201
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Bent DP, Boova RS. Minimally invasive mitral valve replacement after transcatheter edge-to-edge repair. J Surg Case Rep 2021; 2021:rjab197. [PMID: 34055289 PMCID: PMC8159197 DOI: 10.1093/jscr/rjab197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/30/2021] [Accepted: 05/21/2021] [Indexed: 11/12/2022] Open
Abstract
Percutaneous transcatheter edge-to-edge mitral valve repair is available for treatment of both functional and degenerative mitral regurgitation (MR). This technique may be unsuccessful resulting in significant residual or recurrent MR. We described a successful minimally invasive mitral valve replacement in a patient with severe functional MR due to left ventricular dysfunction who previously underwent a transcatheter edge-to-edge repair.
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Affiliation(s)
- Daniel P Bent
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Robert S Boova
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
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202
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Ge Z, Pan W, Li W, Wei L, Kong D, Pan C, Zhou D, Shu X, Ge J. Impact of Leaflet Tethering on Residual Regurgitation in Patients With Degenerative Mitral Disease After Interventional Edge-to-Edge Repair. Front Cardiovasc Med 2021; 8:647701. [PMID: 33996943 PMCID: PMC8116490 DOI: 10.3389/fcvm.2021.647701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Grade 2+ residual mitral regurgitation (MR 2+) is associated with the recurrence of MR and a lower survival rate in interventional mitral valve (MV) edge-to-edge (EE) repair. We sought to determine the MV anatomic factors affecting residual MR 2+ during interventional EE repair with the ValveClamp system in patients with degenerative MR (DMR). Methods: In this multicenter study, 62 patients with significant (grade 3+ to 4+) DMR underwent ValveClamp implantation across eight centers from July 2018 to December 2019. Patient clinical, anatomical, and procedural characteristics were prospectively collected and retrospectively analyzed. Results: A single clamp was implanted in 59 patients, and two clamps were implanted in three patients. Residual MR 2+ was found in 14 patients (22.6%) immediately after the ValveClamp procedure. Patients with residual MR 2+ showed significantly larger preoperative tenting sizes and annular dimensions than the residual MR ≤1+ group. Multivariate analysis identified tenting volume as the major determinant of residual MR 2+ after ValveClamp procedures (odds ratio, 1.410 per 0.1-mL/m2 increase; 95% confidence interval, 1.167–1.705; P < 0.001). Receiver operating characteristic curves identified a tenting volume index ≥0.82 mL/m2 as the optimal cutoff point to predict residual MR 2+ (area under curve, 0.84). Patients with a tenting volume index ≥0.82 mL/m2 were more likely to develop recurrent 3+ MR or undergo MV surgery during short-term follow-up (P < 0.001). Conclusions: Preoperative assessment of the tenting volume index will help to predict intraoperative residual MR 2+ in patients with DMR receiving EE-based interventional repair. Improvements in the interventional strategy are warranted for sustained MR reduction in patients with DMR with unfavorable anatomy.
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Affiliation(s)
- Zhenyi Ge
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.,Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China.,Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dehong Kong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China
| | - Daxin Zhou
- Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.,Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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203
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De Backer O, Wong I, Taramasso M, Maisano F, Franzen O, Søndergaard L. Transcatheter mitral valve repair: an overview of current and future devices. Open Heart 2021; 8:openhrt-2020-001564. [PMID: 33911022 PMCID: PMC8094333 DOI: 10.1136/openhrt-2020-001564] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
The field of transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR) is rapidly evolving. Besides the well-established transcatheter mitral edge-to-edge repair approach, there is also growing evidence for therapeutic strategies targeting the mitral annulus and mitral valve chordae. A patient-tailored approach, careful patient selection and an experienced interventional team is crucial in order to optimise procedural and clinical outcomes. With further data from ongoing clinical trials to be expected, consensus in the Heart Team is needed to address these complexities and determine the most appropriate TMVr therapy, either single or combined, for patients with severe MR.
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Affiliation(s)
| | - Ivan Wong
- Cardiology, Rigshospitalet, Kobenhavn, Denmark
| | - Maurizio Taramasso
- Department of Cardiothoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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204
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Kolte D, Butala NM, Kennedy KF, Wasfy JH, Jena AB, Sakhuja R, Langer N, Melnitchouk S, Sundt TM, Passeri JJ, Palacios IF, Inglessis I, Elmariah S. Association between hospital cardiovascular procedural volumes and transcatheter mitral valve repair outcomes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:27-33. [PMID: 33903039 DOI: 10.1016/j.carrev.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/17/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cardiovascular procedural volumes can serve as metrics of hospital infrastructure and quality, and are the basis for thresholds for initiating transcatheter mitral valve repair (TMVr) programs. Whether hospital volumes of TMVr, surgical mitral valve replacement or repair (SMVRr), and percutaneous coronary intervention (PCI) are indicators of TMVr quality of care is not known. METHODS We used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TMVr procedures. Hospitals were divided into quartiles of TMVr volume. Associations of hospital TMVr, SMVRr, and PCI volumes, as well as SMVRr and PCI outcomes with TMVr outcomes were examined. Outcomes studied were risk-standardized in-hospital mortality rate (RSMR) and 30-day readmission rate (RSRR). RESULTS The study included 3404 TMVr procedures performed across 150 hospitals in the US. The median hospital TMVr volume was 17 (IQR 10, 28). The mean hospital-level RSMR and RSRR for TMVr were 3.0% (95% CI 2.5%, 3.4%) and 14.8% (95% CI 14.5%, 15.0%), respectively. There was no significant association between hospital TMVr volume (as quartiles or as a continuous variable) and TMVr RSMR or RSRR (P > 0.05). Similarly, there was weak or no correlation between hospital SMVRr and PCI volumes and outcomes with TMVr RSMR or RSRR (Pearson correlation coefficients, r = -0.199 to 0.269). CONCLUSION In this study, we found no relationship between hospital TMVr, SMVRr, and PCI volume and TMVr outcomes. Further studies are needed to determine more appropriate structure and process measures to assess the performance of established and new TMVr centers.
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Affiliation(s)
- Dhaval Kolte
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neel M Butala
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Rahul Sakhuja
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathaniel Langer
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Serguei Melnitchouk
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thoralf M Sundt
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Igor F Palacios
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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205
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Flint N, Price MJ, Little SH, Mackensen GB, Wunderlich NC, Makar M, Siegel RJ. State of the Art: Transcatheter Edge-to-Edge Repair for Complex Mitral Regurgitation. J Am Soc Echocardiogr 2021; 34:1025-1037. [PMID: 33872701 DOI: 10.1016/j.echo.2021.03.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
Transcatheter edge-to-edge mitral valve repair has revolutionized the treatment of primary and secondary mitral regurgitation. The landmark EVEREST (Endovascular Valve Edge-to-Edge Repair Study) and COAPT (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk Patients) trials included only clinically stable patients with favorable mitral valve anatomy for edge-to-edge repair. However, since its initial commercial approval in the United States, growing operator experience, device iterations, and improvements in intraprocedural imaging have led to an expansion in the use of transcatheter edge-to-edge repair to more complex mitral valve pathologies and clinical scenarios, many of which were previously considered contraindications for the procedure. Because patients with prohibitive surgical risk are often older and present with complex mitral valve disease, knowledge of the potential effectiveness, versatility, and technical approach to a broad range of anatomy is clinically relevant. In this review the authors examine the current experience with mitral valve transcatheter edge-to-edge repair in various pathologies and scenarios that go well beyond the EVEREST II trial inclusion criteria.
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Affiliation(s)
- Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Weill Cornell Medicine, Houston, Texas
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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206
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Martinez-Gomez E, McInerney A, Tirado-Conte G, de Agustin JA, Jimenez-Quevedo P, Escudero A, Pozo Osinalde E, Viana-Tejedor A, Goirigolzarri J, Marroquin L, Vivas D, Ferrera C, Noriega F, Restrepo-Cordoba MA, Gonzalo N, Escaned J, Fernández-Ortiz A, Amat-Santos I, Estevez-Loureiro R, Macaya C, Nombela-Franco L. Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review. Catheter Cardiovasc Interv 2021; 98:E617-E625. [PMID: 33856097 DOI: 10.1002/ccd.29703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/27/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip. METHODS We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included. RESULTS Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1-4), with an in-hospital mortality and non-fatal complication rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an overall mortality rate of 39.1% at 12-month follow-up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention. CONCLUSIONS Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.
