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Qiu Y, Li M, Song X, Li Z, Ma A, Meng Z, Li Y, Tan M. Predictive nomogram for 28-day mortality risk in mitral valve disorder patients in the intensive care unit: A comprehensive assessment from the MIMIC-III database. Int J Cardiol 2024; 407:132105. [PMID: 38677334 DOI: 10.1016/j.ijcard.2024.132105] [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: 02/21/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Mitral valve disorder (MVD) stands as the most prevalent valvular heart disease. Presently, a comprehensive clinical index to predict mortality in MVD remains elusive. The aim of our study is to construct and assess a nomogram for predicting the 28-day mortality risk of MVD patients. METHODS Patients diagnosed with MVD were identified via ICD-9 code from the MIMIC-III database. Independent risk factors were identified utilizing the LASSO method and multivariate logistic regression to construct a nomogram model aimed at predicting the 28-day mortality risk. The nomogram's performance was assessed through various metrics including the area under the curve (AUC), calibration curves, Hosmer-Lemeshow test, integrated discriminant improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). RESULTS The study encompassed a total of 2771 patients diagnosed with MVD. Logistic regression analysis identified several independent risk factors: age, anion gap, creatinine, glucose, blood urea nitrogen level (BUN), urine output, systolic blood pressure (SBP), respiratory rate, saturation of peripheral oxygen (SpO2), Glasgow Coma Scale score (GCS), and metastatic cancer. These factors were found to independently influence the 28-day mortality risk among patients with MVD. The calibration curve demonstrated adequate calibration of the nomogram. Furthermore, the nomogram exhibited favorable discrimination in both the training and validation cohorts. The calculations of IDI, NRI, and DCA analyses demonstrate that the nomogram model provides a greater net benefit compared to the Simplified Acute Physiology Score II (SAPSII), Acute Physiology Score III (APSIII), and Sequential Organ Failure Assessment (SOFA) scoring systems. CONCLUSION This study successfully identified independent risk factors for 28-day mortality in patients with MVD. Additionally, a nomogram model was developed to predict mortality, offering potential assistance in enhancing the prognosis for MVD patients. It's helpful in persuading patients to receive early interventional catheterization treatment, for example, transcatheter mitral valve replacement (TMVR), transcatheter mitral valve implantation (TMVI).
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Affiliation(s)
- Yuxin Qiu
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Menglei Li
- College of Life Science and Technology, Jinan University, Guangzhou 510630, China
| | - Xiubao Song
- Department of Recovery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zihao Li
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Ao Ma
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Zhichao Meng
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Yanfei Li
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
| | - Minghui Tan
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
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Arty F, Gaddameedi SR, Rathod M, Nasr H, Panchal P, Ricca A. An Unusual Presentation of Acute Severe Mitral Regurgitation. Cureus 2024; 16:e63271. [PMID: 38975426 PMCID: PMC11227890 DOI: 10.7759/cureus.63271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/09/2024] Open
Abstract
Mitral regurgitation (MR) results from retrograde blood flow from the left ventricle to the left atrium. Common etiologies of acute severe MR include papillary muscle rupture from myocardial infarction, leaflet perforation in infective endocarditis, chordal rupture (pop) in myxomatous valve disease, acute rheumatic fever with carditis, or functional MR due to cardiomyopathies, myocarditis or Takotsubo cardiomyopathy. Here, we present an unusual case of acute severe MR due to ruptured chordae tendineae likely secondary to degenerative valve disease. A 59-year-old male with a past medical history of hypertension and renal calculi was evaluated in the outpatient office for a urologic procedure. He was sent to the emergency room with left-sided chest pain, 6/10 in intensity, burning in nature, and non-radiating with no aggravating and relieving factors. He had nausea and vomiting for the past three days. He reported similar chest pain at rest and on exertion multiple times over the past year. He also had a chronic cough with no recent changes. His examination was unremarkable. Chest X-ray showed interstitial lung markings. Electrocardiography revealed an old right bundle branch block, but no ST/T-wave changes. He was admitted and treated for atypical pneumonia with ceftriaxone and azithromycin. The following morning, he complained of persistent chest pain 9/10 in intensity which improved with nitroglycerin. His examination revealed a new onset holosystolic murmur heard over the precordium. A two-dimensional echocardiogram showed a preserved ejection fraction of 55-60%, severe MR with eccentric jet, concerning for partially flail leaflet of the mitral valve. He was transferred to the university hospital for mitral valve replacement. Patients with acute rupture of chordae tendineae usually progress to severe mitral valve regurgitation. These patients usually present with pulmonary edema, signs of heart failure, and cardiogenic shock. Papillary muscle dysfunction, as well as partial or complete rupture of the mitral chordae can be detected as a new-onset holosystolic murmur and can be a crucial sign for early recognition. In our case, the patient developed a new holosystolic murmur on day two of admission which was recognized early, and prompt surgical intervention was performed.
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Affiliation(s)
- Fnu Arty
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | | | - Malay Rathod
- Medicine, Monmouth Medical Center, Long Branch, USA
| | - Hamzeh Nasr
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | | | - Anthony Ricca
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
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3
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Lammers EMJ, Nijdam A, Zijlstra JM, Janus CPM, de Weijer RJ, Appelman Y, Manintveld OC, Teske AJ, van Leeuwen FE, Aleman BMP. Cardiovascular screening outcomes in the Dutch survivorship care program for Hodgkin lymphoma survivors. J Cancer Surviv 2024:10.1007/s11764-024-01561-y. [PMID: 38649650 DOI: 10.1007/s11764-024-01561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 03/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular disease (CVD) due to former lymphoma treatment. In 2013, cardiovascular screening for 5-year HL survivors according to national guidelines was implemented in Dutch survivorship clinics. We aim to assess the following: (1) adherence to screening guidelines and (2) the yield of (risk factors for) CVD in the screening program. METHODS The study population consisted of 5-year HL survivors who received survivorship care at three University Medical Centers from 2013 to 2016 through 2021. Patient characteristics, cardiovascular screening procedures, and outcomes were collected from the medical records. RESULTS In 186 survivors eligible for cardiovascular screening (mean age 47.8 years, 60.8% female), the following diagnostics were performed: complete blood tests (81.0%, median frequency: yearly instead of advised 5-yearly evaluation), electrocardiogram (93.0%), echocardiography (94.6%). Fifty-five percent of survivors had at least one modifiable cardiovascular risk factor (i.e., current smoking, overweight, new/insufficiently controlled hypertension, dyslipidemia, or diabetes). Screening detected ≥ 1 CVD in 31.1% of survivors. Among survivors with available echocardiography report (n = 106), screening detected new aortic and/or mitral valve dysfunction(s) in 51.0% (with grades 3-4 in 4.9%) and impaired left ventricular ejection fraction in 10.3%. CONCLUSIONS Adherence to the screening guidelines in the Dutch HL survivorship care program was reasonable to good and a substantial number of actionable (risk factors for) CVD were diagnosed. IMPLICATIONS FOR CANCER SURVIVORS Our findings inform HL survivors at high risk of late cardiotoxicity about cardiovascular screening findings and demonstrate appropriate therapeutic actions after diagnosis of (risk factors for) CVD.
