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Tom SK, Kalra K, Perdoncin E, Tully A, Devireddy CM, Inci E, Greenbaum A, Grubb KJ. Transcatheter Treatment Options for Functional Mitral Regurgitation: Which Device for Which Patients? Interv Cardiol 2024; 19:e10. [PMID: 39081829 PMCID: PMC11287627 DOI: 10.15420/icr.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/07/2024] [Indexed: 08/02/2024] Open
Abstract
Mitral regurgitation is the most common valvular disease in the developed world, with approximately 24.2 million people being affected worldwide and a higher prevalence in older age groups. Surgical correction of degenerative mitral regurgitation is the standard of care and can restore cardiac function and provide a lasting result, especially when the mitral valve can be repaired. Secondary mitral regurgitation, or functional mitral regurgitation (FMR), describes atrial or ventricular factors leading to poor coaptation of an otherwise non-diseased valve. For FMR, traditional surgery has not produced the same level of benefit. Transcatheter mitral repair and replacement techniques that mimic surgical correction are under investigation. Transcatheter edge-to-edge repair is the only approved catheter-based therapy for FMR in the US. Here, the transcatheter treatment options for FMR are reviewed.
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Affiliation(s)
- Stephanie K Tom
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of MedicineAtlanta, GA, US
| | - Kanika Kalra
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of MedicineAtlanta, GA, US
| | - Emily Perdoncin
- Division of Cardiology, Department of Medicine, Emory University School of MedicineAtlanta, GA, US
| | - Andy Tully
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of MedicineAtlanta, GA, US
| | - Chandan M Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of MedicineAtlanta, GA, US
| | - Errol Inci
- Division of Cardiology, Department of Medicine, Emory University School of MedicineAtlanta, GA, US
| | - Adam Greenbaum
- Division of Cardiology, Department of Medicine, Emory University School of MedicineAtlanta, GA, US
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of MedicineAtlanta, GA, US
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Drake DH, Zhang P, Zimmerman KG, Morrow CD, Sidebotham DA. Anatomic, stage-based repair of secondary mitral valve disease. J Thorac Cardiovasc Surg 2024; 167:1733-1744. [PMID: 36775783 DOI: 10.1016/j.jtcvs.2023.01.006] [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: 09/12/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Intervention for repair of secondary mitral valve disease is frequently associated with recurrent regurgitation. We sought to determine if there was sufficient evidence to support inclusion of anatomic indices of leaflet dysfunction in the management of secondary mitral valve disease. METHODS We performed a systematic review and meta-analysis of published reports comparing anatomic indices of leaflet dysfunction with the complexity of valve repair and the outcome from intervention. Patients were stratified by the severity of leaflet dysfunction. A secondary analysis was performed comparing outcomes when procedural complexity was optimally matched to severity of leaflet dysfunction and when intervention was not matched to dysfunction. RESULTS We identified 6864 publications, of which 65 met inclusion criteria. An association between the severity of leaflet dysfunction and the procedural complexity was highly predictive of satisfactory freedom from recurrent regurgitation. Patients were categorized into 4 groups based on stratification of leaflet dysfunction. Satisfactory results were achieved in 93.7% of patients in whom repair complexity was appropriately matched to severity of leaflet dysfunction and in 68.8% in whom repair was not matched to dysfunction (odds ratio, 0.148; 95% confidence interval, 0.119-0.184; P < .0001). CONCLUSIONS For patients with secondary mitral valve disease, satisfactory outcome from valve repair improves when procedural complexity is matched to anatomic indices of leaflet dysfunction. Anatomic indices of leaflet dysfunction should be considered when planning interventions for secondary mitral regurgitation. Routine inclusion of anatomic indices in trial design and reporting should facilitate comparison of results and strengthen guidelines. There are sufficient data to support anatomic staging of secondary mitral valve disease.
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Affiliation(s)
- Daniel H Drake
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Munson Medical Center, Traverse City, Mich.
| | - Peng Zhang
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
| | | | - Cynthia D Morrow
- Health Systems, Management & Policy, Colorado School of Public Health, Aurora, Colo
| | - David A Sidebotham
- Department of Cardiothoracic Anaesthesia and Cardiothoracic Intensive Care, Auckland City Hospital, Auckland, New Zealand
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3
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Sato T, Moussa ID, Hanna P, Shivkumar K, Mori S. Insights Into Interaction Between Clip Device and the Mitral Valve Apparatus in the Human Heart. JACC Case Rep 2023; 22:101999. [PMID: 37790766 PMCID: PMC10544422 DOI: 10.1016/j.jaccas.2023.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 10/05/2023]
Abstract
Precise appreciation of the 3-dimensional relationship between the edge-to-edge clips and mitral valve apparatus remains clinically challenging. We demonstrate the images of clips observed in situ 4 years after implantation. Detailed observation from this case helps improve our understanding of 3-dimensional clinical cardiac anatomy related to transcatheter edge-to-edge mitral valve repair. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Takanori Sato
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Issam D. Moussa
- Carle Illinois College of Medicine, University of Illinois, Carle Heart and Vascular Institute, Champaign, Illinois, USA
| | - Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, Cardiovascular & Interventional Programs, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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4
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Sharma V, Horwitz PA, Rossen JD, El Accaoui RN. Acute Left Atrial Appendage Thrombus Formation During Transcatheter Mitral Valve Edge-to-Edge Repair. JACC Case Rep 2022; 4:1475-1479. [PMID: 36444181 PMCID: PMC9700075 DOI: 10.1016/j.jaccas.2022.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
We present a case of a 75-year-old man who developed an acute left atrial appendage thrombus immediately following mitral valve transcatheter edge to edge repair despite adequate intraprocedural anticoagulation. The patient was managed with enoxaparin to warfarin bridging with no obvious thromboembolic events on follow-up. Attention to anticoagulation is important to reduce thromboembolic risk during mitral valve transcatheter edge to edge repair. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Vikram Sharma
- Address for correspondence: Dr Vikram Sharma, University of Iowa Hospitals and Clinics, Division of Cardiovascular Medicine, 4223 RCP, 200 Hawkins Drive, Iowa City, Iowa 52242, USA.
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Sato H, Cavalcante JL, Bae R, Bapat VN, Garcia S, Gössl M, Hashimoto G, Fukui M, Enriquez-Sarano M, Sorajja P. Coaptation Reserve Predicts Optimal Reduction in Mitral Regurgitation and Long-Term Survival With Transcatheter Edge-to-Edge Repair. Circ Cardiovasc Interv 2022; 15:e011562. [PMID: 35686547 DOI: 10.1161/circinterventions.121.011562] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although transcatheter edge-to-edge repair (TEER) is effective and safe, there is a need for better prediction of optimal outcomes. We aimed to determine predictors of optimal reduction in mitral regurgitation (MR) and survival with TEER. METHODS We examined mitral anatomy and its change with TEER on outcomes in 183 patients (age, 82 [77-87] years; 53% women). Coaptation reserve was measured as the distance of continuous apposition of the A2 and P2 leaflet segments in 2-dimensional apical long-axis imaging at the site of the predominant jet of MR. Augmentation in coaptation was measured as the total amount of leaflet insertion. Addressable coaptation area was calculated using the physical boundaries of the TEER device. RESULTS Coaptation reserve, its augmentation, and addressable coaptation area were strong predictors of MR reduction (all P<0.001), as well as heart failure hospitalization and death. For patients with either mild or no residual MR, median values for coaptation reserve, its augmentation, and addressable coaptation area were 3.7 (2.8-4.5) mm, 7.3 (5.2-9.5) mm, and 59.0 (48.0-71.8) mm2, respectively. Receiver operating characteristic analyses determined the best values for optimal MR reduction as a coaptation reserve of >3.0 mm (P<0.001), addressable coaptation area of ≥52 mm2 (P<0.001), and coaptation augmentation of ≥4.7 mm (P<0.001). These values were associated with greater 2-year survival free of all-cause mortality and persisting even in analyses restricted to those with mild or no residual MR after TEER. CONCLUSIONS Coaptation reserve and its augmentation are simple, independent parameters that predict optimal MR reduction and better survival in patients undergoing TEER. These findings may have implications for patient selection and expanded use of the therapy.
