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Berger C, Said E, Haller K, Nordine M, Reinthaler M, Landmesser U, Treskatsch S. Dexmedetomidine Sedation Combined With Remifentanil in MitraClip Procedures is Feasible and Improves Hemodynamics. J Cardiothorac Vasc Anesth 2023; 37:50-57. [PMID: 36347731 DOI: 10.1053/j.jvca.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of the study was to compare the overall feasibility, respiratory and hemodynamic stability, as well as process times of a dexmedetomidine-based sedative regimen compared with general anesthesia among patients undergoing MitraClip procedures. DESIGN A retrospective cohort study. SETTING A single tertiary care university center. PARTICIPANTS The study included 79 patients. INTERVENTIONS Dexmedetomidine sedation versus general anesthesia. MEASUREMENTS AND MAIN RESULTS Seventy-nine MitraClip procedures in dexmedetomidine/remifentanil conscious sedation (DCS, n = 26) or general anesthesia (GA, n = 53), performed between 2018 and 2020 at Charité - Universitätsmedizin Berlin, were analyzed retrospectively. Patients' median age was 81 years in both groups without differences in preinterventional EuroScore I (DCS 6 [5; 8], GA 7 [6; 8]) or systolic function (left ventricular ejection fraction: DCS 50% [32; 60] v. GA 50% [36; 60]; tricuspid annular plane systolic excursion: DCS 19 mm [16; 22] v GA 19 mm [15; 22]). During MitraClip procedures, respiratory parameters revealed no differences between groups, whereas patients under DCS showed higher mean arterial pressures (DCS 64 mmHg [59; 74] v GA 58 mmHg [53; 66]) and needed less norepinephrine (DCS 0.0µg/kg/min [0.0; 0.2] v GA 0.08 µg/kg/min [0.05; 0.15]). Emergence from both anesthesia regimens to readiness for intensive care unit transfer was faster in DCS (8 min [4; 18] v GA 16 min [11; 23]); however, total process time was comparable between groups (DCS 128 min [104; 155] v GA 142 min [117; 190]). Two patients required a switch from DCS to GA due to oral bleeding or prolonged procedure time. Both were excluded from the analysis. There was no switch to open surgery and no differences in postoperative complications between DCS and GA. CONCLUSION Dexmedetomidine/remifentanil sedation appears to be feasible and a safe option for MitraClip procedures, and provides better hemodynamic stability with faster emergence times compared with general anesthesia.
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Affiliation(s)
- Christian Berger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany.
| | - Ebtisam Said
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Haller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Michael Nordine
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Markus Reinthaler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität andHumboldt Universität zu Berlin, Department of Cardiology, Campus BenjaminFranklin, Berlin, Germany
| | - Ulf Landmesser
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität andHumboldt Universität zu Berlin, Department of Cardiology, Campus BenjaminFranklin, Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
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Afzal S, Zeus T, Hofsähs T, Kuballa M, Veulemans V, Piayda K, Heidari H, Polzin A, Horn P, Westenfeld R, Kelm M, Hellhammer K. Safety of transoesophageal echocardiography during structural heart disease interventions under procedural sedation: a single-centre study. Eur Heart J Cardiovasc Imaging 2022; 24:68-77. [PMID: 34977935 DOI: 10.1093/ehjci/jeab280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS The aim of this study was to determine the incidence of transoesophageal echocardiography (TOE)-related adverse events (AEs) during structural heart disease (SHD) interventions and to identify potential risk factors. METHODS AND RESULTS We retrospectively analysed 898 consecutive patients undergoing TOE-guided SHD interventions under procedural sedation. TOE-related AEs were classified as bleeding complications, mechanical lesions, conversion to general anaesthesia with intubation, and the occurrence of pneumonia. A follow-up was conducted up to 3 months after the intervention. TOE-related AEs were observed in 5.3% of the patients (n = 48). The highest rate of AEs was observed in the percutaneous mitral valve repair (PMVR) group with 8.2% (n = 32), whereas 4.8% (n = 11) of the patients in the left atrial appendage group and 1.8% (n = 5) in the patent foramen ovale/atrial septal defect group developed a TOE-related AE (P = 0.001). The most frequent AE was pneumonia with an incidence of 2.6% (n = 26) in the total cohort. Bleeding events occurred in 1.8% (n = 16) of the patients, mostly in the PMVR group with 2.1% (n = 8). In the multivariate regression analysis, we found a lower haemoglobin {odds ratio (OR) [95% confidence interval (CI)]: 8.82 (0.68-0.98) P = 0.025} and an obstructive sleep apnoea syndrome (OSAS) [OR (95% CI): 2.51 (1.08-5.84) P = 0.033] to be associated with AE. Furthermore, AEs were related to procedural time [OR (95% CI): 1.01 (1.0-1.01) P = 0.056] and oral anticoagulation [OR (95% CI): 1.97 (0.9-4.3) P = 0.076] with borderline significance in the multivariate regression analysis. No persistent damages were observed. CONCLUSION TOE-related AEs during SHD interventions are clinically relevant. It was highest in patients undergoing PMVR. A lower baseline haemoglobin level and an OSAS were found to be associated with the occurrence of a TOE-related AE.
