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Jaeger P, Toskas I, Henes JK, Shcherbyna S, Schwarz F, Euper M, Seizer P, Langer H, May AE, Geisler T, Gawaz M, Schreieck J, Rath D. Impact of pulmonary hypertension on outcomes after TEER in patients suffering from mitral regurgitation. Clin Res Cardiol 2024:10.1007/s00392-024-02442-1. [PMID: 38565712 DOI: 10.1007/s00392-024-02442-1] [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: 08/29/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
AIM Data on associations of invasively determined hemodynamic parameters with procedural success and outcomes in patients suffering from mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair of the mitral valve (M-TEER) is limited. METHODS AND RESULTS We enrolled 239 patients with symptomatic MR of grade 2 + , who received M-TEER. All patients underwent extensive pre-interventional invasive hemodynamic measurements via right heart catheterization (mean pulmonary arterial pressure (mPAP), systolic- (PAPsys) and diastolic pulmonary arterial pressure (PAPdia), pulmonary arterial wedge pressure (PAWP), a-wave, v-wave, pulmonary vascular resistance (PVR), transpulmonary pressure gradient (TPG), cardiac index (CI), stroke volume index (SVI)). mPAP and PAWP at baseline were neither associated with procedural success, immediate reduction of MR, nor residual MR after 6 months of follow-up. The composite outcome (All-cause mortality (ACM) and/or heart failure induced rehospitalization (HFH)) and HFH differed significantly after M-TEER when stratified according to mPAP, PAWP, PAPdia, a-wave and v-wave. ACM was not associated with the afore mentioned parameters. Neither PVR, TPG, CI nor SVI were associated with the composite outcome and HFH, respectively. In multivariable analyses, PAWP was independently associated with the composite outcome and HFH. PVR and SVI were not associated with outcomes. CONCLUSION PAWP at baseline was significantly and independently associated with HFH and might serve as a valuable parameter for identifying patients at high risk for HFH after M-TEER. ACM and procedural success were not affected by pulmonary arterial pressure before M-TEER. We suggest that the post-capillary component of PH serves as the driving force behind the risk of HFH.
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Affiliation(s)
- Philippa Jaeger
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Ioannis Toskas
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Jessica-Kristin Henes
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Serhii Shcherbyna
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Frederic Schwarz
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Miriam Euper
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Seizer
- Departmen of Cardiology and Angiology, Ostalb-Klinikum, Aalen, Germany
| | - Harald Langer
- Department of Medicine, Cardiology, Angiology, Hemostasis and Intensive Care Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Andreas E May
- Medizinische Klinik I, Klinikum Memmingen, Mannheim, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany.
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Grayburn PA, Mack MJ, Manandhar P, Kosinski AS, Sannino A, Smith RL, Szerlip M, Vemulapalli S. Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair for Primary Mitral Regurgitation Outcomes to Hospital Volumes of Surgical Mitral Valve Repair. Circ Cardiovasc Interv 2024; 17:e013581. [PMID: 38436084 DOI: 10.1161/circinterventions.123.013581] [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: 09/01/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Transcatheter edge-to-edge mitral valve (MV) repair (TEER) is an effective treatment for patients with primary mitral regurgitation at prohibitive risk for surgical MV repair (MVr). High-volume MVr centers and high-volume TEER centers have better outcomes than low-volume centers, respectively. However, whether MVr volume predicts TEER outcomes remains unknown. We hypothesized that high-volume MV surgical centers would have superior risk-adjusted outcomes for TEER than low-volume centers. METHODS We combined data from the American College of Cardiology/Society of Thoracic Surgeons Transcatheter Valve Therapy registry and the Society of Thoracic Surgeons adult cardiac surgery database. MVr was defined as leaflet resection or artificial chords with or without annuloplasty and was evaluated as a continuous variable and as predefined categories (<25, 25-49, and ≥50 MV repairs/year). A generalized linear mixed model was used to evaluate risk-adjusted in-hospital/30-day mortality, 30-day heart failure readmission, and TEER success (mitral regurgitation ≤2+ and gradient <5 mm Hg). RESULTS The study comprised 41 834 patients from 500 sites of which 332 (66.4%) were low, 102 (20.4%) intermediate, and 66 (13.2%) high-volume surgical centers (P<0.001). TEER success was 54.6% and was not statistically significantly different across MV surgical site volumes (P=0.4271). TEER mortality at 30 days was 3.5% with no significant difference across MVr volume on unadjusted (P=0.141) or adjusted (P=0.071) analysis of volume as a continuous variable. One-year mortality was 15.0% and was lower for higher MVr volume centers when adjusted for clinical and demographic variables (P=0.027). Heart failure readmission at 1 year was 9.4% and was statistically significantly lower in high-volume centers on both unadjusted (P=0.017) or adjusted (P=0.015) analysis. CONCLUSIONS TEER can be safely performed in centers with low volumes of MV repair. However, 1-year mortality and heart failure readmission are superior at centers with higher MVr volume.
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Affiliation(s)
- Paul A Grayburn
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Michael J Mack
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | | | | | - Anna Sannino
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Robert L Smith
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Molly Szerlip
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
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Sraya R, Amsalem I, Carasso S, Gilad O, Asher E, Dvir D, Harari E, Glikson M, Marmor D, Shuvy M. Mitral valve gradient changes associate with outcomes of patients undergoing transcatheter edge-to-edge repair. Int J Cardiol 2024; 400:131766. [PMID: 38211677 DOI: 10.1016/j.ijcard.2024.131766] [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: 08/27/2023] [Revised: 11/30/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Transcatheter edge-to-edge repair (TEER) is typically used to treat mitral regurgitation (MR) in patients with high surgical risk. Increased post-procedural mitral valve gradient (MVG) may impact mortality and hospitalizations. We aim to evaluate and compare the absolute postprocedural MVG and the change in the MVG effect on outcomes for patients undergoing TEER therapy. METHODS Patients who underwent TEER for severe MR were divided into two groups, initially by postprocedural absolute MVG, TTE-based at discharge, and then by the difference between preprocedural and postprocedural MVG. Primary endpoints included all-cause mortality and heart failure hospitalization (HFH) during one year after the procedure. RESULTS The study included 100 patients. The mean MVG increased from 3.39 mmHg immediately after the procedure to 4.83 mmHg the following day, an increase of 1.44 mmHg (p < 0.001). First stratification was by MVG on the day following the procedure - MVG ≤5 mmHg (n = 70) and MVG >5 mmHg (n = 30). There was no significant difference in rates of survival (88.6%, 93.3%, p = 0.716) or HFH (18.6%, 33.3%, p = 0.178). Second stratification was by the difference in preprocedural and postprocedural MVG- delta MVG <3 mmHg (n = 55) and delta MVG ≥3 mmHg (n = 45). While survival rates did not significantly differ (87.3% vs. 93.3%, p = 0.503), delta MVG ≥3 mmHg correlated with higher HFH rates (12.7% vs. 35.6%, p = 0.014). CONCLUSIONS The MVG of patients undergoing TEER usually increases on the day after the procedure compared to the immediate post-procedure MVG. Higher delta MVG is associated with higher HFH rate.
