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D'Amario D, Laborante R, Mennuni M, Adamo M, Metra M, Patti G. Efficacy and safety of trans-catheter repair devices for mitral regurgitation: A systematic review and meta-analysis. Int J Cardiol 2024; 411:132245. [PMID: 38851540 DOI: 10.1016/j.ijcard.2024.132245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Several repair strategies emerged as possible treatment for severe mitral regurgitation (MR). A systematic review and meta-analysis was performed to compare the different percutaneous mitral valve repair approaches. METHODS PubMed and Scopus electronic databases were scanned for eligible studies until December 11th, 2023. Clinical efficacy endpoints were all-cause mortality, major adverse cardiovascular events, and post-procedural NYHA functional class <3; the echocardiographic efficacy endpoint was a post-intervention residual MR less than moderate. Safety endpoints and procedural outcome measures were also assessed. RESULTS Eleven studies were included: 8 [N = 1662 patients, mean follow-up (FUP) 294 days] compared MitraClip® vs Pascal® device, 2 (N = 195 patients) MitraClip® vs Carillon® and 1 study (N = 186 patients) evaluated MitraClip® against Cardioband®. The Pascal®-treated group had lower MR degree compared to the MitraClip®-treated group, without difference in post-intervention mean trans-mitral gradient and in clinical and safety endpoints. A longer procedure time was observed in the Pascal® group, albeit with a lower average number of implanted devices per procedure. The two studies comparing MitraClip® and Carillon® were inconsistent in terms of both efficacy and safety outcomes, while the study evaluating MitraClip® vs Cardioband® showed that the latter might confer a significant clinical benefit, with a similar reduction in MR. CONCLUSIONS Pascal® is as safe and clinically effective as MitraClip® in treating patients with MR, with an apparent greater reduction in the magnitude of residual valve insufficiency over the long term. Data on Cardioband® and Carillon® are not robust enough to draw conclusions from the use of such devices.
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Affiliation(s)
- Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Mennuni
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili, Brescia; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Brescia; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy; Division of Cardiology, AOU Maggiore della Carità, Novara, Italy.
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von Stein P, Wienemann H, von Stein J, Sugiura A, Tanaka T, Kavsur R, Öztürk C, Weber M, Haurand JM, Horn P, Kister T, Mahabadi AA, Boeder N, Ruf T, Gerçek M, Mues C, Grothusen C, Novotny J, Weckbach L, Guthoff H, Rudolph F, Polzin A, Baldus S, Rassaf T, Thiele H, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef H, Luedike P, Lurz P, Hausleiter J, Pfister R, Mauri V. Early Outcomes of Two Large Mitral Valve Transcatheter Edge-to-Edge Repair Devices-A Propensity Score Matched Multicenter Comparison. J Clin Med 2024; 13:4187. [PMID: 39064227 PMCID: PMC11278441 DOI: 10.3390/jcm13144187] [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: 06/03/2024] [Revised: 06/19/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Previous trials reported comparable results with PASCAL and earlier MitraClip generations. Limited comparative data exist for more contemporary MitraClip generations, particularly the large MitraClip XT(R/W). We aimed to evaluate acute and 30-day outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) with one of the large devices, either PASCAL P10 or MitraClip XT(R/W) (3rd/4th generation). Methods: A total of 309 PASCAL-treated patients were matched by propensity score to 253 MitraClip-treated patients, resulting in 200 adequately balanced pairs. Procedural, clinical, and echocardiographic outcomes were collected for up to 30 days, including subgroup analysis for mitral regurgitation (MR) etiologies. Results: PASCAL and MitraClip patients were comparable regarding age (80 vs. 79 years), sex (female: 45.5% vs. 50.5%), and MR etiology (degenerative MR: n = 94, functional MR [FMR]: n = 96, mixed MR: n = 10 in each group). Technical success rates were comparable (96.5% vs. 96.0%; p > 0.999). At discharge, the mean gradient was higher (3.3 mmHg vs. 3.0 mmHg; p = 0.038), and the residual mitral valve orifice area was smaller in MitraClip patients (3.0 cm2 vs. 2.3 cm2; p < 0.001). At discharge, the reduction to MR ≤ 2+ was comparable (92.4% vs. 87.8%; p = 0.132). However, reduction to MR ≤ 1+ was more frequently observed in PASCAL patients (67.7% vs. 56.6%; p = 0.029), driven by the FMR subgroup (74.0% vs. 60.0%; p = 0.046). No difference was observed in 30-day mortality (p = 0.204) or reduction in NYHA-FC to ≤II (p > 0.999). Conclusions: Both M-TEER devices exhibited high and comparable rates of technical success and MR reduction to ≤2+. PASCAL may be advantageous in achieving MR reduction to ≤1+ in patients with FMR.