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Affiliation(s)
- Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Go Hashimoto
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - Miho Fukui
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
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Eqbal A, Gupta S, Fam N, Ong G, Bisleri G. The impact of transcatheter edge-to-edge repair on mitral valve annular geometry. Curr Opin Cardiol 2022; 37:150-155. [PMID: 35058414 DOI: 10.1097/hco.0000000000000950] [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] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Mitral valve transcatheter edge-to-edge repair (TEER) is becoming increasingly common to treat severe mitral regurgitation. However, the lack of concomitant annuloplasty raises concerns regarding its durability. As a result, there is an emerging body of literature evaluating the impacts of TEER on mitral annular geometry. In this review, we summarize the most recent literature evaluating the impacts of TEER on annular geometry in the acute, intermediate and long-term. We also review the relationship between changes in annular geometry and clinical endpoints. RECENT FINDINGS Current evidence suggests that TEER acutely induces favourable changes in mitral annular size and shape, which may persist for at least up to 1 year. Few studies suggest that TEER-induced annular remodelling is associated with positive clinical outcomes. SUMMARY The current body of literature is sparse and limited to primarily small case series. Data from the surgical literature suggest that ringless edge-to-edge repair is associated with eventual failure. Unfortunately, few studies evaluate TEER-induced annular changes beyond the acute postprocedural phase. Future research needs to focus on and evaluate the significance of TEER-induced changes in annular dimensions in the long-term.
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Affiliation(s)
- Adam Eqbal
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Neil Fam
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Géraldine Ong
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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7
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Paulus MG, Meindl C, Hamerle M, Schach C, Maier LS, Debl K, Birner C, Unsöld B. Reduction of radiation exposure during transcatheter edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2022; 99:1259-1267. [PMID: 35084083 DOI: 10.1002/ccd.30046] [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: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transcatheter mitral valve repair is an increasingly used therapy for mitral regurgitation which requires fluoroscopic guidance. Limiting radiation exposure during lengthy procedures is important for both patient and operator safety. This study aimed to investigate radiation dose during contemporary use of MitraClip implantation and the effects of a dose reduction program. METHODS A total of 115 patients who underwent MitraClip implantation were prospectively enrolled in a single-center observational study. During the inclusion period, our institution adopted a radiation dose reduction program, comprising lowering of fluoroscopy pulse rate and image target dose. The first 58 patients were treated with conventional fluoroscopy settings, while the following 57 patients underwent the procedure with the newly implemented low dose protocol. RESULTS Radiation dose area product significantly decreased after introduction of the low dose protocol (693 [366-1231] vs. 2265 [1517-3914] cGy·cm2 , p < 0.001). After correcting for fluoroscopy time, gender and body mass index, the low dose protocol emerged as a strong negative predictor of radiation dose (p < 0.001), reducing dose area product by 64% (95% confidence interval [57-70]). Device time, device success, and procedural safety did not differ between the normal dose and low dose group. Furthermore, the low dose protocol was not associated with an increased incidence of a combined endpoint consisting of death, repeat intervention, or heart surgery during 12 months follow-up. CONCLUSION Reduction of radiation exposure during transcatheter mitral valve repair by 64% is feasible without affecting procedural success or safety.
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Affiliation(s)
- Michael G Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Holst LB, Afshari A, Møller MH, Russell L. Pre-procedural platelet transfusion thresholds in hospitalised children - Protocol for a scoping review. Acta Anaesthesiol Scand 2021; 65:558-561. [PMID: 33215692 DOI: 10.1111/aas.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thrombocytopenia is a common condition in hospitalised critically ill children and most platelet transfusions are given as prophylaxis to non-bleeding children prior to invasive procedures such as central venous catheterisation and lumbar puncture. Platelet transfusion may reduce bleeding complications but have also been associated with potential adverse effects and variation in clinical practice exist. To direct future research, we aim to assess the current evidence regarding prophylactic platelet transfusion prior to procedures in hospitalised thrombocytopenic children. METHODS We will conduct a scoping review of all study designs in accordance with the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement. We will include studies on hospitalised children undergoing invasive procedures where the prevalence of thrombocytopenia and the predefined outcome measures, including bleeding, transfusion-related adverse events and use of blood products and life support are reported. We will provide descriptive analyses of the included studies/trials and the quality of evidence will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. CONCLUSION The outlined scoping review will provide an overview on the benefits and harms of prophylactic platelet transfusion prior to invasive procedures in thrombocytopenic hospitalised children.
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Affiliation(s)
- Lars Broksø Holst
- Department of Paediatric and Obstetric Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Arash Afshari
- Department of Paediatric and Obstetric Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
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Khan MS, Siddiqi TJ, Butler J, Friede T, Levy WC, Witte KK, Lipiecki J, Sievert H, Coats AJS. Functional outcomes with Carillon device over 1 year in patients with functional mitral regurgitation of Grades 2+ to 4+: results from the REDUCE-FMR trial. ESC Heart Fail 2021; 8:872-878. [PMID: 33619896 PMCID: PMC8006711 DOI: 10.1002/ehf2.13273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
AIMS The objective of this study was to compare functional outcomes through 1 year in patients with core-lab verified moderate to severe (Grades 2+ to 4+) functional mitral regurgitation (FMR) treated with the Carillon device or control in the blinded sham-controlled REDUCE-FMR (Carillon Mitral Contour System for Reducing Functional Mitral Regurgitation) study. METHODS AND RESULTS The main outcomes of this analysis were the change in 6 min walk test (6MWT) distance, incidence of heart failure hospitalization or death, change in New York Heart Association (NYHA) class, and change in Kansas City Cardiomyopathy Questionnaire (KCCQ) score through 1 year of follow-up. The minimum clinically important difference (MCID) was defined as a ≥30 m increase in 6MWT distance, an NYHA decrease in ≥1 class, and a ≥3 point increase in KCCQ score. The proportion of patients achieving the MCID in each treatment group was compared using Fisher's exact test, and the number needed to treat (NNT) with the Carillon device was calculated. Among 83 patients (62 Carillon and 21 sham), no statistically significant group differences were observed in the baseline characteristics. All outcomes at 1 year numerically favoured the Carillon group, including MCID for the 6MWT distance (59% vs. 23%, P = 0.029; NNT = 2.8), NYHA class (48% vs. 33%, P = 0.38; NNT = 6.9), KCCQ score (69% vs. 47%, P = 0.14; NNT = 4.5), and freedom from heart failure hospitalization or death (60% vs. 48%, P = 0.45; NNT = 8.3). CONCLUSIONS REDUCE-FMR was the first blinded sham-controlled trial to report outcomes with percutaneous therapy for the treatment of FMR. Trends towards improvement in mean 6MWT distance, KCCQ score, and NYHA class were observed with the Carillon device. A substantially higher number of patients achieved MCID for all patient-centred outcomes with the Carillon device compared with the sham procedure.
