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Misumi Y, Kawamura M, Yoshioka D, Kawamura T, Kawamura A, Ito Y, Mikami T, Taira M, Shimamura K, Miyagawa S. Restrictive annuloplasty or replacement on reverse remodeling for nonischemic dilated cardiomyopathy. J Cardiothorac Surg 2024; 19:201. [PMID: 38609986 PMCID: PMC11010381 DOI: 10.1186/s13019-024-02719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND For patients with nonischemic dilated cardiomyopathy (NIDCM), the indications for and results of mitral surgery remain controversial. We reviewed a strategy of mitral repair and replacement for clinically relevant secondary mitral regurgitation (MR) in patients with NIDCM. METHODS We retrospectively reviewed 65 patients with advanced NIDCM (LVEF < 40%) who underwent mitral surgery. Of them, 47 (72%) underwent mitral annuloplasty and 18 (28%) replacement for secondary MR. The primary endpoint was postoperative reduction in indexed LV end-systolic volume (LVESVI). RESULTS At baseline, there was no intergroup difference in LVESVI (123 ± 47 vs. 147 ± 37 ml/m2, P = 0.055), LVEF (27 ± 8% vs. 25 ± 6%, P = 0.41), incidence of severe MR (57% (27/47) vs. 72% (13/18), P = 0.40), or EuroSCORE II score (6.2% vs. 7.6%, P = 0.90). At 6 months, the annuloplasty group reduced LVESVI to a greater degree than the replacement group (P < 0.001), yielding significantly smaller postoperative LVESVI (96 ± 59 vs. 154 ± 61 ml/m2, P < 0.001) and better LVEF (P < 0.001). The rates of moderate/severe recurrent MR were 17% (8/47) and 0%, respectively. Multivariable analysis demonstrated that mitral annuloplasty (OR 6.10, 95% CI 1.14-32.8, P = 0.035) was significantly associated with postoperative LV reverse remodeling. Cumulative survival was not different between the groups (P = 0.26). CONCLUSIONS In patients with NIDCM, mitral annuloplasty reduced LV volume to a greater degree than did mitral replacement. These findings may assist with surgical options for secondary MR associated with NIDCM.
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Affiliation(s)
- Yusuke Misumi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yoshito Ito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Tsubasa Mikami
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Masaki Taira
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita City, Osaka, 565-0871, Japan
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Anker SD, Friede T, von Bardeleben RS, Butler J, Fatima K, Diek M, Heinrich J, Hasenfuß G, Schillinger W, Ponikowski P. Randomized investigation of the MitraClip device in heart failure: Design and rationale of the RESHAPE-HF2 trial design. Eur J Heart Fail 2024; 26:984-993. [PMID: 38654139 DOI: 10.1002/ejhf.3247] [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: 02/27/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS The safety and effectiveness of the MitraClip device to treat functional mitral regurgitation (FMR) has been tested in previous clinical trials yielding somewhat heterogeneous results in heart failure (HF) patients. Over time, the MitraClip device system has been modified and clinical practice evolved to consider also less severely diseased HF patients with FMR for this therapeutic option. The RESHAPE-HF2 trial aims to assess the safety and effectiveness of the MitraClip device system on top of medical therapy considered optimal in the treatment of clinically significant FMR in symptomatic patients with chronic HF. METHODS The RESHAPE-HF2 is an investigator-initiated, prospective, randomized, parallel-controlled, multicentre trial designed to evaluate the use of the MitraClip device (used in the most up-to-date version as available at sites) plus optimal standard of care therapy (device group) compared to optimal standard of care therapy alone (control group). Eligible subjects have signs and symptoms of HF (New York Heart Association [NYHA] class II-IV despite optimal therapy), and have moderate-to-severe or severe FMR, as confirmed by a central echocardiography core laboratory; have an ejection fraction between ≥20% and ≤50% (initially 15-35% for NYHA class II patients, and 15-45% for NYHA class III/IV patients); have been adequately treated per applicable standards, and have received appropriate revascularization and cardiac resynchronization therapy, if eligible; had a HF hospitalization or elevated natriuretic peptides (B-type natriuretic peptide [BNP] ≥300 pg/ml or N-terminal proBNP ≥1000 pg/ml) in the last 90 days; and in whom isolated mitral valve surgery is not a recommended treatment option. The trial has three primary endpoints, which are these: (i) the composite rate of total (first and recurrent) HF hospitalizations and cardiovascular death during 24 months of follow-up, (ii) the rate of total (i.e. first and recurrent) HF hospitalizations within 24 months, and (iii) the change from baseline to 12 months in the Kansas City Cardiomyopathy Questionnaire overall score. The three primary endpoints will be analysed using the Hochberg procedure to control the familywise type I error rate across the three hypotheses. CONCLUSIONS The RESHAPE-HF2 trial will provide sound evidence on the MitraClip device and its effects in HF patients with FMR. The recruitment was recently completed with 506 randomized patients.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Kaneez Fatima