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Affiliation(s)
- Roni Sraya
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Or Gilad
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel; Department of Military Medicine, Hebrew University of Jerusalem, Tzameret Program, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Danny Dvir
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Emanuel Harari
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - David Marmor
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mony Shuvy
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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Hatab T, Samimi S, Bou Chaaya RG, Qamar F, Kharsa C, Wessly P, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Nagueh SF, Zaid S, Goel SS. Echocardiographic Profiling Predicts Clinical Outcomes After Mitral Transcatheter Edge-to-Edge Repair. J Am Heart Assoc 2024; 13:e032784. [PMID: 38390821 PMCID: PMC10944065 DOI: 10.1161/jaha.123.032784] [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: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER. METHODS AND RESULTS We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well-established outcomes-related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal: 0 risk factors, mixed: 1 risk factor, poor: ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all-cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two-year event-free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2-year event-rate with each worsening profile (optimal as reference; mixed profile: hazard ratio (HR), 2.87 [95% CI, 1.71-5.17], P<0.001; poor profile: HR, 3.76 [95% CI, 1.84-6.53], P<0.001). Echocardiographic profile was statistically associated with the 2-year mortality end point (optimal as reference; mixed profile: HR, 3.55 [95% CI, 1.81-5.96], P<0.001; poor profile: HR, 3.39 [95% CI, 2.56-7.33], P=0.02). CONCLUSIONS The echocardiographic profile integrating predischarge TR, MR, and TMPG presents a novel prognostic stratification tool for patients undergoing mitral TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Fatima Qamar
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Chloe Kharsa
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Marvin D Atkins
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Michael J Reardon
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Sherif F Nagueh
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Syed Zaid
- Department of Cardiology Baylor School of Medicine and the Michael E DeBakey VAMC Houston TX
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
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Kagawa S, Hasegawa H, Kuwajima K, Yamane T, Ogawa M, Patel D, Salseth T, Sekhon N, Skaf S, Chakravarty T, Makar M, Makkar RR, Shiota T. Long-Term Impact of Small Mitral Valve Orifice Area after Transcatheter Edge-to-Edge Mitral Valve Repair on Clinical Outcome: A Three-Dimensional Echocardiography Study. J Am Soc Echocardiogr 2024; 37:328-337. [PMID: 37972791 DOI: 10.1016/j.echo.2023.11.007] [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: 06/29/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Iatrogenic mitral stenosis is a complication associated with transcatheter edge-to-edge mitral valve repair. Some reports revealed the impact of mean transmitral pressure gradient after procedure on long-term clinical outcomes. However, the association between prognosis and mitral valve orifice area (MVA) after the procedure has been poorly studied. This study aimed to investigate the association between postprocedural small MVA, derived from three-dimensional (3D) transesophageal echocardiography (TEE), and long-term clinical outcomes in 2 cohorts: the degenerative mitral regurgitation (MR) cohort and the functional MR cohort. METHODS This retrospective study assessed 279 consecutive patients with 3D TEE data during transcatheter edge-to-edge mitral valve repair between January 2010 and December 2016. Mitral valve orifice area after device implantation was measured by 3D planimetry. The patients with degenerative and functional MR were stratified separately into 2 groups according to postprocedural MVA: normal MVA (MVA > 1.5 cm2) group and small MVA (MVA ≤ 1.5 cm2) group. RESULTS Of the 279 patients, 142 (51%) had degenerative MR and 137 (49%) had functional MR. The number of degenerative MR patients with small MVA was 38, whereas 42 patients were in the functional MR cohort. Patients with small MVA had higher rate of all-cause mortality in the degenerative MR group (log-rank test: P = .01) but not in the functional MR group (log-rank test: P = .52). In multivariate analysis small MVA was independently associated with all-cause mortality but not postprocedural transmitral pressure gradient. Neither small MVA nor transmitral pressure gradient was associated with all-cause mortality in patients with functional MR. CONCLUSION Small MVA measured by 3D TEE after transcatheter mitral edge-to-edge repair was associated with poor prognosis in patients with degenerative MR.
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Affiliation(s)
- Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mana Ogawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tracy Salseth
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Navjot Sekhon
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sabah Skaf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Du Y, Han H, Zhang T, Shen H, Han W, Jia S, Yu Y, Guo Y, Wang Z, Liu Y, Shi D, Zhou Y. Prognosis of Elevated Mitral Valve Pressure Gradient After Transcatheter Edge-to-Edge Repair: Systematic Review and Meta-Analysis. Curr Probl Cardiol 2024; 49:102095. [PMID: 37778430 DOI: 10.1016/j.cpcardiol.2023.102095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Elevation in mitral valve pressure gradient (MVPG) after mitral valve transcatheter edge-to-edge repair (M-TEER) is common, however, evidence on its prognosis is scarce and debatable. Thus, this study aims to investigate the impact of increased MVPG after M-TEER on outcomes. Studies reporting the associations between the elevated MVPG after M-TEER and outcomes were identified in a systematic search of published literatures. Associations were pooled by meta-analysis using a random-effects model. The primary outcome was the composite of all-cause mortality and heart failure (HF) hospitalization. Seven observational studies with 2,730 patients (mean age, 77.7 ± 9.3 years; male, 64.4%; functional mitral regurgitation [MR], 65.2%) were eligible for the present analysis. M-TEER was performed entirely using the MitraClip system (Abbott), followed by 29.7% of patients having increased MVPG. Elevated postprocedural MVPG was not associated with a higher risk of the primary outcome, compared to low MVPG [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.95-1.58; p = 0.12; I2 = 53.5%). However, the prognosis of elevated MVPG was observed in degenerative MR patients (HR = 1.37; 95% CI 1.03-1.84; p = 0.03; I2 = 0%), whereas not in functional MR patients. Patients with low MVPG + high residual MR had a higher risk of the primary outcome than those with high MVPG + low residual MR after M-TEER (HR = 1.50; 95% CI 1.10-2.03; p = 0.01; I2 = 13%). In conclusion, elevated MVPG seems to predict adverse outcomes mainly in patients with degenerative MR. Future studies are needed to prove these findings.
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Affiliation(s)
- Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Tianhao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Wei Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yi Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yonghe Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yuyang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China.
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Shechter A, Kaewkes D, Lee M, Makar M, Patel V, Koren O, Koseki K, Nagasaka T, Skaf S, Chakravarty T, Makkar RR, Siegel RJ. Correlates and prognostic implications of LVEF reduction after transcatheter edge-to-edge repair for primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2023; 25:136-147. [PMID: 37590951 DOI: 10.1093/ehjci/jead210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023] Open
Abstract
AIMS To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure. METHODS AND RESULTS We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75-88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared with baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While post-procedural MR, transmitral mean pressure gradient, and functional status were comparable in the two study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs. 5.7%, P = 0.019), be readmitted for HF (17.1% vs. 9.0%, P = 0.033), and experience either of the two (23.8% vs. 12.7%, P = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10-0.78, P = 0.016). CONCLUSION LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Nai Muang, Thailand
| | - Mirae Lee
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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8
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Wienemann H, Mauri V, Ochs L, Körber MI, Eghbalzadeh K, Iliadis C, Halbach M, Wahlers T, Baldus S, Adam M, Kuhn E. Contemporary treatment of mitral valve disease with transcatheter mitral valve implantation. Clin Res Cardiol 2023; 112:571-584. [PMID: 36107228 PMCID: PMC10159974 DOI: 10.1007/s00392-022-02095-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transcatheter mitral valve implantation (TMVI) with self-expanding (SAV) or balloon-expandable (BAV) valves are rising as promising treatment options for high-risk patients with symptomatic mitral valve (MVD) disease unsuitable for alternative treatment options. AIMS The aim of this study was to examine the clinical, procedural and outcome parameters of patients undergoing SAV or BAV for MVD. METHODS In this observational and single-center case series, fifteen consecutive patients treated with the Tendyne Mitral Valve System (SAV) and thirty-one patients treated with SAPIEN prosthesis (BAV) were included. RESULTS The patients (aged 78 years [interquartile range (IQR): 65.5 to 83.1 years], 41% women, EuroSCORE II 10.3% [IQR: 5.5 to 17.0%] were similar regarding baseline characteristics, despite a higher rate of prior heart valve surgery and prevalence of MV stenosis in the SAV-group. At discharge, the SAV-group had a mean transvalvular gradient of 4.2 mmHg, whereas the BAV-group had a mean transvalvular gradient of 6.2 mmHg. None or trace paravalvular leakage (PVL) was assessed in 85% in SAV-group and 80% in the BAV-group. 320 day all-cause and cardiac mortality rates were comparable in both groups (SAV: 26.7% vs BAV: 20%, p = 0.60). Four deaths occurred early in the SAV-group until 32 days of follow-up. CONCLUSIONS In high-risk patients with MVD, TMVI presents a promising treatment option with encouraging mid-term outcomes and good valve durability. TMVI either with BAV or SAV may be developed to an established treatment option.
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Affiliation(s)
- Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany.
| | - Victor Mauri
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Marcel Halbach
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Thorsten Wahlers
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Elmar Kuhn
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
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9
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Sauter R, Lin C, Magunia H, Schreieck J, Dürschmied D, Gawaz M, Patzelt J, Langer HF. Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR. IJC HEART & VASCULATURE 2023; 45:101190. [PMID: 36941997 PMCID: PMC10024191 DOI: 10.1016/j.ijcha.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Background Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR). Results We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve. Results We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip. Conclusions In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
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Key Words
- CO, cardiac output
- COe, cardiac output echocardiographically determinded by combination of TTE and TEE parameters
- COi, invasively determined cardiac output
- Clips
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FMR, functional mitral regurgitation
- Heart failure
- Heart geometry
- Hemodynamics
- ICE, intracardiac echocardiography
- IVUS, intravascular ultrasound
- Interventional cardiology
- Interventional therapy
- LA, left atrium
- LV, left ventricle
- LVEDD, left ventricular end diastolic diameter
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association
- PA, pulmonary artery
- PAP, pulmonary artery pressure
- PASP, pulmonary artery systolic pressure
- PCW, pulmonary capillary wedge
- PCWP, pulmonary capillary wedge pressure
- PHT, pulmonary hypertension
- PMVR
- PMVR, percutaneous mitral valve repair
- RV, right ventricle
- SD, standard deviation
- Structural heart disease
- Surgery
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard Sauter
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Chaolan Lin
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Dürschmied
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F. Langer
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
- Corresponding author at: Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, 68167 Mannheim, Germany.
