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Bonfioli GB, Pagnesi M. Pulmonary vein flow pattern: A marker of successful repair in primary mitral regurgitation? Int J Cardiol 2024; 416:132498. [PMID: 39214470 DOI: 10.1016/j.ijcard.2024.132498] [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: 08/19/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Giovanni Battista Bonfioli
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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Yedidya I, Stassen J, Butcher S, van Wijngaarden AL, Wu Y, van der Bijl P, Marsan NA, Delgado V, Bax J. The prognostic value of changes in pulmonary vein flow patterns after surgical repair for primary mitral regurgitation. Int J Cardiol 2024; 414:132414. [PMID: 39098612 DOI: 10.1016/j.ijcard.2024.132414] [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: 04/17/2024] [Revised: 06/08/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND The pulmonary vein (PV) flow pattern is influenced by the presence of mitral regurgitation (MR). After a successful reduction in MR severity, the pattern is expected to be changed. We aimed to evaluate the prognostic value of a change in the PV flow pattern in patients with primary MR undergoing mitral valve repair (MVR). METHODS The PV flow pattern was assessed with transthoracic echocardiography in 216 patients (age 65 [IQR 56-72] years, 70% male) with primary MR before and after surgical MVR. The population was divided according to a change in the PV flow pattern following MVR into 'improvers' and 'non-improvers'. RESULTS Non-improvers (15%) had a higher prevalence of paroxysmal AF at baseline (46% vs. 22%, p = 0.004), left ventricular dysfunction (LVEF ≤60%) (39% vs. 21%, p = 0.020), and had lower systolic pulmonary artery pressure (28[IQR 25-38] vs. 35[IQR 26-48] mmHg, p = 0.018) compared to improvers (85%). After a median follow-up of 83[IQR 43-140] months, 26(12%) patients died. Non-improvers had higher mortality rates than improvers (p = 0.009). On multivariable Cox regression analysis, a lack of improvement in the PV flow pattern remained independently associated with all-cause mortality (HR 2.322, 95% CI 1.140 to 4.729, P = 0.020). CONCLUSION A lack of improvement in the PV flow pattern is independently associated with worse long-term survival in patients with primary MR undergoing MVR.
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Affiliation(s)
- Idit Yedidya
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva 49100, Israel; Affiliated with the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Department of Cardiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Steele Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia
| | - Aniek L van Wijngaarden
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Yoska Wu
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands; Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland
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Samimi S, Hatab T, Bou Chaaya R, Kharsa C, Qamar F, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Nagueh SF, Zoghbi WA, Zaid S, Goel SS. Impact of systolic dominant pulmonary venous flow morphology on outcomes after mitral transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2024. [PMID: 39295581 DOI: 10.1002/ccd.31232] [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: 03/24/2024] [Revised: 05/25/2024] [Accepted: 09/06/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND The prognostic significance of intraprocedural pulsed-wave Doppler analysis of pulmonary venous flow (PVF) during mitral transcatheter edge-to-edge repair (TEER) remains understudied. We aimed to investigate the prognostic value of systolic dominant-PVF (SD-PVF) morphology post-TEER. METHODS In a retrospective analysis from December 2019 to December 2022, patients undergoing mitral TEER were categorized into SD-PVF and systolic blunting (SB)-PVF groups based on post-TEER morphology. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 1 year. We investigated the association of PVF morphology post-TEER with the primary endpoint at 1 year using Cox regression and compared the prognostic accuracy of PVF variables through receiver operating characteristic (ROC) curve analysis. RESULTS Among 187 patients (mean age 76.4 ± 10.5 years, 51.3% primary etiology), residual mitral regurgitation (MR) ≤mild was observed in 147 (82.4%) patients and 105 (56.2%) had SD-PVF post-TEER. Patients with SD-PVF had a lower incidence of >2+ residual MR after clip deployment, at 30 days (2.1% vs. 13.1%; p = 0.005) and at 1 year (1.4% vs. 9%; p = 0.08). SD-PVF post-TEER was independently associated with the primary endpoint (HR = 0.59, 95% CI = 0.39-0.87; p = 0.009). ROC curve analysis of the prognostic accuracy of SD-PVF demonstrated an AUC of 0.64 (95% CI = 0.54-0.73), comparable to other quantitative measures of PVF. CONCLUSION Assessing PVF morphology after clip deployment offers a simple prognostic tool for patients undergoing mitral TEER. Multicenter cohorts will be necessary to further investigate its prognostic value.