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Affiliation(s)
- Eduardo Martinez-Gomez
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Angela McInerney
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Gabriela Tirado-Conte
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Jose Alberto de Agustin
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Andrés Escudero
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Eduardo Pozo Osinalde
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ana Viana-Tejedor
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Josebe Goirigolzarri
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Marroquin
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - David Vivas
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Carlos Ferrera
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Francisco Noriega
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | - Nieves Gonzalo
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Javier Escaned
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Ignacio Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Carlos Macaya
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
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207
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Garcia-Sayan E, Raghunathan D, Li FM, Dhoble A, Sheu RD, Jelacic S, Reisman M, Smalling RW, Mackensen GB. Initial experience with the fourth generation MitraClip™: Outcomes, procedural aspects, and considerations for device selection. Catheter Cardiovasc Interv 2021; 98:E626-E636. [PMID: 33847434 DOI: 10.1002/ccd.29705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/03/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We present our initial experience with the fourth-generation MitraClip™ (G4) system and propose preliminary criteria for device selection. BACKGROUND The MitraClip™ G4 system recently underwent a "controlled release" for transcatheter edge-to-edge mitral valve repair. The four new devices include technical improvements such as controlled gripper actuation (independent leaflet capture) and continuous left atrial pressure monitoring. To date, a patient-specific device selection algorithm, and the technology's impact on procedural times and success, have not been described. METHODS We present an initial multi-center experience and short-term outcomes with the new system, suggest procedural and imaging considerations, and propose initial guidance for device selection. RESULTS Sixty-one procedures performed by three operators at two centers between November 2019 and May 2020 were analyzed. At 30-day follow-up, there were three deaths (4.9%), four neurological events (6.6%), and seven re-hospitalizations (11.5%). Fifty-nine patients achieved device and procedural success (96.7%), and there was one device-related technical issue (1.6%). Compared to the same operators utilizing the third generation MitraClip™, the G4 system resulted in a significant reduction in the median number of clips used per patient (1 IQR 1-2 vs. 2 IQR 1-3, p = .023) and a trend toward shorter device times. CONCLUSION Based on our initial experience, we found that the MitraClip™ G4 system is associated with high procedural success and fewer devices needed per procedure. The expanded device options may allow a more targeted approach to the myriad of pathologic presentations of mitral regurgitation. This early experience should provide a foundational opportunity for further refinement.
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Affiliation(s)
- Enrique Garcia-Sayan
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Deepa Raghunathan
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Flora M Li
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Abhijeet Dhoble
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Richard D Sheu
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Srdjan Jelacic
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Mark Reisman
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Richard W Smalling
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
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208
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Henning RJ. The current diagnosis and treatment of high-risk patients with chronic primary and secondary mitral valve regurgitation. Future Cardiol 2021; 18:67-87. [PMID: 33840221 DOI: 10.2217/fca-2020-0189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Mitral valve regurgitation (MR) is due primarily to either primary degeneration of the mitral valve with Barlow's or fibroelastic disease or is secondary to ischemic or nonischemic cardiomyopathies. Echocardiography is essential to assess MR etiology and severity, the remodeling of cardiac chambers and to characterize longitudinal chamber changes to determine optimal therapies. Surgery is recommended for severe primary MR if persistent symptoms are present or if left ventricle dysfunction is present with an EF <60% or a left ventricle end-systolic diameter ≥40 mm. For secondary MR, therapy of heart failure with vasodilators and diuretics improves forward cardiac output. Coronary artery bypass grafts (CABG) or percutaneous coronary intervention (PCI) should be considered for severe MR due to ischemia. This review summarizes the pathophysiology, the characteristics, the management and the different interventions for high risk patients with chronic primary and secondary MR.
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Affiliation(s)
- Robert J Henning
- University of South Florida, Tampa, FL 33612, USA.,James A Haley Hospital, Tampa, FL 33612, USA
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209
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Gerçek M, Roder F, Rudolph TK, Fortmeier V, Zittermann A, Rudolph V, Friedrichs KP. PASCAL mitral valve repair system versus MitraClip: comparison of transcatheter edge-to-edge strategies in complex primary mitral regurgitation. Clin Res Cardiol 2021; 110:1890-1899. [PMID: 33837469 PMCID: PMC8639575 DOI: 10.1007/s00392-021-01845-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Abstract
Background The PASCAL system is a novel device for edge-to-edge treatment of mitral regurgitation (MR). The aim of this study was to compare the safety and efficacy of the PASCAL to the MitraClip system in a highly selected group of patients with complex primary mitral regurgitation (PMR) defined as effective regurgitant orifice area (MR-EROA) ≥ 0.40 cm2, large flail gap (≥ 5 mm) or width (≥ 7 mm) or Barlow’s disease. Methods 38 patients with complex PMR undergoing mitral intervention using PASCAL (n = 22) or MitraClip (n = 16) were enrolled. Primary efficacy endpoints were procedural success and degree of residual MR at discharge. The rate of major adverse events (MAE) according to the Mitral Valve Academic Consortium (MVARC) criteria was chosen as the primary safety endpoint. Results Patient collectives did not differ relevantly regarding pertinent baseline parameters. Patients` median age was 83.0 [77.5–85.3] years (PASCAL) and 82.5 [76.5–86.5] years (MitraClip). MR-EROA at baseline was 0.70 [0.68–0.83] cm2 (PASCAL) and 0.70 [0.50–0.90] cm2 (MitraClip), respectively. 3D-echocardiographic morphometry of the mitral valve apparatus revealed no relevant differences between groups. Procedural success was achieved in 95.5% (PASCAL) and 87.5% (MitraClip), respectively. In 86.4% of the patients a residual MR grade ≤ 1 + was achieved with PASCAL whereas reduction to MR grade ≤ 1 + with MitraClip was achieved in 62.5%. Neither procedure time number of implanted devices, nor transmitral gradient differed significantly. No periprocedural MAE according to MVARC occured. Conclusion In this highly selected patient group with complex PMR both systems exhibited equal procedural safety. MitraClip and PASCAL reduced qualitative and semi-quantitative parameters of MR to an at least comparable extent. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01845-8.
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Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
| | - Fabian Roder
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Vera Fortmeier
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Kai P Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
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210
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Hong SJ, Kim JS, Hong GR. Recent Evidence and Initial Experiences of Transcatheter Edge-to-Edge Repair of the Mitral Valve in South Korea. J Chest Surg 2021; 54:165-171. [PMID: 33824230 PMCID: PMC8181699 DOI: 10.5090/jcs.21.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
As a percutaneous technique for the reduction of mitral regurgitation, the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) for transcatheter edge-to-edge repair of the mitral valve was developed in 1998 and first used in 2003. Its main advantage is being less invasive than surgery, because it can be performed through a transcatheter approach without any hemodynamic compromise. Recent studies have shown that this procedure reduces symptoms and improves functional capacity with low complication rates. Two randomized clinical trials have investigated the use of this technique for functional mitral regurgitation. The Korean Ministry of Food and Drug Safety approved its use for degenerative mitral regurgitation in 2019, and this procedure started to be performed in Korea in January 2020. Its use for functional mitral regurgitation was also approved in Korea in 2020. In this article, recent evidence on transcatheter edge-to-edge repair of the mitral valve and our initial experiences in Korea will be reviewed.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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211
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Gammie JS, Grayburn PA, Quinn RW, Hung J, Holmes SD. Quantitating Mitral Regurgitation in Clinical Trials: The Need for a Uniform Approach. Ann Thorac Surg 2021; 114:573-580. [PMID: 33838121 DOI: 10.1016/j.athoracsur.2021.03.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is an established relationship between the degree of mitral regurgitation (MR) and prognosis. Quantitation of MR severity guides therapeutic approaches. Inconsistent definitions and categorization of MR severity in clinical studies limit meaningful comparisons between trials and compromise development of an effective evidence base. The purpose of this study was to quantify heterogeneity in grading systems for MR severity in the contemporary literature. METHODS We performed a systematic review of randomized (RCT) and propensity score (PS) adjusted clinical studies of MV interventions (surgical or percutaneous). A total of 35 articles from 2015-2020 were included (15 RCT, 20 PS). RESULTS There were 22 studies that reported MR severity in numerical categories, either values from the historical "plus" system or numerical MR grades, while 9 studies reported MR severity using text-only descriptive categories. Among the studies that used numerical categories, 2+ MR was defined as moderate in 64% of studies, mild in 27%, and mild-moderate in 9% and 3+ MR was defined as moderate in 14%, moderate-severe in 52%, and severe in 14%. CONCLUSIONS There was substantial variability in MR severity definition and reporting in contemporary clinical studies of MV interventions. We recommend the historical "plus" numerical grading system be abandoned and that inclusion and outcome criteria in MR clinical trials be based on American and European guideline-recommended categories as none/trace, mild, moderate, and severe. Adoption of these simple recommendations will improve the consistency and quality of MR clinical trial design and reporting.
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Affiliation(s)
- James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Paul A Grayburn
- Division of Cardiology, Baylor Scott & White Heart and Vascular Hospital, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Rachael W Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Sari D Holmes
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
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212
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Leurent G, Auffret V, Donal E. Percutaneous Treatment of Mitral Regurgitation With the PASCAL Device: A Full Grasp of the Pathology? JACC Cardiovasc Interv 2021; 13:2779-2781. [PMID: 33303116 DOI: 10.1016/j.jcin.2020.09.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Guillaume Leurent
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France; CHU Rennes, Service de Cardiologie, Rennes, France.
