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Babu A, Bertolini M, Mullen M, Cook A, Mullen A, Capelli C. Effectiveness of a new 3D printed simulator for mitral transcatheter edge-to-edge repair in enhancing the confidence and procedural skills of the operator. 3D Print Med 2024; 10:26. [PMID: 39102099 PMCID: PMC11299365 DOI: 10.1186/s41205-024-00230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/11/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND . Mitral transcatheter edge-to-edge repair (m-TEER) is a minimally invasive procedure for treating mitral regurgitation (MR). m-TEER is a highly technical procedure, and a steep learning curve needs to be overcome for operators to ensure optimal patient outcomes and minimise procedural complications. Training via online simulation and observation of procedures is not sufficient to establish operator confidence; thus, advanced hands-on training modalities need to be explored and developed. METHODS . In this study, a novel anatomical simulator for m-TEER training was evaluated in comparison to a standard model. The proposed simulator resembled the anatomical features of the right and left atrium, left ventricle and mitral valve apparatus. Participants in the questionnaire (n = 18) were recruited across 4 centres in London with (n = 8) and without (n = 10) prior experience in m-TEER. Participants were asked to simulate procedures on both an idealised, routinely used simulator and the newly proposed anatomical model. The questionnaire was designed to assess (i) participants' confidence before and after training and (ii) the realism of the model in the context of the m-TEER procedure. The results of the questionnaires were collected, and statistical analysis (t-test) was performed. RESULTS . Both models were equally beneficial in increasing operator confidence before and after the simulation of the intervention (P = 0.43). However, increased confidence after training with the anatomical model was recorded (P = 0.02). Participants with prior experience with m-TEER therapy were significantly more confident about the procedure after training with the anatomical model than participants who had no prior experience (P = 0.002). On average, all participants thought that the anatomical model was effective as a training simulator (P = 0.013) and should be integrated into routine training (P = 0.015)). Participants with experience thought that the anatomical model was more effective at reproducing the m-TEER procedure than the idealised model (P = 0.03). CONCLUSIONS . This study showed how a more realistic simulator can be used to improve the effectiveness of m-TEER procedural training. Such pilot results suggest planning future and large investigations to evaluate improvements in clinical practice.
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Affiliation(s)
- Angel Babu
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
| | - Michele Bertolini
- Department of Mechanical Engineering, Politecnico di Milano, Milan, 20133, Italy.
| | | | - Andrew Cook
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
| | - Aigerim Mullen
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
- Abbott Structural Heart UK and Ireland, Blyth Valley Business Park, Solihull, B90 8AJ, UK
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK.
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2
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Shim CY, Kim EK, Cho DH, Park JB, Seo JS, Son JW, Kim IC, Lee SH, Heo R, Lee HJ, Lee S, Sun BJ, Yoon SJ, Lee SH, Kim HY, Kim HM, Park JH, Hong GR, Jung HO, Kim YJ, Kim KH, Kang DH, Ha JW, Kim H. 2023 Korean Society of Echocardiography position paper for the diagnosis and management of valvular heart disease, part II: mitral and tricuspid valve disease. J Cardiovasc Imaging 2024; 32:10. [PMID: 38951920 PMCID: PMC11218416 DOI: 10.1186/s44348-024-00021-6] [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: 09/05/2023] [Accepted: 11/30/2023] [Indexed: 07/03/2024] Open
Abstract
This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the diagnosis and management of valvular heart diseases with referring to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee sought to reflect national data on the topic of valvular heart diseases published to date through a systematic literature search based on validity and relevance. In the part II of this article, we intend to present recommendations for diagnosis and treatment of mitral valve disease and tricuspid valve disease.
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Affiliation(s)
- Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hyun Lee
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun Hwa Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
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3
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Koyama Y, Yamamoto M, Ozoe S, Kagase A, Inagaki M, Shimura T, Tomita S, Matsuo H. Late Leaflet Tear of the Mitral Valve Following Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation. JACC Cardiovasc Interv 2024; 17:1507-1508. [PMID: 38925753 DOI: 10.1016/j.jcin.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Yutaka Koyama
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan.