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Affiliation(s)
| | - Tariq Jamal Siddiqi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Wayne C Levy
- UW Heart Institute, University of Washington, Seattle, WA, USA
| | - Klaus K Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 544] [Impact Index Per Article: 181.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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12
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 331] [Impact Index Per Article: 110.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 782] [Impact Index Per Article: 260.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mohadjer A, Brown G, Shah SR, Nallapati C, Waheed N, Bavry AA, Park K. Sex-Based Differences in Coronary and Structural Percutaneous Interventions. Cardiol Ther 2020; 9:257-273. [PMID: 32440761 PMCID: PMC7584690 DOI: 10.1007/s40119-020-00176-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
In the current state of interventional cardiology, the ability to offer advanced therapies to patients who historically were not surgical candidates has grown exponentially in the last few decades. As therapies have expanded in complex coronary and structural interventions, the nuances of treating certain populations have emerged. In particular, the role of sex-based anatomic and outcome differences has been increasingly recognized. As guidelines for cardiovascular prevention and treatment for certain conditions may vary by sex, therapeutic interventions in the structural and percutaneous coronary areas may also vary. In this review, we aim to discuss these differences, the current literature available on these topics, and areas of focus for the future.
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Affiliation(s)
- Ashley Mohadjer
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Garrett Brown
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Syed R Shah
- Department of Internal Medicine, North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL, USA
| | - Charishma Nallapati
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Nida Waheed
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
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16
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Singh GD, Rogers JH, Chen S, Yap J, Smith TWR, Fan D, Stripe B, Aman E. Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique. Catheter Cardiovasc Interv 2020; 97:745-754. [PMID: 33045138 DOI: 10.1002/ccd.29323] [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: 04/30/2020] [Revised: 08/21/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND During MitraClip implantation sub-valvular correction of trajectory and/or alignment may increase adverse clip or leaflet events. With systematic adjunctive use of fluoroscopy ("Parallax technique"), we aimed to assess parameters that minimize the need for corrective measures and help increase procedural efficiency. METHODS We retrospectively analyzed 30 patients without (Fl-) and 39 patients utilizing adjunctive fluoroscopy (Fl+) during MitraClip implantation. After establishing trajectory and supra-valvular alignment, the Parallax technique was utilized. Trajectory and alignment are maintained during advancement. RESULTS All patients had 3 or 4+ MR. There were no differences in baseline demographics. The average number of clips (Fl- vs Fl+) was 1.72 ± 0.8 vs 1.59 ± 0.5, p = .57. For the first clip, the need for sub-valvular alignment (80% vs. 36%, p = .0001), eversion with retraction back to left atrium (23% vs. 10%, p = .001) and the number of grasps (2.3 ± 1.2 vs 1.4 ± 0.9) was reduced. The time from transseptal puncture to first clip deployment (71 ± 21 vs 44 ± 16 min, p = .01) was reduced. Procedural success was achieved in all but one patient in the Fl- group (p = ns). There were no differences noted for in-hospital or 30-day outcomes. CONCLUSIONS Systematic use of a simple and easy to implement "Parallax technique" was associated with reduced need for sub-valvular manipulation and was associated with improved procedural times. Further larger scale studies are needed to assess the applicability of the technique.
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Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Sarah Chen
- Division of Cardiothoracic Surgery, University of California Davis, Davis, California, USA
| | - Jonathan Yap
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Dali Fan
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Benjamin Stripe
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Edris Aman
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
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17
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). ACTA ACUST UNITED AC 2020; 67:446-480. [PMID: 32948329 DOI: 10.1016/j.redar.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
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Affiliation(s)
- P Carmona García
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Coordinadora del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SEDAR
| | - R García Fuster
- Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, España. Coordinador del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SECCE.
| | - E Mateo
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - S Badía Gamarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Trías y Pujol, Badalona, España
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España
| | - E Gutiérrez Carretero
- Servicio de Cirugía Cardiaca, Hospital, Universitario Virgen del Rocío, Sevilla, España
| | - M L Maestre
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - V Legname
- Servicio de Cirugía Cardiaca, Centro Médico Teknon, Barcelona, España
| | - G Fita
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación. Hospital Clínic, Barcelona, España
| | - M Vives
- EDAIC. PhD. Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Universitario Dr Josep Trueta de Girona, España. Representante de España en la EACTA. Co-director del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Representante del subcomité de Educación de EACTA. Co-director grupo EchoSim
| | - T Koller Bernhard
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Sánchez Pérez
- EDAIC. Sección de Cirugía Cardiaca, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR
| | - J Miralles Bagán
- Sección Cardiotorácica, Servicio Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - S Italiano
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - B Darias-Delbey
- Servicio Anestesiología y Reanimación, Proceso del Paciente, Cardioquirúrgico, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, España
| | - J M Barrio
- Sección Anestesia y Reanimación Cardiovascular, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General. Universitario Gregorio Marañón, Madrid, España
| | - J I Sáez de Ibarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - A Hernández
- Departamento de Anestesia y Cuidados Intensivos, Grupo Policlínica, Ibiza, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos, de la SEDAR Representante del subcomité de Educación de EACTA, EDAIC, Codirector grupo EchoSim
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18
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Sodhi N, Lim DS. Transcatheter Treatment of Functional Mitral Regurgitation in Patients with Heart Failure: The COAPT Trial. Interv Cardiol Clin 2020; 9:451-459. [PMID: 32921369 DOI: 10.1016/j.iccl.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Secondary (functional) mitral regurgitation is strongly associated with recurrent heart failure (HF) hospitalizations, poor quality of life, and high rates of mortality. The COAPT trial demonstrated that transcatheter edge-to-edge mitral leaflet repair with the MitraClip device led to a decrease in the severity of secondary mitral regurgitation, a significantly lower rate of hospitalization for heart failure, lower mortality, and better quality of life and functional capacity within 24 months of follow-up compared with medical therapy alone. In this article, the authors review the COAPT trial rationale, design, results, and their clinical implications.
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Affiliation(s)
- Nishtha Sodhi
- Division of Cardiovascular Medicine, Department of Medicine, Advanced Cardiac Valve Center, University of Virginia, 1215 Lee Street, Charlottesville, VA 22909, USA.
