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Galili L, Weissmann J, White Zeira A, Marom G. Numerical modeling for efficiency and endurance assessment of an indirect mitral annuloplasty device. J Mech Behav Biomed Mater 2022; 136:105516. [PMID: 36215769 DOI: 10.1016/j.jmbbm.2022.105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
In recent years, several transcatheter systems have been introduced for treatment of common mitral regurgitation (MR). Such a system that is based on indirect mitral annuloplasty (IMA) is currently indicated for functional MR. Very few clinical studies have been performed to assess the efficiency and durability of such devices, despite their high risk of fracture resulting from ongoing exposure to large cyclic deformations. In this study, numerical models of moderate primary MR were created to test the implantation procedure of a customized IMA device and its sealing efficiency. The ability of the implanted device to reduce systolic leakage was evaluated and affirmed with a model of a more generic device. The long-term durability of the device was tested using a range of Nickel Titanium material properties. Our results demonstrated a considerable reduction in leakage for both the simplified generic device and the more detailed customized device models. The device met different fatigue criteria, confirming its resiliency and safety even after 10 years, even under the harsher conditions of primary MR. This is the first study to assess the performance and fatigue risk of IMA devices for the treatment of more complicated MR conditions. These findings may pave the way for further research to ultimately consider the device in selective cases of PMR.
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Affiliation(s)
- Lee Galili
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Weissmann
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Adi White Zeira
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
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2
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Seifu S, de Marchena E. Microinvasive mitral valve surgery: A new frontier to tackle mitral regurgitation. J Card Surg 2022; 37:4062-4063. [PMID: 34608674 DOI: 10.1111/jocs.16013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Solomon Seifu
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eduardo de Marchena
- Division of cardiovascular Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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Körber MI, Friedrichs KP, Aydin F, Pfister R, Mauri V, Baldus S, Rudolph V, Huntgeburth M. Impact of cleft-like indentations on procedural outcome of percutaneous edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2021; 97:1236-1243. [PMID: 33002279 DOI: 10.1002/ccd.29286] [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: 04/07/2020] [Revised: 08/07/2020] [Accepted: 09/13/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES AND BACKGROUND Percutaneous edge-to-edge mitral valve (MV) repair (PMVR) is broadly applied in high-risk patients with relevant mitral regurgitation (MR). We investigated the incidence of cleft-like indentations (CLI) and their impact on PMVR. METHODS AND RESULTS In a retrospective single center analysis including 263 patients undergoing PMVR with the MitraClip®-system between 11/2012 and 7/2016, MV anatomy was assessed by 3-dimensional transesophageal echocardiography. CLI were present in 37/263 patients (14.1%). Of these, 62.2% had 1 CLI, 27% had 2 CLI, and 10.8% had 3 CLI, mostly concerning segment P2 or P2/3 of the MV. Baseline characteristics were similarly distributed. Interestingly, most patients with CLI suffered from secondary MR (n = 29, 78%). The number of deployed MitraClips was higher in patients with CLI (2 [1.25-2] vs. 2 [1, 2], p = .035), whereas procedural as well as clinical success was similar: MR grade (1.2 vs. 1.5, p = .061), vena contracta width (4.2 vs. 4.5 mm, p = .293), dPmean (4.2 vs. 4.0 mmHg, p = .618) at discharge and NYHA class at 30 days did not differ between groups. Periprocedural complications were rare and equally distributed between groups. At 30 days, MR reduction persisted in patients with CLI (95.8% of these selected patients had a MR grade ≤ 2). CONCLUSIONS CLI of the MV are common in patients undergoing PMVR, also when presenting mainly with secondary MR. While the number of clips needed to address MR is slightly higher in patients with CLI, procedural success rates appear not to be affected. PMVR seems to be a safe treatment option for patients with CLI.
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Affiliation(s)
- Maria Isabel Körber
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Kai Peter Friedrichs
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Fatma Aydin
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Roman Pfister
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Huntgeburth
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
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Choi HM, Park MS, Youn JC. Update on heart failure management and future directions. Korean J Intern Med 2019; 34:11-43. [PMID: 30612416 PMCID: PMC6325445 DOI: 10.3904/kjim.2018.428] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/09/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality, and rapidly expanding health care cost. The number of HF patients is increasing worldwide, and Korea is no exception. There have been marked advances in definition, diagnostic modalities, and treatment of HF over the past four decades. There is continuing effort to improve risk stratification of HF using biomarkers, imaging and genetic testing. Newly developed medications and devices for HF have been widely adopted in clinical practice. Furthermore, definitive treatment for end-stage heart failure including left ventricular assist device and heart transplantation are rapidly evolving as well. This review summarizes the current state-of-the-art management for HF and the emerging diagnostic and therapeutic modalities to improve the outcome of HF patients.