- Department of Research, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Monika Diek
- Department of Cardiology (CVK) of German Heart Center Charité, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Jutta Heinrich
- Clinical Trial Unit, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Heart Research Center Göttingen, Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Schillinger
- Heart Center, Department of Cardiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
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Iovănescu ML, Hădăreanu DR, Toader DM, Florescu C, Istrătoaie O, Donoiu I, Militaru C. The Impact of Atrial Fibrillation on All Heart Chambers Remodeling and Function in Patients with Dilated Cardiomyopathy-A Two- and Three-Dimensional Echocardiography Study. Life (Basel) 2023; 13:1421. [PMID: 37374203 DOI: 10.3390/life13061421] [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: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Atrial fibrillation is frequently seen in patients with dilated cardiomyopathy (DCM), and its presence impacts the function of the heart, with clinical and prognostic consequences. In this prospective single-center study, we aimed to assess the impact of atrial fibrillation on cardiac structure and function, using comprehensive two- and three-dimensional echocardiography. We included 41 patients with DCM and persistent or permanent atrial fibrillation (38 male, age 58.8 ± 11 years), as well as 47 patients with DCM and in sinus rhythm (35 male, age 58 ± 12.5 years). Cardiac chambers and mitral and tricuspid valves' structure and function were assessed via standard two-dimensional, speckle-tracking, and three-dimensional echocardiography (3DE). Patients with DCM and atrial fibrillation had a more impaired left ventricular global longitudinal strain, higher 3DE left atrial volumes, and reduced function compared to patients in sinus rhythm in the presence of similar left ventricle volumes. Mitral annulus configuration was altered in atrial fibrillation DCM patients. Also, right heart volumes were larger, with more severe atrial and ventricular dysfunction, despite similar estimated pulmonary artery pressures and severity of tricuspid regurgitation. Using advanced echocardiography techniques, we demonstrated that atrial fibrillation induces significant remodeling in all heart chambers.
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Affiliation(s)
- Maria L Iovănescu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Diana R Hădăreanu
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Despina M Toader
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Cristina Florescu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Filantropia Clinical Hospital, 200516 Craiova, Romania
| | - Octavian Istrătoaie
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Ionuţ Donoiu
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
| | - Constantin Militaru
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 200642 Craiova, Romania
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Boudoulas KD, Vallakati A, Pitsis AA, Orsinelli DA, Abraham WT. The Use of MitraClip in Secondary Mitral Regurgitation and Heart Failure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1606-1612. [PMID: 32461047 DOI: 10.1016/j.carrev.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
Secondary (also known as functional) mitral regurgitation (MR) has increased substantially over the last several decades due to an increase in the prevalence of dilated cardiomyopathy (ischemic and non-ischemic). Mortality and morbidity in patients with dilated cardiomyopathy is much greater when associated with MR as compared to without MR. MR will result in further left ventricular (LV) volume overload, LV dilation, and pupillary muscle displacement resulting in deterioration of the severity of MR leading to a vicious cycle. Optimization of heart failure medical therapy, and cardiac resynchronization therapy for those that qualify, can improve severity of MR; however, significant MR will persist in certain patients. Transcatheter mitral valve repair to treat significant MR using the MitraClip (Abbott, Menlo Park, California), which grasps and coapts the posterior and anterior mitral valve leaflets, in appropriately selected patients with dilated cardiomyopathy and secondary MR has been shown to improve quality of life and prolong survival.