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Affiliation(s)
- Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Rody Bou Chaaya
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Chloe Kharsa
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Fatima Qamar
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Marvin D Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sherif F Nagueh
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Sammour YM, Bou Chaaya RG, Hatab T, Zaid S, Aoun J, Makram OM, Wessly P, Samimi S, Nagueh SF, Zoghbi WA, Atkins MD, Reardon MJ, Faza N, Little SH, Kleiman NS, Goel SS. Impact of Left Atrial Pressure on Outcomes After Mitral Transcatheter Edge-to-Edge Repair. Circ Cardiovasc Interv 2024; 17:e014055. [PMID: 38836574 DOI: 10.1161/circinterventions.124.014055] [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: 01/29/2024] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Increased left atrial pressure (LAP) has been associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER). We sought to evaluate outcomes based on differences in postprocedural LAP measured after the final clip deployment. METHODS We included consecutive patients who underwent M-TEER at our institution between 2014 and 2022 with LAP monitoring. Patients were stratified into 3 groups according to tertiles of post-TEER mean LAP. Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models. RESULTS We included 273 patients (mean age, 76.8±10.8 years; 42.5% women; 78.4% White). The mean post-TEER LAP was 8.7±1.7 mm Hg in tertile 1 (n=85), 14.4±1.6 mm Hg in tertile 2 (n=95), and 21.9±3.8 mm Hg in tertile 3 (n=93). In comparison with tertile 1, both tertiles 2 and 3 were associated with increased risk of all-cause mortality or heart failure hospitalization at 2 years (adjusted hazard ratio [adjHR], 2.27 [95% CI, 1.25-4.12] and adjHR, 3.00 [95% CI, 1.59-5.64], respectively). Among patients with primary mitral regurgitation, higher LAP was associated with increased risk of 2-year all-cause mortality or heart failure hospitalization (tertile 2 versus 1: adjHR, 3.00 [95% CI, 1.37-6.56]; tertile 3 versus 1: adjHR, 5.52 [95% CI, 2.04-14.95]). However, in patients with secondary mitral regurgitation, neither being in tertile 2 (adjHR, 1.53 [95% CI, 0.55-4.24]) nor tertile 3 (adjHR, 2.18 [95% CI, 0.82-5.77]) were associated with the composite outcome compared with tertile 1. Any degree of LAP reduction following M-TEER was associated with lower mortality or heart failure hospitalization compared with no LAP reduction (adjHR, 0.59 [95% CI, 0.39-0.88]). CONCLUSIONS Elevated LAP after M-TEER was associated with increased 2-year risk of mortality or heart failure hospitalization. Exploration of reasons for elevated LAP after M-TEER and ways to lower it warrant further investigation.
