1
|
Chioncel O, Adamo M, Nikolaou M, Parissis J, Mebazaa A, Yilmaz MB, Hassager C, Moura B, Bauersachs J, Harjola VP, Antohi EL, Ben-Gal T, Collins SP, Iliescu VA, Abdelhamid M, Čelutkienė J, Adamopoulos S, Lund LH, Cicoira M, Masip J, Skouri H, Gustafsson F, Rakisheva A, Ahrens I, Mortara A, Janowska EA, Almaghraby A, Damman K, Miro O, Huber K, Ristic A, Hill L, Mullens W, Chieffo A, Bartunek J, Paolisso P, Bayes-Genis A, Anker SD, Price S, Filippatos G, Ruschitzka F, Seferovic P, Vidal-Perez R, Vahanian A, Metra M, McDonagh TA, Barbato E, Coats AJS, Rosano GMC. Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology. Eur J Heart Fail 2023; 25:1025-1048. [PMID: 37312239 DOI: 10.1002/ejhf.2918] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023] Open
Abstract
Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence-based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear-cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.
Collapse
Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maria Nikolaou
- Cardiology Department, General Hospital 'Sismanogleio-Amalia Fleming', Athens, Greece
| | - John Parissis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandre Mebazaa
- Université Paris Cité, MASCOT Inserm, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, Paris, France
| | - Mehmet Birhan Yilmaz
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Moura
- Armed Forces Hospital, Faculty of Medicine of Porto, Porto, Portugal
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben-Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center and Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
| | - Vlad Anton Iliescu
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius; Centre of Innovative Medicine, Vilnius, Lithuania
| | | | - Lars H Lund
- Karolinska Institute, Department of Medicine, and Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | | | - Josep Masip
- Research Direction, Consorci Sanitari Integral, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Hadi Skouri
- Division of Cardiology, Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amina Rakisheva
- Scientific and Research Institute of Cardiology and Internal Disease, Almaty, Kazakhstan
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Cologne, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Mortara
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Ewa A Janowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Abdallah Almaghraby
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Oscar Miro
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Kurt Huber
- Medical Faculty, Sigmund Freud University, Vienna, Austria
- 3rd Medical Department, Wilhelminen Hospital, Vienna, Austria
| | - Arsen Ristic
- Department of Cardiology of the University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Loreena Hill
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Alaide Chieffo
- Vita Salute-San Raffaele University, Milan, Italy
- IRCCS San Raffaele Scientific, Institute, Milan, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Antoni Bayes-Genis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Susanna Price
- Royal Brompton Hospital & Harefield NHS Foundation Trust, London, UK
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital, Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, Zurich, Switzerland
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Rafael Vidal-Perez
- Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Alec Vahanian
- University Paris Cite, INSERM LVTS U 1148 Bichat, Paris, France
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital London, London, UK
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | | |
Collapse
|
2
|
Hausleiter J, Stocker TJ, Adamo M, Karam N, Swaans MJ, Praz F. Mitral valve transcatheter edge-to-edge repair. EUROINTERVENTION 2023; 18:957-976. [PMID: 36688459 PMCID: PMC9869401 DOI: 10.4244/eij-d-22-00725] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/04/2022] [Indexed: 01/21/2023]
Abstract
Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER.