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Affiliation(s)
- Philipp von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Atsushi Sugiura
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, 53127 Bonn, Germany
| | - Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, 53127 Bonn, Germany
| | - Refik Kavsur
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, 53127 Bonn, Germany
| | - Can Öztürk
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, 53127 Bonn, Germany
| | - Marcel Weber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, 53127 Bonn, Germany
| | - Jean Marc Haurand
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany (A.P.); (M.K.)
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany (A.P.); (M.K.)
| | - Tobias Kister
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, 45122 Essen, Germany
| | - Niklas Boeder
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Tobias Ruf
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Christoph Mues
- Medical Clinic I, Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Julia Novotny
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Ludwig Weckbach
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Henning Guthoff
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Felix Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany (A.P.); (M.K.)
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, 45122 Essen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany (A.P.); (M.K.)
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, 45122 Essen, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
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Krittanawong C, Hahn J, Virk HUH, Bandyopadhyay D, Patel N, Rastogi U, Wang Z, Alam M, Jneid H, Sharma S, Stone GW. In-hospital complications after MitraClip in patients with heart failure and preserved versus reduced ejection fraction in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 62:34-39. [PMID: 38087737 DOI: 10.1016/j.carrev.2023.11.017] [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: 10/30/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 05/14/2024]
Abstract
BACKGROUND The clinical benefits of transcatheter edge to edge mitral valve repair have been well established in patients with heart failure and severe mitral regurgitation (MR) who have prohibitive surgical risk. In March of 2019, the FDA approved the MitraClip for treatment of selected patients with HF and severe secondary MR. However, the relative outcomes of patients with HFrEF and HFpEF treated with MitraClip are largely unknown. We therefore sought to investigate the incidence and characteristics of in-hospital mortality in patients with HFpEF and HFrEF following MitraClip. METHODS The study sample analyzed was originated from the National Inpatient Sample (NIS) registry which includes data from hospitalized patients in the United States (US) between January 1, 2012 and December 31, 2020. Data were extracted from the entire NIS registry using ICD-9 codes. Patients with the primary or secondary diagnosis of MitraClip were identified. Hospitalizations for HFpEF and HFrEF were identified based on ICD-9-CM and ICD-10-CM codes. Demographics, conventional risk factors, and in-hospital outcomes were evaluated. RESULTS 23,260 hospitalizations for MitraClip implantation between 2016 and 2020 were analyzed. The HFrEF group had higher absolute rates of complications as well as a higher observed in-hospital mortality (2.4 % vs 1.7 %; OR 0.75 95 % CI 0.44-1.26; p 0.28) which did not meet statistical significance. Absolute rates of acute myocardial infarction (AMI), acute kidney injury (AKI) and respiratory failure necessitating invasive mechanical ventilation were observed to be higher among HFrEF patients. Post-procedural shock was significantly more common in patients with HFrEF (9.0 % vs 2.8 %: OR 0.34 95 % CI 0.25-0.48 p < 0.001). Significantly longer hospitalizations were observed in the HFrEF cohort (5.3 ± 11.2 days vs 4.2 ± 7.3 days; p < 0.001) as well as a higher total hospitalization cost (61,723 ± 56,728 USD vs 57,278 ± 46,143). CONCLUSIONS In the present study of US patients, those with HFrEF were observed to have statistically higher risk of in-hospital post-procedural shock and longer hospitalization length of stay when compared with patients with HFpEF who underwent MitraClip implantation. Additionally, patients with HFrEF undergoing MitraClip procedure were observed to have higher absolute rates of certain post-procedural complications, however these observations did not reach statistical significance. Understanding of the aforementioned differences after MitraClip implantation may be useful in-patient selection, prognostic guidance, and hypothesis generation to propel future large clinical studies.
