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Challa AB, Negm AS, Mahayni AA, Wamil M, Williamson E, Guerrero M, Weishaar P, Collins JD. Transcatheter Mitral Valve Replacement: Treatment Planning With Computed Tomography. Semin Roentgenol 2024; 59:67-75. [PMID: 38388098 DOI: 10.1053/j.ro.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Apurva Bhavana Challa
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ahmed S Negm
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | | | - Malgorzata Wamil
- Department of Cardiovascular Medicine, Mayo Clinic Healthcare, London, UK
| | - Eric Williamson
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Paul Weishaar
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | - Jeremy D Collins
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN.
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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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Winter MP, Bartko PE, Krickl A, Gatterer C, Donà C, Nitsche C, Koschutnik M, Spinka G, Siller-Matula JM, Lang IM, Mascherbauer J, Hengstenberg C, Goliasch G. Adaptive development of concomitant secondary mitral and tricuspid regurgitation after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2020; 22:1045-1053. [PMID: 32561917 DOI: 10.1093/ehjci/jeaa106] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 11/15/2022] Open
Abstract
AIMS Concomitant secondary atrioventricular regurgitation is frequent in patients with severe aortic stenosis scheduled for transcatheter aortic valve replacement (TAVR). The future implications of leaving associated valve lesions untreated after TAVR remain unknown. Aim of the present study was to characterize the evolution of concomitant secondary atrioventricular regurgitations and to evaluate their impact on long-term prognosis. METHODS AND RESULTS We prospectively enrolled 429 consecutive TAVR patients. All patients underwent comprehensive clinical, laboratory, and echocardiographic assessments prior to TAVR, at discharge, and yearly thereafter. All-cause mortality was chosen as primary study endpoint. At baseline, severe concomitant secondary mitral regurgitation (sMR) was present in 54 (13%) and severe concomitant secondary tricuspid regurgitation (sTR) in 75 patients (17%). After TAVR 59% of patients with severe sMR at baseline experienced sMR regression, whereas analogously sTR regressed in 43% of patients with severe sTR. Persistence of sTR and sMR were associated with excess mortality after adjustment for our bootstrap-selected confounder model with an adjusted HR of 2.44 (95% CI 1.15-5.20, P = 0.021) for sMR and of 2.09 (95% CI 1.20-3.66, P = 0.01) for sTR. Patients showing regression of atrioventricular regurgitation exhibited survival rates indistinguishable to those seen in patients without concomitant atrioventricular regurgitation (sMR: P = 0.83; sTR: P = 0.74). CONCLUSION Concomitant secondary atrioventricular regurgitation in patients with severe AS is a highly dynamic process with up to half of all patients showing regression of associated valvular regurgitation after TAVR and subsequent favourable post-interventional outcome. Persistent atrioventricular regurgitation is a major determinant of unfavourable outcome after TAVR and proposes a window of early sequel intervention.
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Affiliation(s)
- Max-Paul Winter
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Annika Krickl
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Constantin Gatterer
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Carolina Donà
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Christian Nitsche
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Matthias Koschutnik
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Jolanta M Siller-Matula
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.,Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | - Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Nanda A, Bob-Manuel T, Jefferies J, Ibebuogu U, Khouzam RN. A Comparative Analysis of Mitraclip Versus Mitral Valve-In-Valve Replacement for High-Risk Patients With Severe Mitral Regurgitation After Transcatheter Aortic Valve Replacement. Curr Probl Cardiol 2019; 46:100423. [PMID: 31064671 DOI: 10.1016/j.cpcardiol.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
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Lane CE, Eleid MF, Holmes DR. An under‐recognized high‐risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application. Catheter Cardiovasc Interv 2019; 94:274-279. [DOI: 10.1002/ccd.28220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/05/2019] [Accepted: 03/23/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Colleen E. Lane
- Department of Cardiovascular DiseaseMayo Clinic Rochester Minnesota
| | - Mackram F. Eleid
- Department of Cardiovascular DiseaseMayo Clinic Rochester Minnesota
| | - David R. Holmes
- Department of Cardiovascular DiseaseMayo Clinic Rochester Minnesota
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Stähli BE, Reinthaler M, Leistner DM, Landmesser U, Lauten A. Transcatheter Aortic Valve Replacement and Concomitant Mitral Regurgitation. Front Cardiovasc Med 2018; 5:74. [PMID: 29971238 PMCID: PMC6018074 DOI: 10.3389/fcvm.2018.00074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/30/2018] [Indexed: 12/24/2022] Open
Abstract