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Affiliation(s)
| | | | - Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center, TX
| | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, TX
| | - Joe Aoun
- Houston Methodist DeBakey Heart and Vascular Center, TX
| | - Omar M Makram
- Houston Methodist DeBakey Heart and Vascular Center, TX
| | | | - Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center, TX
| | | | | | | | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center, TX
| | | | | | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, TX
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Bohra C, Asch FM, Lerakis S, Little SH, Redfors B, Zhou Z, Li Y, Weissman NJ, Grayburn PA, Kar S, Lim DS, Abraham WT, Lindenfeld J, Mack MJ, Bax JJ, Stone GW. Pulmonary Vein Systolic Flow Reversal and Outcomes in Patients From the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) Trial. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100333. [PMID: 39290680 PMCID: PMC11403024 DOI: 10.1016/j.shj.2024.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/10/2024] [Accepted: 05/18/2024] [Indexed: 09/19/2024]
Abstract
Background The implications of pulmonary vein (PV) flow patterns in patients with heart failure (HF) and mitral regurgitation (MR) are uncertain. We examined PV flow patterns in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial (NCT01626079), in which patients with HF and moderate-to-severe or severe functional MR were randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip device plus guideline-directed medical therapy (GDMT) vs. GDMT alone. We sought to evaluate the prognostic utility of baseline PV systolic flow reversal (PVSFR) in HF patients with severe MR and to determine whether the presence of PVSFR can discriminate patients most likely to benefit from TEER in COAPT trial patients. Methods Patients were categorized by the echocardiographic core laboratory-assessed baseline presence of PVSFR. Two-year outcomes were examined according to PVSFR and treatment. Results Baseline PV flow patterns were evaluable in 526/614(85.7%) patients, 48.9% of whom had PVSFR. Patients with PVSFR had more severe MR, reduced stroke volume and cardiac output, greater right ventricular dysfunction, and worse hemodynamics. By multivariable analysis, PVSFR was not an independent predictor of 2-year all-cause death, or heart failure hospitalization (HFH). The reductions in the 2-year rates of all-cause death and HFH with TEER compared with GDMT alone were similar in patients with and without PVSFR (Pinteraction = 0.40 and 0.12, respectively). The effect of TEER on improving Kansas City Cardiomyopathy Questionnaire scores and 6-minute walk distance were also independent of PVSFR. Conclusions In the COAPT trial, PVSFR identified HF patients with severe MR and more advanced heart disease. Patients with and without PVSFR had consistent reductions in mortality, HFH, and improved quality-of-life and functional capacity after TEER. Clinical Trial Registration ClinicalTrial.gov IdentifierNCT01626079.
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Affiliation(s)
- Chandrashekar Bohra
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Federico M Asch
- Medstar Health Research Institute, Washington, District of Columbia
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen H Little
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Yanru Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Neil J Weissman
- Medstar Health Research Institute, Washington, District of Columbia
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA and Bakersfield Heart Hospital, Bakersfield, California
| | - D Scott Lim
- University of Virginia, Charlottesville, Virginia
| | | | | | | | - Jeroen J Bax
- Leiden University Medical Center, Leiden, Netherlands
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Scalia IG, Farina JM, Wraith R, Brown L, Abbas MT, Pereyra M, Allam M, Mahmoud AK, Kamel MA, Barry T, Fortuin FD, Lester SJ, Sweeney J, Sell-Dottin KA, Alkhouli M, Holmes DR, Chao CJ, Alsidawi S, Ayoub C, Arsanjani R. Association between echocardiographic velocity time integral ratio of mitral valve and left ventricular outflow tract and clinical outcomes post transcatheter edge-to-edge mitral valve repair. Heliyon 2024; 10:e32378. [PMID: 38933987 PMCID: PMC11200332 DOI: 10.1016/j.heliyon.2024.e32378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Background Residual mitral regurgitation (MR) is frequent after transcatheter edge-to-edge repair (TEER). There is controversy regarding the clinical impact of residual MR and its quantitative assessment by transthoracic echocardiography (TTE), which is often challenging with multiple eccentric jets and artifact from the clip. The utility of the velocity time integral (VTI) ratio between the mitral valve (MV) and left ventricular outflow tract (LVOT), (VTIMV/LVOT), a simple Doppler measurement that increases with MR, has not been assessed post TEER. Methods Baseline characteristics, clinical outcomes, and TTE data from patients who underwent TEER between 2014 and 2021 across three academic centers were retrospectively analyzed. Post-procedure TTEs were evaluated for VTIMV/LVOT in the first three months after TEER. One-year outcomes including all-cause and cardiac mortality, major adverse cardiac events, and MV reintervention were compared between patients with high VTIMV/LVOT (≥2.5) and low (<2.5). Results In total, 372 patients were included (mean age 78.7 ± 8.8 years, 68 % male, mean pre-TEER ejection fraction of 50.5 ± 14.7 %). Follow up TTEs were performed at a median of 37.5 (IQR 30-48) days post-procedure. Patients with high VTIMV/LVOT had significantly higher all-cause mortality (HR 2.10, p = 0.003), cardiac mortality (HR 3.03, p = 0.004) and heart failure admissions (HR 2.28, p < 0.001) at one-year post-procedure. There was no association between raised VTIMV/LVOT and subsequent MV reintervention. Conclusion High VTIMV/LVOT has clinically significant prognostic value at one year post TEER. This tool could be used to select patients for consideration of repeat intervention.