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Affiliation(s)
| | - Joshua Hahn
- Division of Cardiology, Department of Internal Medicine, University of Texas Health/McGovern Medical School, Houston, TX, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Neelkumar Patel
- Division of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ujjwal Rastogi
- Cardiovascular Institute of the South, New Iberia, LA, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mahboob Alam
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Hani Jneid
- Chief of the Division of Cardiology at UTMB, Houston, TX, USA
| | - Samin Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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4
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Marcoff L, Koulogiannis K, Aldaia L, Mediratta A, Chadderdon SM, Makar MM, Ruf TF, Gößler T, Zaroff JG, Leung GK, Ku IA, Nabauer M, Grayburn PA, Wang Z, Hawthorne KM, Fowler DE, Dal-Bianco JP, Vannan MA, Bevilacqua C, Meineri M, Ender J, Forner AF, Puthumana JJ, Mansoor AH, Lloyd DJ, Voskanian SJ, Ghobrial A, Hahn RT, Mahmood F, Haeffele C, Ong G, Schneider LM, Wang DD, Sekaran NK, Koss E, Mehla P, Harb S, Miyasaka R, Ivannikova M, Stewart-Dehner T, Mitchel L, Raissi SR, Kalbacher D, Biswas S, Ho EC, Goldberg Y, Smith RL, Hausleiter J, Lim DS, Gillam LD. Echocardiographic Outcomes With Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC Cardiovasc Imaging 2024; 17:471-485. [PMID: 38099912 DOI: 10.1016/j.jcmg.2023.09.015] [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: 07/14/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 06/09/2024]
Abstract
BACKGROUND The CLASP IID randomized trial (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial) demonstrated the safety and effectiveness of the PASCAL system for mitral transcatheter edge-to-edge repair (M-TEER) in patients at prohibitive surgical risk with significant symptomatic degenerative mitral regurgitation (DMR). OBJECTIVES This study describes the echocardiographic methods and outcomes from the CLASP IID trial and analyzes baseline variables associated with residual mitral regurgitation (MR) ≤1+. METHODS An independent echocardiographic core laboratory assessed echocardiographic parameters based on American Society of Echocardiography guidelines focusing on MR mechanism, severity, and feasibility of M-TEER. Factors associated with residual MR ≤1+ were identified using logistic regression. RESULTS In 180 randomized patients, baseline echocardiographic parameters were well matched between the PASCAL (n = 117) and MitraClip (n = 63) groups, with flail leaflets present in 79.2% of patients. Baseline MR was 4+ in 76.4% and 3+ in 23.6% of patients. All patients achieved MR ≤2+ at discharge. The proportion of patients with MR ≤1+ was similar in both groups at discharge but diverged at 6 months, favoring PASCAL (83.7% vs 71.2%). Overall, patients with a smaller flail gap were significantly more likely to achieve MR ≤1+ at discharge (adjusted OR: 0.70; 95% CI: 0.50-0.99). Patients treated with PASCAL and those with a smaller flail gap were significantly more likely to sustain MR ≤1+ to 6 months (adjusted OR: 2.72 and 0.76; 95% CI: 1.08-6.89 and 0.60-0.98, respectively). CONCLUSIONS The study used DMR-specific echocardiographic methodology for M-TEER reflecting current guidelines and advances in 3-dimensional echocardiography. Treatment with PASCAL and a smaller flail gap were significant factors in sustaining MR ≤1+ to 6 months. Results demonstrate that MR ≤1+ is an achievable benchmark for successful M-TEER. (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID]; NCT03706833).
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Affiliation(s)
- Leo Marcoff
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA.