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France; CHU Rennes, Service de Cardiologie, Rennes, France
| | - Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France; CHU Rennes, Service de Cardiologie, Rennes, France
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213
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Rahhab Z, Lim DS, Little SH, Taramasso M, Kuwata S, Saccocci M, Tamburino C, Grasso C, Frerker C, Wißt T, Garberich R, Hausleiter J, Braun D, Avenatti E, Delgado V, Ussia GP, Castriota F, Nerla R, Ince H, Öner A, Estevez‐Loureiro R, Latib A, Regazzoli D, Piazza N, Alosaimi H, de Jaegere PPT, Bax J, Dvir D, Maisano F, Sorajja P, Reardon MJ, Van Mieghem NM. MitraClip After Failed Surgical Mitral Valve Repair-An International Multicenter Study. J Am Heart Assoc 2021; 10:e019236. [PMID: 33794658 PMCID: PMC8174343 DOI: 10.1161/jaha.120.019236] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/01/2021] [Indexed: 12/23/2022]
Abstract
Background Recurrence of mitral regurgitation (MR) after surgical mitral valve repair (SMVR) varies and may require reoperation. Redo mitral valve surgery can be technically challenging and is associated with increased risk of mortality and morbidity. We aimed to assess the feasibility and safety of MitraClip as a treatment strategy after failed SMVR and identify procedure modifications to overcome technical challenges. Methods and Results This international multicenter observational retrospective study collected information for all patients from 16 high-volume hospitals who were treated with MitraClip after failed SMVR from October 29, 2009, until August 1, 2017. Data were anonymously collected. Technical and device success were recorded per modified Mitral Valve Academic Research Consortium criteria. Overall, 104 consecutive patients were included. Median Society of Thoracic Surgeons score was 4.5% and median age was 73 years. At baseline, the majority of patients (82%) were in New York Heart Association class ≥III and MR was moderate or higher in 86% of patients. The cause of MR pre-SMVR was degenerative in 50%, functional in 35%, mixed in 8%, and missing/unknown in 8% of patients. The median time between SMVR and MitraClip was 5.3 (1.9-9.7) years. Technical and device success were 90% and 89%, respectively. Additional/modified imaging was applied in 21% of cases. An MR reduction of ≥1 grade was achieved in 94% of patients and residual MR was moderate or less in 90% of patients. In-hospital all-cause mortality was 2%, and 86% of patients were in New York Heart Association class ≤II. Conclusions MitraClip is a safe and less invasive treatment option for patients with recurrent MR after failed SMVR. Additional/modified imaging may help overcome technical challenges during leaflet grasping.
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Affiliation(s)
- Zouhair Rahhab
- Department of CardiologyThoraxcenterErasmus Medical CenterRotterdamthe Netherlands
| | - David Scott Lim
- Division of Cardiovascular MedicineUniversity of VirginiaCharlottesvilleVA
| | | | | | - Shingo Kuwata
- Heart CenterZürich University HospitalUniversity of ZürichSwitzerland
| | - Matteo Saccocci
- Heart CenterZürich University HospitalUniversity of ZürichSwitzerland
| | - Corrado Tamburino
- Division of CardiologyCAST Policlinico HospitalUniversity of CataniaItaly
| | - Carmelo Grasso
- Division of CardiologyCAST Policlinico HospitalUniversity of CataniaItaly
| | | | - Theresa Wißt
- Department of CardiologyAsklepios Klinik St GeorgHamburgGermany
| | - Ross Garberich
- Minneapolis Heart InstituteAbbott Northwestern HospitalMinneapolisMN
- Valve Science CenterMinneapolis Heart Institute FoundationMinneapolisMN
| | - Jörg Hausleiter
- Medizinische Klinik I der Ludwig‐Maximilians Universität MünchenMunichGermany
| | - Daniel Braun
- Medizinische Klinik I der Ludwig‐Maximilians Universität MünchenMunichGermany
| | | | - Victoria Delgado
- Department of CardiologyLeiden University Medical Centerthe Netherlands
| | - Gian Paolo Ussia
- Department of CardiologyUniversity Campus Bio/MedicoUniversity of Rome Tor VergataRomeItaly
| | - Fausto Castriota
- Interventional Cath Lab Cardiovascular Department Humanitas GavazzeniBergamoItaly
| | - Roberto Nerla
- Interventional Cath Lab Cardiovascular Department Humanitas GavazzeniBergamoItaly
| | - Hüseyin Ince
- Department of CardiologyRostock University Medical CenterRostockGermany
| | - Alper Öner
- Department of CardiologyRostock University Medical CenterRostockGermany
| | | | - Azeem Latib
- Interventional Cardiology UnitSan Raffaele Scientific InstituteMilanItaly
| | - Damiano Regazzoli
- Interventional Cardiology UnitSan Raffaele Scientific InstituteMilanItaly
| | - Nicolo Piazza
- Division of CardiologyDepartment of MedicineMcGill University Health CentreRoyal Victoria HospitalMontrealQuebecCanada
| | - Hind Alosaimi
- Division of CardiologyDepartment of MedicineMcGill University Health CentreRoyal Victoria HospitalMontrealQuebecCanada
| | | | - Jeroen Bax
- Department of CardiologyLeiden University Medical Centerthe Netherlands
| | - Danny Dvir
- Division of CardiologyDepartment of MedicineUniversity of WashingtonSeattleWA
| | - Francesco Maisano
- Heart CenterZürich University HospitalUniversity of ZürichSwitzerland
| | - Paul Sorajja
- Minneapolis Heart InstituteAbbott Northwestern HospitalMinneapolisMN
- Valve Science CenterMinneapolis Heart Institute FoundationMinneapolisMN
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214
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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215
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Dayan V, Garcia-Villarreal OA, Escobar A, Ferrari J, Quintana E, Marin-Cuartas M, Almeida RMS. The Latin American Association of Cardiac and Endovascular Surgery statement regarding the recently released 2020 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease. Braz J Cardiovasc Surg 2021; 36:275-277. [PMID: 34048207 PMCID: PMC8163268 DOI: 10.21470/1678-9741-2021-0952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victor Dayan
- Centro Cardiovascular Universitario, Montevideo, Uruguay
| | | | | | - Javier Ferrari
- Colegio Argentino de Cirujanos Cardiovasculares, Buenos Aires, Argentina
| | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, Stanford University, Stanford, USA
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216
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Bedogni F, Popolo Rubbio A, Grasso C, Adamo M, Denti P, Giordano A, Tusa M, Bianchi G, De Marco F, Bartorelli AL, Montorfano M, Godino C, Citro R, De Felice F, Mongiardo A, Monteforte I, Villa E, Giannini C, Crimi G, Tarantini G, Testa L, Tamburino C. Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO): impact of valve disease aetiology and residual mitral regurgitation after MitraClip implantation. Eur J Heart Fail 2021; 23:1364-1376. [PMID: 33742754 DOI: 10.1002/ejhf.2159] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/28/2021] [Accepted: 03/14/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS The Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) was conceived in order to assess the safety and efficacy of MitraClip therapy in Italy. The aim of this study was to assess procedural and mid-term outcomes, and clinical and echocardiographic predictors of mid-term mortality after MitraClip therapy, stratifying the results according to the diagnosis of functional and degenerative mitral regurgitation (FMR vs. DMR). METHODS AND RESULTS Between January 2016 and March 2020, 1659 patients were prospectively included in the GIOTTO registry (FMR 59.4% vs. DMR 40.6%). Acute Mitral Valve Academic Research Consortium (MVARC) technical success was achieved in 97.2% of patients, without differences between FMR and DMR and with sustained results at 30 days. In the study population, all-cause mortality was 4.0%, 17.5% and 34.6% at 30 days, 1 year and 2 years, respectively. Cardiovascular death was the most frequent cause of mortality. Overall hospitalization rates were 6.3%, 23.4% and 31.7% at 30 days, 1 year and 2 years, respectively. The most frequent cause of hospitalization was heart failure, particularly in the first 30 days. FMR and MVARC structural and functional failure were strongly associated with 1-year mortality. Residual mitral regurgitation 1+ (rMR) was independently related to a reduced risk of 1-year mortality (hazard ratio 0.62; P = 0.005). Coherently, at 2-year follow up, FMR was associated with worse outcomes than DMR, and Kaplan-Meier all-cause mortality was related to rMR. CONCLUSIONS Functional mitral regurgitation aetiology affects 1-year mortality after MitraClip implantation, and differences in mortality and hospitalization rates between FMR and DMR can be observed within 2 years. Optimal rMR 1+ was correlated to a more favourable mid-term outcome, particularly in FMR.