Mitral regurgitation frequently coexists in patients with severe aortic stenosis. Patients with moderate to severe mitral regurgitation at the time of transcatheter aortic valve replacement are at increased risk of future adverse events. Whether concomitant mitral regurgitation is independently associated with worse outcomes after TAVR remains a matter of debate. The optimal therapeutic strategy in these patients-TAVR with evidence-based heart failure therapy, combined TAVR and transcatheter mitral valve intervention, or staged transcatheter therapies-is ill-defined, and guideline-based recommendations in patients at increased risk for open heart surgery are lacking. Hence, a thorough evaluation of the aortic and mitral valve anatomy and function, along with an in-depth assessment of the patients' baseline risk profile, provides the basis for an individualized treatment approach. The aim of this review is therefore to give an overview of the current literature on mitral regurgitation in TAVR, focusing on different diagnostic and therapeutic strategies and optimal clinical decision making.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
| | - Markus Reinthaler
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Partner Site Berlin, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Berlin, Germany
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7
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Ando T, Takagi H, Briasoulis A, Telila T, Slovut DP, Afonso L, Grines CL, Schreiber T. A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions. Catheter Cardiovasc Interv 2017; 91:124-134. [PMID: 28862381 DOI: 10.1002/ccd.27256] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/29/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To summarize the published data of combined transcatheter aortic and mitral valve intervention (CTAMVI). BACKGROUND CTAMVI, a combination of either transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve-in-valve (TAViV) and transcatheter mitral valve replacement (TMVR), transcatheter mitral valve-in-valve/valve-in-ring (TMViV/ViR), or percutaneous mitral valve repair (PMVR) is an attractive alternative in high-surgical risk patients with combined aortic and mitral valve disease. However, its procedural details and clinical outcomes have not been well described. METHODS We performed a systematic review of all the published articles from PUBMED and EMBASE. RESULTS A total of 37 studies with 60 patients were included. The indication for CTAMVI was high or inoperable surgical risk and symptomatic severe aortic stenosis (92%) or severe aortic regurgitation (8%) combined with moderate to severe/severe mitral stenosis (30%) or moderate/severe mitral regurgitation (65%) or both (5%). In majority of the cases, aortic valve intervention was performed prior to the mitral valve. Mortality rate were 25% for TAVR + TMVR (range 42 days to 10 months), 17% for TAVR + TMViV/ViR (range 13 days to 6 months), 0% for TAViV + TMViV/ViR (range 6-365 days), and 15% for TAVR/ViV + PMVR (range 17 days to 419 days). Significant (more than moderate) paravalvular regurgitation post-procedure was rare. CONCLUSIONS CTAMVI appears to confer reasonable clinical outcome. Further large study is warranted to clarify the optimal strategy, procedural details and clinical outcomes in the future.
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Affiliation(s)
- Tomo Ando
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | | | - Tesfaye Telila
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - David P Slovut
- Division of Cardiothoracic Surgery and Cardiology, Montefiore Medical Center, Bronx, New York
| | - Luis Afonso
- Division of Cardiology, Wayne State University, Detroit, Michigan
| | - Cindy L Grines
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Theodore Schreiber
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
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8
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D'Ancona G, Paranskaya L, Öner A, Kische S, Ince H. Mitro-aortic pathology: a point of view for a fully transcatheter staged approach. Neth Heart J 2017; 25:605-608. [PMID: 28770396 PMCID: PMC5653536 DOI: 10.1007/s12471-017-1028-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/24/2017] [Indexed: 11/13/2022] Open
Abstract
Severe aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) often coexist. Although a fully percutaneous treatment for the two conditions, by means of transcatheter aortic valve implantation (TAVI) followed by MitraClip, can be appealing in selected high-risk candidates, critical and strategical reasoning should be applied. In a 3-year period we have developed a single-centre experience of 14 patients who were managed with a staged percutaneous approach to treat severe AVS and MVR. The average interval from TAVI to MitraClip repair was 101 ± 12 days. Success for TAVI was 100% and 92.9% (13/14) for MitraClip. At late follow-up, 3 patients developed MVR 3+. Estimated 1‑year survival was 66.5%. Freedom from 1‑year endpoint (death, stroke, major bleeding, myocardial infarction, and cardiac re-hospitalisation) was 57.9%. In our view, a fully transcatheter approach for mitro-aortic pathology is feasible and should be performed only as a staged procedure in those patients that remain symptomatic, in spite of successful TAVI. It should be emphasised that although the periprocedural success rate is satisfactory, follow-up mortality and re-hospitalisation rates remain high, even at mid-term follow-up. This most probably results from the advanced clinical picture at time of referral for treatment.