| | - Masanori Yamamoto
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Japan
| | - Satoki Ozoe
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Ai Kagase
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Japan
| | - Masahiro Inagaki
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Tetsuro Shimura
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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4
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Russo G, Hahn RT, Alessandrini H, Andreas M, Badano LP, Braun D, Connelly KA, Denti P, Estevez-Loureiro R, Fam N, Gavazzoni M, Hausleiter J, Himbert D, Kalbacher D, Latib A, Lubos E, Ludwig S, Lurz P, Monivas V, Nickenig G, Pedicino D, Pedrazzini G, Pozzoli A, Praz F, Rodes-Cabau J, Rommel KP, Schofer J, Sievert H, Tang G, Thiele H, Unterhuber M, von Bardeleben RS, Webb J, Windecker S, Leon M, Maisano F, Taramasso M. Effects of tricuspid transcatheter edge-to-edge repair on tricuspid annulus diameter - Data from the TriValve registry. Int J Cardiol 2024; 405:131934. [PMID: 38437953 DOI: 10.1016/j.ijcard.2024.131934] [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: 11/17/2023] [Revised: 01/13/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
AIMS T-TEER is an effective therapy for the treatment of tricuspid regurgitation (TR). However, the effects of leaflets clipping on tricuspid valve annulus (TA) have not been investigated in detail. The aim of this study is to investigate the effects of tricuspid transcatheter edge-to-edge repair (T-TEER) on TA diameter. METHODS AND RESULTS The TriValve registry (Transcatheter Tricuspid Valve Therapies, NCT03416166) collected 556 patients from 22 European and North American centres undergoing transcatheter tricuspid valve interventions from 2016 to 2022. Patients undergoing T-TEER with available pre- and post-procedural data on TA diameter measured in the apical 4-chamber view on transthoracic echocardiography were selected for this study. Primary end-point was the reduction of TA diameter after T-TEER. A total of 186 patients were included in the study. In 115 patients (62%) TA diameter was reduced by at least 1 mm as compared to baseline. A significant reduction of TA dimension was observed following T-TEER (mean 2.3 mm [from pre-procedural diameter 46.7 mm to post-procedural diameter 44.4 mm], p < 0.001). In particular, the greatest reduction was observed in those with T-TEER in antero-septal commissure (mean 2.7 mm [from 47.1 mm to 44.4 mm], p < 0.001) as compared to those combining both antero-septal and postero-septal commissures (mean 1.4, from 46.0 mm to 44.6 mm, P = 0.06). A significant reduction of TA dimension was recorded in patients with 1 or 2 clips implanted but not in those patients with ≥3 clips implanted. CONCLUSIONS In almost two third of patients T-TEER reduces TA diameter in addition to leaflet approximation. CONDENSED ABSTRACT The effects of tricuspid transcatheter edge-to-edge repair (T-TEER) on tricuspid valve annulus (TA) have not been studied in details. This study investigates TA diameter as measured in apical 4-chamber view on transthoracic echocardiography before and after T-TEER. A total of 186 patients from the TriValve registry were included in the study. The study results show that 62% of patients have a TA reduction after T-TEER, especially in those receiving 1 or 2 clips in the antero-septal commissure. These suggest that T-TEER reduces tricuspid regurgitation not only by approximation of leaflets, but also by TA diameter reduction.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Italy.
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY,USA
| | - Hannes Alessandrini
- MVZ Structural Heart Department, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paolo Denti
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Joerg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland + Biomedical Faculty, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Fabien Praz
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joseph Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Joachim Schofer
- MVZ Structural Heart Department, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
| | - Gilbert Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY,USA
| | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
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5
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Russo G, d'Aiello A, Pedicino D, Kuwata S, Sangiorgi GM, Taramasso M, Maisano F. Understanding transcatheter edge-to-edge repair "knobology": Advanced catheter steering for different scenarios of transseptal puncture. Catheter Cardiovasc Interv 2024; 103:1138-1144. [PMID: 38695165 DOI: 10.1002/ccd.31062] [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: 11/02/2023] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 06/04/2024]
Abstract
Following the introduction in the latest European and American guidelines, transcatheter edge-to-edge repair has become a valid alternative to surgery for ineligible patients. Among the available technologies, MitraClip (Abbott) was the first to be introduced for the percutaneous treatment of mitral regurgitation with the edge-to-edge technique. Although its safety and effectiveness has been widely demonstrated, the optimal procedural results are highly dependent from operators' experience. In this manuscript, we provide a full guide of advanced steering maneuvers of MitraClip in different scenarios of transseptal puncture.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Alessia d'Aiello
- Fondazione Policlinico Universitario A Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Shingo Kuwata
- St Marianna University School of Medicine, Kawasaki, Japan
| | - Giuseppe Massimo Sangiorgi
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | | | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
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6
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Eng MH, Zahr F. Orthotopic Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2024; 13:227-235. [PMID: 38432765 DOI: 10.1016/j.iccl.2024.01.004] [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 valve dysfunction is prevalent amongst older patients. Of those not suitable for surgical therapy, mitral transcatheter edge-to-edge repair (TEER) can treat as large proportion of patients, many are not suitable TEER candidates. As such, orthotopic transcatheter mitral valve replacement (TMVR) is an important innovation but it faces significant challenges. Orthotopic TMVR requires a prosthesis with stable anchoring, adequate sealing, minimal footprint in the left ventricle and long term durability. Multidisciplinary expertise in advanced imaging, surgery, heart failure are needed for success.