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Affiliation(s)
- Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Maurizio Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Bianchi
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Rodolfo Citro
- University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | | | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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217
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Takinami G, Nakajima Y, Tsuji S, Saito D, Tabayashi A, Koizumi J, Tsuboi J, Kin H. The rare case of a MitraClip device migrating into the left ventricular apex. Gen Thorac Cardiovasc Surg 2021; 69:1267-1270. [PMID: 33770347 DOI: 10.1007/s11748-021-01624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
A 79-year-old man with atrial fibrillation and heart failure due to grade 4 + mitral valve regurgitation after coronary artery bypass underwent the MitraClip procedure using two clips. Three days after the procedure, chest radiographs indicated migration of one of the two clips into the left ventricle. He suffered from 3 + recurrent mitral regurgitation, tricuspid valve regurgitation. The echocardiogram and computed tomography scans indicated migration of the clip into the left ventricular apex; he underwent mitral valve replacement, removal of the migrated clip to prevent embolism, left atrial appendage closure, and tricuspid valve ring-annuloplasty. In the postoperative acute phase, embolism by detached and lost MitraClip device is possible, which can be difficult to remove.
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Affiliation(s)
- Gaku Takinami
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan.
| | - Yoshifumi Nakajima
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan
| | - Shigeto Tsuji
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan
| | - Daiki Saito
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan
| | - Azuma Tabayashi
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan
| | - Junichi Tsuboi
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan
| | - Hajime Kin
- Department of Cardiovascular Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate Prefecture, 028-3695, Japan
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218
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Doldi PM, Brinkmann I, Orban M, Stolz L, Orban M, Stocker T, Loew K, Buech J, Nabauer M, Illigens B, Cerqueira TL, Siepmann T, Massberg S, Hausleiter J, Braun D. Percutaneous edge-to-edge repair of severe mitral regurgitation using the MitraClip XTR versus NTR system. Clin Cardiol 2021; 44:708-714. [PMID: 33760247 PMCID: PMC8119798 DOI: 10.1002/clc.23599] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 01/14/2023] Open
Abstract
Background Transcatheter mitral valve repair (TMVR) has shown to improve symptoms and functional capacity in patients with severe mitral valve regurgitation (MR). Novel device developments provide the technology to treat patients with complex anatomies and large coaptation gaps. Nevertheless, the question of superiority of one device remains unanswered. We aimed to compare the MitraClip XTR and MitraClip NTR system in a real world setting. Hypothesis TMVR with the MitraClip XTR system is equally effective, but associated with a higher risk of leaflet injury. Methods We retrospectively analyzed peri‐procedural and mid‐term clinical and echocardiographic outcomes of 113 patients treated for severe MR between March 2018 and August 2019 at the University Hospital of Munich. Results Postprocedural MR reduction to ≤2+ was comparable in both groups (XTR: 96.1% vs. NTR: 97.6%, p = .38). There was a significant difference in a composite safety endpoint of periprocedural Major adverse cardiac and cerebrovascular events (MACCE) including leaflet injury between groups (XTR 14.6% vs. NTR 1.7%, 95% CI [2.7, 24.6], p = .012). After a median follow‐up of 8.5 (4.4, 14.0) months, durable reduction of MR was confirmed (XTR: in 91.9% vs. NTR: 96.8%, p = .31) and clinical and symptomatic improvement was comparable in both groups accordingly. Conclusion While efficacy was comparable in both treatment groups, patients treated with the MitraClip XTR systems showed more events of acute leaflet tear and single leaflet device attachment (SLDA). A detailed echocardiographic assessment should be done to identify risk candidates for acute leaflet injury.
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Affiliation(s)
- Philipp M Doldi
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany.,German Sites Development Principles and Practice of Clinical Research Harvard T.H., Chan School of Public Health Dresden International University, Dresden, Germany
| | - Isabel Brinkmann
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Thomas Stocker
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Kornelia Loew
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Joscha Buech
- Herzchirurgische Klinik und Poliklinik, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Ben Illigens
- German Sites Development Principles and Practice of Clinical Research Harvard T.H., Chan School of Public Health Dresden International University, Dresden, Germany
| | - Tiago Lemos Cerqueira
- German Sites Development Principles and Practice of Clinical Research Harvard T.H., Chan School of Public Health Dresden International University, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.,Division of Health Care Sciences Center for Clinical Research and Management Education Dresden, Dresden International University, Dresden, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Joerg Hausleiter
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, University Hospital Munich Campus Grosshadern, Marchioninistraße, München, Deutschland, Germany
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219
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. Rev Port Cardiol 2021; 40:293-304. [PMID: 33745777 DOI: 10.1016/j.repc.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
Degenerative mitral valve disease (myxomatous degeneration or fibroelastic deficiency) is the most common indication for surgical referral to treat mitral regurgitation. Mitral valve repair is the procedure of choice whenever feasible and when the results are expected to be durable. Posterior leaflet prolapse is the commonest lesion, found in up to two-thirds of patients. It is the easiest to repair, particularly when limited to one segment. In these cases, rates of repairability and procedural success approach 100%, and there is now ample evidence that the immediate and long-term results are better than those of valve replacement. Notably, minimally invasive valvular procedures, surgical or interventional, have attracted increasing interest in the last decade. When performed by experienced groups, mitral valve repair is unrivaled irrespective of the severity of lesions, from simple to complex, which leaflets are involved, and the type of degenerative involvement (myxomatous or fibroelastic). Its results should be viewed as the benchmark for other present and future technologies. By contrast, percutaneous mitral valve repair is still in its infancy and its results so far fall short of those of surgical repair. Nevertheless, continued investment in transcatheter procedures is of great importance to enable development and improved accessibility, particularly for patients who are considered unsuitable for surgery. In this review, we analyze the current status of management of degenerative mitral valve disease, discussing mitral valve anatomy and pathology, indications for intervention, and current surgical and transcatheter mitral valve procedures and results.
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Affiliation(s)
- Gonçalo F Coutinho
- Cardiothoracic Surgery Department, University Hospital and Center of Coimbra, Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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220
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Levi N, Meerkin D. Transcatheter Repair of the Mitral Valve: Relevant Pathophysiology, Investigation, and Management. Can J Cardiol 2021; 37:1027-1040. [PMID: 33753201 DOI: 10.1016/j.cjca.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022] Open
Abstract
Mitral regurgitation (MR) is a common condition causing significant morbidity and mortality in the Western world. Although surgical therapy has developed over 5 decades to provide solutions, only a minority of patients undergo surgery. The last decade has seen the emergence and application of multiple transcatheter techniques in attempts to address this undertreated population with the large clinical experience of MitraClip providing the most insight. Clear understanding of the pathophysiology of different MR types as well as the role of particularly secondary MR on patient's clinical syndrome allow for better prediction as to which patient subgroups will benefit from different repair techniques or intervention at all. Most of the techniques are based on surgical technique and are applied as single-device/technique solutions, whether leaflet, chordal, or annular solutions, but with broadening experience, combination therapies are likely to find a place in creating a more complete and surgical-like solution.
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Affiliation(s)
- Nir Levi
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Meerkin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
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221
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Impact of effective regurgitant orifice area on outcome of secondary mitral regurgitation transcatheter repair. Clin Res Cardiol 2021; 110:732-739. [PMID: 33661372 PMCID: PMC8099828 DOI: 10.1007/s00392-021-01807-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/16/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the value of effective regurgitant orifice (ERO) in predicting outcome after edge-to-edge transcatheter mitral valve repair (TMVR) for secondary mitral regurgitation (SMR) and identify the optimal cut-off for patients' selection. METHODS Using the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry, that included patients undergoing edge-to-edge TMVR for SMR between November 2008 and January 2019 in 8 experienced European centres, we assessed the optimal ERO threshold associated with mortality in SMR patients undergoing TMVR, and compared characteristics and outcomes of patients according to baseline ERO. RESULTS Among 1062 patients with severe SMR and ERO quantification by proximal isovelocity surface area method in the registry, ERO was < 0.3 cm2 in 575 patients (54.1%), who were more symptomatic at baseline (NYHA class ≥ III: 91.4% vs. 86.9%, for ERO < vs. ≥ 0.3 cm2; P = 0.004). There was no difference in all-cause mortality at 2-year follow-up according to baseline ERO (28.3% vs. 30.0% for ERO < vs. ≥ 0.3 cm2, P = 0.585). Both patient groups demonstrated significant improvement of at least one NYHA class (61.7% and 73.8%, P = 0.002), resulting in a prevalence of NYHA class ≤ II at 1-year follow-up of 60.0% and 67.4% for ERO < vs. ≥ 0.3 cm2, respectively (P = 0.05). CONCLUSION All-cause mortality at 2 years after TMVR does not differ if baseline ERO is < or ≥ 0.3 cm2, and both groups exhibit relevant clinical improvements. Accordingly, TMVR should not be withheld from patients with ERO < 0.3 cm2 who remain symptomatic despite optimal medical treatment, if TMVR appropriateness was determined by experienced teams in dedicated valve centres.