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Affiliation(s)
| | - Ajay Vallakati
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Antonios A Pitsis
- Department of Cardiothoracic Surgery, St. Luke's Hospital, Thessaloniki, Greece
| | - David A Orsinelli
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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Kashiyama N, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Sawa Y. Left Ventricular Stroke Work Index Associated With Outcome After Mitral Valve Surgery for Functional Regurgitation in Nonischemic Dilated Cardiomyopathy. Semin Thorac Cardiovasc Surg 2020; 32:698-709. [DOI: 10.1053/j.semtcvs.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/05/2019] [Indexed: 01/10/2023]
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6
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van Vessem ME, Petrus AH, Palmen M, Braun J, Schalij MJ, Klautz RJ, Beeres SL. Vasoplegia After Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation in Patients With Heart Failure. J Cardiothorac Vasc Anesth 2019; 33:3273-3280. [DOI: 10.1053/j.jvca.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 12/28/2022]
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Petrus AHJ, Klautz RJM, De Bonis M, Langer F, Schäfers HJ, Wakasa S, Vahanian A, Obadia JF, Assi R, Acker M, Siepe M, Braun J. The optimal treatment strategy for secondary mitral regurgitation: a subject of ongoing debate. Eur J Cardiothorac Surg 2019; 56:631-642. [DOI: 10.1093/ejcts/ezz238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Annelieke H J Petrus
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy
| | - Frank Langer
- Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Alec Vahanian
- Department of Cardiology, University Paris Diderot, Paris, France
| | | | - Roland Assi
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Acker
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Centre, Freiburg, Germany
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
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8
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Seferović PM, Polovina M, Bauersachs J, Arad M, Gal TB, Lund LH, Felix SB, Arbustini E, Caforio AL, Farmakis D, Filippatos GS, Gialafos E, Kanjuh V, Krljanac G, Limongelli G, Linhart A, Lyon AR, Maksimović R, Miličić D, Milinković I, Noutsias M, Oto A, Oto Ö, Pavlović SU, Piepoli MF, Ristić AD, Rosano GM, Seggewiss H, Ašanin M, Seferović JP, Ruschitzka F, Čelutkiene J, Jaarsma T, Mueller C, Moura B, Hill L, Volterrani M, Lopatin Y, Metra M, Backs J, Mullens W, Chioncel O, Boer RA, Anker S, Rapezzi C, Coats AJ, Tschöpe C. Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21:553-576. [DOI: 10.1002/ejhf.1461] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Petar M. Seferović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Marija Polovina
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Johann Bauersachs
- Department of Cardiology and AngiologyMedical School Hannover Hannover Germany
| | - Michael Arad
- Cardiomyopathy Clinic and Heart Failure Institute, Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Tuvia Ben Gal
- Department of CardiologyRabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Lars H. Lund
- Department of MedicineKarolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo Pavia Italy
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiological, Thoracic and Vascular SciencesUniversity of Padua Padua Italy
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Gerasimos S. Filippatos
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Elias Gialafos
- Second Department of CardiologyHeart Failure and Preventive Cardiology Section, Henry Dunant Hospital Athens Greece
| | | | - Gordana Krljanac
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe Limongelli
- Department of Cardiothoracic Sciences, Università della Campania ‘Luigi VanvitellI’Monaldi Hospital, AORN Colli, Centro di Ricerca Cardiovascolare, Ospedale Monaldi, AORN Colli, Naples, Italy, and UCL Institute of Cardiovascular Science London UK
| | - Aleš Linhart
- Second Department of Medicine, Department of Cardiovascular MedicineGeneral University Hospital, Charles University in Prague Prague Czech Republic
| | - Alexander R. Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London UK
| | - Ružica Maksimović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Centre for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia Belgrade Serbia
| | - Davor Miličić
- Department of Cardiovascular DiseasesUniversity Hospital Center Zagreb, University of Zagreb Zagreb Croatia
| | - Ivan Milinković
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Michel Noutsias
- Mid‐German Heart Center, Department of Internal Medicine III, Division of CardiologyAngiology and Intensive Medical Care, University Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Ali Oto