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Affiliation(s)
- Eline M J Lammers
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annelies Nijdam
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Cécile P M Janus
- Department of Radiation Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Roel J de Weijer
- Department of Hematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Arco J Teske
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Singireddy S, Atencah SE, Dadzie SK, Opare-Addo KA, Chinnatambi C. Outcomes of Transcatheter Edge-to-Edge Repair in Patients With Chronic Kidney Disease: A Retrospective National Inpatient Sample Study. Cureus 2024; 16:e57420. [PMID: 38699130 PMCID: PMC11062799 DOI: 10.7759/cureus.57420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Background The burden of mitral regurgitation is high, and studies show it is the most common valvular pathology. The management of mitral regurgitation varies and depends on the chronicity, severity, etiology, and comorbidities of the patient. Surgical repair is recommended over replacement. Transcatheter edge-to-edge repair (TEER) has been shown to improve the prognosis of patients with mitral regurgitation and appears relatively safer than surgical repair in patients with high surgical risks. In this study, we examined the outcomes of TEER in patients with chronic kidney disease (CKD) by retrospectively evaluating data from the 2010 to 2016 Nationwide Inpatient Sample (NIS). Methodology We retrospectively evaluated data from the 2010 to 2016 NIS. TEER was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10- CM) codes of 35.97 and 02UG3JZ, respectively, from our dataset. The study sample was stratified based on renal function into two groups (CKD and no CKD). Patients with CKD were identified using ICD-9-CM codes 585.3, 585.4, 585.5, and 585.6 and ICD-10-CM codes N18.3, N18.4, N18.5, and N18.6. Results There was no significant difference in major complications and overall complications between patients with and without CKD. However, heart failure, non-ST-elevation myocardial infarction, cardiac tamponade, and cardiogenic shock were more prevalent in the CKD group. Patients with CKD were also more likely to sustain respiratory failure, post-procedure hemothorax, and require blood product transfusions. For renal complications, analysis showed that superimposed acute kidney injury and the need for hemodialysis were more common in the CKD group. Of note, there was no difference in neurologic complications, gastrointestinal bleeding, and thromboembolic complications between both groups. Patients with CKD who underwent TEER were more likely to have prolonged hospital stays without a significant increase in hospitalization charges. These patients were also more likely to be discharged to rehabilitation facilities. Conclusions CKD confers significant morbidity and mortality to patients undergoing TEER. Providers should be aware of these discrepancies in outcomes for patients with CKD in need of TEER to help better optimize their care.
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Affiliation(s)
| | - Stanley E Atencah
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Samuel K Dadzie
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
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Wang J, Liu X, Pu Z, Chen M, Fang Z, Jin J, Dong J, Guo Y, Cheng B, Xiu J, Luo J, Tang Y, Wang Y, Chen X, Zhang G, Shao Y, Song G, Hong L, Jiang H, Wu Y, Yuan Y, Chen L, He B, Wang J, Xu K, Yang Y, Zhou D, Zhang Q, Li Y, Ma K, Lam YY, Han Y, Ge J, Lim DS, Pivotal Trial Investigators FTD. Safety and efficacy of the DragonFly system for transcatheter valve repair of degenerative mitral regurgitation: one-year results of the DRAGONFLY-DMR trial. EUROINTERVENTION 2024; 20:e239-e249. [PMID: 38389469 PMCID: PMC10870008 DOI: 10.4244/eij-d-23-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/20/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Severe degenerative mitral regurgitation (DMR) can cause a poor prognosis if left untreated. For patients considered at prohibitive surgical risk, transcatheter edge-to-edge repair (TEER) has become an accepted alternative therapy. The DragonFly transcatheter valve repair system is an innovative evolution of the mitral TEER device family to treat DMR. AIMS Herein we report on the DRAGONFLY-DMR trial (ClinicalTrials.gov: NCT04734756), which was a prospective, single-arm, multicentre study on the safety and effectiveness of the DragonFly system. METHODS A total of 120 eligible patients with prohibitive surgical risk and DMR ≥3+ were screened by a central eligibility committee for enrolment. The study utilised an independent echocardiography core laboratory and clinical event committee. The primary endpoint was the clinical success rate, which measured freedom from all-cause mortality, mitral valve reintervention, and mitral regurgitation (MR) >2+ at 1-year follow-up. RESULTS At 1 year, the trial successfully achieved its prespecified primary efficacy endpoint, with a clinical success rate of 87.5% (95% confidence interval: 80.1-92.3%). The rates of major adverse events, all-cause mortality, mitral valve reintervention, and heart failure hospitalisation were 9.0%, 5.0%, 0.8%, and 3.4%, respectively. MR ≤2+ was 90.4% at 1 month and 92.0% at 1 year. Over time, left ventricular reverse remodelling was observed (p<0.05), along with significant improvements in the patients' functional and quality-of-life outcomes, shown by an increase in the New York Heart Association Class I/II from 32.4% at baseline to 93.6% at 12 months (p<0.001) and increased Kansas City Cardiomyopathy Questionnaire (KCCQ) score of 31.1±18.2 from baseline to 12 months (p<0.001). CONCLUSIONS The DRAGONFLY-DMR trial contributes to increasing evidence supporting the safety and efficacy of TEER therapy, specifically the DragonFly system, for treating patients with chronic symptomatic DMR 3+ to 4+ at prohibitive surgical risk.
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Affiliation(s)
- Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoxia Pu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Jin
- Department of Cardiology, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jianzhen Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yansong Guo
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China
| | - Biao Cheng
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, China and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yida Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yan Wang
- Department of Medicine, Xiamen University Cardiovascular Hospital, Xiamen, China
| | - Xiaomen Chen
- Cardiology Center, Ningbo First Hospital, Ningbo, China
| | - Gejun Zhang
- Department of Cardiology, Fuwai Cardiovascular Hospital of Yunnan Province, Kunming, China
| | - Yibing Shao
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lang Hong
- Department of Cardiology, Jiangxi Provincial People's Hospital, Nanchang, China and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yangqin Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiqiang Yuan
- Department of Cardiology, Henan Chest Hospital, Zhengzhou, China
| | - Lianglong Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China and Shanghai Jiao Tong University, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Xu
- Department of Cardiology, General Hospital of the Northern Theater of the Chinese People's Liberation Army, Shenyang, China
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Shanghai, China and Tongji University, Shanghai, China
| | - Yi Li
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | | | - Yat-Yin Lam
- Hong Kong Asia Heart Centre, Canossa Hospital, Hong Kong, China
| | - Yaling Han
- Department of Cardiology, General Hospital of the Northern Theater of the Chinese People's Liberation Army, Shenyang, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - D Scott Lim
- Department of Medicine, University of Virginia Health System Hospital, Charlottesville, VA, USA
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Caldonazo T, Sá MP, Jacquemyn X, Van den Eynde J, Kirov H, Harik L, Fischer J, Vervoort D, Bonatti J, Sultan I, Doenst T. Respect Versus Resect Approaches for Mitral Valve Repair: A Meta-Analysis of Reconstructed Time-to-Event Data. Am J Cardiol 2024; 213:5-11. [PMID: 38104750 DOI: 10.1016/j.amjcard.2023.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/15/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
Mitral valve repair (MVr) has been associated with superior long-term survival and freedom from valve-related complications compared with mitral valve replacement for primary mitral regurgitation (MR). The 2 main approaches for MVr are chordal replacement ("respect approach") and leaflet resection ("resect approach"). We performed a systematic review and a meta-analysis using 3 search databases to compare the long-term end points between both approaches. The primary end point was long-term survival. The secondary end points were long-term MR recurrence and reoperation. After reconstruction of time-to-event data for the individual survival analysis, pooled Kaplan-Meier curves for the end points were generated. A total of 14 studies (5,565 patients) were included in the analysis. The respect approach was associated with superior survival compared with the resect approach in the overall sample (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56 to 0.96, p = 0.024, n = 3,901 patients) but not in the risk-adjusted sample (HR 1.00, 95% CI 0.55 to 1.82, p = 0.991, n = 620 patients). There was no difference between the approaches in the rate of MR recurrence in the overall sample (HR 1.39, 95% CI 0.92 to 2.08, p = 0.116, n = 1,882 patients) or in the risk-adjusted sample (HR 1.62, 95% CI 0.76 to 3.47, p = 0.211, n = 288 patients). The data for reoperation were only available in the overall sample and did not reveal a difference (HR 0.92, 95% CI 0.62 to 1.35, p = 0.663, n = 3,505 patients). In conclusion, the current evidence suggests no difference in long-term mortality, MR recurrence, or reoperation between the resect and respect approaches for MVr after adjusting for patient risk factors. More long-term follow-up data are warranted.
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Affiliation(s)
- Tulio Caldonazo
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany.
