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Benito-González T, Carrasco-Chinchilla F, Estévez-Loureiro R, Pascual I, Arzamendi D, Garrote-Coloma C, Nombela-Franco L, Pan M, Serrador A, Freixa X, Cid Alvarez AB, Hernández Antolín RA, Andraka L, Cruz-González I, López-Minguez JR, Díez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchís J, Bosa F, Ruíz V, Molina E, Becerra-Muñoz VM, Gualis J, Avanzas P, Li CH, Baz JA, Jimenez-Quevedo P, Mesa D, Amat-Santos IJ, Regueiro A, Trillo R, Domínguez Franco AJ, Alonso-Briales JH, Fernández-Vázquez F. Clinical and echocardiographic outcomes of transcatheter mitral valve repair in atrial functional mitral regurgitation. Int J Cardiol 2021; 345:29-35. [PMID: 34610357 DOI: 10.1016/j.ijcard.2021.09.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Isolated atrial fibrillation can cause mitral regurgitation (MR) in patients with normal left ventricular systolic function and no organic disease of the mitral valve. Little information is available regarding outcomes of Mitraclip in patients with atrial functional mitral regurgitation (AFMR). We aimed to evaluate 12-month clinical and echocardiographic outcomes of transcatheter mitral valve repair (TMVR) with MitraClip in patients with AFMR compared to those with ventricular functional or degenerative/mixed MR. METHODS Registry-based analysis of all consecutive patients who underwent TMVR and were included in the Spanish Registry of Mitraclip. Changes in MR and NYHA functional class, and a combined endpoint including all-cause mortality and hospitalizations due to heart failure were the main outcomes. RESULTS Overall, 1074 (69.1% male, 73.3 ± 10.2 years-old) patients were analyzed in this report. 48 patients (4.5%) presented AFMR. AFMR was significantly reduced after TMVR, with a procedural success rate of 91.7%, and this reduction persisted at 12-month (p < 0.001). Patients with AFMR showed a significant functional improvement at 6- and 12-month follow-up in our series (baseline: NYHA III 70.8% IV 18.8% vs. 1-year: NYHA III 21.7% IV 0%; p < 0.001). The probability of survival free of readmission for heart failure and all-cause mortality within the first year after TMVR was 74.9%. Procedural and clinical outcomes, as well as recurrent rates of MR were similar acutely and at 1-year compared to other etiologies. CONCLUSION TMVR in patients with AFMR showed no significant differences compared to ventricular functional or degenerative/mixed MR regarding MR reduction or clinical outcomes.
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Affiliation(s)
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | | | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Dabit Arzamendi
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Manuel Pan
- Department of Cardiology, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Ana Serrador
- Department of Cardiology, University Clinic Hospital, CIBERCV, Valladolid, Spain
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Ana Belén Cid Alvarez
- Department of Cardiology, University Clinic Hospital, CIBERCV, Santiago de Compostela, Spain
| | | | - Leire Andraka
- Department of Cardiology, Hospital Universitario de Basurto, Bilbao, Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Hospital Universitario de Salamanca, CIBERCV, IBSAL, Salamanca, Spain
| | | | - José Luis Díez Gil
- Department of Cardiology, Hospital Universitario y Politécnico La FE, Valencia, Spain
| | | | - Darío Sanmiguel Cervera
- Unidad de Hemodinámica y Cardiologia Intervencionista, Hospital General de Valencia, Valencia, Spain
| | - Juan Sanchís
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Francisco Bosa
- Department of Cardiology, Hospital Universitario de Canarias, Islas Canarias, Spain
| | - Valeriano Ruíz
- Department of Cardiology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Eduardo Molina
- Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Javier Gualis
- Department of Cardiology, University Hospital of León, León, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Chi Hion Li
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José Antonio Baz
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Dolores Mesa
- Department of Cardiology, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - Ander Regueiro
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Ramiro Trillo
- Department of Cardiology, University Clinic Hospital, CIBERCV, Santiago de Compostela, Spain
| | - Antonio Jesús Domínguez Franco
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Juan Horacio Alonso-Briales