Collapse
Affiliation(s)
- Jörg Hausleiter
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy
| | - Nicole Karam
- Paris Cardiovascular Research Center, INSERM and Cardiology Department, European Hospital Georges Pompidou, University of Paris, Paris, France
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Kaur S, Sadana D, Patel J, Gad M, Sankaramangalam K, Krishnaswamy A, Miyasaka R, Harb SC, Kapadia SR. Atrial Fibrillation and Transcatheter Repair of Functional Mitral Regurgitation: Evidence From a Meta-Regression. JACC Cardiovasc Interv 2021; 13:2374-2384. [PMID: 33092711 DOI: 10.1016/j.jcin.2020.06.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of atrial fibrillation (AF) on mortality and efficacy in patients with functional mitral regurgitation (FMR) undergoing MitraClip implantation. BACKGROUND AF is a common arrhythmia in patients with severe FMR undergoing transcatheter mitral valve repair with the MitraClip device. Although AF has been consistently shown to be associated with poor outcomes after mitral valve surgery, the impact of AF on outcomes of MitraClip placement in patients with FMR has not been well studied. METHODS Prospective, retrospective registries, observational studies, and randomized controlled trials on MitraClip reporting AF and FMR as one of the variables from inception until January 2019 were included. RESULTS Of the initial 1,694 studies, 15 studies met the inclusion criteria. From a total of 5,184 patients, 2,105 patients were identified to have FMR and AF. All-cause 30-day mortality in patients with FMR was 3.7% (95% confidence interval: 2.87 to 4.66) and 1-year mortality was 17.9% (95% confidence interval: 16.01 to 19.71). The meta-regression analysis studying the impact of AF among patients with FMR treated with the MitraClip demonstrated no difference in mortality at 30 days but demonstrated significantly increased mortality at 1 year (95% confidence interval: 0.0006 to 0.0027) (p = 0.004). AF did not influence procedural success. CONCLUSIONS This meta-regression identifies AF as an independent negative predictor of long-term mortality after MitraClip implantation in patients with FMR. The mechanism of worse outcomes in patients with AF requires further study.
Collapse
Affiliation(s)
- Simrat Kaur
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Divyajot Sadana
- Department of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Jay Patel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Gad
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kesavan Sankaramangalam
- Department of Internal Medicine, Saint Peter's University Hospital/Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amar Krishnaswamy
- Department of Interventional Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Rhonda Miyasaka
- Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Serge C Harb
- Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Interventional Cardiology, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
4
|
Kreidel F, Zaid S, Tamm AR, Ruf TF, Beiras-Fernandez A, Reinold J, Geyer M, da Rocha E Silva J, Schnitzler K, Michaela H, Münzel T, Tang GHL, von Bardeleben RS. Impact of Mitral Annular Dilation on Edge-to-Edge Therapy With MitraClip-XTR. Circ Cardiovasc Interv 2021; 14:e010447. [PMID: 34304600 DOI: 10.1161/circinterventions.120.010447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center, Valhalla, NY (S.Z.)
| | - Alexander R Tamm
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Tobias F Ruf
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Andres Beiras-Fernandez
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jenny Reinold
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jaqueline da Rocha E Silva
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Katharina Schnitzler
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Hell Michaela
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, NY (G.H.L.T.)
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| |
Collapse
|
5
|
Affiliation(s)
- Georg Nickenig
- University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany. E-mail:
| | | |
Collapse
|
6
|
Adamo M, Metra M, Alfieri O. Percutaneous valve repair of functional mitral regurgitation: aiming at optimal and durable results. Eur J Heart Fail 2020; 22:1849-1851. [DOI: 10.1002/ejhf.1850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Marianna Adamo
- Cardio‐thoracic Department, ASST Spedali Civili di Brescia; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy
| | - Marco Metra
- Cardio‐thoracic Department, ASST Spedali Civili di Brescia; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital Vita‐Salute San Raffaele University Milan Italy
| |
Collapse
|
7
|
Mocavero PE, Melillo E, Esposito C, Ascione L, Crisci M, Cigala E, Piro O, Monteforte I, Monda V, Caso P, Bonzani G, Corcione A. Anesthesiological Management in Transcatheter Mitral Valve Repair With MitraClip: Beyond the EVEREST Criteria. Semin Cardiothorac Vasc Anesth 2019; 23:413-417. [PMID: 30994402 DOI: 10.1177/1089253219842650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Percutaneous mitral valve repair with the MitraClip system recently emerged as a viable and less invasive therapeutic option in patients with severe mitral regurgitation deemed to be high-risk surgical candidates. Mitral valve morphology and geometry features are key elements for MitraClip eligibility. In the setting of functional mitral regurgitation, the presence of a leaflet coaptation gap due to advanced left ventricle remodeling can be a potential exclusion criterion for MitraClip therapy. In this article, the authors present a case of successful MitraClip implantation in a patient with severe functional mitral regurgitation and a significant coaptation gap. Periprocedural and intraoperative pharmacological and anesthesiological management were fundamental for successful grasping and procedural success.