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
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Shrivastava S, Shrivastava S, Allu SVV, Schmidt P, Mohyeldin M, Qasim A. Advancements in MitraClip Intervention for Mitral Regurgitation: A Comprehensive Review and Comparative Analysis of Clinical Trials. Cureus 2024; 16:e54805. [PMID: 38529422 PMCID: PMC10961671 DOI: 10.7759/cureus.54805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
This comprehensive review explores the evolution and clinical impact of MitraClip intervention in the management of mitral regurgitation. Mitral regurgitation results from dysfunction in the mitral valve (MV) apparatus. The MitraClip Clip Delivery System was approved by the Food and Drug Administration (FDA) in 2013. The discussion delves into the procedural foundation of MitraClip intervention, primarily based on Alfieri's technique of edge-to-edge leaflet approximation. As highlighted by key clinical trials, including Endovascular Valve Edge-to-Edge Repair (EVEREST) II Trial, Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) Trial, and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation (MITRA-FR) trial, the efficacy and safety of MitraClip were evaluated in comparison to surgical interventions and guideline-directed medical therapy. Notably, the COAPT demonstrated significant benefits in reducing all-cause mortality and heart failure hospitalization, while the MITRA-FR presented contrasting results, emphasizing the importance of patient selection. An analysis of the EVEREST II trial underscores MitraClip's potential to achieve comparable outcomes to surgical intervention, emphasizing its role in reducing mitral regurgitation and improving clinical status. However, limitations and complications, such as device-related issues and the potential impact on future MV surgery, are discussed. The study also explores the evolving landscape of MV interventions, reflecting advancements and the growing acceptance of MitraClip. In conclusion, the MitraClip device represents a significant advancement in the treatment of mitral regurgitation. The data presented highlights its promising results in terms of reduced hospitalization rates, improved in-hospital mortality, and enhanced quality of life for patients. However, challenges remain, and careful consideration of patient selection and underlying pathology is crucial in determining the optimal treatment approach. Ongoing research and clinical experience will continue to refine our understanding of MitraClip's role in the evolving landscape of MV interventions.
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Affiliation(s)
| | | | | | - Patrik Schmidt
- Internal Medicine, BronxCare Health System, New York, USA
| | | | - Abeer Qasim
- Internal Medicine, BronxCare Health System, New York, USA
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Cheng YY, Shu MWS, Rubenis I, Vijayarajan V, Hsu ACY, Hyun K, Brieger D, Chow V, Kritharides L, Ng ACC. Trends in Isolated Mitral Valve Repair or Replacement Surgery in Australia: A Statewide Cohort Linkage Study. Heart Lung Circ 2024; 33:120-129. [PMID: 38160129 DOI: 10.1016/j.hlc.2023.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Global trends in mitral valve surgery (MVSx) suggest increasing repair compared with replacement, especially in the United States and European countries. The relative use, and outcomes of, MV repair and replacement in Australia are unknown. METHODS New South Wales residents who underwent isolated MVSx between 2001 and 2017 were identified from the Admitted-Patient-Data-Collection database. Mortality outcomes were tracked to 31 Dec 2018 and adjusted based on age, sex, urgency of operation, and comorbidity status. RESULTS The study cohort comprised 5,693 patients: 2020 (35%) underwent repair (MVr), 1,656 (29%) underwent mechanical replacement (mech.MVR), and 2017 (35%) underwent bioprosthetic replacement (bio.MVR). Respective median ages [interquartile range] were 67 yo [59-75 yo], 64 yo [55-71 yo], and 75 yo [68-80 yo] (p<0.001 across groups). Between 2001 and 2017, total MVSx increased steadily with population growth. Whereas the relative use of MVr remained static (34% to 38%), that for bio.MVR (22% to 50%) and mech.MVR (45% to 13%) changed significantly. MVr had the best outcome with 1.2% in-hospital, 2.5% 1-year, and 21.6% total cumulative mortality during a median follow-up of 6.5 years. Compared to MVr, the adjusted hazard ratio (aHR) for mech.MVR and bio.MVR for long-term mortality were 1.41 (95% confidence interval [CI]=1.24-1.61) and 1.73 (95% CI=1.53-1.95), respectively. Heart failure and sepsis were the main cardiovascular and noncardiovascular causes of death in all groups. CONCLUSION In this statewide Australian cohort examined over 17 years, MVr is potentially underutilised despite having superior outcomes to MVR. Access to quality dataset which provides the indication for MVSx and quantitative clinical factors is critical to further improve MVr coverage and outcome MVSx.
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Affiliation(s)
- Yeu-Yao Cheng
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Matthew Wei Shun Shu
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Imants Rubenis
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Arielle Chin-Yu Hsu
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Austin Chin Chwan Ng
- Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, NSW, Australia.
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Al-Tawil M, Sunny JT, Goulden CJ, Akhteruzzaman T, Alqeeq BF, Harky A. The Results of Urgent and Emergent Transcatheter Mitral Valve Repair (MitraClip ®): A Comparison with Standard Elective Repair. Heart Views 2024; 25:13-20. [PMID: 38774544 PMCID: PMC11104547 DOI: 10.4103/heartviews.heartviews_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/20/2024] [Indexed: 05/24/2024] Open
Abstract
Background Mitral regurgitation (MR) is the most common valvular disease worldwide. MR has been managed surgically, with either a mitral valve replacement or repair. Percutaneous transcatheter mitral valve repair (TMVr) with MitraClip® insertion has gained wide popularity and success over medical and surgical therapy for MR. Some patients with acute MR or decompensated heart failure could benefit from urgent TMVr. This meta-analysis aims to compare clinical outcomes of urgent versus elective TMVr. Methods We performed a study-level meta-analysis to compare the clinical outcomes of urgent versus elective TMVr using the MitraClip system. The primary endpoint outcome was all-cause mortality. Additional outcomes included procedural success, postoperative acute kidney injury (AKI), stroke, and length of in-hospital stay. Results Overall, 30-day mortality was significantly higher in the urgent group (odds ratio [OR]: 2.74; 95% confidence interval [CI] [2.17, 3.48]; P < 0.00001; I² =0%). However, subgroup analysis of matched cohorts showed no significant difference between both groups (OR: 1.80; 95% CI [0.94, 3.46]; P = 0.08; I² =0%). One-year mortality was similar between both groups (and: 1.67; 95% CI [0.96, 2.90]; P = 0.07; I² =0%). Procedural success was similar between both groups (89.4% vs. 89.8%; P = 0.43). Postoperative AKI was significantly higher in the urgent group (OR: 4.12; 95% CI [2.87, 5.91]; P < 0.00001; I² =0%). Conclusion Urgent TMVr should be indicated in select populations as it is considered therapeutic with acceptable outcomes therein.
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Affiliation(s)
| | - Jesvin T. Sunny
- Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Basel F. Alqeeq
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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10
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Zahr F, Song HK, Chadderdon S, Gada H, Mumtaz M, Byrne T, Kirshner M, Sharma S, Kodali S, George I, Merhi W, Yarboro L, Sorajja P, Bapat V, Bajwa T, Weiss E, Thaden JJ, Gearhart E, Lim S, Reardon M, Adams D, Mack M, Leon MB. 1-Year Outcomes Following Transfemoral Transseptal Transcatheter Mitral Valve Replacement: Intrepid TMVR Early Feasibility Study Results. JACC Cardiovasc Interv 2023; 16:2868-2879. [PMID: 37902145 DOI: 10.1016/j.jcin.2023.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND High surgical risk may preclude mitral valve replacement in many patients. Transcatheter mitral valve replacement (TMVR) using transfemoral transseptal access is a novel technology for the treatment of mitral regurgitation (MR) in high-risk surgical patients. OBJECTIVES This analysis evaluates 30-day and 1-year outcomes of the Intrepid TMVR Early Feasibility Study in patients with ≥moderate-severe MR. METHODS The Intrepid TMVR Early Feasibility Study is a multicenter, prospective, single-arm study. Clinical events were adjudicated by a clinical events committee; endpoints were defined according to Mitral Valve Academic Research Consortium criteria. RESULTS A total of 33 patients, enrolled at 9 U.S. sites between February 2020 and August 2022, were included. The median age was 80 years, 63.6% of patients were men, and mean Society of Thoracic Surgeons Predicted Risk of Mortality for mitral valve replacement was 5.3%. Thirty-one (93.9%) patients were successfully implanted. Median postprocedural hospitalization length of stay was 5 days, and 87.9% of patients were discharged to home. At 30 days, there were no deaths or strokes, 8 (24.2%) patients had major vascular complications and none required surgical intervention, there were 4 cases of venous thromboembolism all successfully treated without sequelae, and 1 patient had mitral valve reintervention for severe left ventricular outflow tract obstruction. At 1 year, the Kaplan-Meier all-cause mortality rate was 6.7%, echocardiography showed ≤mild valvular MR, there was no/trace paravalvular leak in all patients, median mitral valve mean gradient was 4.6 mm Hg (Q1-Q3: 3.9-5.3 mm Hg), and 91.7% of survivors were in NYHA functional class I/II with a median 11.4-point improvement in Kansas City Cardiomyopathy Questionnaire overall summary scores. CONCLUSIONS The early benefits of the Intrepid transfemoral transseptal TMVR system were maintained up to 1 year with low mortality, low reintervention, and near complete elimination of MR, demonstrating a favorable safety profile and durable valve function.