| | - David Scott Lim
- Division of Cardiovascular Medicine, Department of Medicine, Advanced Cardiac Valve Center, University of Virginia, 1215 Lee Street, Charlottesville, VA 22909, USA; Division of Pediatric Cardiology, Department of Pediatrics, Advanced Cardiac Valve Center, University of Virginia, 1215 Lee Street, Charlottesville, VA 22909, USA
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19
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Öztürk C, Fasell T, Sinning JM, Werner N, Nickenig G, Hammerstingl C, Schueler R. Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip. Catheter Cardiovasc Interv 2020; 96:678-684. [PMID: 32065722 DOI: 10.1002/ccd.28775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/07/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left atrial (LA) volumes and function are believed to improve following interventional reduction of mitral regurgitation (MR) with MitraClip. However, exact LA alterations after MitraClip in patients with functional MR and functional mitral regurgitation (FMR) are unknown. OBJECTIVES We aimed to evaluate the effect of MitraClip on LA volumes and global function in patients with FMR and its importance for patients' prognosis. METHODS All patients underwent three-dimensionally transthoracic echocardiography with an offline evaluation of LA geometry and strain analysis at baseline and follow-up (FU). FU examinations were planned for 6 and 12 months after MitraClip. RESULTS We prospectively included 50 consecutive surgical high-risk (logistic EuroSCORE: 17.2 ± 13.9%) patients (77 ± 9 years, 22% female) with symptomatic moderate-to-severe to severe functional MR without atrial fibrillation. Echocardiographic evaluation showed that the E/E' ratio was significantly higher at FU (15.6 ± 7.3, 24.1 ± 13.2, p = .05) without relevant changes in systolic left ventricle (LV) function (p = .5). LA volumes (end-diastolic volume [LA-EDV] and end-systolic volume [LA-ESV]) (LA-EDV: 83.1 ± 39.5 ml, 115.1 ± 55.3 ml, p = .012; LA-ESV: 58.4 ± 33.4 ml, 80.1 ± 43.9 ml, p = .031), muscular mass (105.1 ± 49.3 g, 145.4 ± 70.6 g, p = .013), as well as LA stroke volume (24.6 ± 12.5 ml, 34.9 ± 19.1 ml, p = .016) significantly increased after the procedure. LA ejection fraction (LA-EF: 31.7 ± 12.8%, 31.1 ± 12.3%, p = .8) and atrial global strain (aGS: -10.8 ± 5.4%, -9.7 ± 4.45%, p = .4) showed no significant changes at FU. Despite no relevant changes during FU, the baseline aGS was found to be the strongest predictor for mortality and adverse interventional outcome. CONCLUSION MitraClip increases atrial stroke volume, atrial volumes, and muscular mass in patients with FMR. We found that the baseline aGS the strongest predictor for mortality, rehospitalization, and higher residual MR at FU.
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Affiliation(s)
- Can Öztürk
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Tamana Fasell
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Nikos Werner
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany
| | | | - Robert Schueler
- Contilia Heart and Vascular Center, Elisabeth Hospital, Essen, Germany
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20
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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21
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Jone P, Sandoval JP, Haak A, Hammers J, Rodriguez‐Zanella H, Quaife RA, Salcedo EE, Carroll JD, Gill E. Echocardiography–fluoroscopy fusion imaging: The essential features used in congenital and structural heart disease interventional guidance. Echocardiography 2020; 37:769-780. [DOI: 10.1111/echo.14670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Pei‐Ni Jone
- Pediatric Cardiology Children’s Hospital Colorado University of Colorado School of Medicine Aurora Colorado
| | - Juan Pablo Sandoval
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | | | | | - Hugo Rodriguez‐Zanella
- Intervención en Cardiopatía Congénita y Estructural Instituto Nacional de Cardiología Ignacio Chávez Mexico City Mexico
| | - Robert A. Quaife
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Ernesto E. Salcedo
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
| | - Edward Gill
- Division of Cardiology University of Colorado School of Medicine Aurora Colorado
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22
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Charitakis K, Schubert S, Hirshfeld JW. Mitral Leaflet Perforation: An Interventional Frontier for Nonsurgical Candidates? JACC Case Rep 2019; 1:694-695. [PMID: 34316911 PMCID: PMC8288578 DOI: 10.1016/j.jaccas.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, Texas
| | - Scott Schubert
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, Texas
| | - John W. Hirshfeld
- Cardiovascular Division, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Jone PN, Haak A, Ross M, Wiktor DM, Gill E, Quaife RA, Messenger JC, Salcedo EE, Carroll JD. Congenital and Structural Heart Disease Interventions Using Echocardiography-Fluoroscopy Fusion Imaging. J Am Soc Echocardiogr 2019; 32:1495-1504. [DOI: 10.1016/j.echo.2019.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 11/16/2022]
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24
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Piazza N, Delgado V, Mylotte D, Hamm C. Eyes of the Heart Team - the interventional imaging specialist: a pathway for future generations. EUROINTERVENTION 2019; 15:828-830. [PMID: 31746746 DOI: 10.4244/eijv15i10a156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada
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25
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Ailawadi G, Lim DS, Mack MJ, Trento A, Kar S, Grayburn PA, Glower DD, Wang A, Foster E, Qasim A, Weissman NJ, Ellis J, Crosson L, Fan F, Kron IL, Pearson PJ, Feldman T. One-Year Outcomes After MitraClip for Functional Mitral Regurgitation. Circulation 2019; 139:37-47. [PMID: 30586701 DOI: 10.1161/circulationaha.117.031733] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Secondary mitral regurgitation (SMR) occurs in the absence of organic mitral valve disease and may develop as the left ventricle dilates or remodels or as a result of leaflet tethering with impaired coaptation, most commonly from apical and lateral distraction of the subvalvular apparatus, with late annular dilatation. The optimal therapy for SMR is unclear. This study sought to evaluate the 1-year adjudicated outcomes of all patients with SMR undergoing the MitraClip procedure in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) Investigational Device Exemption program, which is comprised of the randomized clinical trial, the prospective High-Risk Registry, and the REALISM Continued Access Registry (Multicenter Study of the MitraClip System). METHODS Patients with 3+/4+ SMR enrolled in EVEREST II were stratified by non-high surgical risk (non-HR) and high surgical risk (HR) status (defined as Society of Thoracic Surgeons risk of mortality ≥12% or predefined risk factors). Clinical, echocardiographic, and functional outcomes at 1 year were evaluated. RESULTS A total of 616 patients (482 HR, 134 non-HR; mean age, 73.3±10.5 years; Society of Thoracic Surgeons risk, 10.2±6.9%) with SMR underwent the MitraClip procedure. At baseline, 80.5% of patients were in New York Heart Association class III/IV. Major adverse events at 30 days included death (3.6%), stroke (2.3%), and renal failure (1.5%). At discharge, 88.8% had MR ≤2+. At 1 year, there were 139 deaths, and the Kaplan-Meier estimate of freedom from mortality was 76.8%. The majority of surviving patients (84.7%) remained with MR ≤2+ and New York Heart Association class I/II (83.0%). Kaplan-Meier survival at 1 year was 74.1% in HR patients and 86.4% in non-HR patients ( P=0.0175). At 1 year, both groups achieved comparable MR reduction (MR ≤2+, 84.0% versus 87.0%) and improvement in left ventricular end-diastolic volume (-8.0 mL versus -12.7 mL), whereas New York Heart Association class I/II was found in 80.1% versus 91.8% ( P=0.008) of HR and non-HR patients, respectively. In HR patients, the annualized rate of heart failure hospitalizations decreased from 0.68 to 0.46 in the 12 months before to 12 months after the procedure ( P<0.0001). CONCLUSIONS Transcatheter mitral valve repair with the MitraClip in patients with secondary MR is associated with acceptable safety, reduction of MR severity, symptom improvement, and positive ventricular remodeling. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov . Unique identifiers: NCT00209274, NCT01940120, and NCT01931956.
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Affiliation(s)
- Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery (G.A., I.L.K.), University of Virginia, Charlottesville
| | - D Scott Lim
- Division of Cardiology (D.S.L.), University of Virginia, Charlottesville
| | - Michael J Mack
- Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, TX (M.J.M.)
| | - Alfredo Trento
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (A.T., S.K.)
| | - Saibal Kar
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (A.T., S.K.)
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.A.G.)
| | | | - Andrew Wang
- Duke University Medical Center, Durham, NC (D.D.G., A.W.)
| | - Elyse Foster
- Division of Cardiology, University of California, San Francisco (E.F., A.Q.)
| | - Atif Qasim
- Division of Cardiology, University of California, San Francisco (E.F., A.Q.)
| | | | | | - Lori Crosson
- Abbott Vascular, Santa Clara, CA (J.E., L.C., F.F.)
| | - Frank Fan
- Abbott Vascular, Santa Clara, CA (J.E., L.C., F.F.)