| | | | - Lilian Aldaia
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Anuj Mediratta
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | | | - Moody M Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Jonathan G Zaroff
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Gordon K Leung
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Ivy A Ku
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | | | - Paul A Grayburn
- Baylor Scott and White: The Heart Hospital, Plano, Texas, USA
| | - Zuyue Wang
- Baylor Scott and White: The Heart Hospital, Plano, Texas, USA
| | | | - Dale E Fowler
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | | | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | | | | | | | | | | | | | - Dustin J Lloyd
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Andrew Ghobrial
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | | | | | | | - Elana Koss
- Northwell-North Shore, Manhasset, New York, USA
| | - Priti Mehla
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Serge Harb
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | - Lucas Mitchel
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Sasan R Raissi
- Ascension Saint Thomas Hospital, Nashville, Tennessee, USA
| | | | | | - Edwin C Ho
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Robert L Smith
- Baylor Scott and White: The Heart Hospital, Plano, Texas, USA
| | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Linda D Gillam
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
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Boyle C, Nguyen K, Steiner J, Macon CJ, Marbach JA. Mitral Regurgitation Complicated by Cardiogenic Shock: Reassessing Risk Stratification and Therapeutic Strategies. Interv Cardiol Clin 2024; 13:191-205. [PMID: 38432762 DOI: 10.1016/j.iccl.2023.11.003] [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] [Indexed: 03/05/2024]
Abstract
Mitral regurgitation complicated by cardiogenic shock creates a unique and devastating risk profile for patients and poses significant difficulties for physicians who lack a comprehensive range of effective management strategies. Supportive measures such as intravenous vasodilators, intra-aortic balloon pumps, and percutaneous ventricular assist devices are often necessary to stabilize patients prior to definitive treatment with surgical mitral valve replacement or trans-catheter edge-to-edge repair. This review evaluates the evidence for the available supportive and definitive management strategies in patients with mitral regurgitation complicated by cardiogenic shock and presents a framework to aid clinicians in navigating the complex clinical decision-making process. Additionally, the authors review emerging transcatheter mitral valve replacement technologies that hold promise for expanding the therapeutic armamentarium and improving patient outcomes.
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Affiliation(s)
- Carla Boyle
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Khoa Nguyen
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Johannes Steiner
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Conrad J Macon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA
| | - Jeffrey A Marbach
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, 3161 Southwest Pavilion Loop, Portland, OR 97239, USA.
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Mustafa A, Basman C, Cinelli MP, Goldberg Y, Wang D, Patel V, Kaur A, Singh P, Wei C, Paliwoda E, Kodra A, Pirelli L, Thampi S, Maniatis G, Rutkin B, Kalimi R, Koss E, Trost B, Supariwala AA, Jacob Scheinerman S, Kliger CA. Contemporary experience of mitral transcatheter edge-to-edge repair technology in patients with mitral annular calcification. Catheter Cardiovasc Interv 2024; 103:618-625. [PMID: 38436540 DOI: 10.1002/ccd.30988] [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: 08/08/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mitral annular calcification (MAC) has been an exclusion for many of the earlier pivotal trials that were instrumental in gaining device approval and indications for mitral transcatheter edge-to-edge repair (M-TEER). AIMS To evaluate the impact of MAC on the procedural durability and success of newer generation MitraClip® systems (G3 and G4 systems). METHODS Data were collected from Northwell TEER registry. Patients that underwent M-TEER with third or fourth generation MitraClip device were included. Patients were divided into -MAC (none-mild) and +MAC (moderate-severe) groups. Procedural success was defined as ≤ grade 2 + mitral regurgitation (MR) postprocedure, and durability was defined as ≤ grade 2 + MR retention at 1 month and 1 year. Univariate analysis compared outcomes between groups. RESULTS Of 260 M-TEER patients, 160 were -MAC and 100 were +MAC. Procedural success was comparable; however, there were three patients who required conversion to cardiac surgery during the index hospitalization in the +MAC group versus none in the -MAC group (though this was not statistically significant). At 1-month follow-up, there were no significant differences in MR severity. At 1-year follow-up, +MAC had higher moderate-severe MR (22.1% vs. 7.5%; p = 0.002) and higher mean transmitral gradients (5.3 vs. 4.0 mmHg; p = 0.001) with no differences in mortality, New York Heart Association functional class or ejection fraction. CONCLUSION In selective patients with high burden of MAC, contemporary M-TEER is safe, and procedural success is similar to patients with none-mild MAC. However, a loss of procedural durability was seen in +MAC group at 1-year follow-up. Further studies with longer follow-ups are required to assess newer mTEER devices and their potential clinical implications in patients with a high burden of MAC.