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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Geyer M, Keller K, Sotiriou E, Tamm AR, Ruf TF, Kreidel F, Beiras-Fernandez A, Gori T, Schulz E, Münzel T, von Bardeleben RS. Association of transcatheter direct mitral annuloplasty with acute anatomic, haemodynamic, and clinical outcomes in severe mitral valve regurgitation. ESC Heart Fail 2020; 7:3336-3344. [PMID: 32915515 PMCID: PMC7755018 DOI: 10.1002/ehf2.12957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/08/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Several approaches for transcatheter mitral valve repair for functional mitral valve regurgitation are established. Interventional direct annuloplasty is a novel trans-venous, trans-septal approach. While feasibility was proven recently, knowledge on its influence on cardiac dimensions, pressures, biomarkers, and clinical outcomes is sparse. METHODS AND RESULTS Patients consecutively treated with direct annuloplasty-only procedures between December 2015 and April 2018 were included in this monocentric analysis. Echocardiographic measurements, biomarker levels, clinical status [New York Heart Association (NYHA) class and 6 min walk test] were assessed at baseline, at discharge, and at a 30 day follow-up. Overall, 18 patients (in mean 77.0 ± 7.4 years, 44.4% women) with initially all high-grade mitral valve regurgitation (MR) were included in this study. Procedural success rate was high (94.4%) without severe complications. Direct annuloplasty resulted in MR-reduction (post-procedural-MR mild or no/trace: 72.2%) and the proportion of patients with severe dyspnoea (NYHA III/IV) was reduced (88.9% vs. 50%, P = 0.008). Clinical results were associated with a relevant diminution of left atrial volumes (-16.5%, P < 0.001) and cardiac pressures [left atrial pressure (-32.3%, P = 0.019) and systolic pulmonary arterial pressure (PAP, -15.8%, P = 0.025)]. Patients with lower baseline levels of PAP (P = 0.022) as well as elevated highly sensitive troponin (P = 0.034) were more likely to archive clinical benefit (improvement in NYHA class ≥1 grade) after 1 month, which could not be correlated with the grade of MR-reduction. CONCLUSIONS Transcatheter mitral valve repair by direct annuloplasty results in a relevant reduction of intracardiac pressures, left atrial volumes, dyspnoea, and MR. Lower PAP and higher troponin values at baseline could be associated to dyspnoea reduction.
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Affiliation(s)
- Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Karsten Keller
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | | | - Alexander R Tamm
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Tobias F Ruf
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Felix Kreidel
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Andres Beiras-Fernandez
- Department of Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tommaso Gori
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | | | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
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Geyer M, Sotiriou E, Keller K, Tamm AR, Ruf TF, Kreidel F, Beiras-Fernandez A, Kornberger A, Yang Y, Emrich T, Schulz E, Münzel T, von Bardeleben RS. Feasibility of a MPR-based 3DTEE guidance protocol for transcatheter direct mitral valve annuloplasty. Echocardiography 2020; 37:1436-1442. [PMID: 32777134 DOI: 10.1111/echo.14694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Several interventional approaches have been established for the treatment of severe mitral regurgitation (MR) in patients at elevated risk for surgery. Direct annuloplasty is a relatively novel option in transcatheter mitral valve repair dedicated to reverse pathology in specific subsets of MR. With regard to echocardiographic guidance, this procedure presents with higher efforts in comparison with edge-to-edge therapy to enable safe and exact positioning of the device's anchors; evidence on optimal peri-interventional imaging is sparse. We tested a specific 3D-echo-guidance protocol implementing single-beat multiplanar reconstruction (MPR) and evaluated its feasibility. METHODS Overall, 16 patients consecutively treated with transcatheter direct annuloplasty for severe MR (87.5% functional/6.3% degenerative/6.3% mixed pathology) were entered in this monocentric analysis. Of these, two patients received a combined procedure including edge-to-edge repair. For all implantations, a 3D-echo-guidance protocol inheriting MPR was employed. RESULTS Periprocedural device time decreased continuously (overall mean 140 ± 55.1 minutes, 213 ± 38 minutes in the first 4 vs 108 ± 33 minutes in the last 4 procedures, P = .018) using the MPR-based echo protocol, going along with reduced fluoroscopy times and doses. Technical success rate was high (93.8%) without any serious cardiac-related adverse events. MR could be relevantly improved. CONCLUSION Echocardiographic guidance of transcatheter direct annuloplasty using a real time MPR-based protocol is feasible and safe. Optimized imaging might enable reduced implantation times and potentially increases safety.