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Affiliation(s)
- Shazia Afzal
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Timo Hofsähs
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Matti Kuballa
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Kerstin Piayda
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Houtan Heidari
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany.,CARID (Cardiovascular Research Institute Düsseldorf), Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Katharina Hellhammer
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
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Percutaneous mitral valve repair in severe secondary mitral regurgitation: Analysis of index hospitalization and economic evaluation based on the MITRA-FR trial. Arch Cardiovasc Dis 2021; 114:805-813. [PMID: 34802961 DOI: 10.1016/j.acvd.2021.10.005] [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: 04/08/2021] [Revised: 06/30/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Percutaneous mitral valve repair (pMVR) is reimbursed in France for severe secondary mitral regurgitation (SMR), but French data regarding the hospitalization index stay are lacking. AIMS Our objectives were to describe the index hospitalization stay and to evaluate the cost of hospital stay for pMVR used in SMR. METHODS A secondary evaluation based on patients who were randomized to the intervention group of the MITRA-FR study was undertaken. The economic evaluation was conducted according to the French hospital perspective. Medical resource use was estimated using specific data collected from patients enrolled in the MITRA-FR study and non-specific data from national statistics. RESULTS The population was represented by 144 patients who underwent pMVR at 33 French centres. There was a mean±standard deviation of 7.9±1.5 hospital staff during procedures. The mean procedure duration was 154±68 minutes and increased with the number of implanted clips. Median total length of stay was 8 days. The occurrence of a serious adverse event was not associated with an increased risk of admission to the critical care unit, but was associated with an increased length of stay. The mean total cost was 28,025±3424€, which includes 21,547€ for the cost of medical devices used during pMVR and 6478±3424€ for other costs. CONCLUSION The cost of pMVR is substantial for patients with SMR, which advocates for further efforts to identify the patients with SMR who are likely to derive a clear clinical benefit from the procedure.
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Sharma H, Birkhoelzer SM, Liu B, Su Khin KL, Liu S, Tahir Z, Pimenta D, Ahmad M, Lall K, Banerjee A, Shah BN, Myerson S, Prendergast B, Steeds R. Transcatheter and surgical intervention for secondary mitral regurgitation. Hippokratia 2021. [DOI: 10.1002/14651858.cd014812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Harish Sharma
- Institute of Cardiovascular Sciences; University of Birmingham; Birmingham UK
| | | | - Boyang Liu
- Department of Cardiology; University Hospital Birmingham; Birmingham UK
| | - Kyaw Linn Su Khin
- Department of Cardiology; University Hospital Birmingham; Birmingham UK
| | - Simiao Liu
- Department of Cardiology; Barts Heart Centre, St Bartholomew's Hospital; London UK
| | - Zaheer Tahir
- Cardiothoracic Surgery; University Hospitals Plymouth; Plymouth UK
| | | | - Mahmood Ahmad
- Department of Cardiology; Royal Free Hospital, Royal Free London NHS Foundation Trust; London UK
| | - Kulvinder Lall
- Department of Cardiothoracic Surgery; Barts Health NHS Trust; London UK
| | - Amitava Banerjee
- Institute of Health Informatics Research; University College London; London UK
| | | | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | | | - Richard Steeds
- Department of Cardiology; University Hospitals Birmingham (Queen Elizabeth) NHS FT; Birmingham UK
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5
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Kreusser MM, Weber A, Geis NA, Grossekettler L, Volz MJ, Hamed S, Katus HA, Pleger ST, Frey N, Raake PW. Re-do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure. ESC Heart Fail 2021; 8:4617-4625. [PMID: 34498422 PMCID: PMC8712900 DOI: 10.1002/ehf2.13564] [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: 12/11/2020] [Revised: 07/08/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Aim Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for severe mitral regurgitation (MR) in advanced stages of heart failure (HF). However, progressive left ventricular dilation in these patients may lead to recurrent MR after PMVR and consequent re‐do MitraClip implantation. Here, we describe the characteristics and outcomes of this clinical scenario. Methods and results Patients with systolic HF and functional MR undergoing a re‐do MitraClip procedure were retrospectively analysed. Inclusion criteria were age ≥18 years, technical, device and procedural success at first MitraClip procedure, functional MR and systolic HF with an ejection fraction (EF) of <45%. Seventeen out of 684 patients undergoing PMVR with the MitraClip device at our institution between September 2009 and July 2019 were included. All patients displayed advanced HF with an EF of 20% (±9.9) and highly elevated N‐terminal pro‐brain natriuretic peptide. Technical success of the re‐do MitraClip procedure was 100%, whereas procedural and device success were only achieved in 11 patients (65%). Unsuccessful re‐do procedures were related to lower EF and implantation of more than one clip at initial procedure. However, despite reduction in MR grade and no occurrence of significant mitral stenosis after the procedure, the mortality during 12 months follow‐up remained high (8 of 17; 47%). Conclusions In a cohort of patients with advanced HF undergoing PMVR, re‐do MitraClip procedure was feasible, but procedural success was unsatisfactory and morbidity and mortality remained high, possibly reflecting the advanced stage of HF in these patients.