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Affiliation(s)
- Ahmad Mustafa
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Craig Basman
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Michael P Cinelli
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Ythan Goldberg
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Denny Wang
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Vidhi Patel
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Arpanjeet Kaur
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Priyanka Singh
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Chapman Wei
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Ethan Paliwoda
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Arber Kodra
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Luigi Pirelli
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Shankar Thampi
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Gregory Maniatis
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Bruce Rutkin
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Robert Kalimi
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Biana Trost
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Azhar A Supariwala
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Samuel Jacob Scheinerman
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Chad A Kliger
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
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van-Roessel AM, Asmarats L, Li CHP, Millán X, Fernández-Peregrina E, Menduiña I, Sanchez-Ceña J, Arzamendi D. Mitral transcatheter edge-to-edge repair: patient selection, current devices, and clinical outcomes. Expert Rev Med Devices 2024; 21:187-196. [PMID: 38155555 DOI: 10.1080/17434440.2023.2298713] [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: 09/06/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Over the last two decades, mitral transcatheter edge-to-edge repair (M-TEER) has become a safe and effective therapy for severe mitral regurgitation in patients deemed at high surgical risk. AREAS COVERED This review aims to encompass the most relevant and updated evidence in the field of M-TEER from its inception, focusing on clinical and anatomical features for proper patient and device selection. EXPERT OPINION Growing operator experience and device iterations have resulted in improved clinical outcomes and an expansion of the therapy to patients with complex anatomies and clinical scenarios. Future investigations are warranted to determine the best management options and the most suitable device for every patient with MR.
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Affiliation(s)
- Albert Massó van-Roessel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Chi Hion Pedro Li
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Xavier Millán
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | - Juan Sanchez-Ceña
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
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Paukovitsch M, Felbel D, Tadic M, Keßler M, Scheffler J, Gröger M, Markovic S, Rottbauer W, Schneider LM. The effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area. Clin Res Cardiol 2024:10.1007/s00392-023-02368-0. [PMID: 38270636 DOI: 10.1007/s00392-023-02368-0] [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: 08/21/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Mitral transcatheter edge-to-edge repair (M-TEER) is an established treatment for functional mitral regurgitation (FMR) associated with a risk of creating iatrogenic stenosis. OBJECTIVES To investigate the impact of the P10 and its larger spacer compared to the narrower Ace and its smaller spacer on reduction of mitral valve orifice area (MVOA) during M-TEER. METHODS Consecutive patients undergoing M-TEER for treatment of severe FMR were screened retrospectively. Patients with a single PASCAL device implantation within the central segments of the MV leaflets, non-complex anatomy, and baseline MVOA ≥ 3.5cm2 were selected. Intraprocedural transesophageal echocardiography was used to compare MVOA reduction with 3D multiplanar reconstruction and direct planimetry. Device selection did not follow a prespecified MVOA threshold. RESULTS Seventy-two patients (81.0 years, IQR {74.3-85.0}) were included. In 32 patients, the P10 was implanted (44.4%). MR severity (p = 0.66), MR reduction (p = 0.73), and body surface area (p = 0.56) were comparable. Baseline MVOA tended to be smaller in P10 patients with the larger spacer (5.0 ± 1.1 vs. 5.4 ± 1.3cm2, p = 0.18), however, residual MVOA was larger in these patients (2.7 ± 0.7 vs. 2.3 ± 0.6cm2, p = 0.03). Accordingly, relative MVOA reduction was significantly less in P10 patients (- 45.9 ± 7.6 vs. - 56.3 ± 7.0%, p < 0.01). Indirect annuloplasty was more pronounced in Ace patients whereas mean transmitral gradients were similar. CONCLUSION In FMR patients with non-complex anatomy, the larger spacer of the P10 maintains greater MVOA with similar MR reduction. Hence, the use of the PASCAL Ace device in patients with small MVOAs might correlate with a risk of both clinically relevant orifice reduction and even iatrogenic stenosis.