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Affiliation(s)
- Marvin H Eng
- Structural Heart Program, Division of Cardiology, University of Arizona, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA.
| | - Firas Zahr
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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7
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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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8
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Makkar RR, Chikwe J, Chakravarty T, Chen Q, O’Gara PT, Gillinov M, Mack MJ, Vekstein A, Patel D, Stebbins AL, Gelijns AC, Makar M, Bhatt DL, Kapadia S, Vemulapalli S, Leon MB. Transcatheter Mitral Valve Repair for Degenerative Mitral Regurgitation. JAMA 2023; 329:1778-1788. [PMID: 37219553 PMCID: PMC10208157 DOI: 10.1001/jama.2023.7089] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023]
Abstract
Importance There are limited data on the outcomes of transcatheter edge-to-edge mitral valve repair for degenerative mitral regurgitation (MR) in a real-world setting. Objective To evaluate the outcomes of transcatheter mitral valve repair for degenerative MR. Design, Setting, and Participants Cohort study of consecutive patients in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry who underwent nonemergent transcatheter mitral valve repair for degenerative MR in the US from 2014 through 2022. Exposure Transcatheter edge-to-edge mitral valve repair with the MitraClip device (Abbott). Main Outcomes and Measures The primary end point was MR success, defined as moderate or less residual MR and a mean mitral gradient of less than 10 mm Hg. Clinical outcomes were evaluated based on the degree of residual MR (mild or less MR or moderate MR) and mitral valve gradients (≤5 mm Hg or >5 to <10 mm Hg). Results A total of 19 088 patients with isolated moderate to severe or severe degenerative MR who underwent transcatheter mitral valve repair were analyzed (median age, 82 years; 48% women; median Society of Thoracic Surgeons predicted risk of mortality with surgical mitral valve repair, 4.6%). MR success was achieved in 88.9% of patients. At 30 days, the incidence of death was 2.7%; stroke, 1.2%; and mitral valve reintervention, 0.97%. MR success compared with an unsuccessful procedure was associated with significantly lower mortality (14.0% vs 26.7%; adjusted hazard ratio, 0.49; 95% CI, 0.42-0.56; P < .001) and heart failure readmission (8.4% vs 16.9%; adjusted hazard ratio, 0.47; 95% CI, 0.41-0.54; P < .001) at 1 year. Among patients with MR success, the lowest mortality was observed in patients who had both mild or less residual MR and mean mitral gradients of 5 mm Hg or less compared with those with an unsuccessful procedure (11.4% vs 26.7%; adjusted hazard ratio, 0.40; 95% CI, 0.34-0.47; P < .001). Conclusions and Relevance In this registry-based study of patients with degenerative MR undergoing transcatheter mitral valve repair, the procedure was safe and resulted in successful repair in 88.9% of patients. The lowest mortality was observed in patients with mild or less residual MR and low mitral gradients.
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Affiliation(s)
- Raj R. Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna Chikwe
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Qiudong Chen
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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9
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Russo G, Taramasso M. "Mind the Grasp": Preventing Single Leaflet Device Attachment and Clip Embolization in Transcatheter Edge-to-Edge Procedure. JACC Case Rep 2023; 9:101747. [PMID: 36909268 PMCID: PMC9998716 DOI: 10.1016/j.jaccas.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, Rome, Italy
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10
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Hausleiter J, Lim DS, Gillam LD, Zahr F, Chadderdon S, Rassi AN, Makkar R, Goldman S, Rudolph V, Hermiller J, Kipperman RM, Dhoble A, Smalling R, Latib A, Kodali SK, Lazkani M, Choo J, Lurz P, O'Neill WW, Laham R, Rodés-Cabau J, Kar S, Schofer N, Whisenant B, Inglessis-Azuaje I, Baldus S, Kapadia S, Koulogiannis K, Marcoff L, Smith RL. Transcatheter Edge-to-Edge Repair in Patients With Anatomically Complex Degenerative Mitral Regurgitation. J Am Coll Cardiol 2023; 81:431-442. [PMID: 36725171 DOI: 10.1016/j.jacc.2022.11.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair is safe and effective in treating degenerative mitral regurgitation (DMR) patients at prohibitive surgical risk, but outcomes in complex mitral valve anatomy patients vary. OBJECTIVES The PASCAL IID registry assessed safety, echocardiographic, and clinical outcomes with the PASCAL system in prohibitive risk patients with significant symptomatic DMR and complex mitral valve anatomy. METHODS Patients in the prospective, multicenter, single-arm registry had 3+ or 4+ DMR, were at prohibitive surgical risk, presented with complex anatomic features based on the MitraClip instructions for use, and were deemed suitable for the PASCAL system by a central screening committee. Enrolled patients were treated with the PASCAL system. Safety, effectiveness, and functional and quality-of-life outcomes were assessed. Study oversight also included an echocardiographic core laboratory and clinical events committee. RESULTS The study enrolled 98 patients (37.2% ≥2 independent significant jets, 15.0% severe bileaflet/multi scallop prolapse, 13.3% mitral valve orifice area <4.0 cm2, and 10.6% large flail gap and/or large flail width). The implant success rate was 92.9%. The 30-day composite major adverse event rate was 11.2%. At 6 months, 92.4% patients achieved MR ≤2+ and 56.1% achieved MR ≤1+ (P < 0.001 vs baseline). The Kaplan-Meier estimates for survival, freedom from major adverse events, and heart failure hospitalization at 6 months were 93.7%, 85.6%, and 92.6%, respectively. Patients experienced significant symptomatic improvement compared with baseline (P < 0.001). CONCLUSIONS The outcomes of the PASCAL IID registry establish the PASCAL system as a useful therapy for prohibitive surgical risk DMR patients with complex mitral valve anatomy. (PASCAL IID Registry within the Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID] NCT03706833).
