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Scalia IG, Farina JM, Wraith R, Brown L, Abbas MT, Pereyra M, Allam M, Mahmoud AK, Kamel MA, Barry T, Fortuin FD, Lester SJ, Sweeney J, Sell-Dottin KA, Alkhouli M, Holmes DR, Chao CJ, Alsidawi S, Ayoub C, Arsanjani R. Association between echocardiographic velocity time integral ratio of mitral valve and left ventricular outflow tract and clinical outcomes post transcatheter edge-to-edge mitral valve repair. Heliyon 2024; 10:e32378. [PMID: 38933987 PMCID: PMC11200332 DOI: 10.1016/j.heliyon.2024.e32378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Background Residual mitral regurgitation (MR) is frequent after transcatheter edge-to-edge repair (TEER). There is controversy regarding the clinical impact of residual MR and its quantitative assessment by transthoracic echocardiography (TTE), which is often challenging with multiple eccentric jets and artifact from the clip. The utility of the velocity time integral (VTI) ratio between the mitral valve (MV) and left ventricular outflow tract (LVOT), (VTIMV/LVOT), a simple Doppler measurement that increases with MR, has not been assessed post TEER. Methods Baseline characteristics, clinical outcomes, and TTE data from patients who underwent TEER between 2014 and 2021 across three academic centers were retrospectively analyzed. Post-procedure TTEs were evaluated for VTIMV/LVOT in the first three months after TEER. One-year outcomes including all-cause and cardiac mortality, major adverse cardiac events, and MV reintervention were compared between patients with high VTIMV/LVOT (≥2.5) and low (<2.5). Results In total, 372 patients were included (mean age 78.7 ± 8.8 years, 68 % male, mean pre-TEER ejection fraction of 50.5 ± 14.7 %). Follow up TTEs were performed at a median of 37.5 (IQR 30-48) days post-procedure. Patients with high VTIMV/LVOT had significantly higher all-cause mortality (HR 2.10, p = 0.003), cardiac mortality (HR 3.03, p = 0.004) and heart failure admissions (HR 2.28, p < 0.001) at one-year post-procedure. There was no association between raised VTIMV/LVOT and subsequent MV reintervention. Conclusion High VTIMV/LVOT has clinically significant prognostic value at one year post TEER. This tool could be used to select patients for consideration of repeat intervention.
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Affiliation(s)
- Isabel G. Scalia
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Juan M. Farina
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Rachel Wraith
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mohammed Tiseer Abbas
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Milagros Pereyra
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Ahmed K. Mahmoud
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Moaz A. Kamel
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - F. David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Steven J. Lester
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - John Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Kristen A. Sell-Dottin
- Department of Cardiothoracic Surgery, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN, 55901, USA
| | - David R. Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN, 55901, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN, 55901, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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El Shaer A, Chavez Ponce A, Mazur P, Greason K, Arghami A, Eleid MF, Guerrero M, Rihal CS, Crestanello JA, Alkhouli M. Mitral Valve Surgery for Persistent or Recurrent Mitral Regurgitation After Transcatheter Edge-to-Edge Repair Is Associated With Improved Survival. J Am Heart Assoc 2022; 11:e026236. [PMID: 36250668 PMCID: PMC9673655 DOI: 10.1161/jaha.122.026236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The management of severe mitral regurgitation (MR) after transcatheter edge‐to‐edge repair (TEER) remains a clinical conundrum. Considering the growing volume of TEER, more outcomes data for mitral surgery in this cohort are needed. Methods and Results Symptomatic patients with persistent or recurrent severe MR after TEER evaluated between May 2014 and June 2021 were included. The primary outcome was all‐cause mortality in patients who were treated with surgery versus medical therapy. The Kaplan–Meier and Cox regression methods were used to report risk‐adjusted survival analyses. Among the 142 included patients, 44 (31.0%) underwent mitral surgery. Patients who underwent surgery were younger than those treated medically (74.1±8.9 versus 78.6±10.5 years, P=0.01). Major comorbidities were similar except obesity, sleep apnea, left ventricular dimensions, and ejection fraction. Society of Thoracic Surgeons Predicted Risk of Operative Mortality was 9.0±4.7 versus 7.9±4.9 in the surgical versus medical therapy groups, respectively, P=0.22. Time from TEER to detection of severe MR was similar in both groups (median [interquartile range] 97.5 [39.5–384] versus 93.5 [40–389] days in the surgical versus medical groups, respectively [P>0.05]). In the surgical group, valve replacement was performed in all patients. Operative mortality was 4.5% (observed/expected ratio 0.55), and major complications were uncommon. After risk‐adjustment, surgery was associated with significantly lower all‐cause mortality (adjusted hazard ratio, 0.33 [95% CI, 0.12–0.92], P=0.001) compared with medial therapy. Conclusions Compared with medical therapy, mitral surgery in patients with severe persistent or recurrent MR after TEER is associated with lower mortality despite the high‐risk profile of these patients. Patients with severe MR after TEER should be considered for surgery at a referral mitral surgical center.
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Affiliation(s)
- Ahmed El Shaer
- Department of Cardiovascular Disease Mayo Clinic Rochester MN
| | | | - Piotr Mazur
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Kevin Greason
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Arman Arghami
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Mayra Guerrero
- Department of Cardiovascular Disease Mayo Clinic Rochester MN
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Outcomes of Transcatheter Edge-to-Edge Repair in Degenerative vs. Functional Mitral Regurgitation. J Clin Med 2022; 11:jcm11206010. [PMID: 36294332 PMCID: PMC9605257 DOI: 10.3390/jcm11206010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
Current guidelines support the use of transcatheter edge-to-edge repair (TEER) for patients with both primary and secondary mitral regurgitation. We aimed to compare the prognoses of TEER in degenerative mitral regurgitation (DMR) vs. functional mitral regurgitation (FMR). A total of 208 consecutive patients who underwent TEER over a ten-year period were analyzed. Primary endpoints included rates of all-cause death and major adverse cardiac events (MACE: composite of all-cause death, hospitalizations for heart failure, mitral valve surgery, or TEER re-intervention). A total of 148 (71%) patients were identified with FMR, while 60 (29%) were identified with DMR. Patients in the FMR group were younger (77.2 ± 8.4 vs. 80.2 ± 7.2, p = 0.02), suffered more frequently from coronary artery disease (54.1% vs. 10.0%, p = 0.02), and atrial fibrillation/flutter (70.9% vs. 38.3%, p = 0.02). Rates of 1-year death (21.6% vs. 10.0%, p = 0.03) and MACE (41.2% vs. 21.7%, p = 0.02) were higher for the FMR group, as compared to the DMR group. After correcting for variables, FMR independently predicted rates of MACE (HR-1.78, 95% CI 1.23–2.48, p = 0.04) and had a non-significant effect on one-year mortality (HR-1.67, 95%CI 0.98–3.74, p = 0.07). In our experience, worse overall 1-year composite MACE outcomes were observed after TEER in patients with FMR as compared to patients with DMR.
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