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery (G.A., I.L.K.), University of Virginia, Charlottesville
| | - Paul J Pearson
- Northshore University Health System, Evanston, IL (P.J.P., T.F.)
| | - Ted Feldman
- Northshore University Health System, Evanston, IL (P.J.P., T.F.)
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26
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Öztürk C, Friederich M, Werner N, Nickenig G, Hammerstingl C, Schueler R. Single-center five-year outcomes after interventional edge-to-edge repair of the mitral valve. Cardiol J 2019; 28:215-222. [PMID: 31313274 DOI: 10.5603/cj.a2019.0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/15/2019] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The MitraClip procedure was established as a therapeutic alternative to mitral valve surgery for symptomatic patients with severe mitral regurgitation (MR) at prohibitive surgical risk. In this study, the aim was to evaluate 5-year outcomes after MitraClip. METHODS Consecutive patients undergoing the MitraClip system were prospectively included. All patients underwent clinical follow-up and transthoracic echocardiography. RESULTS Two hundred sixty-five patients (age: 81.4 ± 8.1 years, 46.7% female, logistic EuroSCORE: 19.7 ± 16.7%) with symptomatic MR (60.5% secondary MR [sMR]). Although high procedural success of 91.3% was found, patients with primary MR (pMR) had a higher rate of procedural failure (sMR: 3.1%, pMR: 8.6%; p = 0.04). Five years after the MitraClip procedure, the majority of patients presented with reduced symptoms and improved functional capacity (functional NYHA class: p = 0.0001; 6 minutes walking test: p = 0.04). Sustained MR reduction (≤ grade 2) was found in 74% of patients, and right ventricular (RV) function was significantly increased (p = 0.03). Systolic pulmonary artery pressure (sPAP) was significantly reduced during follow-up only in sMR patients (p = 0.05, p = 0.3). Despite a pronounced clinical and echocardiographical amelioration and low interventional failure, 5-year mortality was significantly higher in patients with sMR (p = 0.05). The baseline level of creatinine (HR: 0.695), sPAP (HR: 0.96) and mean mitral valve gradient (MVG) (HR: 0.82) were found to be independent predictors for poor functional outcome and mortality. CONCLUSIONS Transcatheter mitral valve repair with the MitraClip system showed low complication rates and sustained MR reduction with improved RV function and sPAP 5 years after the procedure was found in all patients, predominantly in patients with sMR. Despite pronounced functional amelioration with low procedure failure, sMR patients had higher 5-year mortality and worse outcomes. Baseline creatinine, MVG, and sPAP were found to be independent predictors of poor functional outcomes and 5-year mortality.
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Affiliation(s)
- Can Öztürk
- Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany.
| | - Mona Friederich
- Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Nikos Werner
- Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Georg Nickenig
- Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | | | - Robert Schueler
- Contilia Heart and Vascular Center, Elisabeth Hospital, Essen, Essen, Germany
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27
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Marmagkiolis K, Hakeem A, Ebersole DG, Iliescu C, Ates I, Cilingiroglu M. Clinical outcomes of percutaneous mitral valve repair with MitraClip for the management of functional mitral regurgitation. Catheter Cardiovasc Interv 2019; 94:820-826. [PMID: 30938045 DOI: 10.1002/ccd.28203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/21/2019] [Accepted: 03/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of percutaneous mitral valve repair for the management of functional mitral insufficiency. BACKGROUND Severe FMR is present in 25-30% of patients with heart failure and is an independent predictor of mortality and hospitalizations in patients with both ischemic and nonischemic cardiomyopathy. MitraClip therapy has been approved for high surgical risk patients with primary mitral regurgitation. Recent studies including two randomized trials have yielded conflicting results in terms of its clinical efficacy and outcomes for FMR. A quantitative evaluation and synthesis of this information are essential in elucidating the role of MitraClip repair for FMR. METHODS We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from September 2008 to September 2018. Studies comparing percutaneous mitral valve repair using the MitraClip device against conservative therapy for the management of functional mitral regurgitation were included. RESULTS Seven studies with 1,174 patients in MitraClip group and 1,015 patients in medical therapy group met inclusion criteria. The 12-month mortality in the MitraClip group was 18.4% compared with 25.9% in the medical therapy group (odds ratio [OR]: 0.65 [0.50, 0.86]; p < .002). The rate of readmission at 12 months was 29.9% in the MitraClip group compared with 54.1% in the medical therapy group (OR: 040 [0.32-0.49]; p < .0001. The prognostic efficacy of MitraClip repair appears to be more substantial over longer follow-up period over medical therapy alone. CONCLUSIONS Based on the results of this meta-analysis, percutaneous mitral valve repair with MitraClip appears to be superior to medical therapy for symptomatic moderate-to-severe functional mitral insufficiency. Further clinical research is needed to identify the ideal patient subgroups who receive maximum benefit with the MitraClip therapy.
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Affiliation(s)
| | - Abdul Hakeem
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Cezar Iliescu
- Division of Cardiology, Department of Medicine, MD Anderson Cancer Center, University of Texas at Houston, Houston, Texas
| | - Ismail Ates
- School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Mehmet Cilingiroglu
- School of Medicine, Bahcesehir University, Istanbul, Turkey.,Arkansas Heart Hospital, Little Rock, Arkansas
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Ikenaga H, Yoshida J, Hayashi A, Nagaura T, Yamaguchi S, Rader F, Siegel RJ, Kar S, Shiota T. Usefulness of Intraprocedural Pulmonary Venous Flow for Predicting Recurrent Mitral Regurgitation and Clinical Outcomes After Percutaneous Mitral Valve Repair With the MitraClip. JACC Cardiovasc Interv 2019; 12:140-150. [DOI: 10.1016/j.jcin.2018.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/17/2018] [Accepted: 09/25/2018] [Indexed: 11/29/2022]
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Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med 2018; 379:2307-2318. [PMID: 30280640 DOI: 10.1056/nejmoa1806640] [Citation(s) in RCA: 1870] [Impact Index Per Article: 311.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes. METHODS At 78 sites in the United States and Canada, we enrolled patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heart failure within 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%. RESULTS Of the 614 patients who were enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of all hospitalizations for heart failure within 24 months was 35.8% per patient-year in the device group as compared with 67.9% per patient-year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of freedom from device-related complications at 12 months was 96.6% (lower 95% confidence limit, 94.8%; P<0.001 for comparison with the performance goal). Death from any cause within 24 months occurred in 29.1% of the patients in the device group as compared with 46.1% in the control group (hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001). CONCLUSIONS Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 24 months of follow-up than medical therapy alone. The rate of freedom from device-related complications exceeded a prespecified safety threshold. (Funded by Abbott; COAPT ClinicalTrials.gov number, NCT01626079 .).
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Affiliation(s)
- Gregg W Stone
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - JoAnn Lindenfeld
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - William T Abraham
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Saibal Kar
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - D Scott Lim
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Jacob M Mishell
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Brian Whisenant
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Paul A Grayburn
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Michael Rinaldi
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Samir R Kapadia
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Vivek Rajagopal
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Ian J Sarembock
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Andreas Brieke
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Steven O Marx
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - David J Cohen
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Neil J Weissman
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
| | - Michael J Mack
- From New York-Presbyterian Hospital and the Cardiovascular Research Foundation (G.W.S.) and Columbia University Medical Center (G.W.S., S.O.M.), New York; Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.L.); the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Christ Hospital, Cincinnati (I.J.S.) - all in Ohio; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.) - both in California; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (D.J.C.); and MedStar Health Research Institute, Hyattsville, MD (N.J.W.)