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Affiliation(s)
| | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Abhijeet Dhoble
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Richard Smalling
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Mohamad Lazkani
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | | | | | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | | | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert L Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
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11
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Russo G, Tang GHL, Sangiorgi G, Pedicino D, Enriquez-Sarano M, Maisano F, Taramasso M. Lifetime Management of Aortic Stenosis: Transcatheter Versus Surgical Treatment for Young and Low-Risk Patients. Circ Cardiovasc Interv 2022; 15:915-927. [PMID: 36378737 DOI: 10.1161/circinterventions.122.012388] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcatheter aortic valve replacement is now indicated across all risk categories of patients with symptomatic severe aortic stenosis and has been proposed as first line option for the majority of patients >74 years old. However, median age of patients enrolled in the transcatheter aortic valve replacement low-risk trials is 74 years and transcatheter aortic valve replacement has never been systematically investigated in young low risk patients. Although the long-term data in surgical aortic valve replacement in young patients (age <75) are well known, such data remain lacking in transcatheter aortic valve replacement. In the absence of clear guideline recommendations in patients with challenging anatomies (eg, hostile calcium, bicuspid), it is important to know the potential advantages and disadvantages of each treatment and to consider how they might integrate with each other in the lifetime management of such patients. In this review, we discuss current outstanding issues on the management of severe aortic stenosis from a lifetime management perspective, particularly in terms of initial intervention and future reinterventions.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome (G.R., G.S.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italia (D.P.).,Università Cattolica del Sacro Cuore, Roma, Italia (D.P.)
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12
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Russo E, Russo G, Cassese M, Braccio M, Carella M, Compagnucci P, Dello Russo A, Casella M. The Role of Cardiac Resynchronization Therapy for the Management of Functional Mitral Regurgitation. Cells 2022; 11:2407. [PMID: 35954250 PMCID: PMC9367730 DOI: 10.3390/cells11152407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023] Open
Abstract
Valve leaflets and chordae structurally normal characterize functional mitral regurgitation (FMR), which in heart failure (HF) setting results from an imbalance between closing and tethering forces secondary to alterations in the left ventricle (LV) and left atrium geometry. In this context, FMR impacts the quality of life and increases mortality. Despite multiple medical and surgical attempts to treat FMR, to date, there is no univocal treatment for many patients. The pathophysiology of FMR is highly complex and involves several underlying mechanisms. Left ventricle dyssynchrony may contribute to FMR onset and worsening and represents an important target for FMR management. In this article, we discuss the mechanisms of FMR and review the potential therapeutic role of CRT, providing a comprehensive review of the available data coming from clinical studies and trials.
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Affiliation(s)
- Eleonora Russo
- Department of Cardiovascular Disease, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Giulio Russo
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, University of Rome, 00133 Rome, Italy
| | - Mauro Cassese
- Department of Cardiac Surgery, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Maurizio Braccio
- Department of Cardiac Surgery, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Massimo Carella
- Scientific Research Department, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, University Hospital ”Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60126 Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy
- Department of Biomedical Sciences and Public Health, University Hospital ”Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60126 Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, 60126 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, University Hospital “Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60126 Ancona, Italy
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13
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Xiling Z, Puehler T, Sondergaard L, Frank D, Seoudy H, Mohammad B, Müller OJ, Sellers S, Meier D, Sathananthan J, Lutter G. Transcatheter Mitral Valve Repair or Replacement: Competitive or Complementary? J Clin Med 2022; 11:jcm11123377. [PMID: 35743448 PMCID: PMC9225133 DOI: 10.3390/jcm11123377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
Over the last two decades, transcatheter devices have been developed to repair or replace diseased mitral valves (MV). Transcatheter mitral valve repair (TMVr) devices have been proven to be efficient and safe, but many anatomical structures are not compatible with these technologies. The most significant advantage of transcatheter mitral valve replacement (TMVR) over transcatheter repair is the greater and more reliable reduction in mitral regurgitation. However, there are also potential disadvantages. This review introduces the newest TMVr and TMVR devices and presents clinical trial data to identify current challenges and directions for future research.
