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Leone AM, Di Giusto F, Lucarelli K, Vicerè A, Anastasia G, Galante D, Petrolati E, Bianchini F, Burzotta F, Aurigemma C, Lombardo A, Locorotondo G, Graziani F, Casamassima V, Grimaldi M, Trani C. A Novel Hemodynamic Index Characterizing Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair: The MPF. JACC. ADVANCES 2024; 3:101099. [PMID: 39105121 PMCID: PMC11299577 DOI: 10.1016/j.jacadv.2024.101099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 08/07/2024]
Abstract
Background Hemodynamic impact of residual mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER) is not always univocally measured by transesophageal echocardiographic (TEE) assessment alone. When analyzing TEER procedure result, operators often encounter discrepancy between TEE guidance and invasive hemodynamic monitoring. Objectives This study sought to investigate the role of invasive hemodynamic monitoring during mitral valve TEER procedure on top of TEE guidance. Methods We analyzed 78 patients with moderate-to-severe or severe MR who underwent TEER. Mitral pulse pressure fraction (MPF) was extracted from intraprocedural continuous left atrial pressure monitoring. Twenty-three patients with the same grade of MR not undergoing TEER were included as a control group. At follow-up, clinical and functional status in the majority of patients undergoing TEER were reassessed by NYHA classification and the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ). Results TEER significantly reduced MR burden on both TEE guidance and invasive hemodynamic monitoring. Post-TEER MPF was significantly reduced compared to both pre-TEER setting (P < 0.001) and control group (P < 0.001). At follow-up, while MR reduction assessed by TEE was associated with an improved functional status in terms of the 12-item KCCQ but not of NYHA classification, a greater reduction in MPF was associated with a significant amelioration of both NYHA classification (P = 0.036) and 12-item KCCQ (P = 0.032). Conclusions MPF could provide an immediate estimate of the real hemodynamic impact of MR and a prompt prediction of the functional improvement after TEER.
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Affiliation(s)
- Antonio Maria Leone
- Unità Operativa Complessa di Cardiologia Diagnostica ed Interventistica - UTIC, Ospedale Isola Tiberina-Gemelli Isola, Roma, Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Federico Di Giusto
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Katya Lucarelli
- Unità Operativa Complessa di Cardiologia, Ospedale Generale Regionale F. Miulli Acquaviva delle Fonti, Acquaviva delle Fonti, Bari, Italy
| | - Andrea Vicerè
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Gianluca Anastasia
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Domenico Galante
- Unità Operativa Complessa di Cardiologia Diagnostica ed Interventistica - UTIC, Ospedale Isola Tiberina-Gemelli Isola, Roma, Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Edoardo Petrolati
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Francesco Bianchini
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Antonella Lombardo
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Gabriella Locorotondo
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Francesca Graziani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Vito Casamassima
- Unità Operativa Complessa di Cardiologia, Ospedale Generale Regionale F. Miulli Acquaviva delle Fonti, Acquaviva delle Fonti, Bari, Italy
| | - Massimo Grimaldi
- Unità Operativa Complessa di Cardiologia, Ospedale Generale Regionale F. Miulli Acquaviva delle Fonti, Acquaviva delle Fonti, Bari, Italy
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy
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Dokollari A, Sicouri S, Ridwan K, Rodriguez R, Gnall E, Harish J, Shah A, Ghorpade N, Bisleri G, Kjelstrom S, Montone G, Abramson S, Hawthorne K, Goldman S, Gray W, Ramlawi B. Clinical and Echocardiographic Outcomes of Patients Undergoing Transcatheter Edge-to-Edge Repair for Functional vs Degenerative Mitral Valve Regurgitation. Curr Probl Cardiol 2024; 49:102064. [PMID: 37652113 DOI: 10.1016/j.cpcardiol.2023.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
To analyze clinical and echocardiographic outcomes after transcatheter edge-to-edge repair (TEER) with mitral valve clip device (MitraClip-TM) for functional vs degenerative mitral valve regurgitation (MR). All consecutive 185 patients undergoing TEER between January 2019 and March 2023 were included in the study. A propensity-adjusted analysis investigated differences among functional vs degenerative MR mechanism groups. Preoperatively, functional vs degenerative MR included 43 vs 142 patients, respectively. Mean ejection fraction (EF) values were 37% vs 57.8%, mean STS-PROM risk score was 7% vs 4% while patients with severe MR included 29 (67.4%) vs 129 (90.9%) patients, respectively. Postoperatively, functional MR patients experienced a higher incidence of prolonged postoperative length of stay (LOS), reduced creatinine clearance, and EF<50% compared to the degenerative MR group. Mean EF was 35.9% vs 56.2% (P < 0.0001) and 1 (2.3%) vs 16 (11.3%) patients had residual severe MR (P = 0.01) in functional vs degenerative MR groups, respectively. At 30-days follow-up, all-cause death incidence was 1 (2.3%) vs 3 (2.1%) patients in functional vs degenerative MR, respectively (P = 0.9). At a mean of 1.6-years follow-up, all-cause death (P = 0.01), major adverse cardiovascular and cerebrovascular events (MACCE) (P = 0.02), cardiac death (P = 0.01) and hazard ratio for all-cause death higher in functional vs degenerative MR group. Mean EF was 39.7% vs 56% (P < 0.001) while residual severe MR was 4 (9.3%) vs 34 (24.5%) (P = 0.1) in functional vs degenerative MR groups, respectively. TEER with MitraClip device showed a higher incidence of all-cause death, cardiac death, and MACCE at follow-up for functional compared to degenerative MR after TEER.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB.