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Kang JJH, Bozso SJ, El-Andari R, Adams C, Nagendran J. Transcatheter mitral valve repair and replacement: the next frontier of transcatheter valve intervention. Curr Opin Cardiol 2021; 36:163-171. [PMID: 33044266 DOI: 10.1097/hco.0000000000000803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW We summarize the recent developments in transcatheter mitral valve repair (TMVr) and replacement (TMVR), discuss determinants of MitraClip outcomes in various mitral regurgitation causes, and highlight newly emerging devices and randomized trials. RECENT FINDINGS The discordant results published in the two recent randomized trials for MitraClip, the COAPT and the MITRA-FR trial have led to the emergence of a new conceptual framework such as the proportionate versus disproportionate mitral regurgitation and hemodynamics assessment tools like the real-time continuous left atrial pressure monitoring. Learning curve and volume-outcome analyses and studies examining the MitraClip usage in patients with degenerative mitral regurgitation are recent developments that have influenced MitraClip regulation and coverage. Several trials for TMVr devices that take an alternative approach to the edge-to-edge repair are underway and advancements in the TMVR technologies are continuing to progress to fill the unmet needs of treating high surgical risk patients whose complex valve anatomy make TMVr unfeasible. SUMMARY Evidence supports careful analysis of the valve area and left ventricular function in addition to the left atrial hemodynamics will improve the MitraClip outcome. Operator experience plays a greater effect when achieving excellent results with 1+ or less residual mitral regurgitation whereas surgical MVr volume did not influence TMVr outcome. Interventions on the complex primary mitral regurgitation remain under the surgical domain, but MITRA high risk (HR) and REPAIR mitral regurgitation trials are underway to evaluate the role of MitraClip in high to intermediate surgical risk patients with primary mitral regurgitation. Despite the slow developments in TMVR, the results of the early trials of its devices are promising.
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Affiliation(s)
| | - Sabin J Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton
| | | | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Declaración de la Latin American Association of Cardiac and Endovascular Surgery (LACES) sobre las guías de recomendación clínica de la AHA/ACC para el tratamiento de pacientes con valvulopatía 2020. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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224
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Hensey M, Brown RA, Lal S, Sathananthan J, Ye J, Cheung A, Blanke P, Leipsic J, Moss R, Boone R, Webb JG. Transcatheter Mitral Valve Replacement: An Update on Current Techniques, Technologies, and Future Directions. JACC Cardiovasc Interv 2021; 14:489-500. [PMID: 33663778 DOI: 10.1016/j.jcin.2020.12.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Growing clinical data support the use of transcatheter therapies for significant mitral valve disease. Currently, edge-to-edge repair is the transcatheter treatment of choice, but many anatomies are not suitable. Transcatheter mitral valve replacement offers several potential advantages over transcatheter repair, most notably a greater and more sustained reduction in mitral regurgitation post-implantation, but also potential disadvantages. To enable the successful treatment of mitral valve disease in a wide range of patients and anatomies, we require an armory of transcatheter devices, including transcatheter mitral valve replacement systems.
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Affiliation(s)
- Mark Hensey
- Department of Cardiology, Saint James's Hospital, Dublin, Ireland.
| | - Richard A Brown
- Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, Northumbria, United Kingdom
| | - Sudish Lal
- Department of Cardiology, Dunedin Hospital, Dunedin, New Zealand
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Moss
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Boone
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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225
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Maisano F. Prevent, Identify, and Manage Complications to Keep Percutaneous Mitral Repair Procedures Safe. JACC Case Rep 2021; 3:377-379. [PMID: 34317540 PMCID: PMC8311008 DOI: 10.1016/j.jaccas.2021.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Francesco Maisano
- Department of Cardiac Surgery, University of Zurich, Zurich, Switzerland
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226
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Plichta RP, Chen EP. Commentary: Show me the data. J Thorac Cardiovasc Surg 2021; 162:587-588. [PMID: 33781590 DOI: 10.1016/j.jtcvs.2021.02.083] [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: 02/18/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ryan P Plichta
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.
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227
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Dayan V, Garcia-Villarreal OA, Escobar A, Ferrari J, Quintana E, Marin-Cuartas M, Almeida R. The Latin American Association of Cardiac and Endovascular Surgery statement regarding the recently released American Heart Association/American College of Cardiology Guideline for the Management of Patients With Valvular Heart Disease 2020. J Thorac Cardiovasc Surg 2021; 162:584-586. [PMID: 34116853 DOI: 10.1016/j.jtcvs.2021.01.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Victor Dayan
- Centro Cardiovascular Universitario, Montevideo, Uruguay.
| | | | | | - Javier Ferrari
- Colegio Argentino de Cirujanos Cardiovasculares, Buenos Aires, Argentina
| | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Rui Almeida
- LACES, University Center Assis Gurgacz, Cascabel, Puerto Rico, Brazil
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228
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Chen M, Sun L. What Is the Next Generation of Transcatheter Mitral Valve Repair Devices? Front Cardiovasc Med 2021; 8:641691. [PMID: 33718460 PMCID: PMC7943436 DOI: 10.3389/fcvm.2021.641691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
In the evolving scenario of the transcatheter mitral valve repair (TMVr), TMVr devices constitute a rapidly expanding field. The standard classification includes edge-to-edge repair, direct annuloplasty, indirect annuloplasty, chordal/papillary muscular repair, and the others. However, the unknowns and uncertainties to innovate a high-performing device are addressed. In this viewpoint, the authors discuss the potential future of the next generation and the challenges of TMVr devices.
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Affiliation(s)
- Mi Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Cardiac Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Lizhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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229
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El-Shurafa H, Arafat AA, Albabtain MA, AlFayez LA, Algarni KD, Pragliola C, Alkhushail A, Samargandy S, AlOtaiby M. Residual versus recurrent mitral regurgitation after transcatheter mitral valve edge-to-edge repair. J Card Surg 2021; 36:1904-1909. [PMID: 33625788 DOI: 10.1111/jocs.15447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/07/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The number of MtraClip procedures is increasing, and consequently, the number of patients with residual or recurrent mitral regurgitation (MR). We aimed to characterize patients who had residual versus recurrent MR after MitraClip and report the outcomes of different treatment strategies. METHODS From 2012 to 2020, 167 patients had MitraClip. Out of them, 16 patients (9.5%) had residual mitral regurgitation (MR), and 27 patients (16.2%) had recurrent MR. RESULTS The median age in patients with residual MR was 67.5 (59-73) years versus 69 (61-78) years in patients with recurrent MR (p = .87). The etiology of mitral valve disease was functional in 13 patients (81.3%) and 22 patients (84.6%) in residual versus recurrent MR patients (p > .99). Cardiac resynchronization therapy-defibrillator implantation was higher in patients with residual MR (p = .02). Survival was 93.7% at 1 year, 76.4% at 3 years versus 92.5% at 1 year, and 84.5% at 3 years in residual versus recurrent MR (p = .69). Two patients in the residual MR group had re-clip, and three had surgery, and in the recurrent MR group, one patient had re-clip, and two patients had surgery (p = .23). Patients who had re-clip were older (p = .09). Surgery was associated with 100% survival at 5 years, 63% after medical therapy and the worst survival was reported in re-clip patients (p = .007). CONCLUSION The outcomes of patients with residual versus recurrent mitral regurgitation after MitraClip were comparable. Survival could be improved with surgery compared with medical therapy and re-clip.