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Affiliation(s)
- Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA.
| | - Howard K Song
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Hemal Gada
- UPMC Pinnacle Harrisburg Campus, Harrisburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- UPMC Pinnacle Harrisburg Campus, Harrisburg, Pennsylvania, USA
| | - Timothy Byrne
- Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | | | - Samin Sharma
- Mount Sinai Medical Center, New York, New York, USA
| | - Susheel Kodali
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - William Merhi
- Spectrum Health Hospitals, Grand Rapids, Michigan, USA
| | - Leora Yarboro
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Tanvir Bajwa
- Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Eric Weiss
- Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | - Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - David Adams
- Mount Sinai Medical Center, New York, New York, USA
| | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
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11
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Thuan PQ, Chuong PTV, Dinh NH. Adoption of minimally invasive mitral valve surgery: single-centre implementation experience in Vietnam. Ann Med Surg (Lond) 2023; 85:5550-5556. [PMID: 37915686 PMCID: PMC10617886 DOI: 10.1097/ms9.0000000000001323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023] Open
Abstract
The adoption of minimally invasive mitral valve surgery (MIMVS) has become a prominent trend in mitral valve procedures. This article emphasizes that the success of the MIMVS program relies not only on effective teamwork but also on comprehensive hospital support and a clearly defined training strategy. Additionally, targeted marketing initiatives that highlight the value of the heart valve centre are crucial for sustaining the program's success and attracting a consistent patient flow. The implementation of these strategies requires diligent execution, consistent maintenance, and continuous improvement to ensure the triumph of the MIMVS program. This article aims to share our experience in implementing MIMVS at our centre, providing valuable insights for centres that have yet to adopt this approach or have low adoption rates. While acknowledging that sharing our centre's experience cannot guarantee success in all centres, customizing the implementation by selecting appropriate features and access points is vital. Each centre may encounter unique challenges, and tailoring the strategy to address specific needs will enhance the effectiveness of the MIMVS program.
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Affiliation(s)
- Phan Quang Thuan
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC
| | | | - Nguyen Hoang Dinh
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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12
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Shekhar S, Kansara T, Morozowich ST, Mohananey D, Agrawal A, Narasimhan S, Nelson JA, Ramakrishna H. Renal Outcomes Following Transcatheter Mitral Valve Repair - Analysis of COAPT Trial Data. J Cardiothorac Vasc Anesth 2023; 37:2119-2124. [PMID: 37210324 DOI: 10.1053/j.jvca.2023.04.026] [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: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
The prevalence of valvular heart disease in the United States has been estimated at 4.2-to-5.6 million, with mitral regurgitation (MR) being the most common lesion. Significant MR is associated with heart failure (HF) and death if left untreated. When HF is present, renal dysfunction (RD) is common and is associated with worse outcomes (ie, it is a marker of HF disease progression). Additionally, a complex interplay exists in patients with HF who also have MR, as this combination further impairs renal function, and the presence of RD further worsens prognosis and often limits guideline-directed management and therapy (GDMT). This has important implications in secondary MR because GDMT is the standard of care. However, with the development of minimally invasive transcatheter mitral valve repair, mitral transcatheter edge-to-edge repair (TEER) has become a new treatment option for secondary MR that is now incorporated into current guidelines published in 2020 that listed mitral TEER as a class 2a recommendation (moderate recommendation with benefit >> risk) as an addition to GDMT in a subset of patients with left ventricular ejection fraction <50%. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, which demonstrated favorable outcomes in secondary MR by adding mitral TEER to GDMT versus GDMT alone, was the evidence base for these guidelines. Considering these guidelines and the understanding that concomitant RD often limits GDMT in secondary MR, there is emerging research studying the renal outcomes from the COAPT trial. This review analyzes this evidence, which could further influence current decision-making and future guidelines.
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Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tikal Kansara
- Department of Hospital Medicine, Cleveland Clinic Union Hospital, Cleveland, Ohio
| | - Steven T Morozowich
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - James A Nelson
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
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13
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Nguyen VA, Nguyen DT, Ong LTT, Tran AV, Tran BLT, Tran CM. Early detection of reduced left ventricular systolic function by 2D speckle tracking echocardiography in patients with primary mitral regurgitation in a Vietnamese cohort. Glob Cardiol Sci Pract 2023; 2023:e202326. [PMID: 38623555 PMCID: PMC11017305 DOI: 10.21542/gcsp.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/12/2023] [Indexed: 04/17/2024] Open
Abstract
Background: Mitral regurgitation (MR) is a common heart valve disease, causing many serious complications in several organ systems, especially the cardiovascular system. The 2D speckle tracking echocardiography (STE) is a new technique for detecting potential cardiac dysfunction when only tissue function abnormalities are present. The study aimed to assess left ventricular (LV) systolic function early by STE in patients with primary MR through global LV deformity along the global longitudinal strain (GLS). Methods: An analytical cross-sectional study was performed on 46 patients with moderate to severe primary MR as recommended by the American Society of Echocardiography (ASE) 2017. Results: The prevalence of patients with GLS reduction with ejection fraction (EF) >60%, New York Heart Association (NYHA) I, and left ventricular internal diameter systolic (LVIDs) <40 mm was 38.1%, 35.7%, and 39.5%, respectively. 100% of patients with EF<60% and LVIDs ≥40 mm had reduced GLS (<16%). The GLS index strongly correlates with the NYHA classification, degree of MR, EF, and echocardiographic parameters. Conclusion: GLS index gives a significant sign in the early detection of cardiac function abnormalities before symptoms or other echocardiographic parameters in patients with MR.
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Affiliation(s)
- Vu Anh Nguyen
- Hue University of Medicine and Pharmacy, Hue, Viet Nam
| | - Diem Thi Nguyen
- Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
| | | | - An Viet Tran
- Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
| | | | - Chau Minh Tran
- Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
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14
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Ausbuettel F, Barth S, Chatzis G, Fischer D, Kerber S, Mueller J, List S, Halbfass P, Deneke T, Nef H, Mueller HH, Divchev D, Schieffer B, Luesebrink U, Waechter C. Catheter ablation of concomitant atrial fibrillation improves survival of patients undergoing transcatheter edge-to-edge mitral valve repair. Front Cardiovasc Med 2023; 10:1229651. [PMID: 37645518 PMCID: PMC10461005 DOI: 10.3389/fcvm.2023.1229651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common concomitant disease in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) and detrimentally affects their outcome. While there is increasing evidence for prognostic improvement and safety of catheter ablation (CA) of AF in the overall cohort of heart failure patients, corresponding data in TEER patients are lacking. Objectives To investigate the impact of treatment regimens for concomitant AF on survival of TEER patients. Methods In a multicenter observational cohort study consecutive patients successfully undergoing TEER were analyzed and survival of patients receiving CA of concomitant AF was compared with that of patients on pharmacological AF treatment and with that of patients without a history of AF, using propensity score matching (PSM). Results A total of 821 patients were analyzed. Of these, 608 (74.1%) had concomitant AF, of whom 48 patients received CA. Patients with CA in AF showed significantly higher 3-year-survival after TEER compared to PSM-patients on pharmacological AF treatment (75.5% [36/48] vs. 49.4% [166/336], p = 0.009). The 3-year-survival after TEER of patients with concomitant AF treated with CA was not significantly different from PSM-patients without AF (75.5% [36/48] vs. 68.3% [98/144], p = 0.36). Conclusions CA of AF is superior to pharmacotherapy as it significantly improves the survival of TEER patients in a PSM analysis. CA even offsets the prognostic disadvantage of coexisting AF in TEER patients. Given the growing evidence of prognostic benefits in the overall cohort of HF patients, our data point out the importance of treating concomitant AF and support CA as an essential part of a holistic management of TEER patients.