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10
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Ueyama H, Block PC. Can patients be selected for transcatheter edge-to-edge repair based on the baseline transmitral gradient? Catheter Cardiovasc Interv 2023; 101:830-831. [PMID: 36906807 DOI: 10.1002/ccd.30607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/13/2023]
Affiliation(s)
- Hiroki Ueyama
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Shechter A, Natanzon SS, Koseki K, Kaewkes D, Lee M, Koren O, Patel V, Skaf S, Chakravarty T, Makar M, Makkar RR, Siegel RJ. Prognostic value of mitral valve haemodynamic parameters obtained by intraprocedural echocardiography in transcatheter edge-to-edge repair. Eur Heart J Cardiovasc Imaging 2023:7030203. [PMID: 36748258 DOI: 10.1093/ehjci/jead011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
AIMS To assess whether intraprocedural transesophageal echocardiographic (TEE)-derived haemodynamic parameters predict outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR). METHODS AND RESULTS This is a single-centre, retrospective analysis encompassing 458 (IQR, 104-1035) days of follow-up after 926 consecutive patients [481 (52%) with functional MR] referred to an isolated mitral TEER between 2013 and 2020. Cases without actual clip deployment, or in whom prior mitral procedures had taken place, were excluded. The primary outcome was the combined rate of all-cause mortality or heart failure (HF) hospitalizations. Secondary endpoints included single components of the primary outcome, as well as MR severity at one month and one year following the procedure. A multivariable analysis identified two intraprocedural echocardiographic observations made after clip deployment as independent predictors of the primary outcome: an above mild MR (HR for whole study period 1.49, 95% CI 1.05-2.13, P = 0.026) and a 100% or more increase from baseline in the transmitral mean pressure gradient (TMPG) (HR for whole study period 1.32, 95% CI 1.01-1.72, P = 0.039). Also, MR grade of above mild and the absence of a normal pulmonary venous flow pattern (PVFP) bilaterally were associated with an increased risk for HF hospitalizations and greater-than-mild 1-month MR. No prognostic role was demonstrated for the change in MR severity, the absolute TMPG, or the mere improvement in PVFP. CONCLUSION Immediate post-TEER MR severity and the relative change in TMPG are predictive of clinical and echocardiographic outcomes following the procedure.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petach Tikva 4941492, Israel.,Faculty of Medicine, Tel Aviv University, 35 Klazkin St, Tel Aviv 6997801, Israel
| | - Sharon Shalom Natanzon
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petach Tikva 4941492, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Nai Muang, Muang Khon District, Khon Kaen 40002, Thailand
| | - Mirae Lee
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, 158 Paryong-ro, Masanhoewon-gu, Gyeongsangnam-do, Changwon, Republic of Korea
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, 1 Efron St, Haifa 3109601, Israel
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA.,David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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12
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Lugo-Fagundo N, Pierre K, Adedinsewo D, Simard T, Alkhouli M, Eleid MF, Rihal CS, Guerrero M, El Sabbagh A. The impact of baseline transmitral diastolic mean gradient on left atrial pressure reduction in patients undergoing transcatheter mitral valve edge-to-edge repair. Catheter Cardiovasc Interv 2023; 101:605-609. [PMID: 36718052 DOI: 10.1002/ccd.30577] [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: 08/24/2022] [Revised: 12/23/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elevated transmitral gradient post transcatheter mitral valve edge-to-edge repair (TEER) has been associated with worse outcomes. Whether an elevated baseline transmitral diastolic mean gradient (MG) ≥5 mmHg is associated with hemodynamic outcomes after TEER is unknown. METHODS A total of 164 consecutive patients undergoing TEER at Mayo Clinic between June 2014 and May 2018 were analyzed in this retrospective study. Baseline demographics, as well as clinical, echocardiographic, and procedural data were obtained. Data on direct left atrial pressure (LAP) before and after TEER were recorded. Logistic regression models were constructed to evaluate the association between preprocedure transmitral diastolic mean gradient (pre-MG) and (1) improvement in LAP following TEER, (2) postprocedure transmitral diastolic mean gradient (post-MG). A decrease in LAP post TEER was considered an improvement in hemodynamic response. Pre-MG was categorized as: ≥5 and <5 mmHg. RESULTS Median age of the cohort was 81.5 years (Q1: 76.3, Q3: 87) and 34% were female. At baseline, median transmitral diastolic MG was 4 mmHg (Q1: 3, Q3: 5) and median LAP was 19 mmHg (Q1:16, Q3: 23.5). In a multivariable model, adjusted for age and sex, patients with pre-MG ≥ 5 mmHg were less likely to see an improvement in LAP post TEER (adjusted odds ratio [aOR]: 0.22, 95% confidence interval [CI]: 0.09, 0.55; p = 0.001) and more likely to have elevated post-MG (aOR; 7.08, 95% CI: 2.93, 17.13; p < 0.001). CONCLUSION Higher pre-MG (≥5 mmHg) was associated with a lower reduction in LAP and higher residual transmitral gradient following TEER suggesting other potential contributors to increased LAP besides mitral regurgitation as a cause of elevated baseline MG.
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Affiliation(s)
- Nahyr Lugo-Fagundo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Keniel Pierre
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
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13
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Imran H, Ahmad K, Baig M, Elgendy IY, Iqbal N, Ehsan A, Sharaf B, Gordon P, Saad M. Transcatheter Edge-to-Edge Repair of Mitral Valve Regurgitation: Closing the Gap to Broaden the Coverage. Rev Cardiovasc Med 2023; 24:15. [PMID: 39076866 PMCID: PMC11270398 DOI: 10.31083/j.rcm2401015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 07/31/2024] Open
Abstract
Background Transcatheter edge-to-edge repair of mitral valve (M-TEER) is reasonable consideration in symptomatic patients with severe degenerative mitral regurgitation (MR) who are at high or prohibitive risk of surgical repair or replacement. In symptomatic patients on maximally tolerated medical therapy with severe secondary MR from left ventricular systolic dysfunction, M-TEER is reasonable therapeutic option. Methods In this review, we present a comprehensive overview of the most recent literature and considerations for M-TEER in patients excluded from key trials. These include patients with cardiogenic shock, acute ischemic MR, atrial functional MR, failed surgical mitral valve prosthesis and pulmonary hypertension. Conclusions M-TEER is feasible and a reasonable alternative option for these patient populations with a significant clinical benefit. However, randomized clinical trials are needed to ascertain findings from these observational studies.
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Affiliation(s)
- Hafiz Imran
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Cardiovascular Institute, Providence, RI 02903, USA
| | - Khansa Ahmad
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Cardiovascular Institute, Providence, RI 02903, USA
| | - Muhammad Baig
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Cardiovascular Institute, Providence, RI 02903, USA
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY 40536, USA
| | - Nasir Iqbal
- Division of Cardiovascular Medicine, Azra Naheed Medical College, 55150 Lahore, Pakistan
| | - Afshin Ehsan
- Lifespan Cardiovascular Institute, Providence, RI 02903, USA
- Division of Cardiothoracic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Barry Sharaf
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Cardiovascular Institute, Providence, RI 02903, USA
| | - Paul Gordon
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Cardiovascular Institute, Providence, RI 02903, USA
| | - Marwan Saad
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Lifespan Cardiovascular Institute, Providence, RI 02903, USA
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14
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De Felice F, Paolucci L, Musto C, Cifarelli A, Coletta S, Gabrielli D, Grasso C, Tamburino C, Adamo M, Denti P, Giordano A, Bartorelli AL, Montorfano M, Citro R, Mongiardo A, Monteforte I, Villa E, Giannini C, Crimi G, Tarantini G, Rubbio AP, Bedogni F. Outcomes in Patients With High Transmitral Gradient After Mitral Valve Transcatheter Edge-to-Edge Repair for Mitral Regurgitation. Am J Cardiol 2022; 182:46-54. [PMID: 36075753 DOI: 10.1016/j.amjcard.2022.07.036] [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: 06/16/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
Despite being highly effective in reducing residual mitral regurgitation and improving outcomes, mitral valve transcatheter edge-to-edge repair (MV-TEER) may be associated with high postprocedural residual mitral gradient (rMG). Conflicting results have been reported regarding the relation between rMG and adverse events. This study aimed to evaluate the predictors and the impact of elevated rMG after MV-TEER on clinical events in patients with functional mitral regurgitation (FMR) at 2 years follow-up. We selected a cohort of 864 patients with FMR who were treated with MV-TEER enrolled in the multicentre Italian Society of Interventional Cardiology (GISE) registry of transcatheter treatment of mitral valve regurgitation (GIOTTO). Patients were stratified into tertiles according to rMG. The primary clinical end point was a composite of all-cause death and hospitalization because of heart failure at 2-year follow-up. Overall, 269 patients (31.5%) with an rMG <3 mm Hg, 259 (30.3%) with an rMG ≥3/<4 mm Hg, and 326 (38.2%) with an rMG ≥4 mm Hg were considered. At multivariate logistic regression, ischemic FMR etiology, baseline MG, and the number of implanted clips were independent predictors of an rMG ≥4 mm Hg. Clinical follow-up was available in 570 patients (63.2%). Patients with an rMG ≥4 mm Hg experienced higher rates of the composite end point than patients of the other tertiles (51.1%, vs 42.3% vs 40.8% log-rank test: p = 0.033). In multivariate Cox's regression, both rMG ≥4 mm Hg (hazard ratio 1.54, 95% confidence interval 1.14 to 2.08) and residual mitral regurgitation ≥2+ (hazard ratio 1.36, 95% confidence interval 1.01 to 1.83) were independent predictors of adverse events at 2-year follow-up. In conclusion, we demonstrated that real-world patients who underwent MV-TEER who show an rMG ≥4 mm Hg are at higher risk of death or hospitalization because of heart failure during a 2-year follow-up. Further studies will be needed to confirm our results.