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Affiliation(s)
- Michael Paukovitsch
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Marijana Tadic
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Mirjam Keßler
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Jinny Scheffler
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Matthias Gröger
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Leonhard Moritz Schneider
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Haschemi J, Haurand JM, Oehler D, Wolff G, Spieker M, Polzin A, Kelm M, Horn P. 1-Year Comparison of PASCAL vs MitraClip for Mitral Valve Transcatheter Edge-to-Edge Repair: A Quasi-Randomized Study. JACC Cardiovasc Interv 2023; 16:2687-2689. [PMID: 37855809 DOI: 10.1016/j.jcin.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 10/20/2023]
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Haurand JM, Haschemi J, Oehler D, Heinen Y, Polzin A, Kelm M, Horn P. Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting. BMC Health Serv Res 2023; 23:945. [PMID: 37667270 PMCID: PMC10476289 DOI: 10.1186/s12913-023-09966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
AIMS We aimed to conduct a clinical process cost analysis to evaluate all upcoming costs of mitral valve transcatheter edge-to-edge repair (M-TEER) treatment using the MitraClip and the PASCAL repair system. METHODS First, we prospectively enrolled 107 M-TEER patients treated with either the PASCAL or MitraClip system and compared all upcoming costs during the M-TEER procedure and the associated in-hospital stay. Second, we retrospectively analysed 716 M-TEER procedures with regard to the occurrence of complications and their associated costs. All materials used in the catheterization laboratory for the procedures were evaluated. The cost analysis considered various expenses, such as general in-hospital costs, device costs, catheter laboratory and material costs. RESULTS In the prospective study, 51 patients were treated using the PASCAL system, and 56 were treated using the MitraClip system. The two groups had comparable baseline characteristics and comorbidities. The total in-hospital costs were 25 414 (Interquartile range (IQR) 24 631, 27 697) € in the PASCAL group and 25 633 (IQR 24 752, 28 256) € in the MitraClip group (p = 0.515). The major cost driver was initial material expenditure, mostly triggered by device costs, which were similar to the PASCAL and MitraClip systems. Overall intensive care unit and general ward costs did not differ between the PASCAL and MitraClip groups. In the retrospective analysis, M-TEER-related complications were rare but were associated with higher costs, mainly due to prolonged hospitalisation. CONCLUSION The major cost driver of M-TEER was the material expenditure, which was mostly triggered by high device costs. The costs of treating patients were similar for the PASCAL and MitraClip systems. M-TEER-related complications are associated with higher costs, mainly due to prolonged hospitalisation. This analysis provides valuable insights into reducing expenses by modifying the process of M-TEER.
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Affiliation(s)
- Jean Marc Haurand
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jafer Haschemi
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Daniel Oehler
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yvonne Heinen
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Elbadawi A, Dang AT, Hamed M, Ali A, Saad M, Jneid H, Chhatriwalla AK, Goel S, Bhatt A, Mani P, Bavry A, Kumbhani DJ. Transcatheter edge-to-edge repair for mitral regurgitation using PASCAL or MitraClip. Catheter Cardiovasc Interv 2023; 102:521-527. [PMID: 37493443 DOI: 10.1002/ccd.30772] [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: 03/07/2023] [Revised: 05/25/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND There is a paucity of data regarding the comparative efficacy and safety of Mitral valve transcatheter edge-to-edge repair (MTEER) using the PASCAL or MitraClip systems for patients with mitral regurgitation (MR). METHODS An electronic search was conducted for MEDLINE, COCHRANE, and EMBASE, through February 2023, for studies comparing the clinical outcomes of MTEER using PASCAL versus MitraClip systems among patients with severe MR. The primary study outcome was residual MR ≤ 2 at discharge. Data were pooled using a random-effects model. RESULTS The final analysis included six studies with a total of 1581 patients, with a weighted follow-up period of 3.5 months. Two studies only included patients with degenerative MR, while the remaining studies included both degenerative and functional MR. There was no significant difference in procedure duration between MTEER with the PASCAL or MitraClip systems. There was no difference in residual MR ≤ 2 at discharge (94.7% vs. 91.9%; odds ratio [OR]: 1.44; 95% confidence interval [CI]: 0.92-2.27) or residual MR ≤ 2 at the mid-term follow-up (94.6% vs. 91.0%, p = 0.05) among the PASCAL versus MitraClip systems. There was no difference between both groups in residual MR ≤ 1 at discharge (73.1% vs. 63.8%, p = 0.12), while there was greater incidence of residual MR ≤ 1 at midterm follow-up with the PASCAL system (71.3% vs. 56.2%, p < 0.001). There was no difference between the PASCAL and MitraClip MTEER systems in technical success (97.0% vs. 97.9%, p = 0.15), procedural success (89.1% vs. 87.1%, p = 0.78), single leaflet detachment (1.8% vs. 1.4%, p = 0.55), or all-cause mortality (3.6% vs. 4.6%, p = 0.71). CONCLUSION In this meta-analysis, we demonstrated comparable efficacy and safety between the PASCAL and MitraClip MTEER systems at short- and mid-term assessments. Randomized trials are warranted to evaluate the comparative long-term outcomes between both MTEER systems.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mohamed Hamed