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Affiliation(s)
- G D'Ancona
- Heart Center, Rostock University Hospital, Rostock, Germany. .,Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany.
| | - L Paranskaya
- Heart Center, Rostock University Hospital, Rostock, Germany
| | - A Öner
- Heart Center, Rostock University Hospital, Rostock, Germany
| | - S Kische
- Heart Center, Rostock University Hospital, Rostock, Germany.,Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany
| | - H Ince
- Heart Center, Rostock University Hospital, Rostock, Germany.,Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany
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9
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Francisco ARG, Infante de Oliveira E, Nobre Menezes M, Carrilho Ferreira P, Canas da Silva P, Nobre Â, Pinto FJ. Combined MitraClip implantation and left atrial appendage occlusion using the Watchman device: A case series from a referral center. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Combined MitraClip implantation and left atrial appendage occlusion using the Watchman device: A case series from a referral center. Rev Port Cardiol 2017; 36:525-532. [PMID: 28673783 DOI: 10.1016/j.repc.2016.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Patients referred for percutaneous transcatheter mitral valve repair using the MitraClip® system frequently have atrial fibrillation, which imposes additional challenges due to the need for oral anticoagulation. Left atrial appendage occlusion is currently regarded as a non-inferior alternative to anticoagulation in patients with non-valvular atrial fibrillation and both high thromboembolic and bleeding risk. Considering that both MitraClip implantation and left atrial appendage occlusion are percutaneous techniques that require transseptal puncture, it is technically attractive to consider their concomitant use. OBJECTIVES We aim to evaluate the feasibility of a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure. METHODS We report the first case series regarding this issue, discussing the specific advantages, pitfalls and technical aspects of combining these two procedures. RESULTS Five patients underwent left atrial appendage occlusion with the Watchman® device followed by MitraClip implantation in the same procedure. All patients experienced significant reduction in mitral valve regurgitation of at least two grades, optimal occluder position, no associated complications and significant clinical improvement assessed by NYHA functional class (reduction of at least one functional class, with four patients in class I at one-month follow-up). CONCLUSION In selected patients rejected for surgical mitral valve repair, with atrial fibrillation and increased risk of bleeding and embolic events, a combined approach with MitraClip implantation and left atrial appendage occlusion in a single procedure is feasible, safe and effective.
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11
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Lee YT, Yin WH, Tsai SK, Hsiung MC, Wei J, Yu HP. Transcatheter Closure of Atrial Septal Defect with Attenuated Anterior Rim after Transcatheter Aortic Valve Implantation: Can It Be Carried out as a Single Procedure? Echocardiography 2015; 33:320-2. [PMID: 26593042 DOI: 10.1111/echo.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a highly effective minimally invasive treatment for symptomatically critical aortic stenosis (AS) in patients at high or prohibitive surgical risk. We report a case of staged transcatheter management of critical AS combined with an atrial septal defect (ASD) with attenuated anterior superior rim. The clinical result of this case suggests that both procedures can be safely performed simultaneously. Therefore, combined transcatheter treatment may appear as a possible strategy in patients with concomitant cardiac conditions.