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA
| | - Khalid Ridwan
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Roberto Rodriguez
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Eric Gnall
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Jarrett Harish
- Cardiac Surgery Department, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Ashish Shah
- Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB
| | - Nitin Ghorpade
- Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB
| | - Gianluigi Bisleri
- Cardiac Surgery Department, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Stephanie Kjelstrom
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA
| | - Georgia Montone
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA
| | - Sandra Abramson
- Division of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Katie Hawthorne
- Division of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Scott Goldman
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - William Gray
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; Division of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
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Nita N, Schneider L, Dahme T, Markovic S, Keßler M, Rottbauer W, Tadic M. Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry. Front Cardiovasc Med 2022; 9:850356. [PMID: 35350535 PMCID: PMC8957866 DOI: 10.3389/fcvm.2022.850356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 12/30/2022] Open
Abstract
Objective This study sought to determine the potential change in trends in the baseline characteristics of patients with symptomatic severe mitral regurgitation who underwent transcatheter edge-to-edge mitral valve repair (M-TEER) over the last decade in a high-volume center. Methodology The investigation included 942 symptomatic patients with moderate-to-severe and severe mitral regurgitation who underwent transcatheter edge-to-edge repair (TEER) at our institution between January 2010 and March 2021. Patients were divided into quintiles and compared separately. Results Patients treated in the last quintile had significantly lower surgical risk (Euro Score 7.2 ± 6.8% in the last quintile vs. 10.9 ± 9.4% in the first quintile, p < 0.001), better New York Heart Association (NYHA) status (NYHA IV 14% in the last quintile vs. 40% in the first quintile, p < 0.001), lower NT-pro-BNP, and smaller left ventricle diameter than patients who were treated in the first quintile. There was no difference in age between quintiles. However, an invasive hemodynamic assessment did not show significant changes over the last decade (sPAP 51.35 ± 16.2 mmHg in the first quintile vs. 51.02 ± 14.5 mmHg in the last quintile, p = 0.90, pulmonary capillary wedge V wave 30.7 ± 14.8 mmHg in the first quintile vs. 27.4 ± 10.3 mmHg in the last quintile, p = 0.40). There is a significant trend of a gradually increasing proportion of patients with degenerative mitral regurgitation (MR) over the last 10 years (p < 0.001). The experience gained in the M-TEER procedure brought a significant reduction in fluoroscopy time and hospitalization duration. Medical therapy significantly changed over the last decade in terms of higher use of angiotensin receptor blockers (ARBs), lower use of angiotensin-converting enzyme inhibitors (ACEIs), and the introduction of angiotensin receptor-neprilysin inhibitors (ARNIs). Conclusion Patients undergoing the M-TEER procedure nowadays have lower surgical risk and are treated before they develop a significant left ventricular (LV) remodeling than before. The increasing expertise on the procedure over the last decade led to a rising number of patients with complex degenerative pathology being treated.