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Abdelrahman Ali
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marwan Saad
- Department of Medicine' Division of Cardiology, Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Adnan K Chhatriwalla
- Division of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sachin Goel
- Division of Cardiology, Houston Methodist, Houston, Texas, USA
| | - Anish Bhatt
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Preethi Mani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anthony Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Lander MM, Brener MI, Goel K, Tang PC, Verlinden NJ, Zalawadiya S, Lindenfeld J, Kanwar MK. Mitral Interventions in Heart Failure. JACC. HEART FAILURE 2023; 11:1055-1069. [PMID: 37611988 DOI: 10.1016/j.jchf.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023]
Abstract
Patients with heart failure with reduced ejection fraction who have secondary mitral regurgitation (SMR) have poorer outcomes and quality of life than those without SMR. Guideline-directed medical therapy is the cornerstone of SMR treatment. Careful evaluation of landmark trials using mitral transcatheter edge-to-edge repair in SMR has led to an improved understanding of who will benefit from percutaneous interventions with emphasis on a multidisciplinary approach. The success with mitral transcatheter edge-to-edge repair in SMR has also spurred the evaluation of its role in populations that were not initially studied, such as end-stage heart failure and cardiogenic shock. A spectrum of transcatheter devices in development and clinical trials promise to further provide a growing array of management options for heart failure with reduced ejection fraction patients with symptomatic SMR.
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Affiliation(s)
- Matthew M Lander
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Michael I Brener
- Division of Cardiology at Columbia University Irving Medical Center, New York, New York, USA
| | - Kashish Goel
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paul C Tang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nathan J Verlinden
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sandip Zalawadiya
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
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13
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Chan N, Dong T, Sabbak N, Xu B, Wang TKM. Contemporary Review of Transcatheter Mitral Valve Interventions for Mitral Regurgitation. Life (Basel) 2023; 13:1511. [PMID: 37511886 PMCID: PMC10381253 DOI: 10.3390/life13071511] [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: 06/01/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Mitral regurgitation (MR) is the most common form of valvular heart disease in the United States, and there are established guidelines for indications for requiring mitral valve surgeries. However, there is an unmet clinical need for a subset of high-risk MR patients, especially those with advanced age, heart failure and/or secondary MR. Following the successes of transcatheter aortic valve replacements, significant advances have occurred over the last decade in transcatheter mitral valve interventions in order to manage these patients in both clinical practice and trials. The three main types of these interventions include a transcatheter edge-to-edge repair, percutaneous mitral annuloplasty (both direct and indirect) and transcatheter mitral valve replacement (including when applied to a prior prosthetic valve, annuloplasty ring and mitral annuloplasty ring). This review aims to discuss the contemporary techniques, evidence, indications, multimodality imaging evaluations and outcomes of the various transcatheter mitral valve interventions.
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Affiliation(s)
- Nicholas Chan
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Tiffany Dong
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Nabil Sabbak
- Section of Invasive and Interventional Cardiology Section, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
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Gerçek M, Narang A, Puthumana JJ, Davidson CJ, Rudolph V. Secondary Mitral Regurgitation and Heart Failure: Current Advances in Diagnosis and Management. Heart Fail Clin 2023; 19:307-315. [PMID: 37230646 DOI: 10.1016/j.hfc.2023.02.010] [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] [Indexed: 05/27/2023]
Abstract
The causes of mitral regurgitation (MR) can be broadly divided into primary and secondary causes. Although primary MR is caused by degenerative alterations of the mitral valve and the mitral valve apparatus, secondary (functional) MR is multifactorial and related to dilation of the left ventricle and/or mitral annulus commonly resulting in concomitant restriction of the leaflets. Therefore, the treatment of secondary MR (SMR) is complex and includes guideline directed heart failure therapy along with surgical and transcatheter approaches that have shown effectiveness in certain subgroups. This review aims to provide insight into current advances in diagnosis and management of SMR.