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Affiliation(s)
- Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Stephan List
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Philipp Halbfass
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
- Department of Cardiology, University Hospital Gießen, Justus Liebig University Gießen, Gießen, Germany
| | - Hans-Helge Mueller
- Institute for Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Waechter
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
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15
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Nus BM, Sledge T, Wu K, Saunders CS, Khalife W. The Quality of MitraClip™ Content on YouTube. Cureus 2023; 15:e43881. [PMID: 37614823 PMCID: PMC10442245 DOI: 10.7759/cureus.43881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 08/25/2023] Open
Abstract
Objective YouTube (YouTube LLC, San Bruno, California, United States) is used as a primary resource for many patients looking to gain healthcare knowledge. Recently, YouTube made efforts to increase the quality of posted content by accrediting trusted healthcare sources. With an increasing emphasis being placed on minimally invasive options, this study was done to investigate the quality of YouTube videos on MitraClip™ (Abbott Laboratories, Chicago, Illinois, United States) with respect to patient education. Methods YouTube was searched using the keyword "MitraClip". A total of 66 videos were evaluated, with 32 of those videos being included for final analysis after applying exclusionary criteria. Three independent reviewers separately scored the videos using the Global Quality Scale. Likes, dislikes, views, comments, and dates of upload were also recorded. Two-tailed t-tests were used to determine statistical significance. Results MitraClip videos on YouTube proved to be of medium quality, receiving an average Global Quality Scale score of 3.39. When stratified by the new YouTube accreditation process, those with accreditation had a significantly higher Global Quality Scale score of 4.11, while non-accredited videos had an average Global Quality Scale score of 3.12 (p<0.01). Shorter and more patient-friendly videos were also significantly lower in quality (p<0.05). Conclusion The YouTube accreditation process has demonstrated initial success at regulating the quality of MitraClip content, thereby reducing the spread of misinformation. However, this progress is undermined by the lack of unique videos present on the platform. Increasing the amount of original content about MitraClip may allow viewers to diversify their educational sources and ultimately gain a better understanding of the procedure.
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Affiliation(s)
- Bradley M Nus
- Cardiology, University of Texas Medical Branch, Galveston, USA
| | - Trey Sledge
- Cardiology, University of Texas Medical Branch, Galveston, USA
| | - Kylie Wu
- Cardiology, Texas College of Osteopathic Medicine, Fort Worth, USA
| | | | - Wissam Khalife
- Cardiology, University of Texas Medical Branch, Galveston, USA
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16
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Bennati L, Vergara C, Giambruno V, Fumagalli I, Corno AF, Quarteroni A, Puppini G, Luciani GB. An Image-Based Computational Fluid Dynamics Study of Mitral Regurgitation in Presence of Prolapse. Cardiovasc Eng Technol 2023; 14:457-475. [PMID: 37069336 PMCID: PMC10412498 DOI: 10.1007/s13239-023-00665-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/12/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE In this work we performed an imaged-based computational study of the systolic fluid dynamics in presence of mitral valve regurgitation (MVR). In particular, we compared healthy and different regurgitant scenarios with the aim of quantifying different hemodynamic quantities. METHODS We performed computational fluid dynamic (CFD) simulations in the left ventricle, left atrium and aortic root, with a resistive immersed method, a turbulence model, and with imposed systolic wall motion reconstructed from Cine-MRI images, which allowed us to segment also the mitral valve. For the regurgitant scenarios we considered an increase of the heart rate and a dilation of the left ventricle. RESULTS Our results highlighted that MVR gave rise to regurgitant jets through the mitral orifice impinging against the atrial walls and scratching against the mitral valve leading to high values of wall shear stresses (WSSs) with respect to the healthy case. CONCLUSION CFD with prescribed wall motion and immersed mitral valve revealed to be an effective tool to quantitatively describe hemodynamics in case of MVR and to compare different regurgitant scenarios. Our findings highlighted in particular the presence of transition to turbulence in the atrium and allowed us to quantify some important cardiac indices such as cardiac output and WSS.
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Affiliation(s)
- Lorenzo Bennati
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy
| | - Christian Vergara
- LaBS, Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Vincenzo Giambruno
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, O. C. M. Piazzale Stefani 1, 37126 Verona, Italy
| | - Ivan Fumagalli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Antonio Francesco Corno
- Children’s Heart Institute, McGovern Medical School, UT Health, 6431 Fannin Street, Houston, TX 77030 USA
| | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- École Polytechnique Fédérale de Lausanne, Rte Cantonale, 1015 Lausanne, Switzerland
| | - Giovanni Puppini
- Department of Radiology, University of Verona, O. C. M. Piazzale Stefani 1, 37126 Verona, Italy
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, O. C. M. Piazzale Stefani 1, 37126 Verona, Italy
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17
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Wong P, Wisneski AD, Sandhu A, Wang Z, Mahadevan VS, Nguyen TC, Guccione JM. Looking towards the future: patient-specific computational modeling to optimize outcomes for transcatheter mitral valve repair. Front Cardiovasc Med 2023; 10:1140379. [PMID: 37168656 PMCID: PMC10164975 DOI: 10.3389/fcvm.2023.1140379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023] Open
Abstract
Severe mitral valve regurgitation (MR) is a heart valve disease that progresses to end-stage congestive heart failure and death if left untreated. Surgical repair or replacement of the mitral valve (MV) remains the gold standard for treatment of severe MR, with repair techniques aiming to restore the native geometry of the MV. However, patients with extensive co-morbidities may be ineligible for surgical intervention. With the emergence of transcatheter MV repair (TMVR) treatment paradigms for MR will evolve. The longer-term outcomes of TMVR and its effectiveness compared to surgical repair remain unknown given the differing patient eligibility for either treatment at this time. Advances in computational modeling will elucidate answers to these questions, employing techniques such as finite element method and fluid structure interactions. Use of clinical imaging will permit patient-specific MV models to be created with high accuracy and replicate MV pathophysiology. It is anticipated that TMVR technology will gradually expand to treat lower-risk patient groups, thus pre-procedural computational modeling will play a crucial role guiding clinicians towards the optimal intervention. Additionally, concerted efforts to create MV models will establish atlases of pathologies and biomechanics profiles which could delineate which patient populations would best benefit from specific surgical vs. TMVR options. In this review, we describe recent literature on MV computational modeling, its relevance to MV repair techniques, and future directions for translational application of computational modeling for treatment of MR.