- Department of CardiologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Öztekin Oto
- Department of Cardiovascular SurgeryDokuz Eylül University Faculty of Medicine İzmir Turkey
| | - Siniša U. Pavlović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Pacemaker Center, Clinical Center of Serbia Belgrade Serbia
| | | | - Arsen D. Ristić
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe M.C. Rosano
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele Pisana Rome Italy
| | - Hubert Seggewiss
- Medizinische Klinik, Kardiologie & Internistische Intensivmedizin, Klinikum Würzburg‐Mitte Würzburg Germany
| | - Milika Ašanin
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Jelena P. Seferović
- Cardiovascular DivisionBrigham and Women's Hospital, Harvard Medical School Boston MA USA
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center Serbia and Faculty of MedicineUniversity of Belgrade Belgrade Serbia
| | - Frank Ruschitzka
- Department of CardiologyUniversity Heart Center Zürich Switzerland
| | - Jelena Čelutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius University Vilnius Lithuania
- State Research Institute Centre for Innovative Medicine Vilnius Lithuania
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health ScienceLinköping University Linköping Sweden
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel, University of Basel Basel Switzerland
| | - Brenda Moura
- Cardiology DepartmentCentro Hospitalar São João Porto Portugal
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast Belfast UK
| | | | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd Volgograd Russia
| | - Marco Metra
- Cardiology, Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, University of Brescia Brescia Italy
| | - Johannes Backs
- Department of Molecular Cardiology and EpigeneticsUniversity of Heidelberg Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim Heidelberg Germany
| | - Wilfried Mullens
- BIOMED ‐ Biomedical Research Institute, Faculty of Medicine and Life SciencesHasselt University Diepenbeek Belgium
- Department of CardiologyZiekenhuis Oost‐Limburg Genk Belgium
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucharest Romania
- Emergency Institute for Cardiovascular Diseases, ‘Prof. C. C. Iliescu’ Bucharest Romania
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Stefan Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT) Berlin Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Charité Berlin Germany
| | - Claudio Rapezzi
- Cardiology, Department of ExperimentalDiagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna Bologna Italy
| | - Andrew J.S. Coats
- Monash University, Australia, and University of Warwick Coventry UK
- Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy, and St George's University of London London UK
| | - Carsten Tschöpe
- Berlin‐Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) Berlin, Department of CardiologyCampus Virchow Klinikum, Charite ‐ Universitaetsmedizin Berlin Berlin Germany
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9
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Secondary mitral regurgitation: percutaneous edge-to-edge repair on the cutting edge? Curr Opin Cardiol 2018; 34:185-193. [PMID: 30575648 DOI: 10.1097/hco.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Secondary mitral regurgitation commonly complicates heart failure. Although the evidence for its management is most robust for treating the underlying cardiomyopathy, treatment aimed at additionally reducing the severity of mitral regurgitation with a percutaneous edge-to-edge device, MitraClip, has recently emerged. RECENT FINDINGS Despite the use of contemporary evidence-based heart failure therapies, patients with secondary mitral regurgitation and heart failure continue to remain at high risk for adverse clinical events; in both the MITRA-FR and COAPT trials, an extremely high event rate was evident in the medically managed arms over the respective 12-24-month follow-up. Data supporting the use of MitraClip to mitigate adverse outcomes in secondary mitral regurgitation is, however, conflicting. In MITRA-FR no difference was noted between MitraClip compared with the medically managed arm for the composite of all-cause death or heart failure hospitalization at 12 months. However, in COAPT, a significant reduction in the rate of heart failure re-hospitalization over 2 years was evident with MitraClip compared with medical therapy alone. SUMMARY Recommendations exist for the use of MitraClip in patients with primary mitral regurgitation and prohibitive surgical risk. However, with the divergent results of two recent high-quality randomized trials, its role in patients with secondary mitral regurgitation remains controversial.