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Affiliation(s)
- Haytham El-Shurafa
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Amr A Arafat
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Monirah A Albabtain
- Department of Cardiology Clinical Pharmacy, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Latifa A AlFayez
- Cardiac Research Center, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Khaled D Algarni
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.,Department of Cardiac Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Claudio Pragliola
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.,Department of Cardiac Surgery, Catholic University, Roma, Italy
| | - Abdullah Alkhushail
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Sondos Samargandy
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad AlOtaiby
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
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230
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Fukuda K, Hasegawa S, Kawamura T, Waratani N, Hirata K, Higashimori A, Yokoi Y. Changes in cardiac sympathetic nerve activity on 123 I-metaiodobenzylguanidine scintigraphy after MitraClip therapy. ESC Heart Fail 2021; 8:1590-1595. [PMID: 33609015 PMCID: PMC8006686 DOI: 10.1002/ehf2.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 01/08/2023] Open
Abstract
Aims In patients with heart failure, over‐activation of the cardiac sympathetic nerve (CSN) function is associated with severity of heart failure and worse outcome. The effects of MitraClip therapy on the CSN activity in patients with mitral regurgitation (MR) remained unknown. In this study, we evaluated the impact of the MitraClip therapy on CSN activity assessed by 123I‐metaiodobezylguanidine (MIBG) scintigraphy. Methods and results We enrolled consecutive patients with moderate‐to‐severe (3+) or severe (4+) MR who were scheduled to undergo MitraClip procedure in this prospective observational study. MIBG scintigraphy was performed at baseline and 6 months after the MitraClip procedure to evaluate the heart–mediastinum ratio and washout rate (WR). Changes in these MIBG parameters were analysed. Of the 13 consecutive patients, 10 were successfully treated with MitraClip procedure and completed follow‐up assessment. With regard to the MIBG parameters, changes in the early and delayed heart–mediastinum ratio from baseline to 6 months were not significant (2.16 ± 0.42 to 2.06 ± 0.34, P = 0.38 and 1.87 ± 0.39 to 1.83 ± 0.39, P = 0.43, respectively), whereas WR was significantly decreased (38.6 ± 3.9% to 32.6 ± 3.94%, P = 0.002). Conclusions The CSN activity of the WR on MIBG imaging was improved 6 months after MitraClip therapy in patients with 3+ or 4+ MR.
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Affiliation(s)
- Keisuke Fukuda
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Seiji Hasegawa
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Tomonori Kawamura
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Naoto Waratani
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Kumiko Hirata
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan.,Department of Medical Science, Osaka Educational University, Osaka, Japan
| | - Akihiro Higashimori
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
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231
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Estévez-Loureiro R, Shuvy M, Taramasso M, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, Freixa X, Villablanca P, Krivoshei L, Fam N, Spargias K, Czarnecki A, Haberman D, Agmon Y, Sudarsky D, Pascual I, Ninios V, Scianna S, Moaraf I, Schiavi D, Chrissoheris M, Beeri R, Kerner A, Fernández-Peregrina E, Di Pasquale M, Regueiro A, Poles L, Iñiguez-Romo A, Fernández-Vázquez F, Maisano F. Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction: Effect of cardiogenic shock on outcomes (IREMMI Registry). Catheter Cardiovasc Interv 2021; 97:1259-1267. [PMID: 33600072 DOI: 10.1002/ccd.29552] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To assess outcomes in patients with acute mitral regurgitation (MR) following acute myocardial infarction (AMI) who received percutaneous mitral valve repair (PMVR) with the MitraClip device and to compare outcomes of patients who developed cardiogenic shock (CS) to those who did not (non-CS). BACKGROUND Acute MR after AMI may lead to CS and is associated with high mortality. METHODS This registry analyzed patients with MR after AMI who were treated with MitraClip at 18 centers within eight countries between January 2016 and February 2020. Patients were stratified into CS and non-CS groups. Primary outcomes were mortality and rehospitalization due to heart failure. Secondary outcomes were acute procedural success, functional improvement, and MR reduction. Multivariable Cox regression analysis evaluated association of CS with clinical outcomes. RESULTS Among 93 patients analyzed (age 70.3 ± 10.2 years), 50 patients (53.8%) experienced CS before PMVR. Mortality at 30 days (10% CS vs. 2.3% non-CS; p = .212) did not differ between groups. After median follow-up of 7 months (IQR 2.5-17 months), the combined event mortality/re-hospitalization was similar (28% CS vs. 25.6% non-CS; p = .793). Likewise, immediate procedural success (90% CS vs. 93% non-CS; p = .793) and need for reintervention (CS 6% vs. non-CS 2.3%, p = .621) or re-admission due to HF (CS 13% vs. NCS 23%, p = .253) at 3 months did not differ. CS was not independently associated with the combined end-point (hazard ratio 1.1; 95% CI, 0.3-4.6; p = .889). CONCLUSIONS Patients found to have significant MR during their index hospitalization for AMI had similar clinical outcomes with PMVR whether they presented in or out of cardiogenic shock, provided initial hemodynamic stabilization was first achieved before PMVR.
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Affiliation(s)
| | - Mony Shuvy
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Tomas Benito-Gonzalez
- Interventional Cardiology Unit, Complejo Asistencial Universitario de Leon, Leon, Spain
| | - Paolo Denti
- Department of Cardiovascular Surgery, San Raffaele University Hospital, Milan, Italy
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Barcelona, Spain
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Xavier Freixa
- Interventional Cardiology Unit, Hospital Clinic, Barcelona, Spain
| | - Pedro Villablanca
- Interventional Cardiology, Structural Heart Disease Interventions, Endovascular Interventions, The Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lian Krivoshei
- Department of Cardiology, Kantonsspital Baden, Baden, Switzerland
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew Czarnecki
- Division of Cardiology, Sunnybrook Heath Sciences Centre, University of Toronto, Shulich Heart Centre, Tronto, Ontario, Canada
| | - Dan Haberman
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem, Israel
| | - Yoram Agmon
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel
| | - Doron Sudarsky
- Cardiovascular Institute, Padeh Medical Center, Tiberias, Israel
| | - Isaac Pascual
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Vlasis Ninios
- Department of Cardiology, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Salvatore Scianna
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
| | - Igal Moaraf
- Department of Cardiology, Kantonsspital Baden, Baden, Switzerland
| | - Davide Schiavi
- Department of Cardiovascular Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Ronen Beeri
- Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel
| | | | - Mattia Di Pasquale
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Ander Regueiro
- Interventional Cardiology Unit, Hospital Clinic, Barcelona, Spain
| | - Lion Poles
- Heart Center, Kaplan Medical Center, Affiliated to the Hebrew University, Jerusalem, Israel
| | | | | | - Francesco Maisano
- Heart Valve Clinic, University Hospital of Zurich, Zurich, Switzerland
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Minol JP, Dimitrova V, Petrov G, Langner R, Boeken U, Lichtenberg A, Akhyari P. Predictive Value of Body Mass Index in Minimally Invasive Mitral Valve Surgery. Thorac Cardiovasc Surg 2021; 70:106-111. [PMID: 33580490 DOI: 10.1055/s-0041-1723973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND With this study we aimed to analyze if the separate consideration of body mass index (BMI) could provide any superior predictive values compared with the established risk scores in isolated minimally invasive mitral valve surgery (MIMVS). This might facilitate future therapeutic decision-making, e.g., regarding the question surgery versus transcatheter mitral valve repair (TMVr). METHODS We assessed the relevance of BMI in non-underweight patients who underwent isolated MIMVS. The risk predictive potential of BMI for mortality and several postoperative adverse events was assessed in 429 consecutive patients. This predictive potential was compared with that of European System for Cardiac Outcome Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons score (STS score) using a comparative receiver operating characteristic curve analysis. RESULTS BMI was a significant numeric predictor of wound healing disorders (p = 0.001) and proved to be significantly superior in case of this postoperative adverse event compared with the EuroSCORE II (p = 0.040) and STS score (p = 0.015). Except for this, the predictive potential of BMI was significantly inferior compared with that of the EuroSCORE II and STS score for several end points, including 30-day (p = 0.029 and p = 0.006) and 1-year (p = 0.012 and p = 0.001) mortality. CONCLUSION Therefore, we suggest that, in the course of decision-making regarding the right treatment modality for non-underweight patients with isolated mitral valve regurgitation, the sole factor of BMI should not be given a predominant weight.
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Affiliation(s)
- Jan-Philipp Minol
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany.,Department of Vascular and Endovascular Surgery, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Vanessa Dimitrova
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Georgi Petrov
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Robert Langner
- Institute of Systems Neuroscience, and Statistical Advisory Office, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
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Percutaneous Mitral Valve Repair: Outcome Improvement with Operator Experience and a Second-Generation Device. J Clin Med 2021; 10:jcm10040734. [PMID: 33673247 PMCID: PMC7918912 DOI: 10.3390/jcm10040734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background and aim: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. Methods: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT system. Results: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively; p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group; p = 0.032). Conclusions: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time.