Collapse
Affiliation(s)
| | - Enrico Melillo
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | | | - Luigi Ascione
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Mario Crisci
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | | | - Orlando Piro
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Vittorio Monda
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Pio Caso
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Giulio Bonzani
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | | |
Collapse
|
8
|
De Rosa R, Silverio A, Baldi C, Di Maio M, Prota C, Radano I, Rey J, Herrmann E, Citro R, Piscione F, Galasso G. Transcatheter Repair of Functional Mitral Regurgitation in Heart Failure Patients ― A Meta-Analysis of 23 Studies on MitraClip Implantation ―. Circ J 2018; 82:2800-2810. [DOI: 10.1253/circj.cj-18-0571] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roberta De Rosa
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Angelo Silverio
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Cesare Baldi
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Marco Di Maio
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, AORN “Ospedali dei Colli”
| | - Costantina Prota
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Ilaria Radano
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Julia Rey
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt
| | - Eva Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt
| | - Rodolfo Citro
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Federico Piscione
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Gennaro Galasso
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| |
Collapse
|
9
|
Nyman CB, Mackensen GB, Jelacic S, Little SH, Smith TW, Mahmood F. Transcatheter Mitral Valve Repair Using the Edge-to-Edge Clip. J Am Soc Echocardiogr 2018; 31:434-453. [PMID: 29482977 DOI: 10.1016/j.echo.2018.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/20/2022]
Abstract
Percutaneous intervention for mitral valve (MV) disease has been established as an alternative to open surgical MV repair in patients with prohibitive surgical risk. Multiple percutaneous approaches have been described and are in various stages of development. Edge-to-edge leaflet plication with the MitraClip (Abbott, Menlo Park, CA) is currently the only Food and Drug Administration-approved device specifically for primary or degenerative lesions. Use of the edge-to-edge clip for secondary mitral regurgitation is currently under investigation and may result in expanded indications. Echocardiography has significantly increased our understanding of the anatomy of the MV and provided us with the ability to classify and quantify the associated mitral regurgitation. For percutaneous interventions of the MV, transesophageal echocardiography imaging is used for patient screening, intraprocedural guidance, and confirmation of the result. Optimal outcomes require the echocardiographer and the proceduralist to have a thorough understanding of intra-atrial septal and MV anatomy, as well as an appreciation for the key points and potential pitfalls of each of the procedural steps. With increasing experience, more complex valvular pathology can be successfully percutaneously treated. In addition to two-dimensional echocardiography, advances in three-dimensional echocardiography and fusion imaging will continue to support the refinement of current technologies, the expansion of clinical applications, and the development of novel devices.