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10
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Petrus AHJ, Tops LF, Timmer E, Versteegh MIM, Dekkers OM, Klautz RJM, Braun J. Prognostic value of left ventricular reverse remodelling and recurrent mitral regurgitation after personalized surgical treatment of patients with non-ischaemic cardiomyopathy and functional mitral regurgitation†. Interact Cardiovasc Thorac Surg 2018; 27:657-663. [DOI: 10.1093/icvts/ivy161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/15/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Annelieke H J Petrus
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Eva Timmer
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Michel I M Versteegh
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
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11
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Chung H, Amaki M, Takashio S, Takahama H, Ohara T, Hasegawa T, Sugano Y, Fujita T, Kobayashi J, Asakura M, Kanzaki H, Anzai T, Kitakaze M. Effect of Mitral Valve Surgery in Patients With Dilated Cardiomyopathy and Severe Functional Mitral Regurgitation. Circ J 2018; 82:131-140. [DOI: 10.1253/circj.cj-17-0104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hyemoon Chung
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Seiji Takashio
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takahiro Ohara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Masanori Asakura
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Hyogo University
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
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12
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Kamperidis V, van Wijngaarden SE, van Rosendael PJ, Kong WK, Leung M, Sianos G, Ajmone Marsan N, Delgado V, Bax JJ. Restrictive Mitral Valve Annuloplasty: Prognostic Implications of Left Ventricular Forward Flow. Ann Thorac Surg 2017; 104:1464-1470. [PMID: 28964411 DOI: 10.1016/j.athoracsur.2017.05.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 04/26/2017] [Accepted: 05/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surgical mitral valve repair for severe secondary mitral regurgitation (MR) remains controversial. The association of MR reduction and changes in left ventricular (LV) hemodynamics with survival has not been investigated. We investigated the independent associates of outcomes in heart failure patients with severe secondary MR who underwent surgical mitral valve repair. METHODS Patients (n = 130, 62 ± 12 years old, 55% men) with chronic severe secondary MR and impaired LV ejection fraction (<0.50, mean 0.31 ± 0.10) treated with surgical mitral valve repair were included. Echocardiographic LV forward stroke volume and LV forward ejection fraction were measured at baseline and at discharge. All-cause mortality was the primary endpoint, and the combination of major adverse cardiac-related events and all-cause mortality was the secondary endpoint. RESULTS At hospital discharge, 77% of patients showed no residual MR and 23% showed mild MR. LV volumes reduced significantly, whereas LV ejection fraction remained unchanged. In contrast, LV forward stoke volume (53 ± 24 mL versus 64 ± 22 mL, p < 0.001) and LV forward ejection fraction (0.32 ± 0.16 versus 0.48 ± 0.24, p < 0.001) significantly increased at discharge. During a median follow-up of 3.44 years, 33 patients (29%) died and 40 had major adverse cardiac-related events. On multivariable analysis, LV forward stroke volume after repair was independently associated with all-cause mortality (hazard ratio 0.98, p = 0.047) and with the combined endpoint (hazard ratio 0.98, p = 0.045) after correcting for other baseline, procedural, and postrepair characteristics. CONCLUSIONS In patients with severe secondary MR treated with surgical repair, LV forward flow was independently associated with better survival and lower risk of the combined endpoint.
