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Drake DH, Zhang P, Zimmerman KG, Morrow CD, Sidebotham DA. Anatomic, stage-based repair of secondary mitral valve disease. J Thorac Cardiovasc Surg 2024; 167:1733-1744. [PMID: 36775783 DOI: 10.1016/j.jtcvs.2023.01.006] [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: 09/12/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Intervention for repair of secondary mitral valve disease is frequently associated with recurrent regurgitation. We sought to determine if there was sufficient evidence to support inclusion of anatomic indices of leaflet dysfunction in the management of secondary mitral valve disease. METHODS We performed a systematic review and meta-analysis of published reports comparing anatomic indices of leaflet dysfunction with the complexity of valve repair and the outcome from intervention. Patients were stratified by the severity of leaflet dysfunction. A secondary analysis was performed comparing outcomes when procedural complexity was optimally matched to severity of leaflet dysfunction and when intervention was not matched to dysfunction. RESULTS We identified 6864 publications, of which 65 met inclusion criteria. An association between the severity of leaflet dysfunction and the procedural complexity was highly predictive of satisfactory freedom from recurrent regurgitation. Patients were categorized into 4 groups based on stratification of leaflet dysfunction. Satisfactory results were achieved in 93.7% of patients in whom repair complexity was appropriately matched to severity of leaflet dysfunction and in 68.8% in whom repair was not matched to dysfunction (odds ratio, 0.148; 95% confidence interval, 0.119-0.184; P < .0001). CONCLUSIONS For patients with secondary mitral valve disease, satisfactory outcome from valve repair improves when procedural complexity is matched to anatomic indices of leaflet dysfunction. Anatomic indices of leaflet dysfunction should be considered when planning interventions for secondary mitral regurgitation. Routine inclusion of anatomic indices in trial design and reporting should facilitate comparison of results and strengthen guidelines. There are sufficient data to support anatomic staging of secondary mitral valve disease.
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Affiliation(s)
- Daniel H Drake
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Mich; Department of Surgery, Munson Medical Center, Traverse City, Mich.
| | - Peng Zhang
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
| | | | - Cynthia D Morrow
- Health Systems, Management & Policy, Colorado School of Public Health, Aurora, Colo
| | - David A Sidebotham
- Department of Cardiothoracic Anaesthesia and Cardiothoracic Intensive Care, Auckland City Hospital, Auckland, New Zealand
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2
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Leurent G, Auffret V, Grinberg D, Le Ruz R, Saint Etienne C, Pierrard R, Champagnac D, Benard T, Lecoq G, Arnould MA, Bonnet G, Lhermusier T, Anselmi A, Corbineau H, Donal E. Transcatheter edge-to-edge repair following surgical valve repair with ring implantation: Results from the multicentre "Clip-in-Ring" registry. Arch Cardiovasc Dis 2022; 115:521-528. [PMID: 36115768 DOI: 10.1016/j.acvd.2022.05.009] [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: 10/22/2021] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Management of mitral regurgitation recurrence after failed surgical valve repair with ring implantation is controversial. AIM To describe the French experience regarding midterm safety and efficacy of transcatheter edge-to-edge mitral valve repair (TEER) in patients with failed surgical valve repair with ring implantation. METHODS The "Clip-in-Ring" registry is a multicentre registry conducted in 11 centres in France, approved by local institutional review boards, of consecutive TEER following surgical valve repair with ring implantation. Outcomes were Mitral Valve Academic Research Consortium (MVARC) technical success, modified 30-day device and procedural success (where 10mmHg is considered as a cut-off for significant mitral stenosis) and MVARC complications. RESULTS Twenty-three patients were studied: mean age, 69±10years; male sex, 74%; EuroSCORE II, 16±17; left ventricular ejection fraction, 53±12%; mitral regurgitation grade 3+/4+, 17%/78%; New York Heart Association class III/IV, 47%/22%; median surgery to TEER delay, 23 (6-94) months. Technical success was 100%. At discharge, residual mitral regurgitation grade was≤2+ in 87% and median transmitral gradient was 4 (3-5) mmHg. Thirty-day modified MVARC device and procedural success was 82%: four patients (17%) had residual mitral regurgitation grade>2+, including two patients who needed complementary surgery. No patient had a 30-day transmitral gradient>7mmHg. No patient died or had a stroke or any life-threatening complications. One patient presented a vascular access complication requiring transfusion. No other MVARC-2 adverse event was reported. CONCLUSIONS TEER in patients with failed mitral ring is feasible and safe. Further studies shoulddelineate its exact role in the therapeutic armamentarium for this medical issue.
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Affiliation(s)
- Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes, 35000 Rennes, France.
| | - Vincent Auffret
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes, 35000 Rennes, France
| | - Daniel Grinberg
- Chirurgie Cardiothoracique et Transplantation, Hôpital Cardiovasculaire Louis-Pradel, Hospices Civils de Lyon, Claude-Bernard University, 69677 Bron, France
| | - Robin Le Ruz
- Department of Cardiology, University Hospital of Nantes, L'Institut du Thorax, Inserm, UMR 1087, CNRS-UMR 6291, 44000 Nantes, France
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine, Université François-Rabelais, 37000 Tours, France
| | - Romain Pierrard
- Service de Cardiologie, CHU Nord, 42100 Saint-Étienne, France
| | - Didier Champagnac
- Service de Cardiologie, Medipôle Lyon Villeurbanne, 69100 Villeurbanne, France
| | - Thomas Benard
- Service Médico-Chirurgical de Valvulopathies, CHU Angers, 49000 Angers, France
| | - Guillaume Lecoq
- Service de Cardiologie, Hôpital Privé Saint-Martin, 14000 Caen, France
| | - Marc Antoine Arnould
- Service de Cardiologie, Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Guillaume Bonnet
- Medico-Surgical Department of Valvulopathies, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Thibault Lhermusier
- Service de Cardiologie, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, 35000 Rennes, France
| | - Hervé Corbineau
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, 35000 Rennes, France
| | - Erwan Donal
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes, 35000 Rennes, France
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Pennington C, Kurosawa TA, Navarro-Cubas X, Bristow P. Use of the Functional Evaluation of Cardiac Health questionnaire to assess health-related quality of life before and after mitral valve repair in dogs with myxomatous mitral valve disease. J Am Vet Med Assoc 2022; 260:1806-1812. [PMID: 35594202 DOI: 10.2460/javma.22.02.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine changes in health-related quality of life up to 12 months after surgery in dogs with myxomatous mitral valve disease that undergo mitral valve repair. ANIMALS 54 dogs that underwent mitral valve repair at a United Kingdom referral hospital. PROCEDURES Health-related quality of life was assessed with a previously validated, owner-completed questionnaire before and 1, 3, 6, and 12 months after surgery. Results There was a significant decrease in total score (corresponding to reduced negative impact of cardiac disease on quality of life) between the preoperative timepoint and all postoperative timepoints. A significant decrease in total score was also demonstrated between the 1- and 3-month timepoints, but no additional significant changes in total score between adjacent timepoints were identified beyond 3 months after surgery. Significant improvements in individual question scores were found up to 12 months after surgery. CLINICAL RELEVANCE Health-related quality of life was significantly improved following mitral valve repair in dogs with myxomatous mitral valve disease and this improvement persisted for up to a year after surgery. These results may be useful when counseling owners of dogs considered candidates for this procedure.