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Wu IY, Barajas MB, Hahn RT. The MitraClip Procedure—A Comprehensive Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2018; 32:2746-2759. [DOI: 10.1053/j.jvca.2018.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Indexed: 11/11/2022]
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Mack MJ, Abraham WT, Lindenfeld J, Bolling SF, Feldman TE, Grayburn PA, Kapadia SR, McCarthy PM, Lim DS, Udelson JE, Zile MR, Gammie JS, Gillinov AM, Glower DD, Heimansohn DA, Suri RM, Ellis JT, Shu Y, Kar S, Weissman NJ, Stone GW. Cardiovascular Outcomes Assessment of the MitraClip in Patients with Heart Failure and Secondary Mitral Regurgitation: Design and rationale of the COAPT trial. Am Heart J 2018; 205:1-11. [PMID: 30134187 DOI: 10.1016/j.ahj.2018.07.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with heart failure (HF) and symptomatic secondary mitral regurgitation (SMR) have a poor prognosis, with morbidity and mortality directly correlated with MR severity. Correction of isolated SMR with surgery is not well established in this population, and medical management remains the preferred approach in most patients. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial was designed to determine whether transcatheter mitral valve (MV) repair with the MitraClip device is safe and effective in patients with symptomatic HF and clinically significant SMR. STUDY DESIGN The COAPT trial is a prospective, randomized, parallel-controlled, open-label multicenter study of the MitraClip device for the treatment of moderate-to-severe (3+) or severe (4+) SMR (as verified by an independent echocardiographic core laboratory) in patients with New York Heart Association class II-IVa HF despite treatment with maximally tolerated guideline-directed medical therapy (GDMT) who have been determined by the site's local heart team as not appropriate for MV surgery. A total of 614 eligible subjects were randomized in a 1:1 ratio to MV repair with the MitraClip plus GDMT versus GDMT alone. The primary effectiveness end point is recurrent HF hospitalizations through 24 months, analyzed when the last subject completes 12-month follow-up, powered to demonstrate superiority of MitraClip therapy. The primary safety end point is a composite of device-related complications at 12 months compared to a performance goal. Follow-up is ongoing, and the principal results are expected in late 2018. CONCLUSIONS HF patients with clinically significant SMR who continue to be symptomatic despite optimal GDMT have limited treatment options and a poor prognosis. The randomized COAPT trial was designed to determine the safety and effectiveness of transcatheter MV repair with the MitraClip in symptomatic HF patients with moderate-to-severe or severe SMR.
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Affiliation(s)
- Michael J Mack
- Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, TX.
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH
| | - JoAnn Lindenfeld
- Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville, TN
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Ted E Feldman
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, IL
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, VA
| | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Donald D Glower
- Division of Cardiology, Duke University Medical Center, Durham, NC
| | - David A Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN
| | - Rakesh M Suri
- Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - Saibal Kar
- Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | | | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center, and The Cardiovascular Research Foundation, New York, NY
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Kar S, Feldman T, Qasim A, Trento A, Kapadia S, Pedersen W, Lim DS, Kipperman R, Smalling RW, Bajwa T, Hermann HC, Hermiller JB, Lasala JM, Reisman M, Glower D, Mauri L, Whitlow P. Five-year outcomes of transcatheter reduction of significant mitral regurgitation in high-surgical-risk patients. Heart 2018; 105:1622-1628. [DOI: 10.1136/heartjnl-2017-312605] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 11/03/2022] Open
Abstract
ObjectivesThis study evaluates the 5-year clinical outcomes of transcatheter mitral valve (MV) repair with the MitraClip device in patients at high risk for MV surgery treated in the Endovascular Valve Edge-to-Edge Repair (EVEREST) II High Risk Study (HRS).MethodsPatients with mitral regurgitation (MR) 3+ or 4+ and predicted surgical mortality risk ≥12% or surgeon assessment based on prespecified high-risk factors were enrolled. Patients prospectively consented to 5 years of follow-up.ResultsAt 5 years, clinical follow-up was achieved in 90% of 78 enrolled patients. The rate of postprocedural adverse events declined from 30 days to 1 year follow-up and was stable thereafter through 5 years. Two patients (2.6%) developed mitral stenosis (MS). Two patients underwent MV surgery, including one due to MS. A total of 42 deaths were reported through 5 years. Effectiveness measures at 5 years showed reductions in MR severity to ≤2+ in 75% of patients (p=0.0107), left ventricular (LV) end-diastolic volume (−38.2 mL; 95% CI −55.0 to –21.4; p<0.0001) and LV end-systolic volume (−14.6 mL; 95% CI −27.7 to −1.5; p=0.0303) compared with baseline. The New York Heart Association (NYHA) functional class improved from baseline to 5 years (p<0.005), and septal-lateral annular dimensions remained stable with no indication of mitral annular dilation through 5 years.ConclusionsThe EVEREST II HRS demonstrated long-term safety and efficacy of MitraClip in high-surgical-risk patients through 5 years. The observed mortality was most likely a consequence of the advanced age and comorbidity profile of the enrolled patients, while improvements in NYHA class in surviving patients were durable through long-term follow-up.Trial registration numberNCT01940120.
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33
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Faletra FF, Ho SY, Leo LA, Paiocchi VL, Mankad S, Vannan M, Moccetti T. Which Cardiac Structure Lies Nearby? Revisiting Two-Dimensional Cross-Sectional Anatomy. J Am Soc Echocardiogr 2018; 31:967-975. [PMID: 29958761 DOI: 10.1016/j.echo.2018.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 12/18/2022]
Abstract
Two-dimensional (2D) transthoracic echocardiography is one of the most used diagnostic tools in clinical cardiology. Similarly, 2D transesophageal echocardiography is considered an indispensable tool for cardiologists and cardiac anesthesiologists worldwide. However, because of their tomographic nature, both techniques display only thin cut planes of a given area of the heart, which are far from representing the "anatomic reality." It is widely accepted that experienced echocardiographers are able to reconstruct mentally a three-dimensional image of any cardiac structure on the basis of their interpretation of multiple tomographic slices. However, this may not be the case with less experienced echocardiographers. In particular, the authors noticed that less experienced echocardiographers are almost totally unaware of which structures lie "nearby" a given 2D tomographic plane, that is, what is adjacent in the elevation plane. In this article, the authors report the use of three-dimensional transesophageal echocardiographic images to discover which structures are located nearby (i.e., "behind" and "in front") the corresponding 2D cross-sections. The authors believe that this novel use of three-dimensional echocardiography is a unique aid to disclose what cannot be seen in a given 2D cross-section, thereby expanding our understanding of 2D echocardiographic anatomy. This may be an effective method to encourage all to "think" in three dimensions, even when they use 2D echocardiography.