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Affiliation(s)
- Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Efthymios Sotiriou
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Karsten Keller
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Alexander R Tamm
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tobias F Ruf
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Andres Beiras-Fernandez
- Department for Thoracic and Cardiovascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Angela Kornberger
- Department for Thoracic and Cardiovascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Yang Yang
- Department of Radiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tilman Emrich
- Department of Radiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Eberhard Schulz
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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Geyer M, Sotiriou E, Tamm AR, Ruf TF, Kreidel F, Yang Y, Emrich T, Beiras-Fernandez A, Gori T, Münzel T, Schulz E, von Bardeleben RS. Advanced Protocol for Three-Dimensional Transesophageal Echocardiography Guidance Implementing Real-Time Multiplanar Reconstruction for Transcatheter Mitral Valve Repair by Direct Annuloplasty. J Am Soc Echocardiogr 2019; 32:1359-1365. [DOI: 10.1016/j.echo.2019.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 02/07/2023]
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Renew JR, Martin AK, Murray AW, Pollak PM, Ramakrishna H. Functional Mitral Regurgitation: Interventions and Outcomes. J Cardiothorac Vasc Anesth 2019; 33:2053-2064. [DOI: 10.1053/j.jvca.2018.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Indexed: 12/19/2022]
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Götz N, Schreieck J, Langer HF, Patzelt J. Treatment of a patient with primary mitral regurgitation using the Cardioband® system. Eur Heart J Case Rep 2019; 3:5489331. [PMID: 31449652 PMCID: PMC6601195 DOI: 10.1093/ehjcr/ytz028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/02/2019] [Indexed: 11/21/2022]
Affiliation(s)
- Nina Götz
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
| | - Harald F Langer
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
| | - Johannes Patzelt
- Department of Cardiology and Cardiovascular Medicine, University Hospital, Eberhard Karls University, Otfried-Müller-Str. 10, Tübingen, Germany
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
The treatment of mitral regurgitation has changed in recent years due to the advent of interventional techniques, mostly the percutaneous edge-to-edge repair, and, more recently, annuloplasty and chordal replacement. In the future, more advances are expected from further development of interventional techniques, careful evaluation and better patient selection.
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Affiliation(s)
- Alec Vahanian
- Cardiology Department, University Paris Diderot, Bichat Hospital, AP-HP, Paris, France
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Ancona F, Agricola E, Stella S, Capogrosso C, Marini C, Margonato A, Hahn RT. Interventional Imaging of the Tricuspid Valve. Interv Cardiol Clin 2018; 7:13-29. [PMID: 29157520 DOI: 10.1016/j.iccl.2017.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nowadays, reasonable transcatheter tricuspid valve (TV) interventions are emerging as therapeutic options for functional tricuspid regurgitation (TR). The preprocedural planning is based on a multimodality imaging approach, which aims to (1) define the mechanisms of TR, (2) characterize TV morphology, (3) analyze the anatomic relationship between the TV apparatus and other structures, and (4) determine the size of the tricuspid annulus and vena cavae. Intraprocedural guidance is based mainly on transesophageal echocardiography (seldom transthoracic) and fluoroscopy, with the recent introduction of fusion imaging.
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Affiliation(s)
- Francesco Ancona
- Echocardiography Laboratory, Clinical Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milano 20132, Italy
| | - Eustachio Agricola
- Echocardiography Laboratory, Clinical Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milano 20132, Italy.
| | - Stefano Stella
- Echocardiography Laboratory, Clinical Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milano 20132, Italy
| | - Cristina Capogrosso
- Echocardiography Laboratory, Clinical Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milano 20132, Italy
| | - Claudia Marini
- Echocardiography Laboratory, Clinical Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milano 20132, Italy
| | - Alberto Margonato
- Echocardiography Laboratory, Clinical Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina 60, Milano 20132, Italy
| | - Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
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Hahn RT. Current transcatheter devices to treat functional tricuspid regurgitation with discussion of issues relevant to clinical trial design. Ann Cardiothorac Surg 2017; 6:240-247. [PMID: 28706866 DOI: 10.21037/acs.2017.03.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Functional or secondary tricuspid regurgitation (TR) has seen increased attention in recent times as relationships with clinically-relevant outcomes have come to light. Despite the association of increased mortality with significant TR, the disease remains under-recognized and thus relatively untreated. In addition, the disease itself has not been extensively studied and the interactions between annular dilatation, right heart disease and pulmonary hypertension are poorly understood. However, the high mortality and recurrence rate with current surgical replacement or repair techniques is well recognised, opening the door to transcatheter therapies for functional TR. The current perspective reviews the rationale for transcatheter solutions, describes some of the current approaches and discusses the ongoing questions of a poorly-studied condition which may limit the design of clinical trials for this disease.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
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Kuwata S, Taramasso M, Guidotti A, Nietlispach F, Maisano F. Evaluation of Valtech’s transcatheter mitral valve repair device. Expert Rev Med Devices 2017; 14:189-195. [DOI: 10.1080/17434440.2017.1292122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Fabian Nietlispach
- University Heart Center Zurich, Zurich University Hospital, Zurich, Switzerland
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