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Affiliation(s)
- Zhang Xiling
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
| | - Thomas Puehler
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
| | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | - Derk Frank
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Hatim Seoudy
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Baland Mohammad
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
| | - Oliver J. Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Stephanie Sellers
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada; (S.S.); (D.M.); (J.S.)
- Cardiovascular Translational Laboratory, St Paul’s Hospital & Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - David Meier
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada; (S.S.); (D.M.); (J.S.)
- Cardiovascular Translational Laboratory, St Paul’s Hospital & Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada; (S.S.); (D.M.); (J.S.)
- Cardiovascular Translational Laboratory, St Paul’s Hospital & Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
- Correspondence: ; Tel.: +49-(0)43150022031; Fax: +49-(0)043150022048
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14
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Masumoto A, Yamamoto H, Takahashi N, Takaya T. A large iatrogenic tearing of atrial septal defect after MitraClip implantation: a rare and cautionary complication during transcatheter edge-to-edge mitral valve repair. Eur Heart J Case Rep 2022; 6:ytac119. [PMID: 35434507 PMCID: PMC9007440 DOI: 10.1093/ehjcr/ytac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/10/2022] [Accepted: 03/15/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Akiko Masumoto
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, 520 Saisho-ko, Himeji, Hyogo 670-0981, Japan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, 520 Saisho-ko, Himeji, Hyogo 670-0981, Japan
| | - Nobuyuki Takahashi
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, 520 Saisho-ko, Himeji, Hyogo 670-0981, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, 520 Saisho-ko, Himeji, Hyogo 670-0981, Japan
- Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
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16
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Fan Y, Chan JSK, Lee APW. Advances in Procedural Echocardiographic Imaging in Transcatheter Edge-to-Edge Repair for Mitral Regurgitation. Front Cardiovasc Med 2022; 9:864341. [PMID: 35419432 PMCID: PMC8996060 DOI: 10.3389/fcvm.2022.864341] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Transcatheter edge-to-edge repair (TEER) therapy is recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for selected patients with symptomatic severe or moderate-severe mitral regurgitation (MR). Echocardiography, in particular transesophageal echocardiography (TEE), plays a critical role in procedural planning and guidance for TEER. Recent innovations and advances in TEE techniques including three-dimensional (3D) imaging, unlimited x-plane imaging, live 3D multiplanar reconstruction, as well as transillumination imaging with color Doppler and transparency rendering have further enhanced procedural imaging for TEER, especially for complex diseases including commissural defects, clefts, and multi-segment pathologies. This review discusses the technology of these advanced procedural imaging techniques and provides a "step-by-step" guide on how to apply them during the TEER procedure with a focus on their added values in treatment of complex valve lesions.
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Affiliation(s)
- Yiting Fan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeffrey Shi Kai Chan
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Alex Pui-Wai Lee
- Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China
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17
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Hoshino N, Muramatsu T, Tsukamoto T, Yamada A. Recurrent mitral regurgitation with haemolytic anaemia after MitraClip procedure: an autopsy case report. Eur Heart J Case Rep 2022; 6:ytac109. [PMID: 35474682 PMCID: PMC9026206 DOI: 10.1093/ehjcr/ytac109] [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: 11/09/2021] [Revised: 11/29/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
Background Transcatheter edge-to-edge mitral valve repair (TMVr) has been developed as an alternative therapeutic approach to patients with severe mitral regurgitation (MR) at high-surgical risks. Single leaflet device attachment (SLDA) is a well-known complication after the TMVr procedure, while an autopsy case experiencing haemolytic anaemia has been scarcely reported. Case summary A 79-year-old woman presented with New York Heart Association Class 3 congestive heart failure due to severe MR. The Heart Team planned TMVr using the MitraClip considering a high-surgical risk due to the history of open-chest surgery. The procedure was successful with two clips and a significant reduction of MR was confirmed. On the 12th day after the procedure, congestive heart failure was worsened and a transthoracic echocardiogram revealed severe MR suggestive of SLDA. Blood test showed normocytic anaemia with serum lactate dehydrogenase level elevation and renal function deterioration. We diagnosed as mechanical haemolysis induced by recurrent MR because of a decrease in serum haptoglobin level and the presence of schizocyte in the blood smear. Despite our intensive medical treatment, she died on the 119th day after the procedure. The pathological autopsy demonstrated that the ruptured leaflet was thickened with layered structure and severe fibrosis, while there were no findings of calcification, vegetations, or abscesses. Discussion Single leaflet device attachment and subsequent mechanical haemolysis are rare but fatal complications after TMVr with the MitraClip. Not only degenerative MR but also functional MR may be associated with valve leaflet degeneration. A possibility of mechanical haemolysis should be considered when recurrent MR is observed after TMVr.