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The Latin American Association of Cardiac and Endovascular Surgery Statement Regarding the Recently Released 2020 ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Ann Thorac Surg 2021; 112:1041-1044. [PMID: 33581157 DOI: 10.1016/j.athoracsur.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 517] [Impact Index Per Article: 172.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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236
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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237
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 320] [Impact Index Per Article: 106.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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238
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Khan MU, Khan MZ, Khan SU, Kaluski E. Transcatheter mitral valve repair in patients with chronic liver disease: Insights from the national inpatient sample. Catheter Cardiovasc Interv 2021; 97:344-352. [PMID: 32770731 DOI: 10.1002/ccd.29173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate contemporary national trends of morbidity, mortality, and healthcare utilization in patients with mitral regurgitation (MR) and co-existing chronic liver disease (CLD) undergoing transcatheter mitral valve repair (TMVR). METHODS The National Inpatient Sample (NIS) was used to assess trends in patients undergoing TMVR between January 2012 and December 2017. Propensity match analysis was done to compare it to subjects without underlying CLD. Logistic regression analysis was used to identify predictors of in-hospital mortality. RESULTS Of 15,270 patients undergoing TMVR, 569 (3.7%) had coexisting CLD. Patients with CLD had a higher proportion of males (61.3 vs 52.6%; p < .01), congestive heart failure (6.9 vs 1.0%; p < .01), renal failure (42.2 vs 36.7%; p < .01), and peripheral vascular disease (19.3 vs 12.5%; p < .01). After propensity matching subjects with CLD had significantly higher hospital mortality (19.8 vs 4.6%; p < .01), acute kidney injury (46.1 vs 37.8%; p < .01), cardiogenic shock (25.4 vs 12.1%; p < .01), mechanical ventilation (26.3 vs 14.0; p < .01), pneumothorax (6.6 vs <2%.; p < .01), length of stay (5 vs 9 days), and average cost of hospitalization (209,573 vs 250,587 $; p < .01). Over the years, in-hospital mortality in patients receiving TMVR has improved in both patients with (from 33.3 in 2013 to 22.2% in 2017) and without CLD (from 2.7 in 2011 to 1.6% in 2017). CONCLUSION Patients with MR undergoing TMVR, with coexisting CLD bear substantially higher comorbidities, complication rates, and inpatient mortality compared with those without CLD. A favorable temporal trend of in-hospital mortality among these subjects is noteworthy.
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Affiliation(s)
- Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Z Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Edo Kaluski
- Guthrie Clinic/Robert Packer Hospital, Sayre, Pennsylvania, USA.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
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239
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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240
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Iliadis C, Spieker M, Kavsur R, Metze C, Hellmich M, Horn P, Westenfeld R, Tiyerili V, Becher MU, Kelm M, Nickenig G, Baldus S, Pfister R. "Get with the Guidelines Heart Failure Risk Score" for mortality prediction in patients undergoing MitraClip. Clin Res Cardiol 2021; 110:1871-1880. [PMID: 33517496 PMCID: PMC8639563 DOI: 10.1007/s00392-021-01804-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/09/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Reliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Heart failure is common in these patients, and risk scores derived from heart failure populations might help stratify TMVR patients. METHODS Consecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the "Get with the Guidelines Heart Failure Risk Score" (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of chronic obstructive lung disease) with all-cause mortality. RESULTS Among 815 patients with available data 177 patients died during a median follow-up time of 365 days. Estimated 1-year mortality by quartiles of the score (0-37; 38-42, 43-46 and more than 46 points) was 6%, 10%, 23% and 30%, respectively (p < 0.001), with good concordance between observed and predicted mortality rates (goodness of fit test p = 0.46). Every increase of one score point was associated with a 9% increase in the hazard of mortality (95% CI 1.06-1.11%, p < 0.001). The score was associated with long-term mortality independently of left ventricular ejection fraction, NYHA class and NTproBNP, and was equally predictive in primary and secondary mitral regurgitation. CONCLUSION The "Get with the Guidelines Heart Failure Risk Score" showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible.
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Affiliation(s)
- Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Refik Kavsur
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Clemens Metze
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Vedat Tiyerili
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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241
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Abstract
Severe mitral valve regurgitation (MR) carries a significant burden both in prognosis and quality of life of patients, as well as on healthcare systems, with high rates of hospitalization for heart failure. While mitral valve surgery constitutes the first-line treatment option for primary MR in suitable patients, surgical treatment for secondary severe MR remains controversial, with a substantial lack of evidence on a survival benefit. In recent decades, percutaneous mitral valve repair has emerged as an alternative treatment for patients deemed not suitable for surgery. Among several devices under development or evaluation, the MitraClip system is the most widespread and is supported by the strongest evidence. While the role of MitraClip in patients with chronic primary MR who are not deemed suitable for surgery is well established, with consistent data showing improvement in both prognosis and quality of life, MitraClip treatment in secondary MR is a rapidly evolving field. Two recent randomized clinical trials generated apparently controversial results but actually provided an interesting pathophysiologic frame that could help discerning patients who will benefit from the procedure versus patients who will not. In this review, we will discuss current treatment options for mitral regurgitation, focusing on percutaneous mitral valve repair with the MitraClip system.
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242
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Di Mauro M, Raviola E, Guarracini S, Di Marco M, Lorusso R, Calafiore AM. Is surgery the fair competitor for MitraClip? J Card Surg 2021; 36:1120-1122. [PMID: 33428264 DOI: 10.1111/jocs.15295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
In the last decades, the overlapping areas of intervention between cardiac surgeons and interventional cardiologists are rocketing, especially in the field of treatment of heart valve disease. But, while for the aortic valve the competition, even for nonhigh risk patients, has become tightened, in the context of mitral regurgitation, the surgery seems to not have competitors. In fact looking the results of studies published so far, a question arises: Is surgery the fair competitor for the Mitraclip? The meta-analysis by Abdul Khader et al. summarized few evidences present in this field, only 11 observational studies and 1 randomized trial, providing an awesome response: "NO." Is therefore not a case if recently two trials, MITRA-FR and COAPT, chose to use as competitor for MitraClip, more rightly, medical therapy instead of surgery. In conclusions, in case of mitral regurgitation (MR), surgery is still largely the gold standard treatment and so MitraClip cannot be mention at all as competitor of surgery. It can be the right choice of case of primary MR where patients showed high risk for surgery. In case of secondary MR, especially with large and poor left ventricle we should wait for a clear answer on its role, yet.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Eliana Raviola
- Department of Cardiac Surgery, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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243
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Khader AA, Allaf M, Lu OW, Lazopoulos G, Moscarelli M, Kendall S, Salmasi MY, Athanasiou T. Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation? J Card Surg 2021; 36:1103-1119. [PMID: 33428247 DOI: 10.1111/jocs.15298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR. METHODS A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies). RESULTS The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009). Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63-4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77-0.99]; p < .001) with considerable heterogeneity (I2 > 90%; p < .001). The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188-0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19-0.46]; p < .001) during midterm follow up. Long term survival (4-5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35-1.41]; p = .323). CONCLUSIONS This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.
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Affiliation(s)
- Ashiq A Khader
- Department of Medicine, Imperial College London, London, UK
| | - Mohammed Allaf
- Department of Medicine, Imperial College London, London, UK
| | - Oscar W Lu
- Division of Biosciences, University College London, London, UK.,Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - George Lazopoulos
- Department of Cardio-thoracic Surgery, University Hospital of Heraklion, Crete, Greece
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Simon Kendall
- Deparment of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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244
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Patel KM, Desai RG, Krishnan S. Mitral Regurgitation in Patients With Coexisting Chronic Aortic Regurgitation: An Evidence-Based Narrative Review. J Cardiothorac Vasc Anesth 2021; 35:3404-3415. [PMID: 33558134 DOI: 10.1053/j.jvca.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Chronic aortic regurgitation (AR) frequently leads to significant downstream changes to the left ventricle and pulmonary vasculature; these structural and physiologic changes result in lower- than expected patient survival. Progressive, uncorrected AR can lead to left ventricle dilation and subsequent mitral valve leaflet tethering, as well as mitral annular dilation, resulting in secondary mitral regurgitation (MR) in up to 45% of patients. Surgical aortic valve replacement (AVR) improves secondary MR in most patients, but survival is significantly lower in those patients who do not show improvement in MR after AVR. Thus, there is considerable debate on whether the mitral valve should be intervened upon at the time of the AVR. In this review, the authors address the long-term outlook for patients with chronic AR and concurrent MR. The authors also review the available evidence on concomitant mitral valve surgery in patients undergoing AVR for AR. Lastly, this narrative review examines the recent advances in transcatheter mitral valve repair and replacement, and explores the potential role of transcatheter mitral therapies in patients with secondary MR due to AR.
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Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Wayne State University School of Medicine, St. Joseph Mercy Oakland Medical Office Building, Pontiac, MI
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245
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Denti P, Sala A, Belluschi I, Alfieri O. Over 15 years: the advancement of transcatheter mitral valve repair. Ann Cardiothorac Surg 2021; 10:15-27. [PMID: 33575172 DOI: 10.21037/acs-2020-mv-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with severe symptomatic mitral regurgitation, if left untreated, have a poor prognosis. In those patients not eligible for mitral valve (MV) surgery, percutaneous repair may improve clinical outcomes. In the past 15 years several devices have been developed to address different MV lesions. This manuscript will review the advancement of transcatheter MV repair through the years, focusing on technologies for which consistent clinical data is available.