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Affiliation(s)
- Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Luca Paolucci
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Carmine Musto
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Alberta Cifarelli
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Silvio Coletta
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Domenico Gabrielli
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - S. Marco," University of Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - S. Marco," University of Catania, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Antonio Luca Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit and Transcatheter Valve Therapy Group, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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15
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Gooden SCM, Hatoum H, Boudoulas KD, Vannan MA, Dasi LP. Effects of MitraClip Therapy on Mitral Flow Patterns and Vortex Formation: An In Vitro Study. Ann Biomed Eng 2022; 50:680-690. [PMID: 35411431 PMCID: PMC11070279 DOI: 10.1007/s10439-022-02944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/03/2022] [Indexed: 11/01/2022]
Abstract
MitraClip transcatheter edge-to-edge repair is used to treat mitral regurgitation (MR). While MR is reduced, diastolic left ventricular flows are altered. An in vitro left heart simulator was used to assess a porcine mitral valve in the native, MR, and MR plus MitraClip cases. Velocity, vorticity, and Reynolds shear stress (RSS) were quantified by particle image velocimetry. Peak velocity increased from 1.20 m/s for native to 1.30 m/s with MR. With MitraClip, two divergent jets of 1.18 and 0.61 m/s emerged. Higher vorticity was observed with MR than native and lessened with MitraClip. MitraClip resulted in shear layer formation and downstream vortex formation. Native RSS decreased from 33 Pa in acceleration to 29 Pa at peak flow, then increased to 31 Pa with deceleration. MR RSS increased from 27 Pa in acceleration to 40 Pa at peak flow to 59 Pa during deceleration. MitraClip RSS increased from 79 Pa in acceleration to 162 Pa during peak flow, then decreased to 45 Pa during deceleration. After MitraClip, two divergent jets of reduced velocity emerged, accompanied by shear layers and recirculation. Chaotic flow developed, resulting in elevated RSS magnitude and coverage. Findings help understand consequences of MitraClip on left ventricular flow dynamics.
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Affiliation(s)
- Shelley Chee-Mei Gooden
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | | | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Lakshmi P Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA.
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16
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Fernández-Peregrina E, Pascual I, Freixa X, Tirado-Conte G, Estévez-Loureiro R, Carrasco-Chinchilla F, Benito-González T, Asmarats L, Sanchís L, Jiménez-Quevedo P, Avanzas P, Caneiro-Queija B, Molina-Ramos AI, Fernández-Vázquez F, Li CH, Flores-Umanzor E, Sans-Roselló J, Nombela-Franco L, Arzamendi D. Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification. EUROINTERVENTION 2022; 17:1300-1309. [PMID: 34483091 PMCID: PMC9743252 DOI: 10.4244/eij-d-21-00205] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND MAC is commonly found in patients affected with MR, and it is associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge repair could be an alternative treatment, although there is little evidence in this population. AIMS The aim of this study was to analyse the safety, efficacy and durability of MitraClip implantation in patients affected with mitral regurgitation (MR) and mitral annulus calcification (MAC). METHODS We analysed the outcomes of 61 suitable patients affected with severe MR and moderate or severe MAC (the "MAC" group) and 791 patients with no or mild MAC (the "NoMAC" group) treated with the MitraClip device. RESULTS Procedural success was similar (91.8% vs 95.1%, p=0.268, in MAC and NoMAC, respectively), with a very low rate of complications. At one-year follow-up, 90.6% of MAC and 79.5% of NoMAC patients had MR grade ≤2 (p=0.129), 80% in both groups remained in NYHA Functional Class ≤II, and a significant reduction in cardiac readmissions was observed (65% vs 78% in MAC vs NoMAC, p=0.145). One-year mortality tended to be higher in MAC patients (19.7% vs 11.3%, p=0.050), with no difference in cardiovascular mortality (15.3% vs 9.2%, p=0.129). CONCLUSIONS MitraClip use in selected patients with moderate or severe MAC is safe, feasible and achieves good clinical and echocardiographic results at one-year follow-up.
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Affiliation(s)
- Estefanía Fernández-Peregrina
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Xavier Freixa
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | | | | | | | - Lluis Asmarats
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Sanchís
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Chi-Hion Li
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jordi Sans-Roselló
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
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17
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Hiraoka A, Hayashida A, Totusgawa T, Toki M, Chikazawa G, Yoshitaka H, Sakaguchi T. Flow adjusted transmitral pressure gradient as a modified indicator of functional mitral stenosis after repair for degenerative mitral regurgitation. J Card Surg 2022; 37:1827-1834. [PMID: 35234318 PMCID: PMC9311205 DOI: 10.1111/jocs.16373] [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: 12/14/2021] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
Abstract
Background and Aim After repair of degenerative mitral regurgitation (DMR), the focus is on functional mitral stenosis (FMS) when there is a decline of mitral hemodynamics. Yet, the clinical impacts and a standardized definition are still undecided. Since common mitral hemodynamic parameters are influenced by transmitral flow, the aim of this study is to seek the impact of flow adjusted transmitral pressure gradient (TMPG) by left ventricular stroke volume (LVSV) on the midterm outcomes. Methods Three hundred one patients who had undergone isolated mitral valve repair for degenerative lesions with annuloplasty prosthesis between October 2012 and June 2019 were included. Postoperative adverse events occurred in 20 patients (6.6%). Flow adjusted TMPG was defined as TMPG/LVSV. Results Common mitral hemodynamic parameters were not associated with adverse events. By multivariable analysis, patients’ age, left ventricular ejection fraction (LVEF) and mean TMPG/LVSV were isolated as independent predictors (adjusted hazard ratio: 1.05, 0.95, and 1.16; p = .037, .005, and .035). Flow adjusted TMPG was significantly higher in the full ring group compared to the partial band group (0.051 mmHg/ml, [0.038–0.068] vs. 0.041 mmHg/ml, [0.031–0.056]; p < .001) and had a significantly negative correlation with the size of the annuloplasty prosthesis (r = −0.37, p < .001). Conclusions Conventional mitral hemodynamic parameters were not associated with adverse cardiac events after repair for DMR. Adjustment by flow has a potential to advance pressure gradient to a more sensitive indicator of FMS associated with clinical outcomes.