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Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany; Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Akhil Narang
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
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15
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Hosseini K, Soleimani H, Nasrollahizadeh A, Jenab Y, Karlas A, Avgerinos DV, Briasoulis A, Kuno T, Doulamis I, Kampaktsis PN. Edge-to-Edge Transcatheter Mitral Valve Repair Using PASCAL vs. MitraClip: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12103579. [PMID: 37240685 DOI: 10.3390/jcm12103579] [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: 04/19/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Transcatheter edge-to-edge repair (TEER) of the mitral valve (MV) can be performed using the PASCAL or MitraClip devices. Few studies offer a head-to-head outcome comparison of these two devices. MATERIAL AND METHODS PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and WHO's International Clinical Trials Registry Platform, from 1 January 2000 until 1 March 2023, were searched. Study protocol details were registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42023405400). Randomized Controlled Trials and observational studies reporting head-to-head clinical comparison of PASCAL and MitraClip devices were eligible for selection. Patients with severe functional or degenerative mitral regurgitation (MR) who had undergone TEER of the MV with either PASCAL or MitraClip devices were included in the meta-analysis. Data from six studies (five observational and one randomized clinical trial) were extracted and analyzed. The main outcomes were a reduction in MR to 2+ or less, improvement of New York Heart Association (NYHA) and 30-day all-cause mortality. Peri-procedural mortality, success rate and adverse events were also compared. RESULTS Data from 785 and 796 patients that underwent TEER using PASCAL and MitraClip, respectively, were analyzed. Thirty-day all-cause mortality (Risk ratio [RR] = 1.51, 95% CI 0.79-2.89), MR reduction to maximum 2+ (RR = 1.00, 95% CI 0.98-1.02) and NYHA improvement (RR = 0.98, 95% CI 0.84-1.15) were similar in both device groups. Both devices had high and similar success rates (96.9% and 96.7% for the PASCAL and MitraClip group, respectively, p value = 0.91). MR reduction to 1+ or less at discharge was similar in both device groups (RR = 1.06, 95% CI 0.95-1.19). Composite peri-procedural and in-hospital mortality was 0.64% and 1.66% in the PASCAL and MitraClip groups, respectively (p value = 0.094). Rates of peri-procedural cerebrovascular accidents were 0.26% in PASCAL and 1.01% in MitraClip (p value = 0.108). CONCLUSIONS Both PASCAL and MitraClip devices have high success and low complication rates for TEER of the MV. PASCAL was not inferior to MitraClip in reducing the MR level at discharge.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
| | - Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran 1411713139, Iran
| | - Amir Nasrollahizadeh
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
| | - Yaser Jenab
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1419733141, Iran
| | - Angelos Karlas
- Institute for Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Department for Vascular and Endovascular Surgery, Rechts der Isar Hospital, Technical University of Munich, 81675 Munich, Germany
| | | | - Alexandros Briasoulis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Toshiki Kuno
- Department of Medicine, Montefiore Medical Center, New York, NY 10461, USA
| | - Ilias Doulamis
- Department of Surgery, The Johns Hopkins Hospital, School of Medicine, Baltimore, MD 21287, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA
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16
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Bansal A, Faisaluddin M, Agarwal S, Badwan O, Harb SC, Krishnaswamy A, Gillinov M, Kapadia SR. Clinical Outcomes of PASCAL Compared With the MitraClip for Symptomatic Mitral Regurgitation. JACC Cardiovasc Interv 2023; 16:1005-1007. [PMID: 37100551 DOI: 10.1016/j.jcin.2023.01.355] [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: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/11/2023]
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17
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El Shaer A, Alkhouli M. The Expanding Landscape of Transcatheter Mitral Valve Therapies: Perplexity or an Opportunity for Precision Medicine. JACC Cardiovasc Interv 2022; 15:2568-2570. [PMID: 36543451 DOI: 10.1016/j.jcin.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Ahmed El Shaer
- Department of Internal Medicine, University of Wisconsin Hospital, Madison, Wisconsin, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.
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