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Affiliation(s)
- Paolo Denti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Alessandra Sala
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Igor Belluschi
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
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246
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Gerosa G, Nadali M, Longinotti L, Ponzoni M, Caraffa R, Fiocco A, Pradegan N, Besola L, D’Onofrio A, Bizzotto E, Bellu R, Gentian D, Colli A. Transapical off-pump echo-guided mitral valve repair with neochordae implantation mid-term outcomes. Ann Cardiothorac Surg 2021; 10:131-140. [PMID: 33575183 PMCID: PMC7867433 DOI: 10.21037/acs-2020-mv-86] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/22/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The NeoChord echo-guided transapical beating heart repair is a promising early-stage minimally invasive surgical procedure for degenerative mitral valve (MV) regurgitation (DMR) correction. The technique has been improved since its inception following procedure standardization, patient selection optimization, and learning curve stabilization. We hereby present the mid-term clinical results through three years of our large single center experience. METHODS All consecutive patients with severe symptomatic DMR due to prolapse or flail of one or both mitral leaflets that underwent the NeoChord procedure between November 2013 and June 2019 were included. Patients were categorized according to MV anatomy; Type A isolated central posterior leaflet prolapse and/or flail, Type B posterior multi-segment prolapse and/or flail, Type C anterior and/or bi-leaflet prolapse or flail, Type D paracommissural prolapse and/or flail and/or significant leaflet and/or annular calcifications. Patients underwent clinical and echocardiographic follow-up at one, three, six, twelve months and yearly thereafter. Clinical outcomes and the composite primary endpoint (patient success) were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria. Mitral regurgitation (MR) severity was graded as absent, mild, moderate and severe according to American Society of Echocardiography (ASE) and European Society of Cardiology (ESC) guidelines. RESULTS Two hundred and three patients were included; median follow-up was 24 months [interquartile range (IQR), 9-36]. Median age was 64 years (IQR, 54-74 years), median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) was 0.60% (IQR, 0.32-1.44%). There were 106 Type A patients (52.2%), 68 Type B (33.5%), 16 Type C (7.9%), and 13 Type D (6.4%). Kaplan-Meier estimate of survival was 99.0%±0.7% at one and two years and 94.0%±2.9% at three years. At one-year follow-up patient success was 91.2%±2.0% and 111 patients (74%) presented a residual MR mild or less (1+). At three-year follow-up patient success was 81.2%±3.8% and 32 patients (64%) had a residual MR mild or less (1+). Patient success was significantly different according to anatomical type (P=0.001). Echocardiographic analysis showed a significant acute left ventricle and left atrial reverse remodeling that was maintained up to three years. CONCLUSIONS The NeoChord echo-guided transapical beating heart repair procedure demonstrated good clinical outcomes and echocardiographic results up to three-year follow-up.
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Affiliation(s)
- Gino Gerosa
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Matteo Nadali
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lorenzo Longinotti
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Matteo Ponzoni
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Raphael Caraffa
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Fiocco
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Nicola Pradegan
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Laura Besola
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Augusto D’Onofrio
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Roberto Bellu
- Cardiology Unit, Policlinico di Abano, Abano Terme, Italy
| | - Denas Gentian
- Cardiology Unit, Policlinico di Abano, Abano Terme, Italy
| | - Andrea Colli
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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247
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Rodriguez E, Raissi R, Bott M, Morse MA. MitraClip™: a step by step guide for surgeons. Ann Cardiothorac Surg 2021; 10:180-182. [PMID: 33575192 DOI: 10.21037/acs-2020-mv-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Ryan Raissi
- Ascension Saint Thomas Heart, Nashville, TN, USA
| | - Merissa Bott
- Ascension Saint Thomas Heart, Nashville, TN, USA
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248
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Oh NA, Kampaktsis PN, Gallo M, Guariento A, Weixler V, Staffa SJ, Avgerinos DV, Colli A, Doulamis IP. An updated meta-analysis of MitraClip versus surgery for mitral regurgitation. Ann Cardiothorac Surg 2021; 10:1-14. [PMID: 33575171 DOI: 10.21037/acs-2020-mv-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Although studies demonstrate its feasibility, there is ongoing debate on the short and long-term outcomes of MitraClip versus surgical repair or mitral valve replacement (MVR). The objective of this meta-analysis is to compare the safety, morbidity, mortality and long-term function following MitraClip compared to MVR. Methods Articles were searched in PubMed and Cochrane databases for studies comparing outcomes of MitraClip and surgery on December 1, 2019. Eligible prospective, retrospective, randomized and non-randomized studies were reviewed. Results A total of nine studies (n=1,873, MitraClip =533, MVR =644) were eligible for review. At baseline, MitraClip patients had more comorbidities than MVR patients, including myocardial infarction (P<0.001), chronic obstructive pulmonary disease (P=0.022) and chronic kidney disease (P<0.001). MitraClip was associated with shorter length of stay (-3.86 days; 95% CI, -4.73 to -2.99; P<0.01) with a similar safety profile. Residual moderate-to-severe mitral regurgitation was more frequent in MitraClip at discharge (OR, 2.81; 95% CI, 1.39-5.69; P<0.01) and at five years (OR, 2.46; 95% CI, 1.54-3.94; P<0.01), and there was a higher need for reoperation on the MitraClip group at latest follow-up (OR, 5.28; 95% CI, 3.43-8.11; P<0.01). The overall mortality was comparable between the two groups (HR, 2.06; 95% CI, 0.98-4.29; P=0.06) for a mean follow-up of 4.8 years. Conclusions Compared to surgery, MitraClip demonstrates a similar safety profile and shorter length of stay in high-risk patients, at the expense of increased residual mitral regurgitation and higher reoperation rate. Despite this, long term mortality appears comparable between the two techniques, suggesting that a patient-tailored approach will lead to optimal results.
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Affiliation(s)
- Nicholas A Oh
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Columbia University, Irving Medical Center, New York City, NY, USA
| | - Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland
| | - Alvise Guariento
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Viktoria Weixler
- Department of Cardiac Surgery, German Heart Institute, Berlin, Germany
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York City, NY, USA
| | - Andrea Colli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Stehli J, Ailawadi G, Lim DS. Edge-to-edge repair: will it still be mainstream repair therapy in 2030? Ann Cardiothorac Surg 2021; 10:158-160. [PMID: 33575186 DOI: 10.21037/acs-2020-mv-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Julia Stehli
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, VA, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - D Scott Lim
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, VA, USA
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Hernandez-Suarez DF, Ranka S, Kim Y, Latib A, Wiley J, Lopez-Candales A, Pinto DS, Gonzalez MC, Ramakrishna H, Sanina C, Nieves-Rodriguez BG, Rodriguez-Maldonado J, Feliu Maldonado R, Rodriguez-Ruiz IJ, da Luz Sant'Ana I, Wiley KA, Cox-Alomar P, Villablanca PA, Roche-Lima A. Machine-Learning-Based In-Hospital Mortality Prediction for Transcatheter Mitral Valve Repair in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 22:22-28. [PMID: 32591310 PMCID: PMC7736498 DOI: 10.1016/j.carrev.2020.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) utilization has increased significantly in the United States over the last years. Yet, a risk-prediction tool for adverse events has not been developed. We aimed to generate a machine-learning-based algorithm to predict in-hospital mortality after TMVR. METHODS Patients who underwent TMVR from 2012 through 2015 were identified using the National Inpatient Sample database. The study population was randomly divided into a training set (n = 636) and a testing set (n = 213). Prediction models for in-hospital mortality were obtained using five supervised machine-learning classifiers. RESULTS A total of 849 TMVRs were analyzed in our study. The overall in-hospital mortality was 3.1%. A naïve Bayes (NB) model had the best discrimination for fifteen variables, with an area under the receiver-operating curve (AUC) of 0.83 (95% CI, 0.80-0.87), compared to 0.77 for logistic regression (95% CI, 0.58-0.95), 0.73 for an artificial neural network (95% CI, 0.55-0.91), and 0.67 for both a random forest and a support-vector machine (95% CI, 0.47-0.87). History of coronary artery disease, of chronic kidney disease, and smoking were the three most significant predictors of in-hospital mortality. CONCLUSIONS We developed a robust machine-learning-derived model to predict in-hospital mortality in patients undergoing TMVR. This model is promising for decision-making and deserves further clinical validation.
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Affiliation(s)
- Dagmar F Hernandez-Suarez
- Division of Cardiovascular Medicine, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR, USA.
| | - Sagar Ranka
- Division of Cardiovascular Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Yeunjung Kim
- Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Jose Wiley
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Angel Lopez-Candales
- Division of Cardiology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Duane S Pinto
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maday C Gonzalez
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Cristina Sanina
- Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA
| | - Brenda G Nieves-Rodriguez
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Jovaniel Rodriguez-Maldonado
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Roberto Feliu Maldonado
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Israel J Rodriguez-Ruiz
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Istoni da Luz Sant'Ana
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Karlo A Wiley
- College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Pedro Cox-Alomar
- Division of Cardiology, Department of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Pedro A Villablanca
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Abiel Roche-Lima
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR, USA
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