Collapse
Affiliation(s)
- Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Thomas W Smith
- Department of Internal Medicine, Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Feroze Mahmood
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
10
|
Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review. Clin Res Cardiol 2017; 106:1005-1017. [DOI: 10.1007/s00392-017-1150-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
|
11
|
Tigges E, Blankenberg S, von Bardeleben RS, Zürn C, Bekeredjian R, Ouarrak T, Sievert H, Nickenig G, Boekstegers P, Senges J, Schillinger W, Lubos E. Implication of pulmonary hypertension in patients undergoing MitraClip therapy: results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail 2017; 20:585-594. [PMID: 29575435 DOI: 10.1002/ejhf.864] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/09/2017] [Accepted: 03/18/2017] [Indexed: 11/09/2022] Open
Abstract
AIMS We sought to evaluate the impact of pulmonary hypertension on outcomes following MitraClip therapy. METHODS AND RESULTS The 643 patients in the TRAnscatheter Mitral valve Interventions (TRAMI) registry were divided into three groups according to echocardiographically graded systolic pulmonary artery pressure (sPAP) (Group 1: patients with sPAP of ≤36 mmHg; Group 2: patients with sPAP of 37-50 mmHg; Group 3: patients with sPAP of >50 mmHg) and followed for 1 year. Recent cardiac decompensation, aortic valve disease and tricuspid valve insufficiency were observed more frequently in patients with higher sPAP. Furthermore, logEuroSCORE, Society of Thoracic Surgeons score and age were higher with rising sPAP values. No differences were observed in mitral regurgitation (MR) severity, co-morbidities or clinical findings (New York Heart Association class, 6-min walking distance). Reduction to MR of grade 1 or lower was achieved more often in patients with lower sPAP levels (P = 0.01). In Groups 2 and 3, sPAP was reduced significantly. Major adverse cardiac or cardiovascular events (MACCEs) occurring in hospital (death, myocardial infarction, stroke; <4% in each group), as well as 30-day rates of MACCEs (6.1% in Group 1, 11.9% in Group 2, 12.4% in Group 3) and rehospitalization (18.9% in Group 1, 24.8% in Group 2, 24.8% in Group 3) did not differ significantly. At 1 year, differences in rates of mortality and MACCEs (20.3% in Group 1, 33.1% in Group 2, 34.7% in Group 3; P < 0.01) were significant. Both Groups 2 [hazard ratio (HR) 1.81, P = 0.0122] and 3 (HR 1.85, P = 0.0092) were independently predictive of death. Rehospitalization rates did not differ during follow-up. CONCLUSIONS Despite higher mortality in patients with elevated sPAP, these data suggest the safety, feasibility and benefit of MitraClip therapy even in advanced stages of disease. An early approach might prevent the progress of pulmonary hypertension and improve outcomes.
Collapse
Affiliation(s)
- Eike Tigges
- Department of General and Interventional Cardiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christine Zürn
- Department of Cardiology, University Medical Centre Tübingen, Tübingen, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Angiology and Pneumology, University Medical Centre Heidelberg, Heidelberg, Germany
| | - Taoufik Ouarrak
- Institute for Myocardial Infarction Research, Ludwigshafen, Germany
| | - Horst Sievert
- Cardiovascular Centre, St Katharinen Hospital, Frankfurt am Main, Germany
| | - Georg Nickenig
- Department of Internal Medicine, Medical Clinic II, University Medical Centre Bonn, Bonn, Germany
| | - Peter Boekstegers
- Department of Cardiology and Angiology, Helios Clinic Siegburg, Siegburg, Germany
| | - Jochen Senges
- Institute for Myocardial Infarction Research, Ludwigshafen, Germany
| | - Wolfgang Schillinger
- Department of Internal Medicine I, Helios Albert-Schweitzer-Hospital, Northeim, Germany
| | - Edith Lubos
- Department of General and Interventional Cardiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
12
|
Lesevic H, Karl M, Braun D, Barthel P, Orban M, Pache J, Hadamitzky M, Mehilli J, Stecher L, Massberg S, Ott I, Schunkert H, Kastrati A, Sonne C, Hausleiter J. Long-Term Outcomes After MitraClip Implantation According to the Presence or Absence of EVEREST Inclusion Criteria. Am J Cardiol 2017; 119:1255-1261. [PMID: 28237285 DOI: 10.1016/j.amjcard.2016.12.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 12/31/2022]
Abstract
Numerous patients are treated with the MitraClip, although they do not fulfill the stringent inclusion criteria of the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) trials. The outcome of those patients is not well known. Therefore, we compared the long-term outcome after MitraClip treatment between patients who matched (group 1) and did not match (group 2) the EVEREST criteria. One hundred thirty-four consecutive patients were treated from September 2009 to July 2012: 59 patients (44%) in group 1 versus 75 patients (56%) in group 2. Investigated end points were acute procedural success (for group 1 vs 2: 97% vs 95%; p = 0.694), all-cause mortality (28% vs 27%; p = 0.656), reintervention (RI) rate (11% vs 37%; p = 0.010), and improvement in mitral regurgitation (MR) (-1.3 ± 1 vs -1.5 ± 1, p = 0.221) and in New York Heart Association functional class (-0.7 ± 1 vs -0.9 ± 0.8, p = 0.253) during the follow-up of 33 months (27.9 to 38.3). The morphologic extent of a flail leaflet was an independent predictor for RI. In conclusion, although the overall outcome was comparable between both groups, recurrent symptomatic MR with need for RI was higher in group 2, mainly because of complex valve pathologies: especially flail width >15 mm and gap ≥10 mm. Improvements in the interventional strategy are warranted for reducing the need for RI in patients with primary MR.