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Affiliation(s)
- Naoki Hoshino
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake 470-1192, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake 470-1192, Japan
| | - Tetsuya Tsukamoto
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Akira Yamada
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake 470-1192, Japan
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18
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Mangieri A, Melillo F, Montalto C, Denti P, Praz F, Sala A, Winkel MG, Taramasso M, Tagliari AP, Fam NP, Rubbio AP, De Marco F, Bedogni F, Toggweiler S, Schofer J, Brinkmann C, Sievert H, Van Mieghem NM, Ooms JF, Paradis JM, Rodés-Cabau J, Brochet E, Himbert D, Perl L, Kornowski R, Ielasi A, Regazzoli D, Baldetti L, Masiero G, Tarantini G, Latib A, Laricchia A, Gattas A, Tchetchè D, Dumonteil N, Francesco G, Agricola E, Montorfano M, Lurz P, Crimi G, Maisano F, Colombo A. Management and Outcome of Failed Percutaneous Edge-to-Edge Mitral Valve Plasty: Insight From an International Registry. JACC Cardiovasc Interv 2022; 15:411-422. [PMID: 35210047 DOI: 10.1016/j.jcin.2021.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/09/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study evaluated the incidence, management, and outcome of patients who experienced MitraClip (Abbott Vascular) failure secondary to loss of leaflet insertion (LLI), single leaflet detachment (SLD), or embolization. BACKGROUND Transcatheter edge-to-edge repair with MitraClip is an established therapy for the treatment of mitral regurgitation (MR), but no data exist regarding the prevalence and outcome according to the mode of clip failure. METHODS Between January 2009 and December 2020, we retrospectively screened 4,294 procedures of MitraClip performed in 19 centers. LLI was defined as damage to the leaflet where the MitraClip was attached, SLD as demonstration of complete separation between the device and a single leaflet tissue, and clip embolization as loss of contact between MitraClip and both leaflets. RESULTS A total of 147 cases of MitraClip failure were detected (overall incidence = 3.5%), and these were secondary to LLI or SLD in 47 (31.9%) and 99 (67.3%) cases, respectively, whereas in 1 (0.8%) case clip embolization was observed. MitraClip failure occurred in 67 (45.5%) patients with functional MR, in 64 (43.5%) patients with degenerative MR, and 16 (10.8%) with mixed etiology. Although the majority of MitraClip failures were detected before discharge (47 intraprocedural and 42 in the hospital), up to 39.5% of cases were diagnosed at follow-up. In total, 80 (54.4%) subjects underwent a redo procedure, either percutaneously with MitraClip (n = 51, 34.7%) or surgically (n = 36, 24.5%) including 4 cases of surgical conversion of the index procedure and 7 cases of bailout surgery after unsuccessful redo MitraClip. After a median follow-up of 163 days (IQR: 22-720 days), 50 (43.9%) subjects presented moderate to severe MR, and 43 (29.3%) patients died. An up-front redo MitraClip strategy was associated with a trend toward a reduced rate of death at follow-up vs surgical or conservative management (P = 0.067), whereas postprocedural acute kidney injury, age, and moderate to severe tricuspid regurgitation were independent predictors of death. CONCLUSIONS MitraClip failure secondary to LLI and SLD is not a rare phenomenon and may occur during and also beyond hospitalization. Redo MitraClip strategy demonstrates a trend toward a reduced risk of death compared with bailout surgery and conservative management. A third of those patients remained with more than moderate MR and had substantial mortality at the intermediate-term follow-up.