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Affiliation(s)
- Yung-Tsai Lee
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Wei-Hsian Yin
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shen Kou Tsai
- School of Medicine, National Taiwan University and Hospital, Taipei, Taiwan
| | - Ming C Hsiung
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Ho-Ping Yu
- Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
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Takagi H, Umemoto T. Coexisting Mitral Regurgitation Impairs Survival After Transcatheter Aortic Valve Implantation. Ann Thorac Surg 2015; 100:2270-6. [PMID: 26277559 DOI: 10.1016/j.athoracsur.2015.05.094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND It remains unclear whether coexisting and untreated mitral regurgitation (MR) affects survival after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). To summarize contemporary evidence, we performed the first metaanalysis of adjusted observational studies reporting post-TAVI mortality in patients with various grades of MR. METHODS MEDLINE and EMBASE were searched until February 2015, with a bibliographic review of secondary sources. Eligible studies were observational studies enrolling patients undergoing TAVI for AS and reporting adjusted odds ratios (ORs), hazard ratios (HRs), or both for early (30-day or in-hospital) all-cause mortality, overall all-cause mortality, or both in patients with apparent (significant) versus unapparent (nonsignificant) MR as outcomes. RESULTS Sixteen eligible studies enrolling a total of 13,672 patients undergoing TAVI for AS were identified and included. Pooled analyses of eight studies (representing 9,356 patients) and 14 studies (representing 7,405 patients) respectively demonstrated a statistically significant increase in early (OR 2.17; 95% confidence interval [CI] 1.50 to 3.14; p < 0.0001) and overall all-cause mortality (HR 1.81; 95% CI 1.37 to 2.40; p < 0.0001) in patients with apparent relative to unapparent MR. The exclusion of any single study from the analyses did not substantively alter the overall results of our analyses, and there was no evidence of significant publication bias. CONCLUSIONS Coexisting and untreated apparent (usually moderate or severe) MR appears to be associated with an increase in both early and overall mortality after TAVI for AS.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
| | - Takuya Umemoto
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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13
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Cierre percutáneo de CIV y TAVI transfemoral asociado a la exclusión de la orejuela: potenciales beneficios del intervencionismo estructural combinado. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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García E, Unzué L, Jiménez P, Nombela L, Almería C, Macaya C. Percutaneous closure of VSD and TAVI with left atrial appendage exclusion in a single procedure: potential benefits of a combined structural interventional procedure. ACTA ACUST UNITED AC 2014; 67:492-4. [PMID: 24863602 DOI: 10.1016/j.rec.2014.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/23/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Eulogio García
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
| | - Leire Unzué
- Servicio de Cardiología, Hospital Universitario Madrid Montepríncipe, Madrid, Spain
| | - Pilar Jiménez
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Nombela
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Almería
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
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15
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Kische S, D'Ancona G, Paranskaya L, Schubert J, Arsoy N, Hauenstein KH, Alozie A, Jovanovich B, Nienaber C, Ince H. Staged total percutaneous treatment of aortic valve pathology and mitral regurgitation: institutional experience. Catheter Cardiovasc Interv 2013; 82:E552-63. [PMID: 23359543 DOI: 10.1002/ccd.24809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 12/05/2012] [Accepted: 01/01/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To summarize our single Institution experience with staged total percutaneous management of aorto-mitral pathology. BACKGROUND Percutaneous treatment of aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) has been recently proposed for patients at high surgical risk. METHODS Data concerning consecutive patients undergoing percutaneous transcatheter AV implantation (TAVI) followed by MV repair with MitraClip® were prospectively collected and analyzed. RESULTS From January 2010 to February 2012 a total of 254 patients were referred to undergo TAVI in our Institution. Seventeen (6.7%) had preoperative severe MVR that remained unchanged after TAVI. Due to exacerbation of symptoms 12 patients were subsequently submitted to MV repair with the MitraClip® device. Mean age was 79 years (72-86 years), median Ambler score was 30.1 (17.2-42.6) and EuroSCORE 22.3 (10.2-48.6). Procedural success rate was 100%. Postprocedural hospitalization was 7.1 ± 2.7 and 4.6 ± 0.9 days after TAVI and MV repair, respectively. Six months follow-up echocardiography confirms improvement in LV-EF (37.2 ± 9.9 vs. 43.5 ± 10.7, P < 0.0001). No patient presents MVR exceeding grade I(+) or prosthetic aortic insufficiency > I grade and all patients experienced an improvement in functional status. CONCLUSIONS Percutaneous treatment of AVS and MVR is feasible and safe. A tailored approach should be considered to treat firstly the AVS and subsequently the MVR when severe MV dysfunction and symptoms persist. Short-term durability of this combined percutaneous approach seems encouraging and justifies the economical burden to treat patients that have no other option.
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Affiliation(s)
- Stephan Kische
- Medical Faculty, Department of Cardiology at University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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