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Affiliation(s)
- Paul Wong
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Andrew D. Wisneski
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Amitoj Sandhu
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Zhongjie Wang
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Vaikom S. Mahadevan
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Tom C. Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Julius M. Guccione
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
- Correspondence: Julius M. Guccione
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18
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Lim DS, Smith RL, Gillam LD, Zahr F, Chadderdon S, Makkar R, von Bardeleben RS, Kipperman RM, Rassi AN, Szerlip M, Goldman S, Inglessis-Azuaje I, Yadav P, Lurz P, Davidson CJ, Mumtaz M, Gada H, Kar S, Kodali SK, Laham R, Hiesinger W, Fam NP, Keßler M, O'Neill WW, Whisenant B, Kliger C, Kapadia S, Rudolph V, Choo J, Hermiller J, Morse MA, Schofer N, Gafoor S, Latib A, Koulogiannis K, Marcoff L, Hausleiter J. Randomized Comparison of Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC Cardiovasc Interv 2022; 15:2523-2536. [PMID: 36121247 DOI: 10.1016/j.jcin.2022.09.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe symptomatic degenerative mitral regurgitation (DMR) has a poor prognosis in the absence of treatment, and new transcatheter options are emerging. OBJECTIVES The CLASP IID (Edwards PASCAL Transcatheter Valve Repair System Pivotal Clinical Trial) randomized trial (NCT03706833) is the first to evaluate the safety and effectiveness of the PASCAL system compared with the MitraClip system in patients with significant symptomatic DMR. This report presents the primary safety and effectiveness endpoints for the trial. METHODS Patients with 3+ or 4+ DMR at prohibitive surgical risk were assessed by a central screening committee and randomized 2:1 (PASCAL:MitraClip). Study oversight also included an echocardiography core laboratory and a clinical events committee. The primary safety endpoint was the composite major adverse event rate at 30 days. The primary effectiveness endpoint was the proportion of patients with mitral regurgitation (MR) ≤2+ at 6 months. RESULTS A prespecified interim analysis in 180 patients demonstrated noninferiority of the PASCAL system vs the MitraClip system for the primary safety and effectiveness endpoints of major adverse event rate (3.4% vs 4.8%) and MR ≤2+ (96.5% vs 96.8%), respectively. Functional and quality-of-life outcomes significantly improved in both groups (P < 0.05). The proportion of patients with MR ≤1+ was durable in the PASCAL group from discharge to 6 months (PASCAL, 87.2% and 83.7% [P = 0.317 vs discharge]; MitraClip, 88.5% and 71.2% [P = 0.003 vs discharge]). CONCLUSIONS The CLASP IID trial demonstrated safety and effectiveness of the PASCAL system and met noninferiority endpoints, expanding transcatheter treatment options for prohibitive surgical risk patients with significant symptomatic DMR.
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Affiliation(s)
- D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA.
| | - Robert L Smith
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Molly Szerlip
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | - Hemal Gada
- UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | | | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | | | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | | | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
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19
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Di Mauro M, Bonalumi G, Giambuzzi I, Messi P, Cargoni M, Paparella D, Lorusso R, Calafiore AM. Mitral valve repair with artificial chords: Tips and tricks. J Card Surg 2022; 37:4081-4087. [PMID: 36321669 PMCID: PMC10092434 DOI: 10.1111/jocs.17076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Mitral valve regurgitation (MR) is a common valvular disorder occurring in up to 10% of the general population. Mitral valve reconstructive strategies may address any of the components, annulus, leaflets, and chords, involved in the valvular competence. The classical repair technique involves the resection of the prolapsing tissue. Chordal replacement was introduced already in the '60, but in the mid '80, some surgeons started to use expanded polytetrafluoroethylene (ePTFE) Gore-Tex sutures. In the last years, artificial chords have been used also using transcatheter approach such as NeoChord DS 1000 (Neochord) and Harpoon TSD-5. The first step is to achieve a good exposure of the papillary muscles that before approaching the implant of the artificial chords. Then, the chords are attached to the papillary muscle, with or without the use of supportive pledgets. The techniques to correctly implant artificial chords are many and might vary considerably from one center to another, but they can be summarized into three big families of suturing techniques: single, running or loop. Regardless of how to anchor to the mitral leaflet, the real challenge that many surgeons have taken on, giving rise to some very creative solutions, has been to establish an adequate length of the chords. It can be established based on anatomically healthy chords, but it is important to bear in mind that surgeons work on the mitral valve when the heart is arrested in diastole, so this length could fail to replicate the required length in the full, beating heart. Hence, some surgeons suggested techniques to overcome this problem. Herein, we aimed to describe the current use of artificial chords in real-world surgery, summarizing all the tips and tricks.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Pietro Messi
- DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy.,Department of Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Marco Cargoni
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
| | - Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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20
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Pasta S, Catalano C, Cannata S, Guccione JM, Gandolfo C. Numerical simulation of transcatheter mitral valve replacement: The dynamic implication of LVOT obstruction in the valve-in-ring case. J Biomech 2022; 144:111337. [DOI: 10.1016/j.jbiomech.2022.111337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022]
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21
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Frishman S, Kight A, Pirozzi I, Maddineni S, Imbrie-Moore AM, Karachiwalla Z, Paulsen MJ, Kaiser AD, Woo YJ, Cutkosky MR. DynaRing: A Patient-Specific Mitral Annuloplasty Ring With Selective Stiffness Segments. J Med Device 2022; 16:031009. [PMID: 35646225 PMCID: PMC9125864 DOI: 10.1115/1.4054445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2022] [Indexed: 09/03/2023] Open
Abstract
Annuloplasty ring choice and design are critical to the long-term efficacy of mitral valve (MV) repair. DynaRing is a selectively compliant annuloplasty ring composed of varying stiffness elastomer segments, a shape-set nitinol core, and a cross diameter filament. The ring provides sufficient stiffness to stabilize a diseased annulus while allowing physiological annular dynamics. Moreover, adjusting elastomer properties provides a mechanism for effectively tuning key MV metrics to specific patients. We evaluate the ring embedded in porcine valves with an ex-vivo left heart simulator and perform a 150 million cycle fatigue test via a custom oscillatory system. We present a patient-specific design approach for determining ring parameters using a finite element model optimization and patient MRI data. Ex-vivo experiment results demonstrate that motion of DynaRing closely matches literature values for healthy annuli. Findings from the patient-specific optimization establish DynaRing's ability to adjust the anterior-posterior and intercommissural diameters and saddle height by up to 8.8%, 5.6%, 19.8%, respectively, and match a wide range of patient data.
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Affiliation(s)
- Samuel Frishman
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
| | - Ali Kight
- Department of Bioengineering, Stanford University, Stanford, CA 94305
| | - Ileana Pirozzi
- Department of Bioengineering, Stanford University, Stanford, CA 94305
| | | | | | | | - Michael J. Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305
| | | | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305
| | - Mark R. Cutkosky
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
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22
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Adhami N, Rozor M, Percy C, Achtem L, Johnston S, Nathoo N, Pak M, Polderman J, Lauck SB. The Road to a Transcatheter Edge to Edge Repair: Patient Experiences Leading Up to the Procedure and in the Early Recovery Period. Eur J Cardiovasc Nurs 2022:6650482. [PMID: 35895525 DOI: 10.1093/eurjcn/zvac066] [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: 11/17/2021] [Accepted: 07/14/2022] [Indexed: 11/14/2022]
Abstract
AIM Mitral valve transcatheter edge-to-edge repair (TEER) is a minimally invasive treatment option for patients with severe symptomatic mitral regurgitation who are at increased risk for cardiac surgery and are receiving optimal medical therapy. Little is known about patients' perspectives of their journey of care, including their experiences leading up to treatment, and their early recovery period. The aim of this study was to explore patients' experiences of their journey to TEER and their perspectives on their early recovery. METHODS AND RESULTS We conducted a qualitative study using interpretive description. A purposive sample of 12 patients, 3 to 6 months post TEER procedure, were recruited from a tertiary hospital. The median age was 79 years and 7 were male and 5 were female. Data collection included semi-structured interviews via the telephone. Data analysis followed an iterative process and utilized thematic analysis. There were four central themes highlighting the experiences of the patients leading up to their procedure: (1) escalating challenges with everyday life; (2) plummeting losses; (3) choosing and readiness to proceed with TEER; and (4) the long and uncertain wait. The theme improved health status highlights the experiences of patients in their early recovery. CONCLUSION Patients' experiences of waiting for TEER are complex and involve multifaceted challenges related to their worsening cardiac symptoms and navigating the health care system. Care pathways must be in place to provide continuity of care and support.