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Affiliation(s)
- Isabel G. Scalia
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Juan M. Farina
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Rachel Wraith
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mohammed Tiseer Abbas
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Milagros Pereyra
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Ahmed K. Mahmoud
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Moaz A. Kamel
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - F. David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Steven J. Lester
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - John Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Kristen A. Sell-Dottin
- Department of Cardiothoracic Surgery, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN, 55901, USA
| | - David R. Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN, 55901, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN, 55901, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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El Shaer A, Chavez Ponce AA, Ali MT, Oguz D, Pislaru SV, Nkomo VT, Padang R, Eleid MF, Guerrero M, Reeder GS, Rihal CS, Alkhouli M, Thaden JJ. Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival. J Am Soc Echocardiogr 2024; 37:530-537. [PMID: 38341053 DOI: 10.1016/j.echo.2024.01.016] [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: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes. METHODS Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated. Pulmonary vein flow patterns post-MV-TEER were reviewed on the procedural transesophageal echocardiogram and classified as normal (systolic dominant or codominant) or abnormal (systolic blunting or reversal). The PVF pattern was correlated with all-cause mortality at follow-up. RESULTS Two-hundred sixty-five patients had diagnostic PVF post-MV-TEER, with 73 (27.5%) categorized as normal and 192 (72.5%) categorized as abnormal. Patients with abnormal PVF morphology were more likely to have atrial fibrillation (70% vs 42%, P < .001) and greater than moderate residual MR (16% vs 3%, P = .01) and had higher mean left atrial pressure (18.1 ± 5.0 vs 15.9 ± 4.2 mm Hg, P = .002) and left atrial V wave (26.6 ± 8.5 vs 21.4 ± 7.3 mm Hg, P < .001) postprocedure. In multivariable analysis, abnormal PVF morphology post-MV-TEER was independently associated with mortality at follow-up (hazard ratio = 1.70; 95% CI, 1.06-2.74; P = .03) after correction for end-stage renal disease, atrial fibrillation, and residual MR. Results were similar in subgroups of patients with moderate or less and those with mild or less residual MR. CONCLUSIONS Pulmonary vein flow morphology is a simple and objective tool to assess MR severity immediately post-MV-TEER and offers important prognostic information to optimize procedural results. Additional studies are needed to determine whether patients with abnormal PVF pattern post-MV-TEER would benefit from more intensive goal-directed medical therapy postprocedure.
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Affiliation(s)
- Ahmed El Shaer
- Department of Internal Medicine, University of Wisconsin Hospital, Madison, Wisconsin
| | | | - Mays T Ali
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Didem Oguz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Zaid S, Wessly P, Hatab T, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Intraprocedural Doppler and Invasive Hemodynamic Profiling Predict Clinical Outcomes After Mitral TEER. JACC Cardiovasc Imaging 2024; 17:454-456. [PMID: 38032586 DOI: 10.1016/j.jcmg.2023.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
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Shechter A, Kaewkes D, Lee M, Makar M, Patel V, Koren O, Koseki K, Nagasaka T, Skaf S, Chakravarty T, Makkar RR, Siegel RJ. Correlates and prognostic implications of LVEF reduction after transcatheter edge-to-edge repair for primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2023; 25:136-147. [PMID: 37590951 DOI: 10.1093/ehjci/jead210] [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: 03/01/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023] Open
Abstract
AIMS To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure. METHODS AND RESULTS We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75-88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared with baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While post-procedural MR, transmitral mean pressure gradient, and functional status were comparable in the two study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs. 5.7%, P = 0.019), be readmitted for HF (17.1% vs. 9.0%, P = 0.033), and experience either of the two (23.8% vs. 12.7%, P = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10-0.78, P = 0.016). CONCLUSION LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Nai Muang, Thailand
| | - Mirae Lee
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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10
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Arzuffi L, Mandurino-Mirizzi A, Magrini G, Frassica R, Disabato G, Ferlini M, Gazzoli F, Scelsi L, Turco A, Munafò A, Ghio S, Ferrario M, Oltrona-Visconti L, Crimi G. Impact of mitral transcatheter edge-to-edge repair on pulmonary vein flow in patients with functional mitral regurgitation. J Cardiovasc Med (Hagerstown) 2023; 24:206-208. [PMID: 36729687 DOI: 10.2459/jcm.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Luca Arzuffi