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Affiliation(s)
- Catrina Pennington
- 1Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Wirral, UK
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4
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Meucci MC, Delgado V. Preoperative assessment of mitral valve regurgitation with two- and three-dimensional transesophageal echocardiography. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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5
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Prognostic value of left atrial strain quantification from 2D ultrasound imaging in post-ischemic heart failure patients: evidence from the REMODEL-HF study. Int J Cardiol 2022; 362:183-189. [DOI: 10.1016/j.ijcard.2022.04.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022]
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Sinn M, Pausch J, Ragab H, Sequeira-Gross T, von Stumm M, Spink C, Adam G, Reichenspurner H, Bannas P, Lund G, Girdauskas E. Changes in left ventricular geometry after subannular repair in type IIIb functional mitral regurgitation. Eur J Cardiothorac Surg 2022; 62:6561280. [DOI: 10.1093/ejcts/ezac226] [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] [Received: 05/13/2021] [Revised: 03/09/2022] [Accepted: 03/25/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
Papillary muscle repositioning in functional mitral regurgitation (FMR) alleviates mitral valve (MV) tenting by reducing the distance between papillary muscle tips and MV annular plane, i.e. apical left ventricular (LV) displacement. We aimed to quantify the effect of papillary muscle repositioning on papillary muscle geometry and to evaluate whether improved papillary muscle geometry after papillary muscle repositioning translates into the global LV reverse remodelling in FMR type IIIb.
METHODS
Patients with severe FMR type IIIb were prospectively enrolled and underwent pre- and postoperative 1.5-T cardiac magnetic resonance imaging. A new variable was defined, the papillary muscle to mitral annulus distance, which quantifies the distance between papillary muscle tips and MV annular plane. All parameters were measured by 2 independent investigators.
RESULTS
A total of 63 patients were enrolled. In all patients, papillary muscle to mitral annulus distance correlated significantly with established markers of LV remodelling and MV tenting severity. In patients who underwent subannular papillary muscle repositioning procedure (surgical cohort, n = 23), preoperative median papillary muscle to mitral annulus distance was 30 mm [interquartile range (IQR): 27–34 mm] and was significantly reduced postoperatively to 25 mm (IQR: 21–27 mm) (P = 0.001). LV end-diastolic diameter was reduced from 66 mm (IQR: 60–71) preoperatively to 58 mm (IQR: 53–67) after the surgery (P = 0.001).
CONCLUSIONS
MV repair with papillary muscle repositioning results in a papillary muscle to mitral annulus distance reduction and significantly improved MV tenting parameters. Improved papillary muscle geometry after papillary muscle repositioning is associated with a global LV reverse remodelling and may, thereby, improve the prognosis of FMR patients.
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Affiliation(s)
- Martin Sinn
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Jonas Pausch
- Department of Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Haissam Ragab
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany
| | | | - Maria von Stumm
- Department of Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany
| | | | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, Augsburg, Germany
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7
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Palmisano A, Nicoletti V, Colantoni C, Monti CB, Pannone L, Vignale D, Darvizeh F, Agricola E, Schaffino S, De Cobelli F, Esposito A. Dynamic changes of mitral valve annulus geometry at preprocedural CT: relationship with functional classes of regurgitation. Eur Radiol Exp 2021; 5:34. [PMID: 34386843 PMCID: PMC8360976 DOI: 10.1186/s41747-021-00231-3] [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: 09/30/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated mitral valve annular geometry changes during the cardiac cycle in patients with severe mitral regurgitation (MR) who underwent cardiac computed tomography angiography (CCTA) prior to percutaneous mitral valve replacement or annuloplasty. METHODS Fifty-one patients with severe MR and high surgical risk (Carpentier classification: 3 type I, 16 type II, 16 type IIIa, 16 type IIIb) underwent multiphase electrocardiographically gated (0-90%) CCTA, using a second generation dual-source CT scanner, as pre-procedural planning. Twenty-one patients without MR served as controls. The mitral valve annulus was segmented every 10% step of the R-R interval, according to the D-shaped segmentation model, and differences among groups were analysed by t-test or ANOVA. RESULTS Mitral annular area and diameters were larger in MR patients compared to controls, particularly in type II. Mitral annular area varied in MR patients throughout the cardiac cycle (mean ± standard deviation of maximum and minimum area 15.6 ± 3.9 cm2 versus 13.0 ± 3.5 cm2, respectively; p = 0.001), with greater difference between annular areas versus controls (2.59 ± 1.61 cm2 and 1.98 ± 0.6 cm2, p < 0.001). The largest dimension was found in systolic phases (20-40%) in most of MR patients (n = 27, 53%), independent of Carpentier type (I: n = 1, 33%; II: n = 10, 63%; IIIa: n = 8, 50%; IIIb: n = 8, 50%), and in protodiastolic phases (n = 14, 67%) for the control group. CONCLUSIONS In severe MR, mitral annular area varied significantly throughout the cardiac cycle, with a tendency towards larger dimensions in systole.
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Affiliation(s)
- Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Nicoletti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Caterina Colantoni
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Luigi Pannone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Echocardiography Unit, School of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Vignale
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Fatemeh Darvizeh
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Eustachio Agricola
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Echocardiography Unit, School of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Schaffino
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco De Cobelli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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8
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Mahmood F, Sharkey A, Maslow A, Mufarrih SH, Qureshi NQ, Matyal R, Khabbaz KR. Echocardiographic Assessment of the Mitral Valve for Suitability of Repair: An Intraoperative Approach From a Mitral Center. J Cardiothorac Vasc Anesth 2021; 36:2164-2176. [PMID: 34334319 DOI: 10.1053/j.jvca.2021.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 11/11/2022]
Abstract
Intraoperative echocardiography of the mitral valve in the precardiopulmonary bypass period is an integral part of the surgical decision-making process for assessment of suitability for repair. Although there are comprehensive reviews in the literature regarding echocardiographic examination of the mitral valve, the authors present a practical stepwise algorithmic workflow to make objective recommendations. Advances in echocardiography allow for quantitative geometric analyses of the mitral valve, along with precise assessment of the valvular apparatus with three-dimensional echocardiography. In the precardiopulmonary bypass period, echocardiographers are required to diagnose and quantify valvular dysfunction, assess suitability for repair, assist in annuloplasty ring sizing, and determine the success or failure of the surgical procedure. In this manuscript the authors outline an algorithmic approach to intraoperative echocardiography examination using two-dimensional and three-dimensional modalities to objectively analyze mitral valve function and assist in surgical decision-making.
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Affiliation(s)
- Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Syed Hamza Mufarrih
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Nada Qaisar Qureshi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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9
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Hellhammer K, Haurand JM, Spieker M, Luedike P, Rassaf T, Zeus T, Kelm M, Westenfeld R, Horn P. Predictors of functional mitral regurgitation recurrence after percutaneous mitral valve repair. Heart Vessels 2021; 36:1574-1583. [PMID: 33811553 PMCID: PMC8379112 DOI: 10.1007/s00380-021-01828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
We aimed to identify predictors of mitral regurgitation recurrence (MR) after percutaneous mitral valve repair (PMVR) in patients with functional mitral regurgitation (FMR). Patients with FMR were enrolled who underwent PMVR using the MitraClip® device. Procedural success was defined as reduction of MR of at least one grade to MR grade ≤ 2 + assessed at discharge. Recurrence of MR was defined as MR grade 3 + or worse at one year after initially successful PMVR. A total of 306 patients with FMR underwent PMVR procedure. In 279 out of 306 patients (91.2%), PMVR was successfully performed with MR grade ≤ 2 + at discharge. In 11.4% of these patients, MR recurrence of initial successful PMVR after 1 year was observed. Recurrence of MR was associated with a higher rate of heart failure rehospitalization during the 12 months follow-up (52.0% vs. 30.3%; p = 0.029), and less improvement in New York Heart Association (NYHA) functional class [68% vs. 19% of the patients presenting with NYHA functional class III or IV one year after PMVR when compared to patients without recurrence (p = 0.001)]. Patients with MR recurrence were characterized by a higher left ventricular sphericity index {0.69 [Interquartile range (IQR) 0.64, 0.74] vs. 0.65 (IQR 0.58, 0.70), p = 0.003}, a larger left atrium volume [118 (IQR 96, 143) ml vs. 102 (IQR 84, 123) ml, p = 0.019], a larger tenting height 10 (IQR 9, 13) mm vs. 8 (IQR 7, 11) mm (p = 0.047), and a larger mitral valve annulus [41 (IQR 38, 43) mm vs. 39 (IQR 36, 40) mm, p = 0.015] when compared to patients with durable optimal long-term results. In a multivariate regression model, the left ventricular sphericity index [Odds Ratio (OR) 1.120, 95% Confidence Interval (CI) 1.039–1.413, p = 0.003)], tenting height (OR 1.207, 95% CI 1.031–1.413, p = 0.019), and left atrium enlargement (OR 1.018, 95% CI 1.000–1.038, p = 0.047) were predictors for MR recurrence after 1 year. In patients with FMR, baseline parameters of advanced heart failure such as spherical ventricle, tenting height and a large left atrium might indicate risk of recurrent MR one year after PMVR.