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Affiliation(s)
- Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Andreas Weber
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Martin J Volz
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Sonja Hamed
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
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Kay B, Chouairi F, Clark KAA, Reinhardt SW, Fuery M, Guha A, Ahmad T, Kaple RK, Desai NR. Comparison of Transcatheter and Open Mitral Valve Repair Among Patients With Mitral Regurgitation. Mayo Clin Proc 2021; 96:1522-1529. [PMID: 34088415 DOI: 10.1016/j.mayocp.2021.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022]
Abstract
In 2013, the Food and Drug Administration approved the first transcatheter mitral valve repair (TMVr) device for degenerative mitral regurgitation for patients at prohibitive surgical risk. To better understand contemporary utilization trends and outcomes, we reviewed hospitalizations, identified using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes, in which the patient underwent TMVr or mitral valve repair (MVr) with a diagnosis of mitral regurgitation, without stenosis, from the National (Nationwide) Inpatient Sample from 2014 to 2017. We included 10,020 hospitalizations in which the patient underwent TMVr and 5845 in which the patient underwent MVr and assessed trends in demographic characteristics, patient comorbidities, total hospital charges, and outcomes. Transcatheter mitral valve repair experienced exponential growth, increasing from 150 to 5115 over the study period (P<.001 for trend), whereas MVr grew to a lesser degree. The median length of stay for TMVr decreased from 4 to 2 days; mortality declined from 3.3% to 1.6% (P<.001 for both). Both TMVr and MVr rates of discharge home increased over the study period. Total charges for TMVr increased from $149,582 to $178,109, whereas those for MVr increased to a lesser degree, from $149,426 to $157,146 (P<.001 for both). Discharge disposition, length of stay, and in-hospital mortality all exhibited favorable trends for both procedures. Caution must be exercised in direct comparisons between procedures as they target somewhat different populations. With expanded indications for TMVr, we anticipate further increases in procedural volume, although the effect on MVr remains unclear.
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Affiliation(s)
- Bradley Kay
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Katherine A A Clark
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Samuel W Reinhardt
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Michael Fuery
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Division of Cardiovascular Medicine, University Hospitals, Case Western Reserve University, Cleveland, OH
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, New Haven, CT
| | - Ryan K Kaple
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, New Haven, CT.
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7
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Jobs A, Grund S, de Waha-Thiele S, Sievert H, Rassaf T, Luedike P, Horn P, Westenfeld R, Patzelt J, Langer H, Lurz P, Desch S, Eitel I, Thiele H, Desch S, Eitel I, Thiele H. Deep sedation versus general anaesthesia for transcatheter mitral valve repair: an individual patient data meta-analysis of observational studies. EUROINTERVENTION 2021; 16:1359-1365. [PMID: 33046436 PMCID: PMC9724987 DOI: 10.4244/eij-d-20-00607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this meta-analysis was to compare general anaesthesia (GA) and deep sedation (DS) with regard to safety and length of intensive care unit (ICU) stay in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR). METHODS AND RESULTS Four studies comparing GA and DS in patients undergoing PMVR were included in an individual patient data meta-analysis. Data were pooled after multiple imputation. The composite safety endpoint of all-cause death, stroke, pneumonia, or major to life-threatening bleeding occurred in 87 of 626 (13.9%) patients with no difference between patients treated with DS as compared to GA (56 and 31 events in 420 and 206 patients, respectively). In this regard, the odds ratio (OR) was 1.27 (95% confidence interval [CI]: 0.78 to 2.09; p=0.338) and 1.26 (95% CI: 0.49 to 3.22; p=0.496) following the one-stage and two-stage approach, respectively. Length of ICU stay was longer after GA as compared to DS (ratio of days 3.08, 95% CI: 2.18 to 4.36, p<0.001, and 2.88, 95% CI: 1.45 to 5.73, p=0.016, following the one-stage and two-stage approach, respectively). CONCLUSIONS Both DS and GA might offer a similar safety profile. However, ICU stay seems to be shorter after DS.