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Affiliation(s)
- Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | | | - Claudio Montalto
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Denti
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandra Sala
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirjam G Winkel
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Ana Paula Tagliari
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Joachim Schofer
- MVZ-Department Structural Heart Disease, Asklepios Clinic St Georg, Hamburg, Germany
| | - Christina Brinkmann
- MVZ-Department Structural Heart Disease, Asklepios Clinic St Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany and Anglia Ruskin University, Chelmsford, United Kingdom
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joris F Ooms
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Laval University, Québec City, Québec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Québec City, Québec, Canada
| | - Eric Brochet
- Cardiology Department University Hospital Bichat, Paris, France
| | | | - Leor Perl
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | - Luca Baldetti
- IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Angie Gattas
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Eustachio Agricola
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Montorfano
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gabriele Crimi
- Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
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19
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Russo G, Maisano F, Massaro G, Terlizzese G, Mariano E, Bonanni M, Matteucci A, Bezzeccheri A, Benedetto D, Chiricolo G, Martuscelli E, Sangiorgi GM. Challenges and Open Issues in Transcatheter Mitral Valve Implantation: Smooth Seas Do Not Make Skillful Sailors. Front Cardiovasc Med 2022; 8:738756. [PMID: 35224022 PMCID: PMC8863742 DOI: 10.3389/fcvm.2021.738756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
According to the European and American guidelines, surgery represents the treatment of choice for mitral valve (MV) disease. However, a number of patients are deemed unsuitable for surgery due to a prohibitive/high operative risk. In such cases, transcatheter therapies aiming at MV repair have been proven to be a valuable alternative and have been recently introduced in the latest American guidelines on valvular heart disease. Indeed, percutaneous repair techniques, particularly transcatheter edge-to-edge, have gained a broad experience and demonstrated to be safe and effective. However, given the complexity and heterogeneity of MV anatomy and pathology, transcatheter MV implantation (TMVI) has grown as a possible alternative to percutaneous MV repair. Current data about TMVI are still limited and come from different settings: valve-in-native MV, valve-in-valve (ViV), valve-in-ring (ViR), and valve-in-mitral annular calcification. Preliminary data are promising although several open issues still need to be addressed. This paper provides a comprehensive review of the available devices in the different clinical settings, to discuss potentialities, limitations, and future directions for TMVI.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy
| | - Gianluca Massaro
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Terlizzese
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Enrica Mariano
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Michela Bonanni
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Andrea Matteucci
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Andrea Bezzeccheri
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Daniela Benedetto
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Gaetano Chiricolo
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Eugenio Martuscelli
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - Giuseppe Massimo Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
- *Correspondence: Giuseppe Massimo Sangiorgi
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20
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Russo G, Taramasso M, Pedicino D, Gennari M, Gavazzoni M, Pozzoli A, Muraru D, Badano LP, Metra M, Maisano F. Challenges and future perspectives of transcatheter tricuspid valve interventions: adopt old strategies or adapt to new opportunities? Eur J Heart Fail 2021; 24:442-454. [PMID: 34894039 DOI: 10.1002/ejhf.2398] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/08/2023] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease and is associated with an increased risk of cardiovascular events and death at long-term follow-up. Functional TR accounts for over 90% of TR and is mainly due to annular or right ventricular dilatation. Most often, TR is observed in patients with left-sided valvular heart disease (with or without previous surgical correction) and pulmonary hypertension. Isolated TR is less frequent, though burdened by high surgical mortality. This, together with an incomplete understanding of the disease, has brought to a significant undertreatment in spite of the growing evidence of the impact of severe TR on mortality. Moreover, uncertainties about the appropriate timing for intervention and the predictors of procedural success have contributed to limit TR treatment. Transcatheter tricuspid valve replacement or repair interventions represent novel and less invasive alternatives to surgery and have shown early promising results. The purpose of this review is to provide a complete and updated overview of TR pathology with a special focus on current percutaneous treatment options, future challenges and directions.
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Affiliation(s)
- Giulio Russo
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mara Gavazzoni
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Denisa Muraru
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Luigi P Badano
- IRCCS, Instituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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22
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Maisano F, Russo G, Tagliari AP, Gavazzoni M, Taramasso M. Left femoral vein access for transcatheter mitral valve interventions in unfavorable interatrial septal anatomy. Catheter Cardiovasc Interv 2021; 98:E971-E976. [PMID: 34533899 DOI: 10.1002/ccd.29950] [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: 07/17/2021] [Accepted: 08/31/2021] [Indexed: 11/07/2022]
Abstract
Optimal transseptal puncture (TSP) position on the interatrial septum as well as proper catheter direction and maneuverability in the left atrium (LA) are key elements for successful mitral valve (MV) interventions. TSP is usually performed from the right femoral vein being more comfortable for the operator and easier to reach the fossa ovalis. In the cases reported, TSP was performed from left femoral vein (LFV) to improve delivery system maneuverability and trajectory inside the LA in the context of MV repair with MitraClip. According to this early experience, LFV approach might be considered as first choice or as an alternative solution in patients in whom a higher position of the delivery system relative to the mitral annulus is needed.