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Affiliation(s)
- Katharina Hellhammer
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jean M Haurand
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Maximilian Spieker
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Peter Luedike
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.,Cardiovascular Research Institute, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Harky A, Botezatu B, Kakar S, Ren M, Shirke MM, Pullan M. Mitral valve diseases: Pathophysiology and interventions. Prog Cardiovasc Dis 2021; 67:98-104. [PMID: 33812859 DOI: 10.1016/j.pcad.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
Valvular heart disease is common and increasingly prevalent among the elderly. The end result of valvular pathologies is cardiac failure and can lead to sudden death; thus, diagnosis and interventions are very important in the early stages of these diseases. The usual treatment methods of mitral regurgitation include percutaneous mitral valve repair, mitral valve replacement and minimally invasive surgery, whereas the treatment methods of mitral stenosis include percutaneous transluminal mitral commissurotomy and mitral commissurotomy as well as open surgical repair. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is ever evolving. The focus of this paper is on the various pathologies of the mitral valve, their etiology and clinical management, offering a comprehensive view of mitral valve diseases.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK; Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Bianca Botezatu
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Sahil Kakar
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Moliu Ren
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Manasi Mahesh Shirke
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Mark Pullan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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11
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Wang TKM. Comparison of percutaneous MitraClip versus mitral valve surgery for severe mitral regurgitation: a meta-analysis: Mitraclip and mitral valve surgery meta-analysis. ASIAINTERVENTION 2020; 6:77-84. [PMID: 34912990 PMCID: PMC8525719 DOI: 10.4244/aij-d-19-00036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/10/2020] [Indexed: 11/03/2023]
Abstract
AIMS Mitral valve surgery (MVS) is the gold-standard treatment for severe symptomatic mitral regurgitation. Percutaneous mitral valve interventions such as the MitraClip procedure offer another dimension to its management particularly in high-risk patients. We meta-analysed the outcomes of MitraClip and MVS. METHODS AND RESULTS PubMed, MEDLINE, Embase, Cochrane and Scopus from 1980/01-2019/06 were searched for eligible studies. Data were extracted and pooled using random-effects models. After screening 959 studies and reviewing 21 full-text articles, nine studies totalling 640 MitraClip and 531 MVS (91% valve repair) procedures were included in the meta-analysis. MitraClip patients were older, with a higher prevalence of previous cardiac surgery, coronary disease and a higher EuroSCORE (all p<0.05) than MVS patients. Pooled operative mortality was similar for MitraClip, 3%, versus MVS, 5%, odds ratio (OR): 0.58, 95%, CI: 0.28-1.19, as well as at 1 year mortality, OR: 1.09, CI: 0.71-1.68 and 3-year mortality, OR: 1.08, CI: 0.72-0.163. MitraClip patients had higher rates of early and late significant mitral regurgitation (MR) and more cardiovascular readmissions, while MVS had higher rates of in-hospital bleeding and pacemaker implantation (all p<0.05). CONCLUSIONS MitraClip patients had a higher baseline risk than MVS, but there were no significant differences in short- and long-term mortality. MitraClip patients had higher rates of cardiovascular admissions and significant MR post-operatively, while MVS patients had more procedural complications.
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Affiliation(s)
- Tom Kai Ming Wang
- Green Lane Cardiovascular Service, Auckland City Hospital, 2 Grafton Road, Grafton, Auckland 1023, New Zealand. E-mail:
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Drake DH, Zimmerman KG, Sidebotham DA. Past, current and future management of secondary mitral valve disease: the importance of anatomic staging. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:968. [PMID: 32953768 PMCID: PMC7475447 DOI: 10.21037/atm.2020.03.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Daniel H Drake
- Department of Surgery, Munson Medical Center, Traverse City, MI, USA
| | - Karen G Zimmerman
- Department of Cardiology, Henry Ford Health System, Detroit, MI, USA
| | - David A Sidebotham
- Department of Cardiothoracic Anesthesia and Cardiothoracic Intensive Care Unit, Auckland City Hospital, Grafton, Auckland, New Zealand
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Kumar A, Al-Khafaji J, Shariff M, Vaz IP, Adalja D, Doshi R. Percutaneous mitral valve repair for secondary mitral valve regurgitation: A systematic review and meta-analysis. Eur J Intern Med 2020; 78:107-112. [PMID: 32094019 DOI: 10.1016/j.ejim.2020.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The first two randomized control trials (RCTs) studying the role of MitraClip in patients with secondary mitral regurgitation (MR) had antagonizing results. We, therefore, performed an updated meta-analysis of RCTs and propensity score-matched observational studies investigating the role of MitraClips in patients with secondary MR. A novel method of Kaplan Meier Curve reconstruction from derived individual patient data will be used to compare the survival probability of control groups in COAPT and MITRA HF trail, and hence, access inter-study heterogeneity. METHODS Medline and Cochrane databases was used for systematic search. We used the Mantel-Haenszel method with a random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI) and inverse variance method with a random-effect model to calculate the mean difference (MD) with 95% confidence interval (CI). We used a fixed-effect approach for meta-regression. RESULTS MitraClip reduced the risk of all-cause mortality [RR: 0.72, CI: 0.55-0.95, P value = 0.02, I2 = 55%, χ2P-value = 0.08] and readmission [RR: 0.62, CI: 0.42-0.92, P value = 0.02, I2 = 90%, χ2P-value<0.01] at two years follow-up. There was no effect of MitraClip on change in cardiovascular mortality and 6 m walking distance at 12 months follow-up. Meta-regression indicated left ventricular end diastolic volume and age among the factors affecting outcomes. Reconstructed Kaplan Meier curves confirmed considerable heterogeneity among patients randomized in MITRA HF and COAPT trial. CONCLUSION The present meta-analysis confirms the beneficial role of percutaneous mitral valve repair in patients with secondary MR. However, all the results were associated with considerable heterogeneity.
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Affiliation(s)
- Ashish Kumar
- Department of Critical Care, St John's Medical college hospital, Bengaluru, Karnataka, India
| | - Jaafar Al-Khafaji
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - Mariam Shariff
- Department of Critical Care, St John's Medical college hospital, Bengaluru, Karnataka, India
| | - Igor Pedreira Vaz
- Department of internal medicine, Jackson Memorial Hospital/University of Miami, Florida, USA
| | - Devina Adalja
- GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada, USA.