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Affiliation(s)
- Alexander Jobs
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, and Leipzig Heart Institute, Leipzig, Germany,Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Simon Grund
- Leibniz Institute for Science and Mathematics Education Kiel, Kiel, Germany
| | - Suzanne de Waha-Thiele
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany,German Center for Cardiovascular Research (DZHK), Berlin, Germany,Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | | | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Johannes Patzelt
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany,German Center for Cardiovascular Research (DZHK), Berlin, Germany,Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Harald Langer
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany,German Center for Cardiovascular Research (DZHK), Berlin, Germany,Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, and Leipzig Heart Institute, Leipzig, Germany
| | - Steffen Desch
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, and Leipzig Heart Institute, Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr. 39, 04289 Leipzig, Germany
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8
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Chan JSK, Kot TKM, Ghani S, Harky A. Local anaesthesia and deep sedation versus general anaesthesia for transcatheter mitral edge-to-edge repair: A systematic review and meta-analysis. J Clin Anesth 2020; 65:109816. [DOI: 10.1016/j.jclinane.2020.109816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/03/2020] [Accepted: 04/04/2020] [Indexed: 01/19/2023]
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9
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Zangrillo A, Morselli F, Lombardi G, Yavorovskiy A, Likhvantsev V, Beretta L, Monaco F, Landoni G. Procedural sedation and analgesia for percutaneous high-tech cardiac procedures. Minerva Cardiol Angiol 2020; 69:358-369. [PMID: 32989964 DOI: 10.23736/s2724-5683.20.05211-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The interest in percutaneous high-tech cardiac procedures has increased in recent years together with its safety and efficacy. In fragile patients, procedural sedation and analgesia are used to perform most of the procedures. General anesthesia remains the technique of choice during the team learning curve and might be required in selected patients or in emergent situations. Despite the high costs of percutaneous high-tech cardiac procedures, the decrease in length of hospital stays, rate of intensive care admission and complications, balance the increase in devices costs. In fragile patients who undergo percutaneous high tech cardiac procedures, the primary role of the anesthesiologist is to prevent the need for postprocedural intensive care unit and complications rate. Starting from the experience of a large university third level hospital we identified the eight most commonly performed contemporary percutaneous high tech cardiac procedures (ventricular tachycardia and atrial fibrillation ablation, protected percutaneous coronary intervention, transcatheter aortic valve implantation, MitraClip® (Abbott Laboratories; Abbott Park, IL, USA), percutaneous patent foramen ovale closure, left atrial appendage closure, and dysfunctional lead extraction), discuss the role of procedural sedation and analgesia in this setting, and explore future perspectives.
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Affiliation(s)
- Alberto Zangrillo
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Andrey Yavorovskiy
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia
| | | | - Luigi Beretta
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Milan, Italy - .,IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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10
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Banga S, Hafiz AM, Chami Y, Gumm DC, Banga P, Howard C, Kim M, Sengupta PP. Comparing sedation vs. general anaesthesia in transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair: a meta-analysis. Eur Heart J Cardiovasc Imaging 2020; 21:511-521. [PMID: 32101610 DOI: 10.1093/ehjci/jeaa019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/15/2020] [Accepted: 01/24/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair (TOE-guided PMVR) using edge-to-edge leaflet plication is typically performed under general anaesthesia (GA). Increasing evidence supports the efficacy and safety of PMVR performed under conscious sedation (CS) or deep sedation (DS). We performed a meta-analysis comparing safety and efficacy of CS/DS vs. GA in PMVR. METHODS AND RESULTS A comprehensive search was performed using PubMed, CINAHL, Ovid MEDLINE, Embase, and the Cochrane Library. Study characteristics, participant demographics, and procedural outcomes with both types of anaesthesia were analysed. Out of 73 articles, five met inclusion criteria. Overall, there was no significant difference in the primary outcome of procedural success rate [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.30-1.88, I2= 0.0%, P = 0.538] or post-procedure in-hospital mortality (OR 1.02; 95% CI 0.38-2.71, I2= 0.0%, P = 0.970) in the patients undergoing PMVR under CS/DS vs. GA. The secondary endpoint of intensive care unit (ICU) length of stay (LOS) was significantly shorter in patients under CS/DS vs. GA (standardized mean difference, SMD = -0.97; 95% CI -1.75 to -0.20; P = 0.014), but the hospital LOS (SMD = 0.36; 95% CI -0.77 to 0.04, P = 0.078) did not show a statistically significant difference between the groups, although it was shorter in the CS/DS group. No difference was observed between CS/DS and GA in fluoroscopy time, procedure time, or complications, including pneumonia, stroke/transient ischaemic attack, and major bleeding. CONCLUSION CS or DS has lower ICU LOS, but comparable procedural success rate and in-hospital mortality, making it a potential alternative to GA for TOE-guided PMVR.