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Affiliation(s)
- Nassim Adhami
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
- University of British Columbia, School of Nursing, Canada T201-2211 Wesbrook Mall Vancouver, BC, Canada, V6T 2B5
| | - Mihaela Rozor
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Celeste Percy
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Leslie Achtem
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Sylvia Johnston
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Naureen Nathoo
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Melissa Pak
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Jopie Polderman
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Sandra B Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
- University of British Columbia, School of Nursing, Canada T201-2211 Wesbrook Mall Vancouver, BC, Canada, V6T 2B5
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23
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Hegeman RMJJ, Gheorghe LL, de Kroon TL, van Putte BP, Swaans MJ, Klein P. State-of-the-Art Review: Technical and Imaging Considerations in Novel Transapical and Port-Access Mitral Valve Chordal Repair for Degenerative Mitral Regurgitation. Front Cardiovasc Med 2022; 9:850700. [PMID: 35497995 PMCID: PMC9039516 DOI: 10.3389/fcvm.2022.850700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Degenerative mitral regurgitation (DMR) based on posterior leaflet prolapse is the most frequent type of organic mitral valve disease and has proven to be durably repairable in most cases by chordal repair techniques either by conventional median sternotomy or by less invasive approaches both utilizing extracorporeal circulation and cardioplegic myocardial arrest. Recently, several novel transapical chordal repair techniques specifically targeting the posterior leaflet have been developed as a far less invasive and beating heart (off-pump) alternative to port-access mitral repair. In order to perform a safe and effective minimally invasive mitral chordal repair, thorough knowledge of the anatomy of the mitral valve apparatus and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, comprehensive understanding of the available novel devices, their delivery systems and the individual procedural steps are required.
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Affiliation(s)
- Romy M. J. J. Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
- *Correspondence: Romy M. J. J. Hegeman,
| | | | - Thomas L. de Kroon
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Bart P. van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Martin J. Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
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24
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Brovman EY. Transcatheter Mitral Valve Implantation-What Makes an Adequate Anchor? J Cardiothorac Vasc Anesth 2022; 36:3418-3419. [PMID: 35545463 DOI: 10.1053/j.jvca.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ethan Y Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
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25
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Li Q, Zhang Y, Huang H, Chen W, Shi S, Chen S, Wang B, Lai W, Huang Z, Luo Z, Chen J, Tan N, Liu J, Liu Y. Are There Any Differences in the Prognostic Value of Left Ventricular Ejection Fraction in Coronary Artery Disease Patients With or Without Moderate and Severe Mitral Regurgitation? Front Cardiovasc Med 2022; 9:799253. [PMID: 35310991 PMCID: PMC8930921 DOI: 10.3389/fcvm.2022.799253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) is a vital variable to describe left ventricle systolic function and contractility of left ventricle. However, the association between LVEF and the prognostic effect in patients with moderate or severe mitral regurgitation (MR) is still controversial. Methods This study comprised 30,775 coronary artery disease (CAD) patients who underwent coronary arteriography (CAG) in the Cardiorenal ImprovemeNt (CIN) registry from January 2007 to December 2018. Patients were divided into none or mild MR group and moderate or severe MR group, and 3 levels of LVEF ≥50, 40–50%, and <40% were further distinguished according to hospital baseline. Univariate and multivariate Cox proportional analyses were used to investigate the association between LVEF levels and long-term all-cause mortality in patients with different MR severities. Results Of 30,775 CAD patients (62.9 ± 10.6 years, females 23.8%), 26,474 (86.0%) patients had none or mild MR. Compared with none or mild MR patients, patients with moderate or severe MR were older and had worse cardio-renal function. In multivariable Cox proportional analysis, LVEF <40% was independently associated with higher mortality compared with LVEF ≥ 50% in all kinds of MR severity {none or mild MR [adjusted hazard ratio (HR): 1.79; 95% CI: 1.56–2.05, p < 0.001], moderate or severe MR [adjusted HR: 1.57; 95% CI: 1.29–1.91, p < 0.001]}. Conclusions LVEF is a reliable prognostic index in CAD patients, even in those with moderate or severe MR. LVEF monitoring would still be clinically useful in CAD patients with moderate or severe MR. Clinical trials are needed to prospectively evaluate the optimal threshold for LVEF in patients with moderate or severe MR.
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Affiliation(s)
- Qiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yifei Zhang
- Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Haozhang Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weihua Chen
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Third Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Shanshan Shi
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Third Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenguang Lai
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiling Luo
- Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Jin Liu
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Yong Liu
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26
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Sá MP, Cavalcanti LRP, Van den Eynde J, Amabile A, Escorel Neto AC, Perazzo AM, Weymann A, Ruhparwar A, Sicouri S, Bisleri G, Torregrossa G, Geirrson A, Ramlawi B. Respect versus resect approaches for mitral valve repair: a study-level meta-analysis. Trends Cardiovasc Med 2022; 33:225-239. [PMID: 35051591 DOI: 10.1016/j.tcm.2022.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
Mitral valve repair (MVr) restores leaflets coaptation while preserving the patient's own valve. The two main techniques are: (a) chordal replacement ("respect approach"), whereby artificial neochordae are used to resuspend prolapsed segments of the affected leaflet - and (b) leaflet resection ("resect approach"), whereby diseased leaflet segment is resected, and the remaining segments are sutured together. Both techniques of MVr are associated with better long-term results, fewer valve-related complications and lower mortality when compared with mitral valve replacement (MVR). They also restore quality of life and improve survival to rates equivalent to those of the general population. We performed a meta-analysis to pool data of clinical studies that compared outcomes of MVr stratified by the surgical technique. Seventeen studies accounting for 6,046 patients fulfilled our eligibility criteria. The "respect approach" outperformed the "resect approach" with lower permanent pacemaker implantation rates and lower mean gradients. Despite any possible advantages of one technique over the other, which approach is best for each patient must be decided on a case-by-case basis and more long-term follow-up data are warranted.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute / Main Line Health, Philadelphia, PA, USA; Division of Cardiac Surgery Research, Lankenau Institute for Medical Research / Main Line Health, Philadelphia, PA, USA.
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Antonio C Escorel Neto
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
| | - Alvaro M Perazzo
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Serge Sicouri
- Division of Cardiac Surgery Research, Lankenau Institute for Medical Research / Main Line Health, Philadelphia, PA, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute / Main Line Health, Philadelphia, PA, USA; Division of Cardiac Surgery Research, Lankenau Institute for Medical Research / Main Line Health, Philadelphia, PA, USA
| | - Arnar Geirrson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Basel Ramlawi
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Recife, Brazil; University of Pernambuco - UPE. Recife, Brazil
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27
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Musuku SR, Mustafa M, Pulavarthi M, Doshi I, Zhang Y, Luu S, Naqvi A, Sunesara I, Richvalsky T, Yukhvid D, Cherukupalli D, DeLago A, Torosoff M, Shapeton AD. Procedural, Short-Term, and Intermediate-Term Outcomes in Propensity-Matched Patients With Severe Mitral Valve Regurgitation Undergoing Urgent Versus Elective MitraClip Percutaneous Mitral Valve Repair. J Cardiothorac Vasc Anesth 2021; 36:1268-1275. [PMID: 35031222 DOI: 10.1053/j.jvca.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/12/2021] [Accepted: 12/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study authors sought to compare outcomes in patients with severe mitral valve regurgitation (MR) undergoing urgent, as compared to elective, mitral valve repair employing MitraClip. They hypothesized that, compared to elective cases, MitraClip procedures performed for urgent indications would be associated with increased intraoperative and postoperative complications but have similar long-term outcomes. DESIGN A retrospective chart review with 3:1 propensity score matching of elective-to-urgent cases. SETTING A single, large-volume tertiary care academic medical center. PARTICIPANTS All consecutive patients with severe MR who underwent elective or urgent MitraClip procedures between December 15, 2015, and October 26, 2020. INTERVENTIONS MR repair with MitraClip. MEASUREMENTS AND MAIN RESULTS As expected, patients in the urgent MitraClip group required a higher level of preprocedural care, and there were significant differences in baseline demographic and clinical variables as compared to the elective group. To reduce baseline characteristics heterogeneity, propensity matching was performed for age, left ventricular systolic dysfunction, congestive heart failure, chronic obstructive pulmonary disease, and smoking histories, using the nearest-neighbor matching with a caliper of 0.2 and with replacement. The final study cohort included 89 urgent and 252 matched elective cases, with a suitable alignment between the treatment groups. Propensity-matched urgent MitraClip patients experienced a longer hospital length of stay (p < 0.001), increased intensive care unit admissions (19% v 4%, p < 0.001) and mechanical ventilation (6.7% v 1.6%, p = 0.023), postprocedural atrial fibrillation (11% v 4.4%, p = 0.036), pericardial effusion (10% v 2.4%, p = 0.005), and acute kidney injury (7.9% v 2%, p = 0.016). Furthermore, patients in the urgent cohort incurred significantly higher 30-day cardiovascular mortality (6.7% v 2%, p = 0.039), increased 30-day (16% v 5.6%, p = 0.006), and 1-year (33% v 20%, p = 0.021) readmission rates. However, there were no statistically significant differences in 30-day and 1-year overall and 1-year cardiovascular mortality. CONCLUSIONS Urgent MitraClip repairs can be performed successfully, when needed, in critically ill patients with severe MR. Despite the procedural success, patients undergoing urgent MitraClip repair remain at high risk for adverse outcomes in the short- and intermediate-term and incur increased cardiovascular mortality and morbidity. Further efforts are required to develop strategies to optimize short and intermediate outcomes in this vulnerable group of patients.