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Affiliation(s)
- Hong-Mi Choi
- Division of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Myung-Soo Park
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Chancellor WZ, Schubert SA, Ailawadi G. Transcatheter interventions for functional mitral regurgitation. Ann Cardiothorac Surg 2018; 7:764-770. [PMID: 30598890 DOI: 10.21037/acs.2018.09.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mitral regurgitation is considered the most prevalent valve disease in the United States and its incidence is increasing due to the aging population. Surgical mitral valve repair and replacement are effective at reducing regurgitation due to ischemia, but many patients with secondary mitral regurgitation do not undergo surgery because they are too high risk. Transcatheter devices that mimic surgical techniques are rapidly being developed to reduce the risks traditionally associated with surgical mitral valve repair and replacement. Despite the challenges posed by complex anatomy and multiple etiologies of mitral valve pathology, early results of transcatheter mitral repair and replacement indicate that they have the potential to increase the number of patients with secondary MR who are candidates for intervention.
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Affiliation(s)
- William Z Chancellor
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Sarah A Schubert
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
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6
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Geis NA, Pleger ST, Bekeredjian R, Chorianopoulos E, Kreusser MM, Frankenstein L, Ruhparwar A, Katus HA, Raake PWJ. Haemodynamic effects of percutaneous mitral valve edge-to-edge repair in patients with end-stage heart failure awaiting heart transplantation. ESC Heart Fail 2018; 5:892-901. [PMID: 30058757 PMCID: PMC6165942 DOI: 10.1002/ehf2.12313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022] Open
Abstract
Aims Functional mitral regurgitation is complicating end‐stage heart failure and potential heart transplantation by increasing pulmonary artery pressures. The aim of the present study was to investigate feasibility and haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair using the MitraClip™ device in patients with end‐stage heart failure awaiting heart transplantation. Methods and results In this retrospective study, we identified nine patients suffering from end‐stage heart failure listed for heart transplantation in whom moderate–severe or severe functional mitral regurgitation was recognized and treated with percutaneous mitral valve edge‐to‐edge repair. Twenty‐two patients listed for heart transplantation and presenting with moderate–severe or severe functional mitral regurgitation treated in the pre‐MitraClip™ era served as controls. Patients were analysed at two separate time points: MitraClip™ group: pre‐procedure and post‐procedure (follow‐up: 215 ± 53 days) and control group: study entry with recognition of moderate–severe or severe functional mitral regurgitation (follow‐up: 197 ± 47 days). Percutaneous mitral valve edge‐to‐edge repair with the MitraClip™ was feasible and safe in our high‐risk end‐stage heart failure population. The intervention resulted in significant reduction of mitral regurgitation (grade 3.0 [0.5] to 1.5 [0.5]; P = 0.009), left atrial diameter (51 mm [16] to 49 mm [4]; follow‐up MitraClip™ vs. control group P = 0.0497), pulmonary artery pressures (sPA 50 mmHg [15] to 45 mmHg [10]; P = 0.02; mPA 34 mmHg [8] to 30 mmHg [10]; P = 0.02), and New York Heart Association class (3.5 [1.0] to 3.0 [0.5]; P = 0.01) and improved mixed‐venous oxygen saturation (57% [11] to 55% [7]; follow‐up MitraClip™ vs. control group P = 0.02). No changes in the control group were observed. Conclusions MitraClip™ implantation as ‘bridge‐to‐transplant’ strategy in patients with end‐stage heart failure and severe functional mitral regurgitation awaiting heart transplantation is feasible and appears to result in favourable haemodynamic effects.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Emmanuel Chorianopoulos
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Nyman CB, Mackensen GB, Jelacic S, Little SH, Smith TW, Mahmood F. Transcatheter Mitral Valve Repair Using the Edge-to-Edge Clip. J Am Soc Echocardiogr 2018; 31:434-453. [PMID: 29482977 DOI: 10.1016/j.echo.2018.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/20/2022]
Abstract
Percutaneous intervention for mitral valve (MV) disease has been established as an alternative to open surgical MV repair in patients with prohibitive surgical risk. Multiple percutaneous approaches have been described and are in various stages of development. Edge-to-edge leaflet plication with the MitraClip (Abbott, Menlo Park, CA) is currently the only Food and Drug Administration-approved device specifically for primary or degenerative lesions. Use of the edge-to-edge clip for secondary mitral regurgitation is currently under investigation and may result in expanded indications. Echocardiography has significantly increased our understanding of the anatomy of the MV and provided us with the ability to classify and quantify the associated mitral regurgitation. For percutaneous interventions of the MV, transesophageal echocardiography imaging is used for patient screening, intraprocedural guidance, and confirmation of the result. Optimal outcomes require the echocardiographer and the proceduralist to have a thorough understanding of intra-atrial septal and MV anatomy, as well as an appreciation for the key points and potential pitfalls of each of the procedural steps. With increasing experience, more complex valvular pathology can be successfully percutaneously treated. In addition to two-dimensional echocardiography, advances in three-dimensional echocardiography and fusion imaging will continue to support the refinement of current technologies, the expansion of clinical applications, and the development of novel devices.
