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Ailawadi G, Lim DS, Grayburn PA. Response by Ailawadi et al to Letter Regarding Article, "One-Year Outcomes After MitraClip for Functional Mitral Regurgitation". Circulation 2019; 140:e175-e176. [PMID: 31356137 DOI: 10.1161/circulationaha.119.040735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gorav Ailawadi
- Department of Surgery, Division of Cardiac Surgery (G.A.), University of Virginia, Charlottesville
| | - D Scott Lim
- Department of Medicine, Division of Cardiology (D.S.L.), University of Virginia, Charlottesville
| | - Paul A Grayburn
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center and Baylor Scott and White Heart Hospital, Dallas, TX (P.A.G.)
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Geis NA, Pleger ST, Bekeredjian R, Chorianopoulos E, Kreusser MM, Frankenstein L, Ruhparwar A, Katus HA, Raake PWJ. Haemodynamic effects of percutaneous mitral valve edge-to-edge repair in patients with end-stage heart failure awaiting heart transplantation. ESC Heart Fail 2018; 5:892-901. [PMID: 30058757 PMCID: PMC6165942 DOI: 10.1002/ehf2.12313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022] Open
Abstract
Aims Functional mitral regurgitation is complicating end‐stage heart failure and potential heart transplantation by increasing pulmonary artery pressures. The aim of the present study was to investigate feasibility and haemodynamic effects of percutaneous mitral valve edge‐to‐edge repair using the MitraClip™ device in patients with end‐stage heart failure awaiting heart transplantation. Methods and results In this retrospective study, we identified nine patients suffering from end‐stage heart failure listed for heart transplantation in whom moderate–severe or severe functional mitral regurgitation was recognized and treated with percutaneous mitral valve edge‐to‐edge repair. Twenty‐two patients listed for heart transplantation and presenting with moderate–severe or severe functional mitral regurgitation treated in the pre‐MitraClip™ era served as controls. Patients were analysed at two separate time points: MitraClip™ group: pre‐procedure and post‐procedure (follow‐up: 215 ± 53 days) and control group: study entry with recognition of moderate–severe or severe functional mitral regurgitation (follow‐up: 197 ± 47 days). Percutaneous mitral valve edge‐to‐edge repair with the MitraClip™ was feasible and safe in our high‐risk end‐stage heart failure population. The intervention resulted in significant reduction of mitral regurgitation (grade 3.0 [0.5] to 1.5 [0.5]; P = 0.009), left atrial diameter (51 mm [16] to 49 mm [4]; follow‐up MitraClip™ vs. control group P = 0.0497), pulmonary artery pressures (sPA 50 mmHg [15] to 45 mmHg [10]; P = 0.02; mPA 34 mmHg [8] to 30 mmHg [10]; P = 0.02), and New York Heart Association class (3.5 [1.0] to 3.0 [0.5]; P = 0.01) and improved mixed‐venous oxygen saturation (57% [11] to 55% [7]; follow‐up MitraClip™ vs. control group P = 0.02). No changes in the control group were observed. Conclusions MitraClip™ implantation as ‘bridge‐to‐transplant’ strategy in patients with end‐stage heart failure and severe functional mitral regurgitation awaiting heart transplantation is feasible and appears to result in favourable haemodynamic effects.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Emmanuel Chorianopoulos
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Lowry JE, Fichtlscherer S, Witte KK. Therapeutic options for functional mitral regurgitation in chronic heart failure. Expert Rev Med Devices 2018; 15:357-365. [PMID: 29724138 DOI: 10.1080/17434440.2018.1473032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Mitral regurgitation is a common finding in patients with chronic heart failure and is associated with a progressive worsening of symptoms, reduced survival and increased cost of care. However, the use of mitral valve surgery for these patients remains controversial and has not been shown to improve survival. Consequently, research has been increasingly directed towards the nonsurgical management of this important co-morbidity of heart failure. AREAS COVERED The present review will describe the relevance of mitral regurgitation in people with chronic heart failure, the current options for percutaneous treatment and the evidence base for each of these. EXPERT COMMENTARY Although at present there are few solid data to guide heart teams in deciding what degree of mitral regurgitation to treat, in which patients, and with what, this situation is likely to change over the next two years with the release of the first large randomised trials of percutaneous interventions.