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Affiliation(s)
| | | | | | | | | | | | - Ali Naqvi
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Imran Sunesara
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Tanya Richvalsky
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Dmitriy Yukhvid
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Divya Cherukupalli
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Augustine DeLago
- Department of Cardiology and Interventional Cardiology, Albany Medical Center, Albany, NY
| | - Mikhail Torosoff
- Department of Cardiology and Interventional Cardiology, Albany Medical Center, Albany, NY
| | - Alexander D Shapeton
- Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine, and Tufts University School of Medicine, Boston, MA
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Matta M, Ayoub C, Abou Hassan OK, Layoun H, Cremer PC, Hussein A, Schoenhagen P, Saliba WI, Rodriguez LL, Griffin BP, Kapadia SR, Harb SC. Anatomic and Functional Determinants of Atrial Functional Mitral Regurgitation. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2021.1943765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Harky A, Botezatu B, Kakar S, Ren M, Shirke MM, Pullan M. Mitral valve diseases: Pathophysiology and interventions. Prog Cardiovasc Dis 2021; 67:98-104. [PMID: 33812859 DOI: 10.1016/j.pcad.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
Valvular heart disease is common and increasingly prevalent among the elderly. The end result of valvular pathologies is cardiac failure and can lead to sudden death; thus, diagnosis and interventions are very important in the early stages of these diseases. The usual treatment methods of mitral regurgitation include percutaneous mitral valve repair, mitral valve replacement and minimally invasive surgery, whereas the treatment methods of mitral stenosis include percutaneous transluminal mitral commissurotomy and mitral commissurotomy as well as open surgical repair. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is ever evolving. The focus of this paper is on the various pathologies of the mitral valve, their etiology and clinical management, offering a comprehensive view of mitral valve diseases.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK; Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Bianca Botezatu
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Sahil Kakar
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Moliu Ren
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Manasi Mahesh Shirke
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Mark Pullan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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Kang JJH, Bozso SJ, El-Andari R, Adams C, Nagendran J. Transcatheter mitral valve repair and replacement: the next frontier of transcatheter valve intervention. Curr Opin Cardiol 2021; 36:163-171. [PMID: 33044266 DOI: 10.1097/hco.0000000000000803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW We summarize the recent developments in transcatheter mitral valve repair (TMVr) and replacement (TMVR), discuss determinants of MitraClip outcomes in various mitral regurgitation causes, and highlight newly emerging devices and randomized trials. RECENT FINDINGS The discordant results published in the two recent randomized trials for MitraClip, the COAPT and the MITRA-FR trial have led to the emergence of a new conceptual framework such as the proportionate versus disproportionate mitral regurgitation and hemodynamics assessment tools like the real-time continuous left atrial pressure monitoring. Learning curve and volume-outcome analyses and studies examining the MitraClip usage in patients with degenerative mitral regurgitation are recent developments that have influenced MitraClip regulation and coverage. Several trials for TMVr devices that take an alternative approach to the edge-to-edge repair are underway and advancements in the TMVR technologies are continuing to progress to fill the unmet needs of treating high surgical risk patients whose complex valve anatomy make TMVr unfeasible. SUMMARY Evidence supports careful analysis of the valve area and left ventricular function in addition to the left atrial hemodynamics will improve the MitraClip outcome. Operator experience plays a greater effect when achieving excellent results with 1+ or less residual mitral regurgitation whereas surgical MVr volume did not influence TMVr outcome. Interventions on the complex primary mitral regurgitation remain under the surgical domain, but MITRA high risk (HR) and REPAIR mitral regurgitation trials are underway to evaluate the role of MitraClip in high to intermediate surgical risk patients with primary mitral regurgitation. Despite the slow developments in TMVR, the results of the early trials of its devices are promising.
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Affiliation(s)
| | - Sabin J Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton
| | | | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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31
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Aranda-Michel E, Sultan I. Commentary: Computational approaches for valve repair: Calculating the unknown. JTCVS OPEN 2020; 3:46-47. [PMID: 36003859 PMCID: PMC9390547 DOI: 10.1016/j.xjon.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
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Fatima M, Mehmood N, Zaidi SMJ, Hamza M, Kaneez M, Irshad U, Azhar MJ, Zubair AB, Rizwan R, Sabir M. MR Product as a Novel Diagnostic Indicator for Chronic Secondary Mitral Regurgitation. Cureus 2020; 12:e10052. [PMID: 32999775 PMCID: PMC7520408 DOI: 10.7759/cureus.10052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Chronic secondary mitral regurgitation (SMR) is a common form of valvular heart disease. Its diagnosis through echocardiography is challenging and dependent on subjective interpretations. The subjective error to diagnose SMR can be reduced by developing accurate predictive quantitative parameters that support echocardiographic interpretations and clinical manifestations. The present study aims to develop a new diagnostic indicator for chronic SMR. The new indicator called MR product is the product of left atrial diameter (LAD) and left ventricular internal dimension at end-systole (LVIDs). Materials and Methods An analytical, case-control study was conducted from transthoracic echocardiography (TTE) reports of 720 patients performed according to the guidelines of the American Society of Echocardiography. The LAD and LVIDs were measured using the standard M Mode TTE. Out of the 720 patients who underwent TTE, 300 patients were diagnosed with chronic SMR by experienced clinicians. Only 115 of those 300 patients met the inclusion criteria for chronic SMR. Results The MR product was significantly associated with chronic SMR (rho = 0.83) and predicted it with an odds ratio of 1.014 (p < 0.001). The MR product was able to diagnose SMR with a sensitivity of 94.8% and a specificity of 92.2%, respectively, for a cut off value of 1,045 mm2. Conclusion A new parameter called MR product (LAD multiplied with LVIDs) has very high sensitivity and specificity for SMR. Therefore, it can aid in establishing its diagnosis, along with other diagnostic modalities. The new parameter may also potentially increase the diagnostic accuracy of the disease.
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Affiliation(s)
- Mishal Fatima
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Nadir Mehmood
- General Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Muhammad Hamza
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Mehwish Kaneez
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Umer Irshad
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | | | | | - Rafay Rizwan
- Cardiology, Rashid Latif Medical College, Lahore, PAK
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Feldman T, Smith R, Popma JJ. Primary MR remains undertreated. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:905-906. [PMID: 30340954 DOI: 10.1016/j.carrev.2018.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ted Feldman
- NorthShore University HealthSystem, Evanston, IL, United States of America.
| | - Robert Smith
- The Heart Hospital Baylor Plano, Plano, TX, United States of America
| | - Jeffrey J Popma
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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