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Affiliation(s)
- Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Thomas W Smith
- Department of Internal Medicine, Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Feroze Mahmood
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Predicting device failure after percutaneous repair of functional mitral regurgitation in advanced heart failure: Implications for patient selection. Int J Cardiol 2018; 257:182-187. [PMID: 29358003 DOI: 10.1016/j.ijcard.2018.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/11/2017] [Accepted: 01/02/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with heart failure (HF) and severe symptomatic functional mitral regurgitation (FMR) may benefit from MitraClip implantation. With increasing numbers of patients being treated the success of procedure becomes a key issue. We sought to investigate the pre-procedural predictors of device failure in patients with advanced HF treated with MitraClip. METHODS From April 2012 to November 2016, 76 patients with poor functional class (NYHA class III-IV) and severe left ventricular (LV) remodeling underwent MitraClip implantation at University Hospitals of Trieste and Bologna (Italy). Device failure was assessed according to MVARC criteria. Patients were subsequently followed to additionally assess the patient success after 12months. RESULTS Mean age was 67±12years, the mean Log-EuroSCORE was 23.4±16.5%, and the mean LV end-diastolic volume index and ejection fraction (EF) were 112±33ml/m2 and 30.6±8.9%, respectively. At short-term evaluation, device failure was observed in 22 (29%) patients. Univariate predictors of device failure were LVEF, LV and left atrial volumes and anteroposterior mitral annulus diameter. Annulus dimension (OR 1.153, 95% CI 1.002-1.327, p=0.043) and LV end-diastolic volume (OR 1.024, 95% CI 1.000-1.049, p=0.049) were the only variables independently associated with the risk of device failure at the multivariate model. CONCLUSIONS Pre-procedural anteroposterior mitral annulus diameter accurately predicted the risk of device failure after MitraClip in the setting of advanced HF. Its assessment might aid the selection of the best candidates to percutaneous correction of FMR.
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Sturla F, Vismara R, Jaworek M, Votta E, Romitelli P, Pappalardo OA, Lucherini F, Antona C, Fiore GB, Redaelli A. In vitro and in silico approaches to quantify the effects of the Mitraclip ® system on mitral valve function. J Biomech 2016; 50:83-92. [PMID: 27863743 DOI: 10.1016/j.jbiomech.2016.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 12/01/2022]
Abstract
Mitraclip® implantation is widely used as a valid alternative to conventional open-chest surgery in high-risk patients with severe mitral valve (MV) regurgitation. Although effective in reducing mitral regurgitation (MR) in the majority of cases, the clip implantation produces a double-orifice area that can result in altered MV biomechanics, particularly in term of hemodynamics and mechanical stress distribution on the leaflets. In this scenario, we combined the consistency of in vitro experimental platforms with the versatility of numerical simulations to investigate clip impact on MV functioning. The fluid dynamic determinants of the procedure were experimentally investigated under different working conditions (from 40bpm to 100bpm of simulated heart rate) on six swine hearts; subsequently, fluid dynamic data served as realistic boundary conditions in a computational framework able to quantitatively assess the post-procedural MV biomechanics. The finite element model of a human mitral valve featuring an isolated posterior leaflet prolapse was reconstructed from cardiac magnetic resonance. A complete as well as a marginal, sub-optimal grasping of the leaflets were finally simulated. The clipping procedure resulted in a properly coapting valve from the geometrical perspective in all the simulated configurations. Symmetrical complete grasping resulted in symmetrical distribution of the mechanical stress, while uncomplete asymmetrical grasping resulted in higher stress distribution, particularly on the prolapsing leaflet. This work pinpointed that the mechanical stress distribution following the clipping procedure is dependent on the cardiac hemodynamics and has a correlation with the proper execution of the grasping procedure, requiring accurate evaluation prior to clip delivery.