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Noack T, Kiefer P, Vivell N, Sieg F, Marin-Cuartas M, Leontyev S, Holzhey DM, Garbade J, Pfannmueller B, Davierwala P, Misfeld M, Seeburger J, Borger MA. Annuloplasty ring dehiscence after mitral valve repair: incidence, localization and reoperation. Eur J Cardiothorac Surg 2020; 57:300-307. [PMID: 31369069 DOI: 10.1093/ejcts/ezz219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Mitral valve (MV) annuloplasty ring dehiscence with subsequent recurrent mitral regurgitation represents an unusual but challenging clinical problem. Incidence, localization and outcomes for this complication have not been well defined. METHODS From 1996 to 2016, a total of 3478 patients underwent isolated MV repair with ring annuloplasty at the Leipzig Heart Centre. Of these patients, 57 (1.6%) underwent reoperation due to annuloplasty ring dehiscence. Echocardiographic data, operative and early postoperative characteristics as well as short- and long-term survival rates after MV reoperation were analysed. RESULTS Occurrences of ring dehiscence were acute (<30 days), early (≤1 year) and late (>1 year) in 44%, 33% and 23% of patients, respectively. Localization of annuloplasty ring dehiscence was found most frequently in the P3 segment (68%), followed by the P2 (51%) and the P1 segments (47%). The 30-day mortality rate and 1- and 5-year survival rates after MV reoperation were 2%, 89% and 74%, respectively. During reoperation, MV replacement was performed in 38 (67%) and MV re-repair in 19 (33%) patients. CONCLUSIONS Annuloplasty ring dehiscence is clinically less common, localized more frequently on the posterior annulus and occurs mostly acutely or early after MV repair. MV reoperation can be performed safely in such patients.
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Affiliation(s)
- Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Nina Vivell
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Franz Sieg
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | | | - Jens Garbade
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Bettina Pfannmueller
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Piroze Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Joerg Seeburger
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
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15
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303 Clinical Outcomes in Patients with Severe Tricuspid Regurgitation (TR). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miranda J, Ramiro V, Pasupati S, Nair R. A082 Clinical Outcomes in Patients With Severe Tricuspid Regurgitation (TR). Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Noack T, Marin Cuartas M, Kiefer P, Garbade J, Pfannmueller B, Seeburger J, Borger MA. Isolated Mitral Valve Repair in Patients with Reduced Left Ventricular Ejection Fraction. Ann Thorac Cardiovasc Surg 2019; 25:326-335. [PMID: 31588074 PMCID: PMC6923726 DOI: 10.5761/atcs.oa.19-00093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: This study aims to analyze the clinical outcomes after isolated mitral valve (MV) repair in patients with reduced left ventricular ejection fraction (LVEF <50%) with focus on perioperative characteristics, survival, and freedom from reoperations. Methods: Between 1997 and 2015, 557 patients with reduced LVEF (age: 62.8 ± 11.7 years, male: 320) underwent MV repair for symptomatic mitral regurgitation (MR). Etiologies were dilated non-ischemic cardiomyopathy and ischemic cardiomyopathy in 487 (87.4%) and 70 (12.6%) patients, respectively; these were classified into three different subgroups: LVEF 40%–49% (group 1), 30%–39% (group 2), and <30% (group 3). Results: Overall, 294, 145, and 118 patients had an LVEF of 40%–49%, 30%–39%, and <30%, respectively. Logistic EuroSCORE was significantly higher (P <0.001) as the LVEF worsened. The survival analysis for groups 1–3, respectively, revealed the following: 30-day mortality: 1.4%, 3.4%, and 7.6% (P <0.001); 1-year survival: 93.9%, 89.4%, and 82% (P <0.001); 5-year survival: 81.2%, 75.2%, and 58% (P <0.001). Conclusion: MV repair in patients with impaired LVEF could be performed safely with good clinical short- and mid-term outcome. Nevertheless, reduced preoperative LVEF correlates with worse perioperative and long-term survival.
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Affiliation(s)
- Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Mateo Marin Cuartas
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Bettina Pfannmueller
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Joerg Seeburger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
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Iung B, Delgado V, Lazure P, Murray S, Sirnes PA, Rosenhek R, Price S, Metra M, Carrera C, De Bonis M, Haude M, Hindricks G, Bax J, Vahanian A. Educational needs and application of guidelines in the management of patients with mitral regurgitation. A European mixed-methods study. Eur Heart J 2019; 39:1295-1303. [PMID: 29300869 DOI: 10.1093/eurheartj/ehx763] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/11/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To assess the knowledge and application of European Society of Cardiology (ESC) Guidelines in the management of mitral regurgitation (MR). Methods and results A mixed-methods educational needs assessment was performed. Following a qualitative phase (interviews), an online survey was undertaken using three case scenarios (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly, and severe secondary MR) in 115 primary care physicians (PCPs), and 439 cardiologists or cardiac surgeons from seven European countries. Systematic cardiac auscultation was performed by only 54% of clinicians in asymptomatic patients. Cardiologists appropriately interpreted echocardiographic assessment of mechanism and quantification of primary MR (≥75%), but only 44% recognized secondary MR as severe. In asymptomatic severe primary MR with an indication for surgery, 27% of PCPs did not refer the patient to a cardiologist and medical therapy was overused by 19% of cardiologists. In the elderly patient with severe symptomatic primary MR, 72% of cardiologists considered mitral intervention (transcatheter edge-to-edge valve repair in 72%). In severe symptomatic secondary MR, optimization of medical therapy was advised by only 51% of PCPs and 33% of cardiologists, and surgery considered in 30% of cases (transcatheter edge-to-edge repair in 64%). Conclusion Systematic auscultation is underused by PCPs for the early detection of MR. Medical therapy is overused in primary MR and underused in secondary MR. Indications for interventions are appropriate in most patients with primary MR, but are unexpectedly frequent for secondary MR. These gaps identify important targets for future educational programs.
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Affiliation(s)
- Bernard Iung
- AP-HP, Cardiology Department, Bichat Hospital, Paris-Diderot University, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Patrice Lazure
- AXDEV Group Inc., 210-8, Place du Commerce, Brossard, Quebec J4W 3H2, Canada
| | - Suzanne Murray
- AXDEV Group Inc., 210-8, Place du Commerce, Brossard, Quebec J4W 3H2, Canada
| | - Per Anton Sirnes
- Cardiology Practice, Østlandske Hjertesenter, Triovingv. 3, 1523 Moss, Norway
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Susanna Price
- Unit of Critical Care, Royal Brompton & Harefield NHS Trust, Sydney Street, London SW3 6NP, UK and National Heart & Lung Institute, Imperial College, Guy Scadding Building, Cale Street, London, SW3 6LY, UK
| | - Marco Metra
- Cardiology Department, University Hospital of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy
| | - Céline Carrera
- Education Committee, European Society of Cardiology, Heart House. 2035 Route des Colles, 06903 Sophia-Antipolis, France
| | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, via Olgettina 60, 20132 Milano, Italy
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Preußenstraße 84, 41464 Neuss, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Alec Vahanian
- AP-HP, Cardiology Department, Bichat Hospital, Paris-Diderot University, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France
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Iung B, Armoiry X, Vahanian A, Boutitie F, Mewton N, Trochu JN, Lefèvre T, Messika-Zeitoun D, Guerin P, Cormier B, Brochet E, Thibault H, Himbert D, Thivolet S, Leurent G, Bonnet G, Donal E, Piriou N, Piot C, Habib G, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Saint Etienne C, Leroux L, Gilard M, Samson G, Rioufol G, Maucort-Boulch D, Obadia JF. Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years. Eur J Heart Fail 2019; 21:1619-1627. [PMID: 31476260 DOI: 10.1002/ejhf.1616] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS The MITRA-FR trial showed that among symptomatic patients with severe secondary mitral regurgitation, percutaneous repair did not reduce the risk of death or hospitalization for heart failure at 12 months compared with guideline-directed medical treatment alone. We report the 24-month outcome from this trial. METHODS AND RESULTS At 37 centres, we randomly assigned 304 symptomatic heart failure patients with severe secondary mitral regurgitation (effective regurgitant orifice area >20 mm2 or regurgitant volume >30 mL), and left ventricular ejection fraction between 15% and 40% to undergo percutaneous valve repair plus medical treatment (intervention group, n = 152) or medical treatment alone (control group, n = 152). The primary efficacy outcome was the composite of all-cause death and unplanned hospitalization for heart failure at 12 months. At 24 months, all-cause death and unplanned hospitalization for heart failure occurred in 63.8% of patients (97/152) in the intervention group and 67.1% (102/152) in the control group [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.77-1.34]. All-cause mortality occurred in 34.9% of patients (53/152) in the intervention group and 34.2% (52/152) in the control group (HR 1.02, 95% CI 0.70-1.50). Unplanned hospitalization for heart failure occurred in 55.9% of patients (85/152) in the intervention group and 61.8% (94/152) in the control group (HR 0.97, 95% CI 0.72-1.30). CONCLUSIONS In patients with severe secondary mitral regurgitation, percutaneous repair added to medical treatment did not significantly reduce the risk of death or hospitalization for heart failure at 2 years compared with medical treatment alone.