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Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Akihiro Hayashida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Toshinori Totusgawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Misako Toki
- Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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18
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Hohmann C, Ludwig M, Walker J, Iliadis C, Schipper JH, Baldus S, Pfister R. Real-world anticoagulatory treatment after percutaneous mitral valve repair using MitraClip: a retrospective, observational study on 1300 patients. Clin Res Cardiol 2022; 111:889-899. [PMID: 35220447 PMCID: PMC9334399 DOI: 10.1007/s00392-022-01988-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Aims This study sought to investigate current anticoagulatory treatment patterns and clinical outcome in patients undergoing transcatheter mitral valve repair (MitraClip). Methods and results In a retrospective study of a German claims database (InGef research database), anticoagulatory treatment regimens were assessed using any drug prescription post discharge within the first 90 days after MitraClip procedure. Clinical events between 30 days and 6 months were examined by treatment regime. The study population comprised 1342 patients undergoing MitraClip procedure between 2014 and 2018. 22.4% received antiplatelet monotherapy, 20.8% oral anticoagulation (OAC) plus antiplatelet therapy, 19.4% OAC monotherapy, 11.7% dual antiplatelet therapy, 2.8% triple therapy and 21.0% did not receive any anticoagulatory drugs. 63% of patients with OAC received non-vitamin-K antagonist oral anticoagulants (NOAC). A total of 168 patients were newly prescribed OAC after MitraClip, of whom 12 patients (7.1%) had no diagnosis of atrial fibrillation or venous thromboembolism. 40% of patients with OAC prior to MitraClip did not have any OAC after MitraClip. The adjusted risk of all-cause mortality was significantly increased in patients with no anticoagulatory treatment (HR 3.84, 95% CI 2.33–6.33, p < 0.0001) when compared to antiplatelet monotherapy whereas the other regimes were not significantly different. Conclusions This large real-world data analysis demonstrates a heterogeneous spectrum of prescriptions for anticoagulant therapies after MitraClip. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted for controlled trials in order to establish evidence-based recommendations on anticoagulatory treatment after percutaneous mitral valve repair. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-01988-2.
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19
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Kato Y, Okada A, Amaki M, Nishimura K, Kanzaki H, Kataoka Y, Miyamoto K, Hamatani Y, Amano M, Takahama H, Hasegawa T, Kusano K, Fujita T, Kobayashi J, Yasuda S, Izumi C. Three-dimensional echocardiography for predicting mitral stenosis after MitraClip for functional mitral regurgitation. J Echocardiogr 2022; 20:151-158. [PMID: 35084686 DOI: 10.1007/s12574-022-00564-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2021] [Accepted: 01/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postprocedural mitral stenosis (MS), or increased transmitral mean pressure gradient (TMPG), is one of the limitations of transcatheter edge-to-edge mitral valve repair using MitraClip (Abbott Vascular Inc., Santa Clara, USA); however, the usefulness of three-dimensional transesophageal echocardiography (3D-TEE) for predicting postprocedural MS in functional mitral regurgitation (MR) has not been fully elucidated. METHODS Eighty-two consecutive functional MR patients who underwent transcatheter mitral valve repair using MitraClip were retrospectively studied. Postprocedural MS was defined as TMPG ≥ 5 mmHg by echocardiography. RESULTS Ten patients had postprocedural MS, and 3D-TEE showed that patients with postprocedural MS had smaller preprocedural mitral valve orifice area (MVOA), anteroposterior and mediolateral diameter, leaflet area, and annulus area. Receiver operating characteristic analysis showed that leaflet area (area under the curve (AUC) 0.829), annulus area (AUC 0.813), anteroposterior diameter (AUC 0.797) and mediolateral diameter (AUC 0.803) evaluated using 3D-TEE were predictors of postprocedural MS, and their predictive abilities were higher than those of preprocedural MVOA (AUC 0.756) and preprocedural TMPG (AUC 0.716). Adding leaflet area to TMPG and MVOA resulted in higher C-statistics for predicting postprocedural MS (from 0.716 to 0.845 and from 0.756 to 0.853, respectively). CONCLUSIONS In functional MR patients treated with MitraClip, leaflet area and annulus area evaluated using 3D-TEE had high predictive values for postprocedural MS, and their predictive abilities were higher than those of preprocedural TMPG or MVOA.
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Affiliation(s)
- Yuta Kato
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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20
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Sudarsky D, Kusniec F, Grosman-Rimon L, Lubovich A, Kinany W, Hazanov E, Gelbstein M, Birati EY, Carasso S. Immediate Post-Procedural and Discharge Assessment of Mitral Valve Function Following Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation and Association with Outcomes. J Clin Med 2021; 10:jcm10225448. [PMID: 34830731 PMCID: PMC8624366 DOI: 10.3390/jcm10225448] [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: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
The correlation between residual mitral regurgitation (rMR) grade or mitral valve pressure gradient (MVPG), at transcatheter edge-to-edge mitral valve repair (TEEMr) completion and at discharge, is unknown. Furthermore, there is disagreement regarding rMR grade or MVPG from which prognosis diverts. We retrospectively studied 82 patients that underwent TEEMr. We tested the correlation between rMR or MVPG and evaluated their association, with outcomes. Moderate or less rMR (rMR ≤ 2) at TEEMr completion was associated with improved survival, whereas mild or less rMR (rMR ≤ 1) was not. Patients with rMR ≤ 1 at discharge demonstrated a longer time of survival, of first heart failure hospitalization and of both. The correlation for both rMR grade (r = 0.5, p < 0.001) and MVPG (r = 0.51, p < 0.001), between TEEMr completion and discharge, was moderate. MR ≤ 2 at TMEER completion was the strongest predictor for survival (HR 0.08, p < 0.001) whereas rMR ≤ 1 at discharge was independently associated with a lower risk of the combined endpoint (HR 4.17, p = 0.012). MVPG was not associated with adverse events. We conclude that the assessments for rMR grade and MVPG, at the completion of TEEMr and at discharge, should be distinctly reported. Improved outcome is expected with rMR ≤ 2 at TEEMr completion and rMR ≤ 1 at discharge. Higher MVPG is not associated with unfavorable outcomes.
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Affiliation(s)
- Doron Sudarsky
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Correspondence:
| | - Fabio Kusniec
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Liza Grosman-Rimon
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Ala Lubovich
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Wadia Kinany
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Evgeni Hazanov
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Michael Gelbstein
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Edo Y. Birati
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
| | - Shemy Carasso
- The Lidya and Carol Kittner, B. Padeh Medical Center, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya 15208, Israel; (F.K.); (L.G.-R.); (A.L.); (W.K.); (E.H.); (M.G.); (E.Y.B.); (S.C.)
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
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21
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Kaewkes D, Patel V, Ochiai T, Flint N, Ahmad Y, Kim I, Koseki K, Sharma R, Joseph J, Yoon SH, Chakravarty T, Nakamura M, Makar M, Makkar R. Usefulness of Computed Tomography to Predict Mitral Stenosis After Transcatheter Mitral Valve Edge-to-Edge Repair. Am J Cardiol 2021; 153:109-118. [PMID: 34210503 DOI: 10.1016/j.amjcard.2021.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022]
Abstract
Multidetector computed tomography (MDCT) can provide valuable information for preprocedural planning of transcatheter mitral valve interventions. However, no data exists on pre-MDCT parameters predicting high transmitral pressure gradient (TMPG) post-MitraClip procedure. We analyzed the preprocedural MDCTs of 156 consecutive patients with mitral regurgitation undergoing MitraClip implantation at our institution. The mean TMPG was assessed by periprocedural transesophageal and pre-discharge transthoracic echocardiography. MDCT-derived mitral annulus area (MAA), anterior-posterior (AP) and medial-lateral (ML) mitral annulus diameters, and mitral valve orifice area (MVOA) were smaller in patients with mean TMPG ≥5 mmHg than those with mean TMPG <5 mmHg after 1-or 2-clip implantation. Small MAA, AP and ML diameters, and MVOA were moderately correlated with high TMPG post-MitraClip, in which MAA and MVOA had the highest degree of correlation after 1-clip (r = -0.46 both), whereas MAA and ML had the strongest degree of correlation after 2-clip (r = -0.39 both) and at discharge (r = -0.38 both). From the receiver-operating-characteristic curve analyses, no significant differences in the area under the curve were observed among these MDCT parameters for low TMPG after MitraClip implantation, except for those between MAA and AP diameter at discharge (p=0.026). For optimal cutoff values, MAA ≥1100 and ≥1300 mm2 had positive predictive values of 89% and 91%, while both MAA ≥750 and ≥900 mm2 had negative predictive values of 100%, for mean TMPG <5 mmHg after 1-and 2-clip implantation, respectively. In conclusion, in patients undergoing the MitraClip procedure, preprocedural MDCT parameters are useful to predict postprocedural mitral stenosis.
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Affiliation(s)
- Danon Kaewkes
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Tomoki Ochiai
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Nir Flint
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yousif Ahmad
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Isic Kim
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Department of Cardiology, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Keita Koseki
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Department of Cardiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Rohan Sharma
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Jubin Joseph
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Sung-Han Yoon
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Tarun Chakravarty
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Moody Makar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Raj Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California.
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22
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Shah MA, Dalak FA, Alsamadi F, Shah SH, Qattea MB. Complications Following Percutaneous Mitral Valve Edge-to-Edge Repair Using MitraClip. JACC Case Rep 2021; 3:370-376. [PMID: 34317539 PMCID: PMC8311053 DOI: 10.1016/j.jaccas.2020.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022]
Abstract
Percutaneous mitral valve edge-to-edge repair with MitraClip (Abbott, Abbott Park, Illinois) has emerged as an effective and safe treatment for symptomatic mitral regurgitation in suitable patients. The safety of the MitraClip procedure is well established, and the rate of major complications is 4.35%. We present 4 cases of mitral regurgitation in patients who had complications following the MitraClip procedure. (Level of Difficulty: Intermediate.)