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Rottländer D, Beucher H, Ghaddioui KA, Boekstegers P. Continuous atrial pressure monitoring via steerable guide catheter in transcatheter mitral and tricuspid edge-to-edge repair. Catheter Cardiovasc Interv 2022; 99:1796-1806. [PMID: 35114055 DOI: 10.1002/ccd.30109] [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: 10/25/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 11/06/2022]
Abstract
Transcatheter edge-to-edge repair (TEER) has emerged to address severe mitral and tricuspid valve regurgitation in patients who are at high perioperative risk for open-heart surgery. No clinical data is available for continuous left and right atrial pressure monitoring using the steerable guiding catheter (SGC) during TEER. In a prospective single-center study, 40 patients with severe mitral (n = 20) or tricuspid (n = 20) regurgitation underwent TEER with the registration of atrial pressure via the SGC. All patients had successful TEER using the PASCAL Ace repair system, while atrial pressure was monitored continuously via the SGC. Simultaneous right or left atrial pressure monitoring via the SGC and a pigtail catheter during mitral and tricuspid TEER showed excellent reliability for SGC pressure registration. While for mitral TEER the beneficial effects of continuous atrial pressure monitoring are well known, we further evaluated the outcome of patients with tricuspid TEER. Echocardiographic and clinical results after tricuspid TEER showed a reduction of quantitative echocardiographic tricuspid regurgitation parameters and improved New York Heart Association classification after 3-month follow-up. Also, qualitative tricuspid valve assessment showed improved tricuspid regurgitation classification postimplantation and at 3-month follow-up. Furthermore, right atrial pressure was reduced by 37.6% and mean right atrial pressure by 30.6% after successful tricuspid TEER using the PASCAL Ace device. Continuous atrial pressure monitoring using the SGC of the PASCAL Ace repair system is reliable during mitral and tricuspid TEER. Furthermore, successful tricuspid TEER leads to reduced right atrial pressure.
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Affiliation(s)
- Dennis Rottländer
- Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany.,Department of Cardiology, School of Medicine, Faculty of Health, University Witten/Herdecke, Witten, Germany
| | - Harald Beucher
- Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany
| | | | - Peter Boekstegers
- Department of Cardiology, School of Medicine, Faculty of Health, University Witten/Herdecke, Witten, Germany.,Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany
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Lloyd JW, Rihal CS, Eleid MF. Hemodynamics rounds: Hemodynamics of mitral valve interventions. Catheter Cardiovasc Interv 2020; 96:712-724. [PMID: 32034874 DOI: 10.1002/ccd.28755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/20/2020] [Indexed: 12/23/2022]
Abstract
Mitral valvulopathy presents as regurgitation, stenosis, or mixed disease and can occur in both native and prosthetic valves. Such disease develops in conjunction with pathophysiologic changes in the left atrium (LA) and drives changes in LA compliance, pressure, and thus clinical syndromes. With advances in the understanding and treatment of structural heart disease and in the setting of higher-risk patient populations, less-invasive transcatheter approaches have become increasingly commonplace in the treatment of mitral valve disease. Over time, transcatheter mitral valve interventions have evolved to include paravalvular leak closure, mitral valve repair, and mitral valve replacement. Parallel to this evolution, advances in invasive intracardiac pressure monitoring, particularly at the level of the LA, have also occurred. These advances emphasize the unique interplay between mitral valve disease and LA function; account for limitations of noninvasive assessment; and guide beneficial outcomes in each area of transcatheter mitral valve intervention. As a result, continuous transseptal LA pressure monitoring has developed into an indispensable instrument in successful percutaneous mitral valve intervention, complementing traditional noninvasive assessment.
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Affiliation(s)
- James W Lloyd
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Ramlawi B, Skiles J, Myers D, Ali O, Viens C. Transcatheter mitral repair: MitraClip technique. Ann Cardiothorac Surg 2018; 7:824-826. [PMID: 30598899 DOI: 10.21037/acs.2018.10.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Basel Ramlawi
- Heart & Vascular Center, Valley Health System, Winchester, VA 22601, USA
| | - Jeffrey Skiles
- Heart & Vascular Center, Valley Health System, Winchester, VA 22601, USA
| | - Debra Myers
- Heart & Vascular Center, Valley Health System, Winchester, VA 22601, USA
| | - Omar Ali
- Heart & Vascular Center, Valley Health System, Winchester, VA 22601, USA
| | - Claudia Viens
- Heart & Vascular Center, Valley Health System, Winchester, VA 22601, USA
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