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Affiliation(s)
- Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | | | - Omar A Pappalardo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy; Division of cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Carlo Antona
- Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Surgery Department, "Luigi Sacco" University general Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Gianfranco B Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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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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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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13
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Kim JH, Sung SC, Chon MK, Kim JO, Lee SH, Lee SY, Je HG, Choo KS, Hwang JM, Kim JS, Park YH, Chun KJ, Kim CM. Mitral loop cerclage as a variant form of mitral cerclage annuloplasty that adds a device (CSTV) for preventing potential complications: a preclinical proof of concept and feasibility study. EUROINTERVENTION 2016; 11:e1669-79. [PMID: 27056114 DOI: 10.4244/eijv11i14a319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Although mitral cerclage annuloplasty can reduce mitral regurgitation, the potential risks for erosion of the surrounding tissue or conduction blockage are barriers to human translation. This preclinical study aimed to provide a proof of concept for a novel approach, mitral loop cerclage (MLC), designed to address these shortcomings. METHODS AND RESULTS MLC consists of: (1) a novel appliance termed a coronary sinus and tricuspid valve protective device (CSTV) that includes a tension locker, and (2) a nylon-coated, braided stainless steel rope (0.6 mm thick) with a coronary artery protective device in a single unit (cerclage rope). Nine healthy farm swine underwent MLC in short-term (two weeks, n=4) and midterm (six weeks, n=5) survival experiments under X-ray fluoroscopic guidance imaging. The procedural success rate was 100%. MLC resulted in a significant reduction of the septal lateral dimension of the mitral annulus (24.58±2.16 vs. 21.26±1.43 mm, p=0.04) and left ventricular (LV) volume in diastole (75.9±3.9 vs. 70.6±5.0 ml, p=0.04) in the midterm group. No conduction abnormalities or serious complications were noted beyond trivial tricuspid regurgitation in all cases (n=9). Necropsy showed no evidence of tissue erosion and an excellent biocompatibility of the implanted devices. CONCLUSIONS MLC, as a novel approach for catheter-based mitral valve repair, appeared feasible in this short-term preclinical model. Further studies with longer follow-up in a cardiomyopathic animal model are needed to verify the clinical feasibility and safety of MLC.
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Affiliation(s)
- June-Hong Kim
- School of Medicine, Pusan National University & Cardiovascular Center, Yangsan Hospital, Yangsan, South Korea
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14
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Natarajan N, Patel P, Bartel T, Kapadia S, Navia J, Stewart W, Tuzcu EM, Schoenhagen P. Peri-procedural imaging for transcatheter mitral valve replacement. Cardiovasc Diagn Ther 2016; 6:144-59. [PMID: 27054104 DOI: 10.21037/cdt.2016.02.04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mitral regurgitation (MR) has a high prevalence in older patient populations of industrialized nations. Common etiologies are structural, degenerative MR and functional MR secondary to myocardial remodeling. Because of co-morbidities and associated high surgical risk, open surgical mitral repair/replacement is deferred in a significant percentage of patients. For these patients transcatheter repair/replacement are emerging as treatment options. Because of the lack of direct visualization, pre- and intra-procedural imaging is critical for these procedures. In this review, we summarize mitral valve anatomy, trans-catheter mitral valve replacement (TMVR) options, and imaging in the context of TMVR.
