valve regurgitation. J Thorac Cardiovasc Surg 2016; 153:143-144. [PMID: 27986247 DOI: 10.1016/j.jtcvs.2016.04.035] [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: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Shuiyun Wang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bing Tang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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549
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Frerker C, Schmidt T, Schlüter M, Bader R, Schewel J, Schewel D, Thielsen T, Kreidel F, Alessandrini H, Schlingloff F, Schäfer U, Kuck KH. Transcatheter implantation of aortic valve prostheses into degenerated mitral valve bioprostheses and failed annuloplasty rings: outcomes according to access route and Mitral Valve Academic Research Consortium (MVARC) criteria. EUROINTERVENTION 2016; 12:1520-1526. [DOI: 10.4244/eij-d-16-00209] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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550
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McCune C, McKavanagh P, Menown IBA. A Review of the Key Clinical Trials of 2015: Results and Implications. Cardiol Ther 2016; 5:109-132. [PMID: 27277596 PMCID: PMC5125106 DOI: 10.1007/s40119-016-0063-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Multiple significant, potentially practice changing clinical trials in cardiology have been conducted and subsequently presented throughout the past year. METHODS In this paper, the authors have reviewed and contextualized significant cardiovascular clinical trials presented at major international conferences of 2015 including American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, American Diabetes Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, Heart Rhythm Congress, and the American Heart Association Scientific Sessions. RESULTS The authors describe new trial data for heart failure (including eplerenone, finerenone, patiromer, sacubitril/valsartan, the beta 3 agonist mirabegron, sitagliptin, empagliflozin, alginate-hydrogel LV epicardial implant), anticoagulation (idarucizumab and andexanet alfa reversal agents, adherence programmes, practice in ablation), transcatheter aortic valve replacement (long-term data, valve-in-valve use, the TriGuard embolic deflecting device), patent foramen ovale closure, cardiovascular prevention (PCSK9 inhibitors, hypertension treatment) and antiplatelets strategies (extended duration therapy with clopidogrel or ticagrelor). Trial data are also described for contemporary technologies including the Biofreedom polymer-free drug coated stent, bioabsorbable stents, PCI strategies, left main treatment, atrial fibrillation ablation techniques, leadless pacemakers and the role of coronary computed tomographic angiography. CONCLUSIONS This paper summarizes and contextualizes multiple pertinent 2015 clinical trials and will be of interest to both clinicians and cardiology researchers.
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Affiliation(s)
- Claire McCune
- Craigavon Cardiac Centre, Craigavon Hospital, Southern Trust, Craigavon, BT63 5QQ, Northern Ireland, UK
| | - Peter McKavanagh
- Craigavon Cardiac Centre, Craigavon Hospital, Southern Trust, Craigavon, BT63 5QQ, Northern Ireland, UK
| | - Ian B A Menown
- Craigavon Cardiac Centre, Craigavon Hospital, Southern Trust, Craigavon, BT63 5QQ, Northern Ireland, UK.
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