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Affiliation(s)
- Vasileios Kamperidis
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Suzanne E van Wijngaarden
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Philippe J van Rosendael
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - William Kf Kong
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, National University Heart Center, National University Health System, Singapore
| | - Melissa Leung
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Georgios Sianos
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, The Netherlands.
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13
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Functional mitral regurgitation in patients with heart failure and depressed ejection fraction. Curr Opin Cardiol 2016; 31:483-92. [DOI: 10.1097/hco.0000000000000325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK. The Diagnosis and Evaluation of Dilated Cardiomyopathy. J Am Coll Cardiol 2016; 67:2996-3010. [DOI: 10.1016/j.jacc.2016.03.590] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 01/23/2023]
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Taramasso M, Inderbitzin DT, Guidotti A, Nietlispach F, Gaemperli O, Zuber M, Maisano F. Transcatheter direct mitral valve annuloplasty with the Cardioband system for the treatment of functional mitral regurgitation. Multimed Man Cardiothorac Surg 2016; 2016:mmw004. [PMID: 27247326 DOI: 10.1093/mmcts/mmw004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/28/2016] [Indexed: 06/05/2023]
Abstract
Direct mitral valve annuloplasty is a transcatheter mitral valve repair approach that mimics the conventional surgical approach to treat functional mitral regurgitation. The Cardioband system (Valtech Cardio, Inc., Or-Yehuda, Israel) is delivered by a trans-septal approach and the implant is performed on the atrial side of the mitral annulus, under live echo and fluoroscopic guidance using multiple anchor elements. The Cardioband system obtained CE mark approval in October 2015, and initial clinical experiences are promising with regard to feasibility, safety and efficacy.
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Affiliation(s)
- Maurizio Taramasso
- Cardiovascular Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Devdas T Inderbitzin
- Cardiovascular Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Guidotti
- Cardiovascular Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Nietlispach
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Cardiovascular Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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16
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Armeni P, Boscolo PR, Tarricone R, Capodanno D, Maggioni AP, Grasso C, Tamburino C, Maisano F. Real-world cost effectiveness of MitraClip combined with Medical Therapy Versus Medical therapy alone in patients with moderate or severe mitral regurgitation. Int J Cardiol 2016; 209:153-60. [PMID: 26894467 DOI: 10.1016/j.ijcard.2016.01.212] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/07/2016] [Accepted: 01/31/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND We evaluated the real-world cost-effectiveness of the MitraClip system (Abbott Vascular Inc., Menlo Park, CA) plus medical therapy for patients with moderate/severe mitral regurgitation, as compared with medical therapy (MT) alone. METHODS Clinical records of patients with moderate to severe functional mitral regurgitation treated with MitraClip (N=232) or with MT (N=151) were collected and outcome analyzed with propensity score adjustment to reduce selection bias. Twelve-month outcomes were modeled over a lifetime horizon to conduct a cost-effectiveness analysis, in the payer's perspective. Costs and benefits were discounted at an annual rate of 3.5%. RESULTS After propensity score adjustment, the average treatment effect was -9.5% probability of dying at 12months and, following lifetime modeling, 3.35±0.75 incremental life years and 3.01±0.57 incremental quality-adjusted life years. MitraClip contributed to a higher decrease in re-hospitalizations at 12months (difference=-0.54±0.08) and generated a more likely improvement in the New York Heart Association (NYHA) class at 12months versus NYHA at enrollment. Incremental costs, adapted to five possible scenarios, ranged from 14,493 to 29,795 € contributing to an incremental cost-effectiveness ratio ranging from 4796 to 7908 €. CONCLUSIONS Compared to MT alone and given conventional threshold values, MitraClip can be considered a cost-effective procedure. The cost-effectiveness of MitraClip is in line or superior to the one of other non-pharmaceutical strategies for heart failure.