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Affiliation(s)
- Sandeep Banga
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, USA
| | - Abdul Moiz Hafiz
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Youssef Chami
- Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Darrel C Gumm
- Division of Cardiology, University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Preeti Banga
- University of Illinois College of Medicine at Peoria, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Carmen Howard
- Library of the Health Sciences at Peoria, University of Illinois at Chicago, Peoria, IL, USA
| | - Minchul Kim
- Center of Outcomes Research, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Partho P Sengupta
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, USA
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Châteauneuf G, Nazif TM, Beaupré F, Kodali S, Rodés-Cabau J, Paradis JM. Cerebrovascular events after transcatheter mitral valve interventions: a systematic review and meta-analysis. Heart 2020; 106:1759-1768. [DOI: 10.1136/heartjnl-2019-316331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/29/2022] Open
Abstract
ObjectiveCurrent guidelines support the use of transcatheter mitral valve interventions to treat some selected high-risk patients with significant mitral valvulopathy. As with any other interventional cardiac procedure, concerns have been raised about cerebrovascular event. The aim of this systematic review and meta-analysis was to determine the incidence of cerebrovascular events following (1) transcatheter mitral valve edge-to-edge repair with mitral valve clip and (2) transcatheter mitral valve replacement (TMVR).MethodsWe conducted a systematic review of studies reporting the cerebrovascular adverse events after transcatheter mitral valve edge-to-edge repair and TMVR procedures. The primary endpoint was the incidence of cerebrovascular events as defined by the Mitral Valve Academic Research Consortium. An event that occurred within 30 days or during index hospitalisation was defined as periprocedural; otherwise it was defined as non-periprocedural. This study was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Aggregated study-level data were pooled using a random effect model. The quality of each study was appraised with the Hawker checklist, a method of systematically reviewing research from different paradigms.ResultsSixty studies totalling 28 155 patients undergoing edge-to-edge repair with mitral valve clip were included in the analysis. Periprocedural stroke and non-periprocedural stroke rates were 0.9% (95% CI 0.6 to 1.1) and 2.4% (95% CI 1.6 to 3.2), respectively. For TMVR procedures, 26 studies including 1910 patients were analysed. The estimated periprocedural stroke incidence was 1% (95% CI 0.5 to 1.8) compared with 7% (95% CI 0.8 to 18.5) for non-periprocedural stroke.ConclusionsTranscatheter mitral valve interventions are associated with low rates of cerebrovascular events. The exact mechanisms of these complications are still poorly understood given the relative paucity of good quality data.Trial registration numberCRD42019117257.
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Bini T, Agostini C, Stolcova M, Meucci F, Di Mario C. One more option in heart failure: correction of mitral regurgitation with MitraClip ®. Intern Emerg Med 2019; 14:1033-1040. [PMID: 31297739 DOI: 10.1007/s11739-019-02140-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/26/2019] [Indexed: 01/19/2023]
Abstract
Degenerative mitral regurgitation in elderly patients and functional mitral regurgitation secondary to severe left ventricular dysfunction are not easy options for conventional surgery. Recently, a new percutaneous approach has been proposed with the MitraClip®, based on the Alfieri edge-to-edge repair technique. The aim of the study is to report, compare and discuss the results of two multicenter randomized trials: MITRA.FR and COAPT in light of the current practice. In both trials patients with functional mitral regurgitation grade 3/4+ or 4/4+ were randomly assigned, in 1:1 ratio, to undergo percutaneous repair and optimal medical therapy or optimal medical therapy alone. Other baseline characteristics reflecting severity of mitral regurgitation and of left ventricular impairment were statistically different, such as the effective regurgitant orifice area (0.31 cm2 in MITRA.FR vs 0.41 cm2 in COAPT) and the indexed LVEDV (135 ± 37 ml/m2 in MITRA.FR vs 101 ± 34 ml/m2 in COAPT). A 24 months follow-up and a 12 months follow-up have been completed, respectively, in COAPT and MITRA.FR. Out of the 307 patients enrolled in the MITRA.FR, 152 were randomized to percutaneous treatment but only in 138 (95.8%) the MitraClip® was actually implanted. At the end of the follow-up a residual mitral regurgitation of at least grade 3+ has been observed in 17% of the patients. A composite of death from any cause or unplanned hospitalizations for heart failure at 12 months respectively occurred in 83 patients (54.6%) treated percutaneously and 78 patients (51.3%) treated with medical therapy only. A total of 614 patients have been enrolled in the COAPT and 293 underwent transcatheter treatment. A successful implantation of the MitraClip® was achieved in 287 patients (98.0%). Hospitalization for heart failure at 24 months occurred in 160 patients in the device group and in 283 in the control group, with an annualized ratio of 35.8% and 67.9%, respectively (p > 0.001). The conflicting results of the two trials may have many explanations, but probably the main cause is the most stringent inclusion criteria in COAPT. The effective reduction of mitral regurgitation and improvement in exercise capacity already observed in registries including more than 70,000 patients was confirmed in a randomized trial with improvement observed in hard end-points. This has already led to an extension of FDA approval to functional regurgitation and a more liberal use across the world.