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23
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Oguz D, Padang R, Pislaru SV, Nkomo VT, Mankad SV, Alkhouli M, Guerrero M, Reeder GS, Eleid MF, Rihal CS, Thaden JJ. Clinical predictors and impact of postoperative mean gradient on outcome after transcatheter edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2021; 98:E932-E937. [PMID: 34245208 DOI: 10.1002/ccd.29867] [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: 04/01/2021] [Revised: 05/31/2021] [Accepted: 07/01/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The predictors and clinical significance of increased Doppler-derived mean diastolic gradient (MG) following transcatheter edge-to-edge mitral valve repair (MVTEER) remain controversial. OBJECTIVE We sought to examine baseline correlates of Doppler-derived increased MG post-MVTEER and its impact on intermediate-term outcomes. METHODS Patients undergoing MVTEER were analyzed retrospectively. Post-MVTEER increased MG was defined as >5 mmHg or aborted clip implantation due to increased MG intraprocedurally. Baseline MG and 3D-guided mitral valve area (MVA) by planimetry were retrospectively available in 233 and 109 patients. RESULTS 243 patients were included; 62 (26%) had MG > 5 mmHg post-MVTEER or aborted clip insertion, including 7 (11%) that had aborted clip implantation. Mortality occurred in 63 (26%) during a median follow up of 516 days (IQR 211, 1021). Increased post-MVTEER MG occurred more frequently in females (44% vs. 16%, p < 0.001), those with baseline MVA <4.0 cm2 (71% vs. 16%), baseline MG ≥4 mmHg (61% vs. 20%), or multiple clips implanted (33% vs. 21%, p = 0.04). Increased post-MVTEER MG was associated with increased subsequent mortality compared to those with normal gradient (HR 1.91 95% CI 1.15-3.18 p = 0.016) as was aborted clip insertion compared to all others (HR 5.23 95% CI 2.06-13.28 p < 0.001). CONCLUSIONS Smaller baseline MVA and increased baseline MG are associated with increased MG post-MVTEER and patients with a Doppler-derived post-MVTEER MG >5 mmHg suffered excess subsequent mortality. In high risk patients considered for MVTEER, identification of those at risk of iatrogenic mitral stenosis with MVTEER is important as they may be optimally treated with alternate surgical or transcatheter therapies.
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Affiliation(s)
- Didem Oguz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Öztürk C, Sprenger K, Tabata N, Sugiura A, Weber M, Nickenig G, Schueler R. The predictive value of intraprocedural mitral gradient for outcomes after MitraClip and its peri-interventional dynamics. Echocardiography 2021; 38:1115-1124. [PMID: 34085714 DOI: 10.1111/echo.15126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/25/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The current data on the impact of the increased mitral gradient (MG) on outcomes are ambiguous, and intraprocedural assessment of MG can be challenging. Therefore, we aimed to evaluate (a) peri-interventional dynamics of MG, (b) the impact of intraprocedural MG on clinical outcomes, and (c) predictors for unfavorable MG values after MitraClip. METHODS We prospectively included patients who underwent MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after 6 months. 12-month survival was documented. RESULTS One hundred and seventy five patients (age 81.2 ± 8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups according to intraprocedural MG with a threshold of 4.5 mm Hg, determined by a multivariate analysis of predictors for 12-month mortality (<4.5 mm Hg: Group 1, ≥4.5 mm Hg: Group 2). Intraprocedural MG ≥4.5 mm Hg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, P = .03, OR: 1.70, P = .05), and >3.9 mm Hg was associated with adverse functional outcomes (OR: 1.96, P = .04). The baseline leaflet-to-annulus index >1.1 was found to be the strongest independent predictor (OR: 9.74, P = .001) for unfavorable intraprocedural MG, followed by the number of implanted clips (P = .01), MG at baseline (P = .02), and central clip implantation (P = .05). CONCLUSION An intraprocedural MG <3.9 mm Hg appears to be the best strategy for 1-year survival and favorable functional outcomes after edge-to-edge MV repair with MitraClip independently from MR etiology. Peri-interventional echocardiographic and procedural parameters are useful for the adequate assessment of intraprocedural MG.
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Affiliation(s)
- Can Öztürk
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Kim Sprenger
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Noriaki Tabata
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Robert Schueler
- Contilia Heart and Vascular Center, Elisabeth Hospital, Essen, Germany
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25
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Zheng R, Kusunose K. Review: application of current imaging modalities in the management of left-sided valvular heart disease. Cardiovasc Diagn Ther 2021; 11:793-803. [PMID: 34295706 DOI: 10.21037/cdt.2020.02.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/31/2020] [Indexed: 11/06/2022]
Abstract
In terms of valvular heart disease (VHD) imaging, transthoracic echocardiography (TTE) is the preferred first choice because of its widespread availability. Other modalities, such as transesophageal echocardiography, computed tomography and magnetic resonance imaging, have played a supplementary role in diagnosis for severity, deciding the timing/type of treatment, detection of post procedural complications, and prognostic predictions. However, there are few consensuses on how to employ these modalities, as the evidence is not extensive as that for TTE. On the other hand, these imaging modalities also have their own unique strengths. If employed properly, these modalities have the potential to play a more prominent role in clinical decision making. In this review, we focus on the potential, limitations and application of current imaging modalities in the management of left-sided VHD.
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Affiliation(s)
- Robert Zheng
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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26
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Oguz D, Padang R, Rashedi N, Pislaru SV, Nkomo VT, Mankad SV, Malouf JF, Guerrero M, Reeder GS, Eleid MF, Rihal CS, Thaden JJ. Risk for Increased Mean Diastolic Gradient after Transcatheter Edge-to-Edge Mitral Valve Repair: A Quantitative Three-Dimensional Transesophageal Echocardiographic Analysis. J Am Soc Echocardiogr 2021; 34:595-603.e2. [DOI: 10.1016/j.echo.2021.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 02/08/2023]
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27
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Comprehensive echocardiographic prediction of postprocedural transmitral pressure gradient following transcatheter mitral valve repair. Int J Cardiovasc Imaging 2021; 37:2947-2955. [PMID: 34046774 DOI: 10.1007/s10554-021-02290-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
Iatrogenic mitral stenosis following transcatheter mitral valve repair (TMVR) for relevant mitral regurgitation (MR) is a potential adverse side-effect, known to affect long-term outcome. However, only few determinants of an elevated mean transmitral pressure gradient (TMPG) have been described thus far. We sought to develop an integrative model for the prediction of TMPG following MitraClip (MC) therapy. From 01/2013 to 03/2017, a total of 175 consecutive patients were successfully (MR ≤ 2 + at discharge) treated with a MitraClip implantation at our centre. Of these, a total of 148 patients (54% male, 77.0 ± 6.0 years, 58% with secondary MR) had complete echocardiographic data sets comprising pre- and postinterventional two- and three-dimensional transthoracic (TTE) and transoesophageal (TOE) echocardiograms. Comprehensive studies of predefined parameters were performed. An expert-based prediction model including preprocedural variables (annular ellipticity, mitral valve commissure-to-commissure diameter, preprocedural transmitral pressure gradient and MR aetiology) was set up and validated with a total of 200 bootstrap samples. A nomogram was developed to predict the postprocedural TMPG based on selected echocardiographic variables. Introduction of nomogram-based guiding of MC therapy could help identify patients at risk for postprocedural mitral stenosis, have an influence on preprocedural patient selection and intraprocedural decision making.