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Affiliation(s)
| | - Siew Yen Ho
- Cardiac Morphology, Royal Brompton Hospital and Imperial College London, London, United Kingdom
| | - Laura Anna Leo
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | | | | | - Tiziano Moccetti
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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34
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Labrousse L, Dijos M, Leroux L, Oses P, Seguy B, Markof M, Lafitte S. Guidance of the MitraClip® procedure by 2D and 3D imaging. Arch Cardiovasc Dis 2018; 111:432-440. [DOI: 10.1016/j.acvd.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
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35
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Guiding the percutaneous mitral valve repair by real-time three-dimensional transesophageal echocardiography: Beyond procedural navigation. J Cardiol 2018; 71:327-328. [DOI: 10.1016/j.jjcc.2017.12.002] [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: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/18/2022]
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36
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Ruf T, Heidrich F, Sveric K, Pfluecke C, Stephan AM, Strasser R, Wiedemann S. ELMSTREET (Esophageal Lesions during MitraClip uSing TRansEsophageal Echocardiography Trial). EUROINTERVENTION 2017; 13:e1444-e1451. [DOI: 10.4244/eij-d-17-00125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Curio J, Reinthaler M, Kasner M, Al-Hindwan HSA, Baeckemo-Johansson J, Neumann T, Jacobs S, Lauten A, Landmesser U. Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome. J Interv Cardiol 2017; 31:83-90. [DOI: 10.1111/joic.12457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jonathan Curio
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | - Markus Reinthaler
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
- Helmholtz Institution Geesthacht; Campus Teltow; Berlin Germany
| | - Mario Kasner
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | | | | | - Tim Neumann
- Department of Anaesthetics; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | - Stephan Jacobs
- Department of Cardiothoracic Surgery; German Heart Center Berlin; Berlin Germany
| | - Alexander Lauten
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | - Ulf Landmesser
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
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38
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Eleid MF, Reeder GS, Rihal CS. Comparison of left atrial pressure monitoring with dedicated catheter versus steerable guiding catheter during transcatheter mitral valve repair. Catheter Cardiovasc Interv 2017; 92:374-378. [DOI: 10.1002/ccd.27430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/11/2017] [Accepted: 10/30/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Mackram F. Eleid
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
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39
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Faletra FF, Berrebi A, Pedrazzini G, Leo LA, Paiocchi VL, Cautilli G, Casso G, Cassina T, Moccetti T, Malouf JF. 3D transesophageal echocardiography: A new imaging tool for assessment of mitral regurgitation and for guiding percutaneous edge-to-edge mitral valve repair. Prog Cardiovasc Dis 2017; 60:305-321. [DOI: 10.1016/j.pcad.2017.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 12/17/2022]
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40
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Echocardiographic-Fluoroscopic Fusion Imaging in Transseptal Puncture: A New Technology for an Old Procedure. J Am Soc Echocardiogr 2017; 30:886-895. [DOI: 10.1016/j.echo.2017.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Indexed: 02/02/2023]
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41
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Maor E, Raphael CE, Panaich SS, Reeder GS, Nishimura RA, Nkomo VT, Rihal CS, Eleid MF. Acute Changes in Left Atrial Pressure After MitraClip Are Associated With Improvement in 6-Minute Walk Distance. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004856. [DOI: 10.1161/circinterventions.116.004856] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
Background—
Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT).
Methods and Results—
Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68%) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234–394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1–6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6–19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19–47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (
P
=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49% increased likelihood for improvement in 6-minute walk (
P
=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (
P
=0.05).
Conclusions—
Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.
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Affiliation(s)
- Elad Maor
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Claire E. Raphael
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Guy S. Reeder
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rick A. Nishimura
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Hayashida K, Yasuda S, Matsumoto T, Amaki M, Mizuno S, Tobaru T, Jujo K, Ootomo T, Yamaguchi J, Fukuda K, Saito S, Foster E, Qasim A, Kitakaze M, Yozu R, Takayama M. AVJ-514 Trial - Baseline Characteristics and 30-Day Outcomes Following MitraClip ® Treatment in a Japanese Cohort. Circ J 2017; 81:1116-1122. [PMID: 28321004 DOI: 10.1253/circj.cj-17-0115] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The MitraClip®system is a transcatheter-based therapeutic option for patients with chronic mitral regurgitation (MR) who are at high risk for surgery. A prospective, multicenter, single-arm study was initiated to confirm the transferability of this system to Japan.Methods and Results:Patients with symptomatic chronic moderate-to-severe (3+) or severe (4+) functional or degenerative MR with a Society of Thoracic Surgery (STS) score ≥8%, or the presence of 1 predefined risk factor were enrolled. Patients with left ventricular (LV) ejection fraction (EF) <30% were excluded. MR severity and LV function were assessed by an independent echocardiography core lab. Primary outcome included major adverse events (MAE) at 30 days and acute procedural success (APS). A total of 30 patients (age: 80±7 years; STS score: 10.3%±6.6%) were treated with the MitraClip®. At baseline, all patients had MR 3+/4+ with 53%/47% patients with degenerative/functional etiology with mean LVEF of 50.2±12.8%, and 37% of patients were NYHA class III/IV. APS was achieved in 86.7% with no occurrence of MAE. At 30 days, 86.7% of patients had MR ≤2+ and 96.7% were NYHA class I/II. CONCLUSIONS The MitraClip®procedure resulted in clinically meaningful improvements in MR severity, function and quality of life measures, and low MAE rates. These early results suggest the transferability of this therapy to appropriately selected Japanese patients. (Trial Registration: clinicaltrials.gov Identifier NCT02520310.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Atif Qasim
- University of California at San Francisco
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Kałmucki P, Jerzykowska O, Dankowski R, Baszko A, Kramer L, Szyszka A, Siminiak T. Percutaneous Trans-Coronary Venous Mitral Annuloplasty in Patients With Functional Mitral Regurgitation: Analysis of Poznan Carillon Registry Data. J Interv Cardiol 2016; 29:632-638. [DOI: 10.1111/joic.12349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Piotr Kałmucki
- Department of Interventional Cardiology; Poznan University of Medical Sciences; Poznan Poland
- HCP Medical Center; Pozan Poland
| | | | - Rafał Dankowski
- Department of Interventional Cardiology; Poznan University of Medical Sciences; Poznan Poland
- HCP Medical Center; Pozan Poland
| | - Artur Baszko
- Department of Interventional Cardiology; Poznan University of Medical Sciences; Poznan Poland
- HCP Medical Center; Pozan Poland
| | - Lucyna Kramer
- Department of Interventional Cardiology; Poznan University of Medical Sciences; Poznan Poland
| | - Andrzej Szyszka
- Department of Interventional Cardiology; Poznan University of Medical Sciences; Poznan Poland
- HCP Medical Center; Pozan Poland
| | - Tomasz Siminiak
- Department of Interventional Cardiology; Poznan University of Medical Sciences; Poznan Poland
- HCP Medical Center; Pozan Poland
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44
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Hidalgo F, Mesa D, Ruiz M, Delgado M, Rodríguez S, Pardo L, Pan M, López A, Romero MA, Suárez de Lezo J. Impacto del remodelado del anillo mitral tras el procedimiento MitraClip en la reducción de la insuficiencia mitral funcional. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hidalgo F, Mesa D, Ruiz M, Delgado M, Rodríguez S, Pardo L, Pan M, López A, Romero MA, Suárez de Lezo J. Effects of Mitral Annulus Remodeling Following MitraClip Procedure on Reduction of Functional Mitral Regurgitation. ACTA ACUST UNITED AC 2016; 69:1020-1025. [PMID: 27212447 DOI: 10.1016/j.rec.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The percutaneous mitral valve repair procedure (MitraClip) appears to reduce mitral annulus diameter in patients with functional mitral regurgitation, but the relationship between this and regurgitation severity has not been demonstrated. The aim of this study was to determine the effect of mitral annulus remodeling on the reduction of mitral regurgitation in patients with functional etiology. METHODS The study included all patients with functional mitral regurgitation treated with MitraClip at our hospital until January 2015. Echocardiogram (iE33 model, Philips) was performed in all patients immediately after device positioning. Changes in the mitral annulus correlated with mitral regurgitation severity, as assessed using the effective regurgitant orifice area. RESULTS The study included 23 patients (age, 65±14 years; 74% men; left ventricular ejection fraction, 31%±13%; systolic pulmonary artery pressure, 47±10 mmHg). After the procedure, the regurgitant orifice area decreased by 0.30 cm2±0.04 cm2 (P<.0005), from a baseline of 0.49 cm2±0.09 cm2. Anteroposterior diameter decreased by 3.14 mm±1.01 mm (P<.0005) from a baseline of 28.27 mm±4.9 mm, with no changes in the intercommissural diameter (0.50 mm±0.91 mm vs 40.68 mm±4.7 mm; P=.26). A significant association was seen between anteroposterior diameter reduction and regurgitant orifice area reduction (r=.49; P=.020). CONCLUSIONS In patients with functional mitral regurgitation, the MitraClip device produces an immediate reduction in the anteroposterior diameter. This remodeling may be related to the reduction in mitral regurgitation.