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Affiliation(s)
- Francesco Maisano
- Department of Cardiac Surgery, University Hospital San Raffaele, Milan, Italy
| | - Giulio Russo
- Fondazione Policlinico A. Gemelli, IRCSS, Università Cattolica del Sacro Cuore-Roma, Rome, Italy.,Department of Cardiology, University of Zurich, Zurich, Switzerland
| | - Ana Paula Tagliari
- Department of Cardiology, University of Zurich, Zurich, Switzerland.,Department of Cardiology and Cardiovascular Sciences, Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences-Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mara Gavazzoni
- Department of Cardiology, University of Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, HerzZentrum Hirslanden, Zurich, Switzerland
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23
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Cosyns B, Sade LE, Gerber BL, Gimelli A, Muraru D, Maurer G, Edvardsen T. The year 2020 in the European Heart Journal-Cardiovascular Imaging: part II. Eur Heart J Cardiovasc Imaging 2021:jeab225. [PMID: 34718480 DOI: 10.1093/ehjci/jeab225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Indexed: 12/18/2022] Open
Abstract
The European Heart Journal-Cardiovascular Imaging was launched in 2012 and has during these years become one of the leading multimodality cardiovascular imaging journal. The journal is now established as one of the top cardiovascular journals and is the most important cardiovascular imaging journal in Europe. The most important studies published in our Journal from 2020 will be highlighted in two reports. Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease. While Part I of the review has focused on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging.
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Affiliation(s)
- Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
- Department of Cardiology, University of Baskent, Bağlıca Kampüsü, Dumlupınar Blv. 20. Km, 06810 Etimesgut/Ankara, Turkey
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate 10/2806, Brussels, Belgium
| | - Alessia Gimelli
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Italy
| | - Denisa Muraru
- Department of Cardiac, Neurological and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo Norway and Institute for clinical medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
- KG Jebsen Cardiac Research Centre, Institute for clinical medicine, University of Oslo, Sognsvannsveien 20, NO-0424 Oslo, Norway
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24
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Gavazzoni M, Taramasso M, PozzoliZ A, Euscher D, Kuck KH, Bohnen S, Zuber M, Voci D, Maisano F, Alessandrini H. Outcomes of Transcatheter Mitral Valve Repair With Edge-to-Edge Technique in Patients With Barlow Disease. JACC Cardiovasc Interv 2021; 14:2308-2310. [PMID: 34674871 DOI: 10.1016/j.jcin.2021.08.014] [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: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
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25
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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26
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Russo G, Taramasso M, Maisano F. Transseptal puncture: procedural guidance, challenging situations and management of complications. EUROINTERVENTION 2021; 17:720-727. [PMID: 33775929 PMCID: PMC9724844 DOI: 10.4244/eij-d-20-00454] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A number of interventional procedures based on the transseptal puncture (TSP) have been developed in recent years. The increasing number of interventional procedures, as well as the use of large-bore sheaths and complex devices, has led to improvements in technique and equipment. The combined use of fluoro-scopy and of transoesophageal echocardiography (TEE) has increased safety and precision. However, TSP still represents a tricky procedure, which may become even more difficult in cases of challenging interatrial septa, and life-threatening complications may occur. Consequently, an in-depth knowledge of procedural steps, equipment, echocardiographic views, fossa ovalis anatomy and how to manage the most frequent complications is critical to performing a successful TSP.
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Affiliation(s)
- Giulio Russo
- University Hospital, Zurich, Switzerland,Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy,Università Cattolica Del Sacro Cuore, Rome, Italy
| | | | - Francesco Maisano
- Klinik für Herz- und Gefässchirurgie, UniversitätsSpital, Rämistrasse 100, CH-8091 Zürich, Switzerland
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27
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 2252] [Impact Index Per Article: 750.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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28
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Russo G, Gennari M, Gavazzoni M, Pedicino D, Pozzoli A, Taramasso M, Maisano F. Transcatheter Mitral Valve Implantation: Current Status and Future Perspectives. Circ Cardiovasc Interv 2021; 14:e010628. [PMID: 34407621 DOI: 10.1161/circinterventions.121.010628] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mitral transcatheter therapies represent the treatment of choice for all patients deemed unsuitable for cardiac surgery. So far, the largest clinical experience has been limited to percutaneous repair techniques. However, given the complexity and heterogeneity of mitral valve anatomy and pathology, transcatheter mitral valve implantation will widen the mitral valve therapies horizon, toward a patient-tailored approach. Current data about transcatheter mitral valve implantation is still limited and, although some data are promising, there are still some issues to be addressed. This review provides a comprehensive insight into the available devices and describes potential advantages and limitations of transcatheter mitral valve implantation.
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Affiliation(s)
- Giulio Russo
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Marco Gennari
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,IRCCS Centro Cardiologico Monzino, Milan, Italy (M. Gennari)
| | - Mara Gavazzoni
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Alberto Pozzoli
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland (A.P.)
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29
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Lee APW, Fan Y, Baig FN, Lam YY. Mechanisms of Mitral Regurgitation. JACC: ASIA 2021; 1:115-116. [PMID: 36338368 PMCID: PMC9627915 DOI: 10.1016/j.jacasi.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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