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Affiliation(s)
- Bernard Iung
- Université de Paris and INSERM 1148, Paris, France.,APHP, Hôpital Bichat, DHU FIRE, Paris, France
| | - Xavier Armoiry
- Pharmacy Department and Laboratoire MATEIS, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | - Florent Boutitie
- Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Villeurbanne, France
| | - Nathan Mewton
- Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center & Heart Failure Department, INSERM 1407, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Jean-Noël Trochu
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Nantes, France
| | | | - David Messika-Zeitoun
- Université de Paris and INSERM 1148, Paris, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Patrice Guerin
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Nantes, France
| | | | - Eric Brochet
- Université de Paris and INSERM 1148, Paris, France
| | - Hélène Thibault
- Hôpital Cardiovasculaire Louis Pradel, Service des Explorations Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | - Sophie Thivolet
- Hôpital Cardiovasculaire Louis Pradel, Service des Explorations Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | - Erwan Donal
- CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Nicolas Piriou
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Nantes, France
| | | | | | | | | | | | - Patrick Ohlmann
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | | | | | | | - Géraldine Samson
- Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center & Heart Failure Department, INSERM 1407, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Gilles Rioufol
- Hopital Cardiovasculaire Louis Pradel, Service d'Hémodynamique et Cardiologie Interventionnelle, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Delphine Maucort-Boulch
- Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Villeurbanne, France
| | - Jean François Obadia
- Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
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Goliasch G, Bartko PE, Pavo N, Neuhold S, Wurm R, Mascherbauer J, Lang IM, Strunk G, Hülsmann M. Refining the prognostic impact of functional mitral regurgitation in chronic heart failure. Eur Heart J 2019; 39:39-46. [PMID: 29020337 DOI: 10.1093/eurheartj/ehx402] [Citation(s) in RCA: 262] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/27/2017] [Indexed: 01/17/2023] Open
Abstract
Aims Significant efforts are currently undertaken to reduce functional mitral regurgitation (FMR) in patients with chronic heart failure in the hope to improve prognosis. We aimed to assess the prognostic impact of FMR in heart failure with reduced ejection fraction (HFrEF) under optimal medical therapy (OMT) and various conditions of HFrEF. We further intended to identify a heart failure phenotype, where FMR is most likely a driving force and not a mere bystander of the disease. Methods and results We prospectively included 576 consecutive HFrEF patients into our long-term observational study. Functional [i.e. New York Heart Association (NYHA) class], echocardiographic, invasive haemodynamic, and biochemical (i.e. NT-proBNP, MR-proANP, MR-proADM, CT-proET-1, copeptin) measurements were performed at baseline. During a median follow-up of 62 months (interquartile range 52-76), 47% of patients died. Severe FMR was a significant predictor of mortality [hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.34-2.30; P < 0.001], independent of clinical (adjusted HR 1.61, 95% CI 1.22-2.12; P = 0.001), and echocardiographic (adjusted HR 1.46, 95% CI 1.09-1.94; P = 0.01) confounders, OMT (adjusted HR 1.81, 95% CI 1.25-2.63; P = 0.002), and neurohumoral activation (adjusted HR 1.38, 95% CI 1.03-1.84; P = 0.03). Subanalysis revealed that severe FMR was associated with poor outcome in an intermediate-failure phenotype of HFrEF i.e. patients with NYHA class II (adjusted HR 2.17, 95% CI 1.07-4.44; P = 0.03) and III (adjusted HR 1.80, 95% CI 1.17-2.77; P = 0.008), moderately reduced left ventricular function (adjusted HR 2.37, 95% CI 1.36-4.12; P = 0.002), and within the second quartile (871-2360 pg/mL) of NT-proBNP (adjusted HR 2.16, 95% CI 1.22-3.86; P = 0.009). Conclusion In a patient cohort under OMT, the adverse prognostic impact of FMR is given predominantly in a sub-cohort of a specific intermediate-failure phenotype-well-defined functionally, haemodynamically, biochemically, and morphologically.
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Affiliation(s)
- Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Stephanie Neuhold
- Department of Medicine IV, Kaiser Franz Josef Spital, Kundratstraße 3, 1100 Wien, Vienna, Austira
| | - Raphael Wurm
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Guido Strunk
- FH Campus Wien and Complexity Research, Favoritenstrasse 226, 1100 Wien, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Abstract
Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition. However, new, minimally invasive transcatheter therapies, in particular the MitraClip system, have shown promise in the treatment of FMR in selected patients. This review will summarize the pathophysiology underlying FMR, the prognosis of patients with heart failure and FMR, and the various medical and procedural treatment options currently available and under investigation.
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Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne 2019; 14:326-332. [PMID: 31119001 PMCID: PMC6528108 DOI: 10.5114/wiitm.2019.81663] [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: 09/13/2018] [Accepted: 10/24/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Minimally invasive mitral valve surgery (MIMVS) has become a widely accepted alternative to the standard sternotomy approach for treatment of mitral valve (MV) disease. Because the extent and location of mini-thoracotomies employed for MIMVS vary from center to center, the conclusions regarding superior cosmesis are not generalizable. The totally thoracoscopic periareolar (TTP) – MIMVS technique has been used at our department for minimally invasive cardiac surgery since 2015. Aim To report early surgical data as well as mid-term outcomes in patients undergoing TTP-MIMVS. Material and methods Between 2015 and 2017, 48 consecutive patients (mean age: 65.4 ±10; 83% men; EuroSCORE II: 5.1 ±4%) underwent TTP-MIMVS due to mitral and mitral/tricuspid valve (TV) disease; patients’ demographics and clinical outcomes were prospectively collected. Kaplan-Meier estimates of survival and freedom from re-intervention were analyzed as well. Results Mean follow-up was 1.7 (max 2.5) years. Of 48 patients, 33 (69%) underwent isolated MV repair, 4 (8%) isolated MV replacement and 11 (23%) MV/TV repair. The cardiopulmonary bypass and aortic cross-clamp time was 166 ±70 and 103 ±39 min respectively. There was no conversion to either full sternotomy or a mini-thoracotomy approach. Median (interquartile range) duration of intensive care unit stay was 1.2 (1.0–2.0) days. There was one in-hospital death (2.1%) in the TTP-MIMVS group. No strokes or wound infections were observed. Within the investigated follow-up, the freedom from reoperation rate was 96.4%; remote survival was estimated at 96.9%. Conclusions The study proved that TTP-minimally invasive surgery was safe and feasible in mitral and tricuspid valve surgery. It has been associated with superior esthetics. Mitral repairs performed through TTP access are durable in mid-term observation.