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Affiliation(s)
- Judith E Lowry
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| | - Stephan Fichtlscherer
- b Department of Internal Medicine, Division of Cardiology , University Hospital Frankfurt , Frankfurt am Main , Germany
| | - Klaus K Witte
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
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Wengenmayer T, Reinöhl J, Steinfurt J, Mittag A, Bode C, Biermann J. Implantation of CARILLON ® Mitral Contour System with transvenous left ventricular lead in place. Clin Res Cardiol 2017; 106:796-801. [PMID: 28477282 DOI: 10.1007/s00392-017-1121-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac resynchronisation therapy (CRT) is an established treatment option for chronic heart failure patients with left bundle branch block. Although a concomitant functional mitral regurgitation is often reduced by CRT, many patients need additional mitral valve repair. Placing a CARILLON® Mitral Contour System (CMCS) over a transvenous CRT lead is currently not recommended, since both of them are implanted in the coronary sinus (CS). The aim of this study was to investigate the feasibility of sequential implantation of a transvenous LV lead followed by CMCS implantation, and to assess LV lead performance and possibility of extraction. METHODS AND RESULTS Standard transvenous LV leads were implanted in the CS of five female sheep. After establishing regular anatomical position with stable electrical parameters of the LV lead, a CMCS was additionally implanted in the CS. After an observation period of 100 days, lead performance and positions of lead and CMCS were studied. Sequential implantation of the two components was feasible in sheep. After 100 days, all leads showed regular measurements of impedance, threshold, and sensing. There was no migration of either the LV lead or the CMCS. In all cases, the LV lead could be completely extracted without migration of the CMCS. There were no acute or long-term complications. CONCLUSIONS In an animal model of healthy adult sheep, implantation of CMCS with a transvenous LV lead already in place was feasible and without major problems with either the CMCS or the LV lead. Electrical performance of the LV leads was excellent. All LV leads could be extracted without migration of the CMCS.
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Affiliation(s)
- T Wengenmayer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - J Reinöhl
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - J Steinfurt
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - A Mittag
- IMTR, Institute of Medical Technology and Research, Rottmersleben, Germany
| | - C Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - J Biermann
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Versaci F, Vizzari G, Sergi D, Trivisonno A, Andò G, Nardi S, Ussia GP, Romeo F. Cardiac resynchronization therapy before and after MitraClip implantation: An advantageous upgrading to reduce mitral regurgitation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:26-29. [PMID: 28119045 DOI: 10.1016/j.carrev.2017.01.006] [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: 11/14/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
MitraClip therapy has been proposed as therapeutic option in selected patients with degenerative or functional mitral regurgitation (FMR), leading to clinical and prognostic benefits. Previous studies demonstrated the safety and the efficacy of MitraClip therapy on symptoms and left ventricular remodeling in cardiac resynchronization therapy (CRT) non-responder patients. We report a case of a CRT non-responder patient treated with MitraClip implantation followed by a new upgrading of the CRT for persistent FMR at the follow-up. The optimization of the interventricular delay, guided by echocardiographic parameters, resulted in a significant clinical and functional benefit. Echo-guided CRT upgrading can provide additive efficacy for patients in whom MitraClip implantation does not significantly improve FMR and symptoms.
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Affiliation(s)
- Francesco Versaci
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Italy
| | - Giampiero Vizzari
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Domenico Sergi
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Italy
| | | | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Stefano Nardi
- Department of Cardiology, "Pineta Grande" Hospital, Castelvolturno (CE), Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Italy
| | - Francesco Romeo
- Department of Cardiovascular Disease, Tor Vergata University of Rome, Italy
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