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Affiliation(s)
- Navin Natarajan
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Parag Patel
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Thomas Bartel
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Samir Kapadia
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Jose Navia
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - William Stewart
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - E Murat Tuzcu
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Paul Schoenhagen
- 1 Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; 2 Department of Cardiovascular Medicine, 3 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA ; 4 Imaging Institute, Cleveland Clinic, Cleveland, OH 44106, USA
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15
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Giannini C, Fiorelli F, De Carlo M, Guarracino F, Faggioni M, Giordano P, Spontoni P, Pieroni A, Petronio AS. Comparison of Percutaneous Mitral Valve Repair Versus Conservative Treatment in Severe Functional Mitral Regurgitation. Am J Cardiol 2016; 117:271-7. [PMID: 26651454 DOI: 10.1016/j.amjcard.2015.10.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
Percutaneous mitral valve repair (PMVR) using the MitraClip System is feasible and entails clinical improvement even in patients with high surgical risk and severe functional mitral regurgitation (MR). The aim of this study was to assess survival rates and clinical outcome of patients with severe, functional MR treated with optimal medical therapy (OMT) compared with those who received MitraClip device. Sixty patients treated with OMT were compared with a propensity-matched cohort of 60 patients who underwent PMVR. Baseline demographics and echocardiographic variables were similar between the 2 groups. The mean age of patients was 75 years, and 67% were men. The median logistic EuroSCORE and EuroSCORE II were 17% and 6%, respectively, because of the presence of several co-morbidities. The mechanism of MR was functional in all cases with an ischemic etiology in 52% of patients. Median left ventricle ejection fraction was 34%. All the patients were symptomatic for dyspnea with 63% and 12% in the New York Heart Association class III and IV, respectively. In PMVR group, the procedure was associated with safety and very low incidence of procedural complications with no occurrence of procedural and inhospital mortality. After a median follow-up of 515 days (248 to 828 days), patients treated with PMVR demonstrated overall survival, survival freedom from cardiac death and survival free of readmission due to cardiac disease curves higher than patients treated conservatively (log-rank test p = 0.007, p = 0.002, and p = 0.04, respectively). In conclusion, PMVR offers a valid option for selected patients with high surgical risk and severe, functional MR and entails better survival outcomes compared with OMT.
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16
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Triantafyllis AS, Kortlandt F, Bakker ALM, Swaans MJ, Eefting FD, van der Heyden JAS, Post MC, Rensing BWJM. Long-term survival and preprocedural predictors of mortality in high surgical risk patients undergoing percutaneous mitral valve repair. Catheter Cardiovasc Interv 2015; 87:467-75. [PMID: 26268819 DOI: 10.1002/ccd.26137] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 04/29/2015] [Accepted: 07/11/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate long-term survival in high surgical risk patients undergoing percutaneous mitral valve repair (MVR) using the MitraClip(®) system and to identify preprocedural predictors of long-term mortality. BACKGROUND Data for long-term survival and preprocedural predictors of mortality after percutaneous MVR in high surgical risk patients are sporadic. METHODS From January 2009 to April 2013, 136 consecutive high surgical risk patients, with symptomatic moderate-to-severe or severe mitral regurgitation (MR), underwent percutaneous MVR using the MitraClip system. Cardiac and overall survival was determined at one and 2 years postprocedure. Univariate and multivariate analysis was performed to identify preprocedural predictors of long-term mortality. RESULTS One year postprocedure, cardiac and overall survival was 86.7% and 84.6%, respectively and at 2 years cardiac and overall survival was 77.7% and 74.8%, respectively. In univariate analysis advanced age, lower body mass index, impaired renal function, elevated levels of log-N-terminal-pro-brain-natriuretic-peptide (log-NTproBNP), poor performance in functional tests (New York Heart Association (NYHA) class) and high logistic Euroscore (LES) and Society of Thoracic Surgeons (STS) score were identified as preprocedural predictors of long-term cardiac mortality. In multivariate analysis preoperative NYHA class III and IV, elevated levels of log-NTproBNP and advanced age predicted long-term cardiac mortality. CONCLUSIONS Percutaneous MVR using the MitraClip system has favorable long-term survival rates in high surgical risk patients. Preprocedural NYHA functional class III and IV, elevated log-NTproBNP levels and advanced age predict higher long-term cardiac mortality and should be considered during patient selection.
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Affiliation(s)
| | - Friso Kortlandt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Annelies L M Bakker
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Frank D Eefting
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Martijn C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Benno W J M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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17
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Del Trigo M, Rodés-Cabau J. Transcatheter Structural Heart Interventions for the Treatment of Chronic Heart Failure. Circ Cardiovasc Interv 2015; 8:e001943. [DOI: 10.1161/circinterventions.114.001943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Maria Del Trigo
- From the Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
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18
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Zamorano JL, González-Gómez A, Lancellotti P. Mitral valve anatomy: implications for transcatheter mitral valve interventions. EUROINTERVENTION 2015; 10 Suppl U:U106-11. [PMID: 25256321 DOI: 10.4244/eijv10sua15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mitral regurgitation is a common valvular heart disease and its prevalence is expected to increase with population ageing. Percutaneous techniques for the treatment of mitral regurgitation are emerging as an alternative therapeutic option. However, the mitral valve is a complex structure, and a comprehensive understanding of the anatomy of the mitral valve apparatus and its surrounding structures is crucial for a correct selection of patients and the success of transcatheter mitral valve interventions.