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Affiliation(s)
- Francisco Hidalgo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | - Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Martín Ruiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Mónica Delgado
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Sara Rodríguez
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Laura Pardo
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Amador López
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Miguel A Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Schäfer U, Maisano F, Butter C, Franzen O, Baldus S, Hausleiter J, Ussia GP, Sievert H, Geist V, Widder JD, Moccetti T, Schillinger W. Impact of Preprocedural Left Ventricular Ejection Fraction on 1-Year Outcomes After MitraClip Implantation (from the ACCESS-EU Phase I, a Prospective, Multicenter, Nonrandomized Postapproval Study of the MitraClip Therapy in Europe). Am J Cardiol 2016; 118:873-880. [PMID: 27575279 DOI: 10.1016/j.amjcard.2016.06.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022]
Abstract
This report describes the 12-month outcomes of the a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe (ACCESS-EU postapproval study of MitraClip therapy) with respect to preprocedural left ventricular ejection fraction (LVEF). Transcatheter deployment of the MitraClip device may be considered for patients who are not suitable for conventional surgery. A total of 567 patients with significant mitral regurgitation (MR) underwent MitraClip therapy. Of those, 393 had functional MR (FMR) and were subdivided by preprocedural LVEF (A: 10% to 20%, B: >20% to 30%, C: >30% to 40%, D: >40%). Procedural safety and efficacy and treatment outcomes including MR grade, New York Heart Association (NYHA) functional class, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire were analyzed at baseline, 30 days, and 12 months. Baseline mean logistic EuroSCORE was 25 ± 19; 87% of patients were in NYHA classes III or IV (A: 96%, B: 83%, C: 90%, D: 86%). There was no incidence of death or stroke intraprocedurally. Eleven patients died within 30 days with no differences among subgroups. Kaplan-Meier survival at 12 months was 81.8% (A: 71%, B: 79%, C: 87%, D: 86%). There was a significant improvement in MR severity at 30 days and 12 months (p <0.0001). At 12 months, all subgroups experienced similar improvements in NYHA class, 6-minute walk test, and Minnesota Living with Heart Failure Questionnaire. This real-world registry reports promising results of MitraClip therapy in patients with FMR. In conclusion, the low rates of hospital mortality and adverse events in patients with FMR-even in patients with severely reduced LVEF-provide additional evidence of substantial benefits after MitraClip implantation.
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Affiliation(s)
- Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Centre, Hamburg, Germany.
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Butter
- Department of Cardiology, Heart Centre Brandenburg, Bernau, Germany
| | - Olaf Franzen
- Department of Cardiology, Klinik im Park, Zürich, Switzerland
| | - Stephan Baldus
- Department of Cardiology, University Heart Centre, Cologne, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Gian Paolo Ussia
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg), Bad Segeberg, Germany
| | - Julian Daniel Widder
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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Eleid MF, Reeder GS, Malouf JF, Lennon RJ, Pislaru SV, Nkomo VT, Rihal CS. The Learning Curve for Transcatheter Mitral Valve Repair With MitraClip. J Interv Cardiol 2016; 29:539-545. [DOI: 10.1111/joic.12326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Guy S. Reeder
- Department of Cardiovascular Diseases; Mayo Clinic; Minnesota
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Abstract
Transcatheter aortic valve replacement for treatment of aortic stenosis has now become an accepted alternative to surgical valve replacement for some patients. In addition, transcatheter mitral valve repair is also routinely used in high surgical risk patients with mitral regurgitation. Other transcatheter procedures are in rapid development. The current review attempts to summarize the procedures and echocardiographic imaging used for transcatheter valve replacement or valve repair.
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Affiliation(s)
- Rebecca T. Hahn
- From the Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY
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49
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Khalique OK, Hahn RT. Multimodality Imaging in Transcatheter Mitral Interventions. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005071. [DOI: 10.1161/circimaging.116.005071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Omar K. Khalique
- From the Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY
| | - Rebecca T. Hahn
- From the Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY
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50
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Jone PN, Ross MM, Bracken JA, Mulvahill MJ, Di Maria MV, Fagan TE. Feasibility and Safety of Using a Fused Echocardiography/Fluoroscopy Imaging System in Patients with Congenital Heart Disease. J Am Soc Echocardiogr 2016; 29:513-21. [PMID: 27143284 DOI: 10.1016/j.echo.2016.03.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fused real-time three-dimensional transesophageal echocardiography and fluoroscopy has been used in adult patients during percutaneous mitral valve and aortic valve procedures. The use of fused echocardiographic/x-ray fluoroscopic imaging (FEX) in pediatric patients undergoing congenital heart disease catheterization has not been evaluated for feasibility and safety. The aims of this study were to assess the feasibility and safety of FEX for interventional guidance and to perform a comparison of atrial septal defect (ASD) device closure using this technology with traditional guidance methods. METHODS Prospective evaluation of FEX in congenital cardiac interventions was conducted. A subset of patients with ASD closures were compared with patients with historical ASD closures with and without FEX. The interventionalist and echocardiographer rated the anatomic quality of the fusion imaging as (1) excellent, (2) good, or (3) poor. In addition, the utility of FEX procedural guidance was graded as (1) superior, (2) no added benefit, or (3) inferior to that of standard guidance by fluoroscopy and transesophageal echocardiography. RESULTS FEX was successfully used in 26 procedures on 25 patients with congenital heart disease from January 2013 to February 2015. The median age was 9 years (range, 3-26 years), and the median weight was 29 kg (range, 16-77 kg). Twenty-six procedures were performed, including ASD closure, Fontan fenestration closure, and transcatheter valve placement in the tricuspid valve position. There was reduced fluoroscopy time and radiation dose in patients with ASDs who underwent imaging using this new technology (P < .001 and P < .03, respectively). There were no statistically significant differences in procedural times between the two groups. Anatomic definition was rated as excellent in 20 of 26 procedures, with the remaining six rated was good. Twenty-one of 26 procedures were graded as superior (81%), and five of 26 (19%) were graded as providing no added benefit. There were no complications in any of the procedures. CONCLUSIONS In this early experience, FEX is feasible and safe in patients undergoing congenital heart disease catheterization and provides useful guidance in the majority of interventional procedures. There were relative reductions in fluoroscopy time and radiation dose with the use of FEX for ASD closure.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
| | - Michael M Ross
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - John A Bracken
- Philips Research North America, Briarcliff Manor, New York
| | - Matthew J Mulvahill
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael V Di Maria
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Thomas E Fagan
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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