Collapse
|
13
|
Berardini A, Biagini E, Saia F, Stolfo D, Previtali M, Grigioni F, Pinamonti B, Crimi G, Salvi A, Ferrario M, De Luca A, Gazzoli F, Bacchi Reggiani ML, Raineri C, Sinagra G, Rapezzi C. Percutaneous mitral valve repair: The last chance for symptoms improvement in advanced refractory chronic heart failure? Int J Cardiol 2016; 228:191-197. [PMID: 27875721 DOI: 10.1016/j.ijcard.2016.11.241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/06/2016] [Accepted: 11/10/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The role of percutaneous mitral valve repair (PMVR) in patients with end-stage heart failure (HF) and functional mitral regurgitation (FMR) is unclear. METHODS Seventy-five consecutive patients with FMR grade≥3+ and severe HF symptoms despite optimal medical therapy and resynchronization therapy underwent PMVR with the MitraClip system (Abbott, Abbott Park, IL, USA) at 3 centers. Clinical evaluation, echocardiography and pro-BNP measurement were performed at baseline and at 6-month. RESULTS Mean age was 67±11years, logistic EuroSCORE=23±18%, left ventricle ejection fraction (LVEF) 30±9%. In 6 patients (8%) PMVR was performed as a bridge to heart transplant; many patients were dependent from iv diuretics and/or inotropes. Rate of serious adverse in-hospital events was 1.3% (1 patient who died after conversion to cardiac surgery). Sixty-three patients (84%) were discharged with MR≤2+. At 6-month, 4 patients died (5%), 80% had MR≤2+ and 75% were in New York Heart Association class ≤II. Median pro-BNP decreased from 4395pg/ml to 2594pg/ml (p=0.04). There were no significant changes in LV end-diastolic volume (222±75ml vs. 217±79, p=0.19), end-systolic volume (LVESV, 154±66ml vs. 156±69, p=0.54) and LVEF (30±9% vs. 30±12%, p=0.86). Significant reverse remodeling (reduction of LVESV≥10%) was observed in 25%, without apparent association with baseline characteristics. The number of hospitalizations for HF in comparison with the 6months before PMVR were reduced from 1.1±0.8 to 0.3±0.6 (p<0.001). CONCLUSIONS In extreme risk HF patients with FMR, PMVR improved symptoms and reduced re-hospitalization and pro-BNP levels at 6months, despite the lack of LV reverse remodeling.
Collapse
Affiliation(s)
- Alessandra Berardini
- Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Elena Biagini
- Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Davide Stolfo
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Mario Previtali
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Grigioni
- Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Bruno Pinamonti
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Gabriele Crimi
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Salvi
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Maurizio Ferrario
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio De Luca
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Fabrizio Gazzoli
- Department of Cardiac Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Maria Letizia Bacchi Reggiani
- Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Claudia Raineri
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Claudio Rapezzi
- Cardiology Unit, Cardio-thoraco-vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Italy.
| |
Collapse
|
14
|
Metra M. October 2016 at a glance: treatment of heart failure. Eur J Heart Fail 2016; 18:1209-1210. [DOI: 10.1002/ejhf.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
| |
Collapse
|