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19
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Revuelta JM. La reparación de la insuficiencia mitral entre 2 orillas. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.01.003] [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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20
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21
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22
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Soofi MA, Alsamadi F. Restoration of normal left ventricular geometry after percutaneous mitral annuloplasty: case report and review of literature. Catheter Cardiovasc Interv 2014; 86:E107-10. [PMID: 25258184 DOI: 10.1002/ccd.25689] [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: 02/11/2014] [Revised: 06/30/2014] [Accepted: 09/22/2014] [Indexed: 11/05/2022]
Abstract
Surgical mitral valve intervention is not considered suitable in patients with severe functional mitral regurgitation due to severe dilated cardiomyopathy and severe systolic dysfunction. In such patients percutaneous mitral valve intervention is the next best alternative. We are presenting case report of a patient who presented with severe dyspnea progressing to orthopnea and paroxysmal nocturnal dyspnea. He was found to have severe functional mitral regurgitation and severe left ventricle systolic dysfunction. Surgical mitral intervention was not considered suitable and percutaneous mitral annuloplasty was done. At one month follow-up significant improvement in symptoms were noted with improvement in severity of mitral regurgitation severity. At 6 months follow-up further improvement in symptoms were noted along with significant improvement in the severity of mitral regurgitation and normalization of left ventricle geometry. At 1 year follow-up his symptoms further improved, left ventricle geometry remained normal and mitral regurgitation severity remained mild to moderate. Our case demonstrate that in patient with severe LV systolic dysfunction, severe mitral regurgitation and left bundle branch block percutaneous mitral annuloplasty can obviate the need for CRT-D due to significant improvement in LV function and geometry along with regression in severity of mitral regurgitation. Improvement in mitral regurgitation severity and LV geometry started early and kept improving with excellent result at 6 and 12 months.
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Affiliation(s)
| | - Faisal Alsamadi
- Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
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23
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Nombela-Franco L, Urena M, Ribeiro HB, Rodés-Cabau J. Advances in percutaneous treatment of mitral regurgitation. ACTA ACUST UNITED AC 2014; 66:566-82. [PMID: 24776207 DOI: 10.1016/j.rec.2013.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/05/2013] [Indexed: 11/17/2022]
Abstract
Percutaneous techniques for the treatment of mitral regurgitation have aroused much interest in recent years. Percutaneous mitral annuloplasty can be performed indirectly by using devices implanted in the coronary sinus or directly by using a retrograde approach. However, as yet, the results of these techniques are scarce and some devices have a high complications rate. The most frequent percutaneous mitral valve repair technique consists of mitral leaflet plication by implanting 1 or more percutaneous clips (MitraClip) in an imitation of the Alfieri surgical technique. Clinical experience with this device is broader than that with any other. The MitraClip device is associated with improved mitral regurgitation in a high percentage of carefully-selected patients. However, the single randomized study performed to date (EVEREST) showed its efficacy to be less than that of surgical repair and we await the results of new randomized studies that should clarify which patient-type can benefit most from this technique. Other left ventricular remodeling devices, tendinous cord implantation, and leaflet ablation are currently undergoing preclinical development or first-in-human experimentation. Finally, the development of biological prostheses for percutaneous mitral valve replacement is at an early stage. Many promising experiments at the preclinical phase and initial experiments in humans will very probably multiply in the near future. However, the true role of this technique in treating mitral valve disease will have to be evaluated in appropriately designed randomized controlled studies.
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Affiliation(s)
- Luis Nombela-Franco
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marina Urena
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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25
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Ducas RA, White CW, Wassef AW, Farag A, Bhagirath KM, Freed DH, Tam JW. Functional Mitral Regurgitation: Current Understanding and Approach to Management. Can J Cardiol 2014; 30:173-80. [DOI: 10.1016/j.cjca.2013.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 11/25/2022] Open
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26
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Alegria-Barrero E, Chan PH, Foin N, Syrseloudis D, Tavazzi G, Price S, Lindsay AC, Duncan A, Moat N, Di Mario C, Franzen OW. Concept of the central clip: when to use one or two MitraClips®. EUROINTERVENTION 2014; 9:1217-24. [DOI: 10.4244/eijv9i10a204] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Mitral regurgitation is an increasing valvular disease that represents a difficult management challenge. Surgical treatment for degenerative mitral regurgitation is the standard of care treatment. Percutaneous therapies have emerged rapidly over the past years as an option for treatment of mitral regurgitation for selected, predominantly high-risk patients. Catheter-based devices mimic these surgical approaches with less procedural risk. Mitraclip® implantation mimics the surgical edge-to-edge leaflet repair technique, reducing the regurgitant area. We review the increasing evidence with the Mitraclip device reported to date.