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Giandomenico Disabato
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | | | - Andrea Munafò
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Gabriele Crimi
- Division of Cardiology
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
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11
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Shechter A, Natanzon SS, Koseki K, Kaewkes D, Lee M, Koren O, Patel V, Skaf S, Chakravarty T, Makar M, Makkar RR, Siegel RJ. Prognostic value of mitral valve haemodynamic parameters obtained by intraprocedural echocardiography in transcatheter edge-to-edge repair. Eur Heart J Cardiovasc Imaging 2023:7030203. [PMID: 36748258 DOI: 10.1093/ehjci/jead011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
AIMS To assess whether intraprocedural transesophageal echocardiographic (TEE)-derived haemodynamic parameters predict outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR). METHODS AND RESULTS This is a single-centre, retrospective analysis encompassing 458 (IQR, 104-1035) days of follow-up after 926 consecutive patients [481 (52%) with functional MR] referred to an isolated mitral TEER between 2013 and 2020. Cases without actual clip deployment, or in whom prior mitral procedures had taken place, were excluded. The primary outcome was the combined rate of all-cause mortality or heart failure (HF) hospitalizations. Secondary endpoints included single components of the primary outcome, as well as MR severity at one month and one year following the procedure. A multivariable analysis identified two intraprocedural echocardiographic observations made after clip deployment as independent predictors of the primary outcome: an above mild MR (HR for whole study period 1.49, 95% CI 1.05-2.13, P = 0.026) and a 100% or more increase from baseline in the transmitral mean pressure gradient (TMPG) (HR for whole study period 1.32, 95% CI 1.01-1.72, P = 0.039). Also, MR grade of above mild and the absence of a normal pulmonary venous flow pattern (PVFP) bilaterally were associated with an increased risk for HF hospitalizations and greater-than-mild 1-month MR. No prognostic role was demonstrated for the change in MR severity, the absolute TMPG, or the mere improvement in PVFP. CONCLUSION Immediate post-TEER MR severity and the relative change in TMPG are predictive of clinical and echocardiographic outcomes following the procedure.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petach Tikva 4941492, Israel.,Faculty of Medicine, Tel Aviv University, 35 Klazkin St, Tel Aviv 6997801, Israel
| | - Sharon Shalom Natanzon
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petach Tikva 4941492, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Nai Muang, Muang Khon District, Khon Kaen 40002, Thailand
| | - Mirae Lee
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, 158 Paryong-ro, Masanhoewon-gu, Gyeongsangnam-do, Changwon, Republic of Korea
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, 1 Efron St, Haifa 3109601, Israel
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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12
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Gavazzoni M, Zuber M, Taramasso M, Cascella A, Voci D, Pozzoli A, Ferrari E, Maisano F. Transesophageal Echocardiography For The Assessment of Left Atrial Pressure After Trans-Septal Mitral Valve Interventions. Am J Cardiol 2022; 177:100-107. [PMID: 35738912 DOI: 10.1016/j.amjcard.2022.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
The measure of left atrial pressure (LAP) is an ideal marker for the clinical efficacy of transcatheter mitral valve intervention. Currently, only the invasive measurement of LAP (i-LAP) is available and no echocardiographic methods are reliable in the setting of transcatheter mitral valve intervention. This study sought to validate a new echocardiographic method for the estimation of LAP (e-LAP) by comparing it with i-LAP. During percutaneous edge-to-edge procedure with MitraClip, the i-LAP was routinely monitored. Across the iatrogenic interatrial septum defect, the flow was sampled with continuous-wave Doppler echocardiography for deriving the mean pressure gradient between the left atrium and the right atrium, and the central venous pressure was added to obtain the e-LAP. The correlation between the measures derived from these 2 methods was explored. A total of 34 consecutive patients were included. Intraclass correlation coefficient between e-LAP and i-LAP was high (intraclass correlation coefficient [95% confidence interval] 0.809 [0.625 to 0.902], R Pearson 0.6, p <0.001); a bias of -1.3 mm Hg for e-LAP versus i-LAP was found (p = 0.32). The median follow-up was 108 days (interquartile range 40 to 264). No death occurred and 6 patients were rehospitalized for heart failure. Postimplant e-LAP was correlated with rehospitalization at follow-up (hazard ratio 1.46, 95% confidence interval 1.022 to 2.1, p = 0.038). A cut-off value of 9.5 mm Hg for the e-LAP was identified as predictor of rehospitalization for heart failure. The evaluation of e-LAP has optimal reliability compared with i-LAP; a value more than 9.5 mm Hg was found to be related to higher risk of events at short follow-up.
