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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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Brugiatelli L, Rolando M, Lofiego C, Fogante M, Capodaglio I, Patani F, Tofoni P, Maurizi K, Nazziconi M, Massari A, Furlani G, Signore G, Esposto Pirani P, Schicchi N, Dello Russo A, Di Eusanio M, Vagnarelli F. Transcatheter Mitral Valve Intervention: Current and Future Role of Multimodality Imaging for Device Selection and Periprocedural Guidance. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1082. [PMID: 39064511 PMCID: PMC11278759 DOI: 10.3390/medicina60071082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Mitral regurgitation (MR) is a broadly diffuse valvular heart disease (VHD) with a significant impact on the healthcare system and patient prognosis. Transcatheter mitral valve interventions (TMVI) are now well-established techniques included in the therapeutic armamentarium for managing patients with mitral regurgitation, either primary or functional MR. Even if the guidelines give indications regarding the correct management of this VHD, the wide heterogeneity of patients' clinical backgrounds and valvular and heart anatomies make each patient a unique case, in which the appropriate device's selection requires a multimodal imaging evaluation and a multidisciplinary discussion. Proper pre-procedural evaluation plays a pivotal role in judging the feasibility of TMVI, while a cooperative work between imagers and interventionalist is also crucial for procedural success. This manuscript aims to provide an exhaustive overview of the main parameters that need to be evaluated for appropriate device selection, pre-procedural planning, intra-procedural guidance and post-operative assessment in the setting of TMVI. In addition, it tries to give some insights about future perspectives for structural cardiovascular imaging.
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Affiliation(s)
- Leonardo Brugiatelli
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Marco Rolando
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
| | - Carla Lofiego
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
| | - Marco Fogante
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy
| | | | | | - Paolo Tofoni
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Kevin Maurizi
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Marco Nazziconi
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Arianna Massari
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Giulia Furlani
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Giovanni Signore
- Department of Transalational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Paolo Esposto Pirani
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy
| | - Antonio Dello Russo
- “G.M. Lancisi” Cardiovascular Center, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Department, Polytechnic University of Marche, AOU delle Marche, 60121 Ancona, Italy
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Lurz P, Schmitz T, Geisler T, Hausleiter J, Eitel I, Rudolph V, Lubos E, von Bardeleben RS, Brambilla N, De Marco F, Berti S, Nef H, Linke A, Hengstenberg C, Baldus S, Spargias K, Denti P, Nickenig G, Möllmann H, Rottbauer W, Praz F, Butter C, Reinthaler M, Van Mieghem NM, Sherif M, Swaans M, Witkowski A, Buch M, Seidler T, Iñiguez A, Thiele H, Eißmann M, Schreieck J, Näbauer M, Marcoff L, Koulogiannis K, Rassaf T, Luedike P. Mitral Valve Transcatheter Edge-to-Edge Repair: 1-Year Outcomes From the MiCLASP Study. JACC Cardiovasc Interv 2024; 17:890-903. [PMID: 38599692 DOI: 10.1016/j.jcin.2024.02.022] [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: 10/10/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Mitral transcatheter edge-to-edge repair (M-TEER) is a guideline-recommended treatment option for patients with severe symptomatic mitral regurgitation (MR). Outcomes with the PASCAL system in a post-market setting have not been established. OBJECTIVES The authors report 30-day and 1-year outcomes from the MiCLASP (Transcatheter Repair of Mitral Regurgitation with Edwards PASCAL Transcatheter Valve Repair System) European post-market clinical follow-up study. METHODS Patients with symptomatic, clinically significant MR were prospectively enrolled. The primary safety endpoint was clinical events committee-adjudicated 30-day composite major adverse event rate and the primary effectiveness endpoint was echocardiographic core laboratory-assessed MR severity at discharge compared with baseline. Clinical, echocardiographic, functional, and quality-of-life outcomes were assessed at 1 year. RESULTS A total of 544 patients were enrolled (59% functional MR, 30% degenerative MR). The 30-day composite major adverse event rate was 6.8%. MR reduction was significant from baseline to discharge and sustained at 1 year with 98% of patients achieving MR ≤2+ and 82.6% MR ≤1+ (all P < 0.001 vs baseline). One-year Kaplan-Meier estimate for survival was 87.3%, and freedom from heart failure hospitalization was 84.3%. Significant functional and quality-of-life improvements were observed at 1 year, including 71.6% in NYHA functional class I/II, 14.4-point increase in Kansas City Cardiomyopathy Questionnaire score, and 24.2-m improvement in 6-minute walk distance (all P < 0.001 vs baseline). CONCLUSIONS One-year outcomes of this large cohort from the MiCLASP study demonstrate continued safety and effectiveness of M-TEER with the PASCAL system in a post-market setting. Results demonstrate high survival and freedom from heart failure hospitalization, significant and sustained MR reduction, and improvements in symptoms, functional capacity, and quality of life.
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Affiliation(s)
- Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany.
| | - Thomas Schmitz
- Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Nordrhine Westfalia, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians University, Munich, Germany
| | - Ingo Eitel
- Universitaetsklinikum Schleswig Holstein Lübeck and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Volker Rudolph
- Herz-und Diabeteszentrum NRW-Bad Oeynhausen, Bad Oeynhausen, Germany
| | | | | | - Nedy Brambilla
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Sergio Berti
- Ospedale del Cuore, Fondazione C.N.R. Reg. Toscana-Massa Italy
| | - Holger Nef
- Universitätsklinikum Giessen UKGM, Gießen, Germany
| | - Axel Linke
- Technische Universität Dresden, Herzzentrum Universitätsklinik für Innere Medizin/Kardiologie, Dresden, Germany
| | | | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | | | | | | | | | | | | | - Christian Butter
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School (MHB), Bernau, Germany
| | | | | | - Mohammad Sherif
- Deutsches Herzzentrum der Charité-Campus Virchow Klinikum, Berlin, Germany
| | - Martin Swaans
- St. Antonius Nieuwegein, Nieuwegein, the Netherlands
| | | | - Mamta Buch
- Manchester University NHS FT, Manchester, United Kingdom
| | - Tim Seidler
- Universitaeres Herzzentrum Goettingen, Goettingen, Germany
| | | | - Holger Thiele
- Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Mareike Eißmann
- Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Nordrhine Westfalia, Germany
| | - Juergen Schreieck
- Department of Cardiology and Angiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians University, Munich, Germany
| | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | - Tienush Rassaf
- West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital, Essen, Germany
| | - Peter Luedike
- West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital, Essen, Germany
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