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Affiliation(s)
- Eduardo Alegria-Barrero
- Interventional Cardiology, Torrejon University Hospital, Madrid, Spain; Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Olaf W Franzen
- Interventional Cardiology, Klinik im Park, Hirslanden Zurich, Zurich, Switzerland
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28
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Giannini C, Petronio AS, De Carlo M, Guarracino F, Conte L, Fiorelli F, Pieroni A, Di Bello V. Integrated reverse left and right ventricular remodelling after MitraClip implantation in functional mitral regurgitation: an echocardiographic study. Eur Heart J Cardiovasc Imaging 2013; 15:95-103. [DOI: 10.1093/ehjci/jet141] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Nombela-Franco L, Urena M, Ribeiro HB, Rodés-Cabau J. Avances en el tratamiento percutáneo de la insuficiencia mitral. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Grasso C, Capodanno D, Scandura S, Cannata S, Immè S, Mangiafico S, Pistritto A, Ministeri M, Barbanti M, Caggegi A, Chiarandà M, Dipasqua F, Giaquinta S, Occhipinti M, Ussia G, Tamburino C. One- and twelve-month safety and efficacy outcomes of patients undergoing edge-to-edge percutaneous mitral valve repair (from the GRASP Registry). Am J Cardiol 2013; 111:1482-7. [PMID: 23433761 DOI: 10.1016/j.amjcard.2013.01.300] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/20/2013] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
Abstract
The aim of this study was to report on the 30-day and 1-year outcomes of percutaneous mitral valve repair with the MitraClip technique in patients with grade ≥3+ mitral regurgitation (MR) at high risk for conventional surgical therapy enrolled in the prospective Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation (GRASP) registry. Acute device success was defined as residual MR ≤2+ after clip implantation. The primary safety end point was the rate of major adverse events at 30 days. The primary efficacy end point was freedom from death, surgery for mitral valve dysfunction, or grade ≥3+ MR at 30 days and 1 year. A total of 117 patients were treated. Eighty-nine patients (76%) presented with functional MR and 28 patients (24%) with organic MR. Acute device success was observed in all patients. Device implantation time significantly diminished with experience and varied significantly between cases with 1 versus ≥2 clips. No procedural mortality was recorded. Major adverse events occurred in 4 patients at 30 days (4.3%). Deterioration to MR ≥3+ was recorded in 25% of patients with degenerative MR and 7% of those with functional MR at 1 year. No surgery for mitral valve dysfunction occurred within 1 year. Freedom from death, surgery for mitral valve dysfunction, or grade ≥3+ MR was 96.4% and 75.8% at 30 days and 1 year, respectively. No significant differences were noted in the primary efficacy end point between patients with degenerative MR and those with functional MR. In conclusion, percutaneous mitral valve repair with the MitraClip technique was shown to be safe and reasonably effective in 117 patients from a real-world setting.
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31
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Green P, Rosner GF, Schwartz A. Valvular heart disease in older adults: evolving technology to meet the needs of aging patients. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ahe.13.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Valvular heart disease is associated with aging and the incidence is increasing as the population ages. Aortic stenosis and mitral regurgitation represent the majority of valvular disease in older adults. Severe valvular disease is associated with the development of heart failure, arrhythmia and death. Unfortunately, medical therapy is ineffective for the treatment of severe symptomatic valvular disease. As a result of advances in surgical techniques and catheter-based technologies, older adults who were once deemed ‘too old/sick’ are now being offered definitive treatment. However, the presence of comorbidities and frailty in the elderly make patient selection difficult and prediction of overall response to therapy less reliable compared with younger patients. In the elderly, goals of therapy may differ, with an emphasis placed on quality of life, functionality, maintaining independence and palliation of severe symptoms rather than increased longevity. We review the epidemiology and treatment approaches for valvular heart disease in older adults.