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Affiliation(s)
- Tommaso Bini
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy.
| | - Cecilia Agostini
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, University Hospital Careggi, Florence, Italy
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Alcici ME, Lodi-Junqueira L, Sant'Anna Athayde GR, Soares JR, Gomes Tiago DA, Tavares PL, Saad GP, Ferreira de Sales I, Okello E, Rwebembera J, Esteves WAM, Nunes MCP. The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries. Glob Heart 2019; 14:311-316. [PMID: 31451239 DOI: 10.1016/j.gheart.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Severe valve disease, which requires intervention, remains strongly associated with mortality in patients with rheumatic heart disease. Percutaneous mitral commissurotomy (PMC) is the procedure of choice for the treatment of patients with isolated or predominantly rheumatic mitral stenosis. This procedure has been performed under sedation to avoid the potential effects of general anesthesia on intracardiac pressure measurements. However, there are limited data on sedation during PMC, especially using easily available medications in low- and middle-income countries. OBJECTIVES This study was designed to evaluate the efficacy and hemodynamic effects of conscious sedation during PMC in patients with significant mitral stenosis. METHODS This study prospectively enrolled 23 patients who underwent PMC with the Inoue balloon technique for hemodynamically significant mitral stenosis. For conscious sedation, midazolam 25 μg/kg and fentanyl 1 μg/kg were administered, and 5 min after the infusion, the level of sedation was evaluated by Ramsay sedation scale. A range of invasive hemodynamic measurements, including cardiac output and pulmonary artery pressures, were recorded before and immediately after sedation. RESULTS The mean age was 44.9 ± 10.8 years, and 19 patients (83%) were women. After sedation, the majority of patients were in categories 2 and 3 of the Ramsay sedation scale (cooperative, orientated, tranquil, and responding to commands). Oxygen saturation dropped from an average of 98.5% to 96.0% without supplementary oxygen. Left ventricular systolic pressure and central aortic pressures decreased after sedation. However, none of the other parameters changed significantly after sedation, including pulmonary artery pressures, pulmonary vascular resistance, and cardiac index. CONCLUSIONS This simple model of conscious sedation was able to promote anxiolysis, analgesia, and comfort for the procedure without serious hemodynamic effects, which can be a reasonable choice in developing countries.
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Affiliation(s)
- Marta Eugenia Alcici
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Lodi-Junqueira
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Guilherme Rafael Sant'Anna Athayde
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Rodrigues Soares
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Diogo Antônio Gomes Tiago
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Priscila Lima Tavares
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gabriel Prado Saad
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Igor Ferreira de Sales
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | | | - William A M Esteves
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Carmo P Nunes
- Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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15
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Gregory SH, Sodhi N, Zoller JK, Quader N, Ridley CH, Maniar HS, Lasala JM, Zajarias A. Anesthetic Considerations for the Transcatheter Management of Mitral Valve Disease. J Cardiothorac Vasc Anesth 2019; 33:796-807. [DOI: 10.1053/j.jvca.2018.05.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 12/19/2022]
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16
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Wu IY, Barajas MB, Hahn RT. The MitraClip Procedure—A Comprehensive Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2018; 32:2746-2759. [DOI: 10.1053/j.jvca.2018.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Indexed: 11/11/2022]
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17
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Transcatheter Valve Procedures and the Anesthesiologist. Int Anesthesiol Clin 2018; 56:74-97. [PMID: 30204609 DOI: 10.1097/aia.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Invasive hemodynamics and cardiac biomarkers to predict outcomes after percutaneous edge-to-edge mitral valve repair in patients with severe heart failure. Clin Res Cardiol 2018; 108:375-387. [PMID: 30191296 DOI: 10.1007/s00392-018-1365-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for high-risk or non-surgical candidates with severe mitral regurgitation (MR) and advanced stages of heart failure (HF). However, these patients have a high mortality despite PMVR, and predictors for outcomes are not well established. Here, we evaluated invasive hemodynamics, echocardiography parameters, and biomarkers to predict outcomes after PMVR in severe HF patients. METHODS Patients with reduced ejection fraction (EF) and severe and moderate-to-severe MR undergoing PMVR at our centre between September 2009 and January 2016 were analysed retrospectively. Inclusion criteria were: left ventricular EF < 45%, preoperative right heart catheterization, successful MitraClip deployment ("technical success"), and follow-up for at least 1 year after the procedure. Data from preoperative right heart catheterization, echocardiography, and biomarkers were assessed. Primary endpoint was all-cause mortality at 1 year after PMVR. We performed univariate and multivariate Cox regression analyses and generated a risk score to predict outcomes. RESULTS Of 174 patients with PMVR and severe HF, 79.9% had functional MR. Mean EF was 25% (17.2; 30.7) and advanced New York Heart Association functional class was prevalent (class II: 13%; class III: 70%; and class IV: 17%). The cumulative incidences of all-cause death were 6.9% and 17.8% at 30 days and 1 year, respectively. In the Cox multivariate model, high-sensitive troponin T [hsTnT; hazard ratio (HR) 1.01; confidence interval (CI) 1.01-1.02; p < 0.0001] and mixed venous O2-saturation (HR 0.92; CI 0.89-0.96; p < 0.0001) were found to significantly and independently predict outcomes. A simple risk score including these two parameters was sufficient to discriminate between low- and high-risk patients (HR 7.22; CI 3.4-15.5; p < 0.001). CONCLUSION In a cohort of patients with severe HF undergoing PMVR, patients with elevated hsTnT and reduced mixed venous O2-saturation carried the worst prognosis. A simple risk score including these two parameters may improve patient selection and outcomes after PMVR.