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28
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Lim DS, Smith RL, Zahr F, Dhoble A, Laham R, Lazkani M, Kodali S, Kliger C, Hermiller J, Vora A, Sarembock IJ, Gray W, Kapadia S, Greenbaum A, Rassi A, Lee D, Chhatriwalla A, Shah P, Rodés-Cabau J, Ibrahim H, Satler L, Herrmann HC, Mahoney P, Davidson C, Petrossian G, Guerrero M, Koulogiannis K, Marcoff L, Gillam L. Early outcomes from the CLASP IID trial roll-in cohort for prohibitive risk patients with degenerative mitral regurgitation. Catheter Cardiovasc Interv 2021; 98:E637-E646. [PMID: 34004077 DOI: 10.1002/ccd.29749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/21/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We report the 30-day outcomes from the roll-in cohort of the CLASP IID trial, representing the first procedures performed by each site. BACKGROUND The currently enrolling CLASP IID/IIF pivotal trial is a multicenter, prospective, randomized trial assessing the safety and effectiveness of the PASCAL transcatheter valve repair system in patients with clinically significant MR. The trial allows for up to three roll-in patients per site. METHODS Eligibility criteria were: DMR ≥3+, prohibitive surgical risk, and deemed suitable for transcatheter repair by the local heart team. Trial oversight included a central screening committee and echocardiographic core laboratory. The primary safety endpoint was a 30-day composite MAE: cardiovascular mortality, stroke, myocardial infarction (MI), new need for renal replacement therapy, severe bleeding, and non-elective mitral valve re-intervention, adjudicated by an independent clinical events committee. Thirty-day echocardiographic, functional, and quality of life outcomes were assessed. RESULTS A total of 45 roll-in patients with mean age of 83 years and 69% in NYHA class III/IV were treated. Successful implantation was achieved in 100%. The 30-day composite MAE rate was 8.9% including one cardiovascular death (2.2%) due to severe bleeding from a hemorrhagic stroke, one MI, and no need for re-intervention. MR≤1+ was achieved in 73% and ≤2+ in 98% of patients. 89% of patients were in NYHA class I/II (p < .001) with improvements in 6MWD (30 m; p = .054) and KCCQ (17 points; p < .001). CONCLUSIONS Early results representing sites with first experience with the PASCAL repair system showed favorable 30-day outcomes in patients with DMR≥3+ at prohibitive surgical risk.
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Affiliation(s)
- D Scott Lim
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Robert L Smith
- Department of Surgery, Division of Cardiovascular Surgery, Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Firas Zahr
- Department of Medicine, Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Abhijeet Dhoble
- Department of Medicine, Division of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Roger Laham
- Department of Medicine, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohamad Lazkani
- Department of Medicine, Division of Cardiovascular Medicine, UCHealth Medical Center of the Rockies, Loveland, Colorado, USA
| | - Susheel Kodali
- Department of Medicine, Division of Cardiovascular Medicine, Columbia University Medical Center, New York, New York, USA
| | - Chad Kliger
- Department of Medicine, Division of Cardiovascular Medicine, Northwell-Lenox Hill, New York, New York, USA
| | - James Hermiller
- Department of Medicine, Division of Cardiovascular Medicine, St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Amit Vora
- Department of Medicine, Division of Cardiovascular Medicine, UPMC Pinnacle Health Harrisburg, Harrisburg, Pennsylvania, USA
| | - Ian J Sarembock
- Department of Medicine, Division of Cardiovascular Medicine, The Christ Hospital and Lindner Clinical Research Center, Cincinnati, Ohio, USA
| | - William Gray
- Department of Medicine, Division of Cardiovascular Medicine, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - Samir Kapadia
- Department of Medicine, Division of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Adam Greenbaum
- Department of Medicine, Division of Cardiovascular Medicine, Emory University, Atlanta, Georgia, USA
| | - Andrew Rassi
- Department of Medicine, Division of Cardiovascular Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - David Lee
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Adnan Chhatriwalla
- Department of Medicine, Division of Cardiovascular Medicine, Saint Luke's Hospital of Kansas City, Kansas City, Missouri, USA
| | - Pinak Shah
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Josep Rodés-Cabau
- Department of Medicine, Division of Cardiovascular Medicine, Laval Hospital, Quebec City, Quebec, Canada
| | - Homam Ibrahim
- Department of Medicine, Division of Cardiovascular Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Lowell Satler
- Department of Medicine, Division of Cardiovascular Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Howard C Herrmann
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Mahoney
- Department of Medicine, Division of Cardiovascular Medicine, Sentara Norfolk General Hospital, Norfolk, Virginia, USA
| | - Charles Davidson
- Department of Medicine, Division of Cardiovascular Medicine, Northwestern University, Chicago, Illinois, USA
| | - George Petrossian
- Department of Medicine, Division of Cardiovascular Medicine, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Mayra Guerrero
- Department of Medicine, Division of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Konstantinos Koulogiannis
- Department of Medicine, Division of Cardiovascular Medicine, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Leo Marcoff
- Department of Medicine, Division of Cardiovascular Medicine, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Linda Gillam
- Department of Medicine, Division of Cardiovascular Medicine, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
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29
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Pierre K, Adedinsewo DA, Al-Hijji M, Miranda WR, Alkhouli M, Eleid MF, Guerrero M, Pollak PM, Rihal CS, El Sabbagh A. 30-day patient reported outcomes can be predicted by change in left atrial pressure and not change in transmitral gradient following MitraClip. Catheter Cardiovasc Interv 2021; 97:1244-1249. [PMID: 33502087 DOI: 10.1002/ccd.29477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/27/2020] [Accepted: 12/13/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Change in left atrial pressure (LAP) has been shown to be associated with symptom improvement post-MitraClip; however, the association between acute procedural changes in transmitral diastolic mean gradient (MG) compared to LAP and symptom improvement is not well established. METHODS 164 consecutive patients undergoing MitraClip at Mayo Clinic between June 2014 and May 2018 were included. Preclip and postclip MG and LAP were recorded. Baseline demographics, clinical, and echocardiographic outcomes, including 30-day New York Heart Association (NYHA) functional status were obtained from patient charts. RESULTS Median age was 81.5 years (IQR: 76.3, 87), 34% were female and 94.5% had NYHA class III and IV functional status at baseline. At baseline, median MG was 4 mmHg (IQR: 3, 5) and LAP was 19 mmHg (IQR: 16, 23.5). Following MitraClip deployment, the median MG was 4 mmHg (IQR: 3, 6) and the median LAP was 17 mmHg (IQR: 14, 21), 69.5% of patients had less than moderate MR. There was no statistically significant association between change in MG and NYHA functional class at 30 days (OR = 0.95, 95% CI: 0.76-1.20). However, a reduction in LAP following MitraClip deployment was significantly associated with improvement in NYHA functional status at 30 days following adjustments for age and sex (aOR 3.36, 95% CI: 1.34-8.65). There was no significant correlation between change in mean LAP and change in MG (p = .98). CONCLUSION Unlike change in left atrial pressure, change in MG post-MitraClip was not associated with patient reported outcomes at 30 days and did not correlate with change in left atrial pressure. Long-term follow up is needed to evaluate the impact of LA pressure on symptoms.
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Affiliation(s)
- Keniel Pierre
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Mohammed Al-Hijji
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter M Pollak
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
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30
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Besler C, Noack T, von Roeder M, Kitamura M, Kresoja KP, Flo Forner A, Bevilacqua C, Desch S, Ender J, Borger MA, Thiele H, Lurz P. Transcatheter edge-to-edge mitral valve repair with the PASCAL system: early results from a real-world series. EUROINTERVENTION 2020; 16:824-832. [PMID: 32515739 DOI: 10.4244/eij-d-20-00216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study sought to characterise the real-world performance and clinical outcomes of the PASCAL system, a leaflet approximation device for transcatheter mitral valve repair. METHODS AND RESULTS Fifty patients in NYHA Class II-IV despite optimal medical therapy (median age 78.0 years [IQR 74.5-81.0], 52% female, log EuroSCORE 21.6 [IQR 13.2-30.2]) were treated for severe mitral regurgitation (MR) and followed up for one month. Primary and secondary MR was present in 24% and 68% of patients, respectively, with a mixed aetiology observed in 8%. A 1-device strategy was employed in 26/50 patients (52%), a 2-device strategy in 23/50 (46%) patients, and a 3-device strategy in 1/50 (2%) patients. Technical and procedural success was achieved in 100% and 98% of patients, respectively. MR grade ≤1 was observed in 39/50 (78%) patients at discharge, and in 36/46 (78%) patients at one month, with transvalvular gradients remaining ≤5 mmHg in all patients. One device embolisation and one single leaflet device attachment were observed during follow-up. After one month, 73% of patients reported an improvement in NYHA class, and six-minute walk test distance increased by 73±12 m in patients without relevant tricuspid regurgitation. CONCLUSIONS In a real-world population, the PASCAL device effectively reduces MR and leads to functional improvements on short-term follow-up.