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Patterson T, Adams H, Allen C, Rajani R, Prendergast B, Redwood S. Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives. Front Cardiovasc Med 2019; 6:60. [PMID: 31165074 PMCID: PMC6536087 DOI: 10.3389/fcvm.2019.00060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
The incidence of mitral regurgitation (MR) is approximately 1.7% in the developed world, and this increases to more than 10% in patients aged over 75 years. Functional (or secondary) mitral regurgitation (FMR) is defined as poor leaflet coaptation and tethering secondary to either ischemic or non-ischemic left ventricular (LV) dysfunction and dilatation. FMR is more common than degenerative (or primary) MR and is associated with significantly worse outcomes in patients with heart failure, post myocardial infarction and following coronary artery bypass graft surgery. Patients with severe degenerative MR have excellent outcomes with surgical repair, however the benefits of surgery in FMR are less clear. Although annuloplasty is associated with a lower operative mortality compared to replacement, the recurrence rate of mitral regurgitation is high in patients with FMR and neither surgical repair or replacement have been shown to reduce hospitalisation or death in FMR. Furthermore, nearly half of patients are deemed too high risk for surgery and therefore most patients are managed conservatively and there remains an unmet clinical need. Transcatheter mitral valve interventions are an emerging alternative for those at high surgical risk. This mini review focuses on indirect mitral annuloplasty: anatomical considerations, patient selection, current devices, implantation techniques and the associated clinical outcome data.
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Affiliation(s)
- Tiffany Patterson
- Cardiovascular, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Heath Adams
- Cardiovascular, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher Allen
- Cardiovascular, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Ronak Rajani
- Cardiovascular, King's College London, St. Thomas Hospital, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascular, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Redwood
- Cardiovascular, King's College London, St. Thomas Hospital, London, United Kingdom
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Díez‐Villanueva P, Vera A, Ariza‐Solé A, Alegre O, Formiga F, López‐Palop R, Marín F, Vidán MT, Martínez‐Sellés M, Salamanca J, Sionis A, García‐Pardo H, Bueno H, Sanchís J, Abu‐Assi E, González‐Salvado V, Llaó I, Alfonso F. Mitral Regurgitation and Prognosis After Non‐ST‐Segment Elevation Myocardial Infarction in Very Old Patients. J Am Geriatr Soc 2019; 67:1641-1648. [DOI: 10.1111/jgs.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alberto Vera
- Hospital Universitario de La Princesa Madrid Spain
| | | | - Oriol Alegre
- Hospital Universitari de Bellvitge Barcelona Spain
| | | | - Ramon López‐Palop
- Cardiology Department Hospital Universitario San Juan Alicante Spain
| | | | - María T. Vidán
- Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Complutense, Universidad Europea Madrid Spain
| | - Manuel Martínez‐Sellés
- Hospital General Universitario Gregorio Marañón, CIBERCV. Universidad Complutense, Universidad Europea Madrid Spain
| | | | - Alessandro Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
| | | | - Héctor Bueno
- Hospital Doce de Octubre Madrid Spain
- Centro Nacional de Investigaciones Cardiovasculares Madrid Spain
| | - Juan Sanchís
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBER‐CV Valencia Spain
| | | | | | - Isaac Llaó
- Hospital Universitari de Bellvitge Barcelona Spain
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25
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The new place of imaging in cardiology, from diagnosis to treatment. Arch Cardiovasc Dis 2019; 112:543-545. [PMID: 31027901 DOI: 10.1016/j.acvd.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 11/21/2022]
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26
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Noack T, Van Linden A, Kiefer P, Seeburger J, Sündermann S, Holzhey D, Conradi L, Bleiziffer S, Ensminger S, Treede H, Walther T. Indikationsstellung und Patientenselektion für die kathetergestützte Behandlung der Mitralklappeninsuffizienz. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-018-0263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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Transcatheter Mitral Valve Intervention for Chronic Mitral Regurgitation: A Plethora of Different Technologies. Can J Cardiol 2018; 34:1200-1209. [DOI: 10.1016/j.cjca.2018.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023] Open
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28
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Gonzalez Navarrete SL, de Agustín Loeches JA, Pozo Osinalde E, de Jesús K, Madrigal A, López SL, Ortiz E, Saltijeral A, Enriquez-Rodriguez E, Gómez de Diego JJ, Mahía P, Marcos Alberca P, García Fernández MA, Macaya C, Pérez de Isla L. Mitral valve navigator. A new diagnostic tool for effective regurgitant orifice quantification in mitral regurgitation. Echocardiography 2018; 35:1812-1817. [DOI: 10.1111/echo.14114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Eduardo Pozo Osinalde
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | - Keyla de Jesús
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | - Adahir Madrigal
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | - Silvana L. López
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | - Eduardo Ortiz
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
- Philips HealthTech; Andover Massachusetts
| | - Adriana Saltijeral
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
- Cardiology Department; Hospital del Tajo; Universidad Alfonso X el sabio; Aranjuez Madrid Spain
| | | | - José J. Gómez de Diego
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | - Patricia Mahía
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | - Pedro Marcos Alberca
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | | | - Carlos Macaya
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
| | - Leopoldo Pérez de Isla
- Cardiology Department; Hospital Clínico San Carlos; IDISSC; Universidad Complutense; Madrid Spain
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Extraction of open-state mitral valve geometry from CT volumes. Int J Comput Assist Radiol Surg 2018; 13:1741-1754. [DOI: 10.1007/s11548-018-1831-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
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Alfakhouri A, Heidrich FM, Sveric KM, Pfluecke C, Kvakan H, Quick S, Speiser U, Youssef A, Strasser RH, Wiedemann S. Three-dimensional transoesophageal echocardiography is crucial for valid assessment of mitral valve leaflet morphology in severe mitral regurgitation prior to interventional repair. Acta Cardiol 2018; 73:352-360. [PMID: 28978263 DOI: 10.1080/00015385.2017.1385437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Interventional mitral valve (MV) repair of severe symptomatic mitral regurgitation (MR) is a therapeutic option in high-risk surgical or inoperable patients. Assessment of the MV remains a crucial part of pre-interventional screening. Three-dimensional transoesophageal echocardiography (3D-TOE) may compensate for well-known pitfalls that occur in 2D-TOE. PURPOSE We investigated whether the functional length of the central segments of the posterior and anterior MV leaflets (PML-P2 and AML-A2) is more reliably determined by 3D-TOE full volume datasets (3D-MPR) or orthogonal biplane-imaging (Xplane) when compared to 2D-TOE. METHODS AND RESULTS Between February 2014 and August 2015, 265 consecutive patients with moderate to severe symptomatic MR were screened. Seventy patients were judged suitable for interventional MV repair by the in-house Heart-Team. Eventually, 59 patients remained for data analysis. Inter-observer variability was lowest in 3D-MPR followed by Xplane (r = 0.92 and 0.90, p < .001 for both) and highest in Mplane (r = 0.82, p < .001). Mean functional PML-P2 lengths were similar in Xplane (12.6 ± 1.7 mm) and 3D-MPR (12.1 ± 2.0 mm), however, significantly different in 2D-TOE (10.0 ± 2.1 mm, p < .001). 2D-TOE underestimated PML-P2 length with a bias of -2.5 mm compared to Xplane and -1.95 mm compared to 3D-MPR. In contrast, functional AML-A2 length was determined similar across all methods. CONCLUSIONS Our results demonstrate the superiority of 3D-TOE over 2D-TOE for accurate MV assessment in MR, especially for the determination of the functional PML length. Erroneous MV leaflet assessment may result in inadequate therapy restriction if the MV is deemed not suitable for interventional repair.