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Affiliation(s)
- Philip Green
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, Milstein Building, Room 5-435, NY 10032, USA
| | - Gregg F Rosner
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, Milstein Building, Room 5-435, NY 10032, USA
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, Milstein Building, Room 5-435, NY 10032, USA.
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32
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Boronyak SM, Merryman WD. The once and future state of percutaneous mitral valve repair. Future Cardiol 2013; 8:779-93. [PMID: 23013128 DOI: 10.2217/fca.12.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
There has been a great deal of interest in percutaneous mitral valve repair techniques in recent years, with several devices undergoing animal testing and clinical trials. Percutaneous annuloplasty and leaflet repair devices are currently in development, and while safety rates have generally been equal or superior to conventional surgical techniques, efficacy has been suboptimal. Most current percutaneous mitral valve repair devices can only reduce regurgitant volumes by approximately 20-40%, but these reductions may be enough to treat high-risk patients, including the elderly and those with comorbidities, who are otherwise ineligible for surgery. An analysis of how these devices alter the geometry and mechanics of the mitral valve apparatus can provide insight into long-term efficacy and durability and may lead to improvements in the reduction of mitral regurgitation. In the future, multiple percutaneous techniques may be utilized in combination to increase overall efficacy. In this article, we report on percutaneous mitral valve repair techniques with published clinical or animal data.
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Affiliation(s)
- Steven M Boronyak
- Department of Biomedical Engineering, Vanderbilt University Nashville, Nashville, TN 37232-0493, USA
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33
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Abstract
Mitral regurgitation (MR) is a common complication in heart failure patients, severely worsening their outcome. Because of the high perioperative risk, mitral valve surgery, which is the standard therapy for MR, is often not offered to these patients. Interventional therapies for mitral valve therapy might therefore constitute a novel therapeutic option particularly in this group. This article gives an overview of the available and evolving interventional strategies for mitral valve repair with a special emphasis on heart failure patients.
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34
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Perlowski A, Feldman T. Percutaneous Mitral Valve Interventions. Interv Cardiol Clin 2013; 2:203-224. [PMID: 28581984 DOI: 10.1016/j.iccl.2012.09.002] [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: 06/07/2023]
Abstract
Percutaneous interventions for mitral valve disease represent both the oldest and the newest of catheter interventions. Balloon mitral valvuloplasty was among the first effective catheter therapies for valvular heart disease. The technique and device approach was initially reported by Inoue in 1982 and, remarkably, is virtually unchanged between then and now. Conversely, novel catheter therapies to repair mitral regurgitation are now in their infancy, with only the earliest human experience. This article details the spectrum of these therapies.
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Affiliation(s)
| | - Ted Feldman
- NorthShore University HealthSystem, Evanston, Illinois, USA; Division of Cardiology, Evanston Hospital, Walgreen Building 3rd Floor, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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35
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Shames S, Gillam LD. Role of Echocardiography to Guide New Transcatheter Interventions for Valvular Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Dixon SR, Safian RD. The Year in Interventional Cardiology. J Am Coll Cardiol 2012; 59:1497-508. [DOI: 10.1016/j.jacc.2011.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 12/17/2011] [Indexed: 12/29/2022]
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37
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George JC, Varghese V, Dangas G, Feldman TE. Percutaneous mitral valve repair: lessons from the EVEREST II (Endovascular Valve Edge-to-Edge REpair Study) and beyond. JACC Cardiovasc Interv 2012; 4:825-7. [PMID: 21777895 DOI: 10.1016/j.jcin.2011.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Narayan RL, Sharma SK. Looking to the Future of Percutaneous Treatment of Patients with Valvular Heart Disease. Interv Cardiol Clin 2012; 1:139-149. [PMID: 28582064 DOI: 10.1016/j.iccl.2011.09.004] [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: 11/16/2022]
Abstract
The development of transcatheter valvular therapeutics has revolutionized interventional cardiology over the past decade. Nonetheless, despite these prominent advances in percutaneous valve technology, numerous obstacles regarding safety and efficacy must be overcome before the precise clinical role of these devices becomes clear. This article discusses the current status of transcatheter valve replacement and repair as it pertains to the aortic and mitral valve and deliberates on the bright future of a promising tool that will drastically affect clinical interventional practice.
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Affiliation(s)
- Rajeev L Narayan
- Cardiovascular Diseases, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Samin K Sharma
- Cardiac Catheterization Laboratory, Mount Sinai Heart, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029, USA
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