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Atrioventricular valve disease: challenges and achievements in percutaneous treatment. Clin Res Cardiol 2018; 107:88-93. [DOI: 10.1007/s00392-018-1303-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/13/2018] [Indexed: 01/20/2023]
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20
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Hellhammer K, Afzal S, Tigges R, Spieker M, Rassaf T, Zeus T, Westenfeld R, Kelm M, Horn P. High body mass index is a risk factor for difficult deep sedation in percutaneous mitral valve repair. PLoS One 2018; 13:e0190590. [PMID: 29304185 PMCID: PMC5755851 DOI: 10.1371/journal.pone.0190590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022] Open
Abstract
Background The safety and efficacy of deep sedation (DS) in MitraClip® procedures have been shown previously. However, clinical experience demonstrates that in some patients DS is difficult to achieve. We hypothesize that some patient characteristics can predict difficult DS. Methods We prospectively analysed 69 patients undergoing MitraClip® procedures using DS. Application of DS was graded as simple (group 1) or difficult (group 2) depending on a cumulative score based on one point for each of the following criteria: decrease in oxygen saturation, retention of carbon dioxide, disruptive body movements, and the need for catecholamines. Patients with one point or less were classified as group 1, and patients with two or more points were classified as group 2. Results In 58 of 69 patients (84.1%), the performance of DS was simple, while in 11 patients (15.9%), DS was difficult to achieve. Patients with difficult DS were characterized by a higher body mass index (33.7 ± 6.0 kg/m2 vs. 26.1 ± 4.1; p = 0.001), younger age (67 ± 13 years vs. 75 ± 13 years; p = 0.044), and reduced left ventricular ejection fraction (36% ± 10 vs. 45% ± 14; p = 0.051) and presented more often with an obstructive sleep apnoea syndrome (6.9% vs. 45.5%; p = 0.003). In the multivariate analysis, body mass index was an independent predictor of difficult DS. Using a body mass index of 31 kg/m2 as a cut-off value, the sensitivity of predicting difficult DS was 73%, and the specificity was 88%. Using a body mass index of 35 kg/m2 as a cut-off value, the specificity increased to 97%, with a sensitivity of 36%. Conclusion In patients with a higher body mass index who undergo MitraClip® procedures, DS might be difficult to perform.