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Affiliation(s)
- Amr Alfakhouri
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | | | | | - Christian Pfluecke
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Heda Kvakan
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Silvio Quick
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Uwe Speiser
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Akram Youssef
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Ruth H. Strasser
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Stephan Wiedemann
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
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Affiliation(s)
- Paul Sorajja
- From the Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN
| | - Mario Gossl
- From the Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN
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Zangrillo A, Alvaro G, Belletti A, Pisano A, Brazzi L, Calabrò MG, Guarracino F, Bove T, Grigoryev EV, Monaco F, Boboshko VA, Likhvantsev VV, Scandroglio AM, Paternoster G, Lembo R, Frassoni S, Comis M, Pasyuga VV, Navalesi P, Lomivorotov VV. Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A Substudy of a Multicenter Randomized Trial. J Cardiothorac Vasc Anesth 2018; 32:2152-2159. [PMID: 29580796 DOI: 10.1053/j.jvca.2018.02.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) occurs frequently after cardiac surgery. Levosimendan might reduce the incidence of AKI in patients undergoing cardiac surgery. The authors investigated whether levosimendan administration could reduce AKI incidence in a high-risk cardiac surgical population. DESIGN Post hoc analysis of a multicenter randomized trial. SETTING Cardiac surgery operating rooms and intensive care units of 14 centers in 3 countries. PARTICIPANTS The study comprised 90 patients who underwent mitral valve surgery with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and perioperative myocardial dysfunction. INTERVENTIONS Patients were assigned randomly to receive levosimendan (0.025-0.2 μg/kg/min) or placebo in addition to standard inotropic treatment. MEASUREMENTS AND MAIN RESULTS Forty-six patients were assigned to receive levosimendan and 44 to receive placebo. Postoperative AKI occurred in 14 (30%) patients in the levosimendan group versus 23 (52%) in the placebo group (absolute difference -21.8; 95% confidence interval -41.7 to -1.97; p = 0.035). The incidence of major complications also was lower (18 [39%]) in the levosimendan group versus that in the placebo group (29 [66%]) (absolute difference -26.8 [-46.7 to -6.90]; p = 0.011). A trend toward lower serum creatinine at intensive care unit discharge was observed in the levosimendan group (1.18 [0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76] mg/dL) (95% confidence interval -0.23 [-0.49 to 0.01]; p = 0.07). CONCLUSIONS Levosimendan may improve renal outcome in cardiac surgery patients with chronic kidney disease undergoing mitral valve surgery who develop perioperative myocardial dysfunction. Results of this exploratory analysis should be investigated in future properly designed randomized controlled trials.
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Affiliation(s)
- Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Alvaro
- Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Antonio Pisano
- Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei Colli - Monaldi Hospital, Naples, Italy
| | - Luca Brazzi
- Department of Anesthesia and Intensive Care, AOU Città della Salute e della Scienza, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maria G Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Guarracino
- Division of Cardiothoracic Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny V Grigoryev
- Department of Anesthesiology and Intensive Care, State Research Institute for Complex Issues of Cardiovascular Disease, Kemerovo, Russia
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vladimir A Boboshko
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Valery V Likhvantsev
- Department of Anesthesiology and Intensive Care, Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - Anna M Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samuele Frassoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Comis
- Department of Cardiovascular Anesthesia and Intensive Care, AO Ordine Mauriziano, Turin, Italy
| | - Vadim V Pasyuga
- Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russia
| | - Paolo Navalesi
- Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy; Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
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Abstract
Valvular heart disease (VHD) and heart failure (HF) are major health issues that are steadily increasing in prevalence in Western populations. VHD and HF frequently co-exist, which can complicate the accurate diagnosis of the severity of valve stenosis or regurgitation and affect decisions about therapeutic options. Transthoracic echocardiography is the first-line imaging modality to determine left ventricular (LV) systolic function, to grade valvular stenosis or regurgitation and to characterise the mechanism underlying valvular dysfunction. 3D transoesophageal echocardiography, cardiovascular magnetic resonance and cardiac CT are alternative imaging modalities that help in the diagnosis of patients with HF and VHD. The integration of multimodality cardiovascular imaging is important when deciding whether the patient should receive transcatheter aortic valve repair and replacement therapies. In this article, the use of multimodality imaging to diagnose and treat patients with VHD and HF is reviewed.
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Affiliation(s)
- Tomaz Podlesnikar
- Heart and Lung Centre, Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
| | - Victoria Delgado
- Heart and Lung Centre, Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
| | - Jeroen J Bax
- Heart and Lung Centre, Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
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Penicka M, Kotrc M, Ondrus T, Mo Y, Casselman F, Vanderheyden M, Van Camp G, Van Praet F, Bartunek J. Minimally invasive mitral valve annuloplasty confers a long-term survival benefit compared with state-of-the-art treatment in heart failure with functional mitral regurgitation. Int J Cardiol 2017. [PMID: 28624330 DOI: 10.1016/j.ijcard.2017.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clinical impact of the minimally invasive surgical mitral valve annuloplasty (MVA) of functional mitral regurgitation (FMR) in systolic heart failure on top of the state-of-the-art standards of care remains controversial. Therefore, we aimed to compare clinical outcomes of isolated MVA using the mini-invasive videothoracoscopic approach versus the state-of-the-art (CON=conservative) treatment in patients with chronic systolic heart failure and symptomatic FMR. METHODS The study population consisted of 379 patients (age 68.9±11.0years, 62.8% males) with left ventricular (LV) systolic dysfunction, symptomatic FMR and previous heart failure hospitalization. A total of 167 patients underwent undersized MVA and 212 patients were treated conservatively. A concomitant MAZE was performed in 53 (31.7%) patients. RESULTS In the MVA group, the periprocedural and the 30-day mortality were 1.2% and 4.8%, respectively. During the median follow-up of 7.1years (IQR 3.5-9.8years) a total of 74 (44.3%) and 138 (65.1%) died in the MVA and the CON group, respectively (p<0.001). The lowest mortality was observed in MVA combined with MAZE (22.6%; p<0.01). In Cox regression analysis, age, MVA with MAZE emerged as independent predictors of both all-cause mortality and rehospitalizations for heart failure (all p<0.05). MVA was associated with significantly greater symptomatic improvement and reduction of FMR than the conservative treatment (both p<0.001). Reverse LV remodeling was observed only in the MVA combined with MAZE group (p<0.01). CONCLUSIONS In patients with symptomatic FMR, minimally invasive MVA, in particular in combination with MAZE, confers an independent long-term survival benefit compared with the state-of-the-art treatment.
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Affiliation(s)
| | - Martin Kotrc
- Cardiovascular Center, OLV Clinic Aalst, Belgium
| | - Tomas Ondrus
- Cardiovascular Center, OLV Clinic Aalst, Belgium
| | - Yujing Mo
- Cardiovascular Center, OLV Clinic Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic Aalst, Belgium
| | | | - Guy Van Camp
- Cardiovascular Center, OLV Clinic Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic Aalst, Belgium
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Impact of Frailty on Outcomes in Patients Undergoing Percutaneous Mitral Valve Repair. JACC Cardiovasc Interv 2017; 10:1920-1929. [DOI: 10.1016/j.jcin.2017.07.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 11/18/2022]
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Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38:2739-2791. [PMID: 28886619 DOI: 10.1093/eurheartj/ehx391] [Citation(s) in RCA: 4260] [Impact Index Per Article: 608.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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37
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Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H, Collet JP, Coman IM, Czerny M, Delgado V, Fitzsimons D, Folliguet T, Gaemperli O, Habib G, Harringer W, Haude M, Hindricks G, Katus HA, Knuuti J, Kolh P, Leclercq C, McDonagh TA, Piepoli MF, Pierard LA, Ponikowski P, Rosano GM, Ruschitzka F, Shlyakhto E, Simpson IA, Sousa-Uva M, Stepinska J, Tarantini G, Tchétché D, Aboyans V. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52:616-664. [DOI: 10.1093/ejcts/ezx324] [Citation(s) in RCA: 429] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review. Clin Res Cardiol 2017; 106:1005-1017. [DOI: 10.1007/s00392-017-1150-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
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Capoulade R, Piriou N, Serfaty JM, Le Tourneau T. Multimodality imaging assessment of mitral valve anatomy in planning for mitral valve repair in secondary mitral regurgitation. J Thorac Dis 2017; 9:S640-S660. [PMID: 28740719 PMCID: PMC5505945 DOI: 10.21037/jtd.2017.06.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 12/23/2022]
Abstract
Secondary mitral regurgitation (MR) is frequent valvular heart disease and conveys worse prognostic. Therapeutic surgical or percutaneous options are available in the context of severe symptomatic secondary MR, but the best approach to treat these patients remains unclear, given the lack of clear clinical evidence of benefit. A comprehensive evaluation of the mitral valve apparatus and the left ventricle (LV) has the ability to clearly define and characterize the disease, and thus determine the best option for the patient to improve its clinical outcomes, as well as quality of life and symptoms. The current report reviews the mitral valve (MV) anatomy, the underlying mechanisms associated with secondary MR, the related therapeutic options available, and finally the usefulness of a multimodality imaging approach for the planning of surgical or percutaneous mitral valve intervention.