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Affiliation(s)
- Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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31
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Gyoten T, Schenk S, Grimmig O, Just S, Fritzsche D, Messroghli D. Outcome of medical therapy, repeat intervention, and mitral valve surgery after failed MitraClip therapy. Gen Thorac Cardiovasc Surg 2020; 69:803-810. [PMID: 33118111 DOI: 10.1007/s11748-020-01530-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Optimal treatment for residual mitral regurgitation (MR) after MitraClip failure is not clearly defined. We report our clinical experience and discuss treatment options. METHODS Between January 2013 and January 2018, 37 patients (75 ± 8.9 years, 46% male) were admitted for symptomatic MR (grade 3.1 ± 0.47) diagnosed after previous MitraClip therapy. Clinical outcome of these patients, who underwent medical therapy alone (n = 8, M-group), repeat MitraClip therapy (n = 8, reMC group), or mitral valve surgery (n = 21, S-group) for residual MR, were retrospectively analyzed. RESULTS Thirty-day survival was 88% (M-group), 100% (reMC-group), and 76% (S-group). The rate of discharge to home was 88% in the reMC-group, better than 38% in the M-group (p = 0.051) and 19% in the S-group (p < 0.001). Perioperative non-survivors in the S-group had high surgical risk with median logistic EuroSCORE of 64.6% (interquartile range 57.4%-87.0%); all died from low cardiac output syndrome or multiple organ failure. The main MR pathologies resulted from leaflet tear and tethering in the M-group, tethering in the reMC-group, and degenerative valve and leaflet tear in the S-group. Kaplan-Meier analysis of overall survival at 1 year showed better outcome for patients in the reMC-group (50%, 95% CI 15.2-77.5%) and S-group (47.6%, 95% CI 25.7-66.7%), as compared to those in the M-group (12.5%, 95% CI 0.70-42.3%) (log-rank test p = 0.108 and p = 0.167, respectively). CONCLUSION Medical therapy alone after failed MitraClip therapy resulted in poor 1-year prognosis. In patients without extremely high surgical risk, repeat MitraClip therapy, or surgical revision MIGHT BE CONSIDERED depending on valve pathology and cardiac comorbidities.
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Affiliation(s)
- Takayuki Gyoten
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany.
| | - Sören Schenk
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Oliver Grimmig
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Sören Just
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Dirk Fritzsche
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Charité, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
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32
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Ludwig S, Kalbacher D, Schofer N, Schäfer A, Koell B, Seiffert M, Schirmer J, Schäfer U, Westermann D, Reichenspurner H, Blankenberg S, Lubos E, Conradi L. Early results of a real-world series with two transapical transcatheter mitral valve replacement devices. Clin Res Cardiol 2020; 110:411-420. [PMID: 33074368 PMCID: PMC7907022 DOI: 10.1007/s00392-020-01757-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Aims Transcatheter mitral valve replacement (TMVR) with dedicated devices promises to fill the treatment gap between open-heart surgery and edge-to-edge repair for patients with severe mitral regurgitation (MR). We herein present a single-centre experience of a TMVR series with two transapical devices. Methods and results A total of 11 patients were treated with the Tendyne™ (N = 7) or the Tiara™ TMVR systems (N = 4) from 2016 to 2020 either as compassionate-use procedures or as commercial implants. Clinical and echocardiographic data were collected at baseline, discharge and follow-up and are presented in accordance with the Mitral Valve Academic Research Consortium (MVARC) definitions. The study cohort [age 77 years (73, 84); 27.3% male] presented with primary (N = 4), secondary (N = 5) or mixed (N = 2) MR etiology. Patients were symptomatic (all NYHA III/IV) and at high surgical risk [logEuroSCORE II 8.1% (4.0, 17.4)]. Rates of impaired RV function (72.7%), severe pulmonary hypertension (27.3%), moderate or severe tricuspid regurgitation (63.6%) and prior aortic valve replacement (63.6%) were high. Severe mitral annulus calcification was present in two patients. Technical success was achieved in all patients. In 90.9% (N = 10) MR was completely eliminated (i.e. no or trace MR). Procedural and 30-day mortality were 0.0%. At follow-up NYHA class was I/II in the majority of patients. Overall mortality after 3 and 6 months was 10.0% and 22.2%. Conclusions TMVR was performed successfully in these selected patients with complete elimination of MR in the majority of patients. Short-term mortality was low and most patients experienced persisting functional improvement. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01757-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany. .,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.
| | - D Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - N Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Schäfer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - B Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - J Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - U Schäfer
- Marienkrankenhaus Hamburg, Department of Cardiology, Angiology and Intensive Care, Hamburg, Germany
| | - D Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - H Reichenspurner
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - S Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - E Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - L Conradi
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Paulus MG, Meindl C, Böhm L, Holzapfel M, Hamerle M, Schach C, Maier LS, Debl K, Unsöld B, Birner C. Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation. PLoS One 2020; 15:e0232817. [PMID: 32463820 PMCID: PMC7255600 DOI: 10.1371/journal.pone.0232817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/22/2020] [Indexed: 01/11/2023] Open
Abstract
Background and objectives MitraClip implantation is an established therapy for secondary mitral regurgitation (MR) in high-risk patients and has shown to improve several important outcome parameters such as functional capacity. Patient selection is both challenging and crucial for achieving therapeutic success. This study investigated baseline predictors of functional improvement as it was quantified by the six-minute walk distance (6MWD) after transcatheter mitral valve repair. Methods and results We retrospectively analyzed 79 patients with secondary MR treated with MitraClip implantation at an academic tertiary care center. Before and four weeks after the procedure, all patients underwent comprehensive clinical assessment, six-minute walk tests and echocardiography. 6MWD significantly improved after MitraClip therapy (295 m vs. 265 m, p < 0.001). A linear regression model including seven clinical baseline variables significantly predicted the change in 6MWD (p = 0.002, R2 = 0.387). Female gender, diabetes mellitus and arterial hypertension were found to be significant negative predictors of 6MWD improvement. At baseline, female patients had significant higher left ventricular ejection fraction (49% vs. 42%, p = 0.019) and lower 6MWD (240 m vs. 288 m, p = 0.034) than male patients. Conclusion MitraClip implantation in secondary MR significantly improves functional capacity in high-risk patients even in the short term of four weeks after the procedure. Female gender, diabetes mellitus and arterial hypertension are baseline predictors of a less favourable functional outcome. While further validation in a larger cohort is recommended, these parameters may improve patient selection for MitraClip therapy.
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Affiliation(s)
- Michael G. Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Böhm
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Magdalena Holzapfel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
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Patzelt J, Zhang W, Sauter R, Mezger M, Nording H, Ulrich M, Becker A, Patzelt T, Rudolph V, Eitel I, Saad M, Bamberg F, Schlensak C, Gawaz M, Boekstegers P, Schreieck J, Seizer P, Langer HF. Elevated Mitral Valve Pressure Gradient Is Predictive of Long-Term Outcome After Percutaneous Edge-to-Edge Mitral Valve Repair in Patients With Degenerative Mitral Regurgitation ( MR ), But Not in Functional MR. J Am Heart Assoc 2019; 8:e011366. [PMID: 31248323 PMCID: PMC6662353 DOI: 10.1161/jaha.118.011366] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study analyzed the effects on long-term outcome of residual mitral regurgitation ( MR ) and mean mitral valve pressure gradient ( MVPG ) after percutaneous edge-to-edge mitral valve repair using the MitraClip system. Methods and Results Two hundred fifty-five patients who underwent percutaneous edge-to-edge mitral valve repair were analyzed. Kaplan-Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical end point (all-cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used. After percutaneous edge-to-edge mitral valve repair, mean MVPG increased from 1.6±1.0 to 3.1±1.5 mm Hg ( P<0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive of the combined end point while elevated MVPG >4.4 mm Hg was not according to Kaplan-Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities. In the cohort with degenerative MR , elevated MVPG was associated with increased occurrence of the primary end point, whereas this was not observed in the cohort with functional MR . Conclusions MVPG >4.4 mm Hg after MitraClip implantation was predictive of clinical outcome in the patient cohort with degenerative MR . In the patient cohort with functional MR , MVPG >4.4 mm Hg was not associated with increased clinical events.
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Affiliation(s)
- Johannes Patzelt
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Wenzhong Zhang
- 3 Department of Cardiology Affiliated Hospital of Qingdao University Qingdao Shandong China
| | - Reinhard Sauter
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Matthias Mezger
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Henry Nording
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Miriam Ulrich
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Annika Becker
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | | | | | - Ingo Eitel
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Mohammed Saad
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Fabian Bamberg
- 7 Department of Diagnostic and Interventional Radiology University Hospital Freiburg Germany
| | - Christian Schlensak
- 8 Department of Cardiovascular Surgery University Hospital Eberhard Karls University Tübingen Tübingen Germany
| | - Meinrad Gawaz
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Peter Boekstegers
- 9 Klinik für Kardiologie und Angiologie Klinikum Siegburg Siegburg Germany
| | - Juergen Schreieck
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Peter Seizer
- 4 Departments of Cardiology and Cardiovascular Medicine University Hospital Eberhard Karls University Tübingen Germany
| | - Harald F Langer
- 1 Department of Cardiology, Angiology and Intensive Care Medicine University Hospital Universitätsklinikum Schleswig-Holstein Lübeck Germany.,2 German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
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