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Affiliation(s)
- Katharina Hellhammer
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Shazia Afzal
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Renate Tigges
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Maximilian Spieker
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Tienush Rassaf
- University Hospital Essen, Medical Faculty, Dept. of Medicine, Division of Cardiology and Vascular Medicine, Essen, Germany
| | - Tobias Zeus
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Ralf Westenfeld
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Malte Kelm
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Patrick Horn
- University Hospital Düsseldorf, Medical Faculty, Dept. of Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
- * E-mail:
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Patzelt J, Ulrich M, Magunia H, Sauter R, Droppa M, Jorbenadze R, Becker AS, Walker T, von Bardeleben RS, Grasshoff C, Rosenberger P, Gawaz M, Seizer P, Langer HF. Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair. J Am Heart Assoc 2017; 6:JAHA.117.007485. [PMID: 29197832 PMCID: PMC5779052 DOI: 10.1161/jaha.117.007485] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous edge-to-edge mitral valve repair (PMVR) has become an established treatment option for mitral regurgitation in patients not eligible for surgical repair. Currently, most procedures are performed under general anesthesia (GA). An increasing number of centers, however, are performing the procedure under deep sedation (DS). Here, we compared patients undergoing PMVR with GA or DS. METHODS AND RESULTS A total of 271 consecutive patients underwent PMVR at our institution between May 2014 and December 2016. Seventy-two procedures were performed under GA and 199 procedures under DS. We observed that in the DS group, doses of propofol (743±228 mg for GA versus 369±230 mg for DS, P<0.001) and norepinephrine (1.1±1.6 mg for GA versus 0.2±0.3 mg for DS, P<0.001) were significantly lower. Procedure time, fluoroscopy time, and dose area product were significantly higher in the GA group. There was no significant difference between GA and DS with respect to overall bleeding complications, postinterventional pneumonia (4% for GA versus 5% for DS), or C-reactive protein levels (361±351 nmol/L for GA versus 278±239 nmol/L for DS). Significantly fewer patients with DS needed a postinterventional stay in the intensive care unit (96% for GA versus 19% for DS, P<0.001). Importantly, there was no significant difference between DS and GA regarding intrahospital or 6-month mortality. CONCLUSIONS DS for PMVR is safe and feasible. No disadvantages with respect to procedural outcome or complications in comparison to GA were observed. Applying DS may simplify the PMVR procedure.
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Affiliation(s)
- Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Miriam Ulrich
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- Department of Anesthesiology, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Reinhard Sauter
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Michal Droppa
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Rezo Jorbenadze
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Annika S Becker
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tobias Walker
- Department of Cardiovascular Surgery, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | | | - Christian Grasshoff
- Department of Anesthesiology, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital Eberhard Karls University Tuebingen, Tuebingen, Germany
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Horn P, Hellhammer K, Minier M, Stenzel MA, Veulemans V, Rassaf T, Luedike P, Pohl J, Balzer J, Zeus T, Kelm M, Westenfeld R. Deep sedation Vs. general anesthesia in 232 patients undergoing percutaneous mitral valve repair using the MitraClip®
system. Catheter Cardiovasc Interv 2017; 90:1212-1219. [DOI: 10.1002/ccd.26884] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/31/2016] [Accepted: 11/20/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Patrick Horn
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Katharina Hellhammer
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Michael Minier
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Monika A. Stenzel
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Verena Veulemans
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Tienush Rassaf
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Peter Luedike
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Julia Pohl
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Jan Balzer
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Tobias Zeus
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Malte Kelm
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
| | - Ralf Westenfeld
- Division of Cardiology; Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf; Düsseldorf Germany
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de Waha S, Desch S, Eitel I, Thiele H. Response to Prof. Dr. med. Gunther Wiesner, Prof. Dr. med. Peter Tassani-Prell, and Dr. Patrick Mayr. Clin Res Cardiol 2016; 106:162-163. [DOI: 10.1007/s00392-016-1049-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Impact of cardiac comorbidities on early and 1-year outcome after percutaneous mitral valve interventions: data from the German transcatheter mitral valve interventions (TRAMI) registry. Clin Res Cardiol 2016; 106:249-258. [DOI: 10.1007/s00392-016-1044-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/11/2016] [Indexed: 12/25/2022]
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Deep sedation versus general anesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system. Clin Res Cardiol 2015; 105:535-43. [PMID: 26683202 DOI: 10.1007/s00392-015-0951-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous edge-to-edge mitral valve reconstruction (PMVR) has emerged as a treatment option in patients with severe mitral regurgitation not considered suitable candidates for surgery. The majority of PMVR procedures are performed under general anesthesia (GA), although deep sedation (DS) appears to be an attractive alternative. We thus sought to assess the impact on intensive care unit (ICU) length of stay, efficacy, and safety of DS in comparison to GA in patients undergoing PMVR using the MitraClip(®) system. METHODS Sixty consecutive patients underwent PMVR procedures at two centers. The first 30 patients were treated by GA followed by 30 patients undergoing DS under different settings. The primary clinical endpoint was ICU length of stay. The primary efficacy endpoint included procedural success and procedural duration. The safety endpoint was defined as a composite of death, stroke, cardiogenic shock, moderate and severe bleeding as well as pneumonia. RESULTS The ICU length of stay was significantly shorter in the DS group in comparison to GA patients (p = 0.001). The hospital length of stay did not differ following DS in comparison to GA (p = 0.96). Procedural success was high in both groups (100 versus 96.7 %, p = 0.34) at similar procedural duration time (p = 0.60). No difference between GA and DS was observed with respect to the occurrence of the combined safety endpoint (p = 0.47). CONCLUSIONS In comparison to GA, DS reduces the ICU length of stay in PMVR without negative effects on safety and efficacy. Prospective randomized trials are needed to confirm these findings.
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