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Affiliation(s)
- Patrizio Armeni
- CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy
| | - Paola R Boscolo
- CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- CERGAS (Centre for Research on Social and Healthcare Management) Bocconi University, Milan, Italy; Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | | | | | - Carmelo Grasso
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Francesco Maisano
- Cardiovascular Surgery Department, University Hospital of Zurich, Switzerland
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Do age, diabetes and left ventricular function affect the outcomes of ischemic mitral valve repair? POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 11:239-45. [PMID: 26336429 PMCID: PMC4283876 DOI: 10.5114/kitp.2014.45670] [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: 03/12/2014] [Revised: 03/12/2014] [Accepted: 06/20/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It is well documented that older age, chronic concomitant diseases (such as diabetes mellitus, chronic obstructive lung disease, etc.), and poor left ventricular function can increase the postoperative complication rate and worsen the general outcomes of coronary artery bypass (CABG) and concomitant repair of ischemic mitral regurgitation (MR). MATERIAL AND METHODS Retrospective data of 394 patients after CABG and mitral valve (MV) repair (mainly annuloplasty) were analyzed. Patients were grouped according to age, diabetes mellitus (DM), and left ventricular ejection fraction (LVEF). Echocardiography data, the rate of postoperative complications (cardiogenic shock, preoperative myocardial infarction, bleeding from the gastrointestinal tract, cognitive disorders, stroke, sepsis, deep wound infection), and early and late mortality were compared between paired groups. RESULTS There were no differences between age groups in reverse positive remodeling of LV. A significantly higher incidence of sepsis and deep wound infection in younger patients was observed. Patients with DM had no change in the pre-postoperative NYHA class and a higher rate of perioperative MI (10.3% vs. 3.1% respectively, p < 0.05) in comparison to patients with no DM. In all LVEF groups, MR was significantly decreased, but reverse positive remodeling of LV was pronounced only in those with "poor" and "moderately lowered" LVEF. Postoperative complications did not differ among these three groups. CONCLUSIONS Elderly age, concomitant DM and lowered LVEF do not influence either early or late mortality, including early postoperative outcomes after MV repair for ischemic MR following CABG. Concomitant DM increases the rate of perioperative MI and impairs reverse remodeling of LV.
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D’Ancona G, Kische S, Agma HU, Ince H. Treatment of secondary mitral valve regurgitation: why we need combined and evolving percutaneous strategies to tackle this moving target. EUROINTERVENTION 2015; 11 Suppl W:W49-52. [DOI: 10.4244/eijv11swa13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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D'ascenzo F, Moretti C, Marra WG, Montefusco A, Omede P, Taha S, Castagno D, Gaemperli O, Taramasso M, Frea S, Pidello S, Rudolph V, Franzen O, Braun D, Giannini C, Ince H, Perl L, Zoccai G, Marra S, D'Amico M, Maisano F, Rinaldi M, Gaita F. Meta-analysis of the usefulness of Mitraclip in patients with functional mitral regurgitation. Am J Cardiol 2015; 116:325-31. [PMID: 25975726 DOI: 10.1016/j.amjcard.2015.04.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 02/08/2023]
Abstract
Midterm outcomes for patients presenting with heart failure and functional mitral regurgitation (MR) treated with Mitraclip remain unclear. Pubmed, Medline, and Google Scholar were systematically searched for studies enrolling patients with severe-moderate MR who underwent Mitraclip implantation. All events after at least 6 months were the primary safety end point (including death, rehospitalization for heart failure, and reinterventions), whereas change in the ejection fraction, left ventricular volumes, arterial pulmonary pressure, and left atrial diameters were considered as secondary end points. Meta-regression analysis was performed to evaluate the effect of baseline clinical and echocardiographic parameters on efficacy outcomes: 875 patients were included in 9 studies; 1.48 clips (1.3 to 1.7) for patients were implanted, and after a median follow-up of 9 months (6 to 12), 409 patients (78% [75% to 83%]) were in class New York Heart Association I/II and 57 (11% [8% to 14%]) still had moderate-to-severe MR. Overall adverse events occurred in 137 (26% [20% to 31%]) of the patients and 78 (15% [1% to 17%]) of them died; 6-minute walk test improved by 100 m (83 to 111), whereas a significant reduction in left ventricular volumes and systolic pulmonary pressure was reported. At meta-regression analysis, an increase in left ventricle systolic volumes positively affected reduction of volumes after Mitraclip, whereas atrial fibrillation reduced the positive effect of the valve implantation on ejection fraction on end-diastolic and -systolic volumes. In conclusion, Mitraclip represents an efficacious strategy for patients with heart failure and severe MR. It offers a significant improvement in functional class and in cardiac remodeling, in patients with severely dilated hearts as well, although its efficacy remains limited in the presence of atrial fibrillation.