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Affiliation(s)
- Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
| | - Nicolas Piriou
- Institut du Thorax, CHU Nantes, Nantes University, Nantes, France
- Department of Nuclear Medicine, CHU Nantes, Nantes University, Nantes, France
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Doenst T, Essa Y, Jacoub K, Moschovas A, Gonzalez-Lopez D, Kirov H, Diab M, Bargenda S, Faerber G. Cardiac surgery 2016 reviewed. Clin Res Cardiol 2017; 106:851-867. [PMID: 28396989 DOI: 10.1007/s00392-017-1113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 01/09/2023]
Abstract
For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term "cardiac surgery". Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Yasin Essa
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Khalil Jacoub
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - David Gonzalez-Lopez
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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41
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Pieri M, Belletti A, Oriani A, Landoni G, Latib A, Mangieri A, Colombo A, Zangrillo A, Monaco F. Anesthetic Management of Cardioband Implantation: Data From a Preliminary Experience and New Insights. J Cardiothorac Vasc Anesth 2017; 31:482-488. [DOI: 10.1053/j.jvca.2016.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Indexed: 11/11/2022]
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42
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Hayashida K, Yasuda S, Matsumoto T, Amaki M, Mizuno S, Tobaru T, Jujo K, Ootomo T, Yamaguchi J, Fukuda K, Saito S, Foster E, Qasim A, Kitakaze M, Yozu R, Takayama M. AVJ-514 Trial - Baseline Characteristics and 30-Day Outcomes Following MitraClip ® Treatment in a Japanese Cohort. Circ J 2017; 81:1116-1122. [PMID: 28321004 DOI: 10.1253/circj.cj-17-0115] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The MitraClip®system is a transcatheter-based therapeutic option for patients with chronic mitral regurgitation (MR) who are at high risk for surgery. A prospective, multicenter, single-arm study was initiated to confirm the transferability of this system to Japan.Methods and Results:Patients with symptomatic chronic moderate-to-severe (3+) or severe (4+) functional or degenerative MR with a Society of Thoracic Surgery (STS) score ≥8%, or the presence of 1 predefined risk factor were enrolled. Patients with left ventricular (LV) ejection fraction (EF) <30% were excluded. MR severity and LV function were assessed by an independent echocardiography core lab. Primary outcome included major adverse events (MAE) at 30 days and acute procedural success (APS). A total of 30 patients (age: 80±7 years; STS score: 10.3%±6.6%) were treated with the MitraClip®. At baseline, all patients had MR 3+/4+ with 53%/47% patients with degenerative/functional etiology with mean LVEF of 50.2±12.8%, and 37% of patients were NYHA class III/IV. APS was achieved in 86.7% with no occurrence of MAE. At 30 days, 86.7% of patients had MR ≤2+ and 96.7% were NYHA class I/II. CONCLUSIONS The MitraClip®procedure resulted in clinically meaningful improvements in MR severity, function and quality of life measures, and low MAE rates. These early results suggest the transferability of this therapy to appropriately selected Japanese patients. (Trial Registration: clinicaltrials.gov Identifier NCT02520310.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Atif Qasim
- University of California at San Francisco
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43
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Affiliation(s)
- Bernard D Prendergast
- From Department of Cardiology, St. Thomas' Hospital, London, United Kingdom (B.D.P.); and Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy (M.D.B.).
| | - Michele De Bonis
- From Department of Cardiology, St. Thomas' Hospital, London, United Kingdom (B.D.P.); and Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy (M.D.B.)
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44
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Van Praet KM, Stamm C, Sündermann SH, Meyer A, Unbehaun A, Montagner M, Nazari Shafti TZ, Jacobs S, Falk V, Kempfert J. Minimally Invasive Surgical Mitral Valve Repair: State of the Art Review. Interv Cardiol 2017; 13:14-19. [PMID: 29593831 DOI: 10.15420/icr.2017:30:1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Minimally invasive surgical mitral valve repair (MVRepair) has become routine for the treatment of mitral valve regurgitation, and indications have been expanded to include reoperations. Current European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines for the management of valvular heart disease recommended standards in terms of mitral valve disease differentiation, timing of intervention and surgical techniques to improve patient care. Numerous minimally invasive techniques to lessen the invasiveness have been described, such as the minimal-access J-sternotomy (ministernotomy), the parasternal incision, the port-access technique and the right minithoracotomy. Despite the development of catheter-based techniques, surgical repair remains the gold standard today for nearly all patients with degenerative valvular diseases and the majority of patients with other types of valvular diseases. Techniques include resection of the prolapsed segment, neo-chordae implantation and ring annuloplasty. In this review, the current indications for mitral valve surgery are summarised and state-of-the-art MVRepair techniques are highlighted.
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Affiliation(s)
| | | | - Simon H Sündermann
- German Heart CenterBerlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Alexander Meyer
- German Heart CenterBerlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | | | | | - Timo Z Nazari Shafti
- German Heart CenterBerlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | | | - Volkmar Falk
- German Heart CenterBerlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany.,Berlin Institute of Health (BIH), Germany.,Charité - Universitätsmedizin Berlin, Germany
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45
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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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46
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Shamoun FE, Craner RC, Seggern RV, Makar G, Ramakrishna H. Percutaneous and minimally invasive approaches to mitral valve repair for severe mitral regurgitation-new devices and emerging outcomes. Ann Card Anaesth 2016; 18:528-36. [PMID: 26440239 PMCID: PMC4881663 DOI: 10.4103/0971-9784.166462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mitral valve disease is common in the United States and around the world, and if left untreated, increases cardiovascular morbidity and mortality. Mitral valve repair is technically more demanding than mitral valve replacement. Mitral valve repair should be considered the first line of treatment for mitral regurgitation in younger patients, mitral valve prolapse, annular dilatation, and with structural damage to the valve. Several minimally invasive percutaneous treatment options for mitral valve repair are available that are not restricted to conventional surgical approaches, and may be better received by patients. A useful classification system of these approaches proposed by Chiam and Ruiz is based on anatomic targets and device action upon the leaflets, annulus, chordae, and left ventricle. Future directions of minimally invasive techniques will include improving the safety profile through patient selection and risk stratification, improvement of current imaging and techniques, and multidisciplinary education.
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47
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Silaschi M, Chaubey S, Aldalati O, Khan H, Uzzaman MM, Singh M, Baghai M, Deshpande R, Wendler O. Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short- and Long-Term Outcomes in a Propensity-Matched Cohort. J Am Heart Assoc 2016; 5:JAHA.116.003605. [PMID: 27468927 PMCID: PMC5015286 DOI: 10.1161/jaha.116.003605] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Because of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV‐repair) is the “gold standard” treatment for MV disease, in elderly patients, there is controversy about whether MV‐repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20 years. Methods and Results Our in‐hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with MV disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV‐repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty‐day mortality was 5.4% (MV‐repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1‐ and 5‐year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P<0.01). Median survival after MV‐repair was 7.8 years, close to 8.5 years (95% CI: 8.2–9.4) in the age‐matched UK population (ratio 0.9). Rate of re‐operation for MV‐dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV‐repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%, P=0.03). Conclusions Excellent outcomes can be achieved after MV surgery in elderly patients. Long‐term survival is superior after MV‐repair and the re‐operation rate is low. MV‐repair should be the preferred surgical approach in elderly patients.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Omar Aldalati
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | | | - Mrinal Singh
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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49
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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50
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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