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Affiliation(s)
- Mara Gavazzoni
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy.
| | | | | | - Andrea Cascella
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy; Università degli Studi di Milano-bicocca, Milano, Italy
| | - Davide Voci
- Angiology Department, University of Zürich, Zürich, Switzerland
| | - Alberto Pozzoli
- Cardiac Surgery Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Enrico Ferrari
- Cardiac Surgery Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Francesco Maisano
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy
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13
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Pozo Osinalde E, Salinas Gallegos A, Gordillo X, Nombela Franco L, Marcos-Alberca P, Mahía P, Tirado-Conte G, Gómez de Diego JJ, Jiménez Quevedo P, Fernández-Ortíz A, Pérez-Villacastín J, de Agustín Loeches JA. Correlation of Intraprocedural and Follow Up Parameters for Mitral Regurgitation Grading after Percutaneous Edge-to-Edge Repair. J Clin Med 2022; 11:2276. [PMID: 35566402 PMCID: PMC9102104 DOI: 10.3390/jcm11092276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: There is no consensus on the best intraprocedural parameter to evaluate residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral repair (TEER). Thus, our aim was to evaluate the predictive value of different MR parameters from intraprocedural transesophageal echocardiogram (TEE) for grading in consecutive transthoracic echocardiogram (TTE) during the follow up. Methods: All the consecutive patients who underwent TEER with MitraClip between 2010 and 2020 in our center were considered. TEE-derived immediate postprocedural MR parameters were reassessed to blindly compare them with follow up MR grading in sequential TTE. Results: We finally included 88 patients (64.8% males; 76 ± 10 years-old). Significant MR was detected in 14.3% of the cases at 6 months, in similar proportion than at postprocedural at 1 month. Among all the intraprocedural TEE quantitative parameters only additive and maximum VC were associated with significant MR persistence. Moreover, on ROC analysis maximum VC demonstrated an excellent discriminatory power (AUC 0.96; p < 0.001) to identify MR ≥ III at 6 months. Thus, a cut-off point of 0.45 cm demonstrated 88% sensitivity and 89% specificity. Conclusion: Among intraprocedural TEE parameters to evaluate residual MR in TEER, maximum and additive VC were the most reliable to predict persistence of significant insufficiency.
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Affiliation(s)
- Eduardo Pozo Osinalde
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Alejandra Salinas Gallegos
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Internal Medicine Department, Universidad de La Frontera, Temuco 4781218, Chile
- Cardiology Department, Hospital Dr. Hernán Henríquez Aravena, Temuco 4781151, Chile
| | - Ximena Gordillo
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Noninvasive Cardiology Department, Instituto Nacional Cardiovascular (INCOR), Lima 15072, Peru
| | - Luis Nombela Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Pedro Marcos-Alberca
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Patricia Mahía
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Gabriela Tirado-Conte
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - José Juan Gómez de Diego
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Pilar Jiménez Quevedo
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Antonio Fernández-Ortíz
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Julián Pérez-Villacastín
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Jose Alberto de Agustín Loeches
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (A.S.G.); (X.G.); (L.N.F.); (P.M.-A.); (P.M.); (G.T.-C.); (J.J.G.d.D.); (P.J.Q.); (A.F.-O.); (J.P.-V.); (J.A.d.A.L.)
- Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
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14
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Hahn RT, Kodali SK. State-of-the-art intra-procedural imaging for the mitral and tricuspid PASCAL Repair System. Eur Heart J Cardiovasc Imaging 2021; 23:e94-e110. [PMID: 34136901 PMCID: PMC8863082 DOI: 10.1093/ehjci/jeab040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
Advanced intra-procedural imaging techniques have been integral to technical and procedural success transcatheter devices. A novel leaflet approximation therapy, the PASCAL Transcatheter Valve Repair System (Edwards Lifesciences, Irvine, CA, USA) has demonstrated high procedural success, acceptable safety, and significant clinical improvement in patients with severe mitral and tricuspid regurgitation and has CE mark approval in Europe with pivotal trials underway in the USA. This review outlines the pre-procedural imaging views and advanced transoesophageal imaging protocols both mitral and tricuspid valve device implantation.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Susheel K Kodali
- Columbia University Medical Center, New York Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
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15
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Fadel BM, Pibarot P, Kazzi BE, Al-Admawi M, Galzerano D, Alhumaid M, Alamro B, Mahjoub H, Echahidi N, Mohty D. Spectral Doppler Interrogation of the Pulmonary Veins for the Diagnosis of Cardiac Disorders: A Comprehensive Review. J Am Soc Echocardiogr 2021; 34:223-236. [DOI: 10.1016/j.echo.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
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16
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Caballero A, Mao W, McKay R, Hahn RT, Sun W. A Comprehensive Engineering Analysis of Left Heart Dynamics After MitraClip in a Functional Mitral Regurgitation Patient. Front Physiol 2020; 11:432. [PMID: 32457650 PMCID: PMC7221026 DOI: 10.3389/fphys.2020.00432] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
Percutaneous edge-to-edge mitral valve (MV) repair using MitraClip has been recently established as a treatment option for patients with heart failure and functional mitral regurgitation (MR), which significantly expands the number of patients that can be treated with this device. This study aimed to quantify the morphologic, hemodynamic and structural changes, and evaluate the biomechanical interaction between the MitraClip and the left heart (LH) complex of a heart failure patient with functional MR using a fluid-structure interaction (FSI) modeling framework. MitraClip implantation using lateral, central and double clip positions, as well as combined annuloplasty procedures were simulated in a patient-specific LH model that integrates detailed anatomic structures, incorporates age- and gender-matched non-linear elastic material properties, and accounts for mitral chordae tethering. Our results showed that antero-posterior distance, mitral annulus spherecity index, anatomic regurgitant orifice area, and anatomic opening orifice area decreased by up to 28, 39, 52, and 71%, respectively, when compared to the pre-clip model. MitraClip implantation immediately decreased the MR severity and improved the hemodynamic profile, but imposed a non-physiologic configuration and loading on the mitral apparatus, with anterior and posterior leaflet stress significantly increasing up to 210 and 145% during diastole, respectively. For this patient case, while implanting a combined central clip and ring resulted in the highest reduction in the regurgitant volume (46%), this configuration also led to mitral stenosis. Patient-specific computer simulations as used here can be a powerful tool to examine the complex device-host biomechanical interaction, and may be useful to guide device positioning for potential favorable clinical outcomes.
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Affiliation(s)
- Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Raymond McKay
- Division of Cardiology, The Hartford Hospital, Hartford, CT, United States
| | - Rebecca T. Hahn
- Division of Cardiology, Columbia University Medical Center, New York, NY, United States
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
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17
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de Sousa C, Surkova E, Lerakis S. Comprehensive Periprocedural Transesophageal Echocardiography Is a Key to Success in Transcatheter Mitral Valve Repair. JACC Case Rep 2020; 2:555-558. [PMID: 34317293 PMCID: PMC8298787 DOI: 10.1016/j.jaccas.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Carla de Sousa
- Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Elena Surkova
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Stamatios Lerakis
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
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18
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Changing the Tide of Left Atrial Inflow. JACC Cardiovasc Imaging 2019; 12:1914-1916. [DOI: 10.1016/j.jcmg.2018.08.004] [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: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022]
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19
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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