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20
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Secondary Mitral Regurgitation in Heart Failure. J Am Coll Cardiol 2015; 65:1231-1248. [DOI: 10.1016/j.jacc.2015.02.009] [Citation(s) in RCA: 303] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/16/2015] [Accepted: 02/03/2015] [Indexed: 12/23/2022]
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BAIL DOROTHEEH. (Meta)-Analysis of Safety and Efficacy Following Edge-to-Edge Mitral Valve Repair Using the MitraClip System. J Interv Cardiol 2015; 28:69-75. [DOI: 10.1111/joic.12168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- DOROTHEE H.L. BAIL
- Competence-Center Quality Assurance; Medical Service of Statutory Healthcare Insurance; Tuebingen and Stuttgart; Germany
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22
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Functional Mitral Regurgitation: Therapeutic Strategies for a Ventricular Disease. J Card Fail 2014; 20:252-67. [DOI: 10.1016/j.cardfail.2014.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/02/2014] [Accepted: 01/10/2014] [Indexed: 12/25/2022]
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24
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Badescu GC, Kisslo J, Risum N, Glower DD, Swaminathan M. Dyssynchrony: A Different Kind of Mitral Regurgitation. J Cardiothorac Vasc Anesth 2013; 27:1421-3. [DOI: 10.1053/j.jvca.2013.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Indexed: 01/04/2023]
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25
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Hauser J, Michel-Behnke I, Khazen C, Laufer G, Pees C. Successful cardiac resynchronization therapy in a 1.5-year-old girl with dilated cardiomyopathy and functional mitral regurgitation. Int J Cardiol 2013; 167:e83-4. [DOI: 10.1016/j.ijcard.2013.03.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
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26
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Functional mitral regurgitation: a 30-year unresolved surgical journey from valve replacement to complex valve repairs. Heart Fail Rev 2013; 19:341-58. [DOI: 10.1007/s10741-013-9392-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Nicolini F, Maestri F, Agostinelli A, Molardi A, Benassi F, Gallingani A, Gherli T. Surgical treatment for functional mitral regurgitation secondary to dilated cardiomyopathy: Current options and future trends. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.31a016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Atluri P, Acker MA. Mitral valve surgery for dilated cardiomyopathy: current status and future roles. Semin Thorac Cardiovasc Surg 2012; 24:51-8. [PMID: 22643662 DOI: 10.1053/j.semtcvs.2012.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2012] [Indexed: 11/11/2022]
Abstract
There are a large number of patients with functional mitral regurgitation resulting from dilated cardiomyopathy. The decision between surgical correction and medical management of severe mitral regurgitation in heart failure can be difficult. The data regarding long-term benefits and mortality after surgical intervention are contradictory. Recent data suggest that mitral regurgitation can be surgically corrected in heart failure with symptomatic improvements and beneficial reverse remodeling. Contrary to prior beliefs, mitral valve repair can be performed safely with minimal postoperative mortality. Data from multi-institutional, randomized prospective trials will help to elucidate many of the questions and concerns regarding repair of severe functional mitral regurgitation.
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Affiliation(s)
- Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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