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Camaj A, Thourani VH, Gillam LD, Stone GW. Heart Failure and Secondary Mitral Regurgitation: A Contemporary Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101195. [PMID: 39131058 PMCID: PMC11308134 DOI: 10.1016/j.jscai.2023.101195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 08/13/2024]
Abstract
Secondary mitral regurgitation (SMR) in patients with heart failure (HF) is associated with significant morbidity and mortality. In recent decades, SMR has received increasing scientific attention. Advances in echocardiography, computed tomography and cardiac magnetic resonance imaging have refined our ability to diagnose, quantify and characterize SMR. Concurrently, the treatment options for this high-risk patient population have continued to evolve. Guideline-directed medical therapies including beta-blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors target the underlying cardiomyopathy, and along with diuretics to treat pulmonary congestion, remain the cornerstone of therapy. Cardiac resynchronization therapy also reduces MR, alleviates symptoms and prolongs life in selected HF patients with SMR. While data supporting surgical mitral valve repair or replacement for SMR are limited, transcatheter edge-to-edge repair (TEER) has been demonstrated to improve survival, reduce the rate of hospitalization for heart failure, and improve functional capacity and quality-of-life in select patients with SMR who remain symptomatic despite medical therapy. Emerging transcatheter mitral valve repair and replacement technologies are undergoing investigation in TEER-eligible and TEER-ineligible patients. The optimal management of HF patients with SMR requires a multidisciplinary team of cardiologists, cardiac surgeons, imaging experts, and other organ specialists to select the best treatment approaches to improve the prognosis of these high-risk patients.
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Affiliation(s)
- Anton Camaj
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Linda D. Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Gregg W. Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Bruoha S, Assafin M, Ho E, Tang GH, Latib A. Transcatheter Mitral Valve Repair. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch64.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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3
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Eqbal A, Gupta S, Fam N, Ong G, Bisleri G. The impact of transcatheter edge-to-edge repair on mitral valve annular geometry. Curr Opin Cardiol 2022; 37:150-155. [PMID: 35058414 DOI: 10.1097/hco.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Mitral valve transcatheter edge-to-edge repair (TEER) is becoming increasingly common to treat severe mitral regurgitation. However, the lack of concomitant annuloplasty raises concerns regarding its durability. As a result, there is an emerging body of literature evaluating the impacts of TEER on mitral annular geometry. In this review, we summarize the most recent literature evaluating the impacts of TEER on annular geometry in the acute, intermediate and long-term. We also review the relationship between changes in annular geometry and clinical endpoints. RECENT FINDINGS Current evidence suggests that TEER acutely induces favourable changes in mitral annular size and shape, which may persist for at least up to 1 year. Few studies suggest that TEER-induced annular remodelling is associated with positive clinical outcomes. SUMMARY The current body of literature is sparse and limited to primarily small case series. Data from the surgical literature suggest that ringless edge-to-edge repair is associated with eventual failure. Unfortunately, few studies evaluate TEER-induced annular changes beyond the acute postprocedural phase. Future research needs to focus on and evaluate the significance of TEER-induced changes in annular dimensions in the long-term.
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Affiliation(s)
- Adam Eqbal
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton
| | - Neil Fam
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Géraldine Ong
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Structural Heart Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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4
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Zeng G, Li G, Jia Y, Chen S, Chen P, He Z. Detachment Force of the Helical Anchor in Mitral Annulus. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Purpose of Review We aimed to picture the contemporary landscape of available catheter-based repair and replacement solutions for mitral regurgitation (MR) in Europe. Recent Findings Edge-to-edge repair remains the dominant technique for transcatheter mitral valve repair especially in the context of secondary mitral regurgitation. Two recent randomized trials reported seemingly contradicting clinical results with transcatheter edge-to-edge repair for patients with heart failure and severe secondary MR. A proportionality framework related to secondary MR was proposed to help explain inconsistencies but requires further research. (In)Direct annuloplasty primarily aims to correct secondary MR; however, the scientific basis seems less robust. One dedicated transcatheter heart valve has the CE mark for mitral valve replacement but requires transapical access. Balloon-expandable transcatheter aortic valve platforms are emerging for transvenous transseptal mitral replacement in the context of mitral annular calcification, a failing surgical mitral bioprosthesis, or annuloplasty. Advanced computed tomography imaging techniques improved pre-procedural planning and introduced the option for modeling and simulation. Summary Development of a toolbox of catheter-based technologies, complementary imaging modalities, and refined patient selection offer novel perspectives to high-risk patients with primary or secondary MR. Clinical trials are required to help formulate evidence-based guidelines for the management of mitral valve disease.
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Perez-Camargo D, Chen M, Taramasso M. Devices for transcatheter mitral valve repair: current technology and a glimpse into the future. Expert Rev Med Devices 2021; 18:609-628. [PMID: 34092173 DOI: 10.1080/17434440.2021.1940141] [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] [Indexed: 10/21/2022]
Abstract
Introduction: Due to a large unmet need for the treatment of mitral regurgitation, transcatheter mitral valve repair devices have emerged in the last decade as an alternative therapeutic option. Given the complexity of this disease, several device systems for transcatheter mitral valve repair have been developed and are categorized according to its mechanism of action; each device has advantages and disadvantages for certain clinical and pathophysiologic characteristics, and in order to improve outcomes, proper patient selection among other key points are fundamental.Areas covered: The purpose of this article is to review the current state-of-the-art technologies available for transcatheter mitral valve repair, patient suitability, outcomes, and future perspectives.Expert opinion: Transcatheter therapy for mitral regurgitation improves outcomes and pushes the boundaries of biomedical technology while maintaining scientific rigor for device development. Surgical and percutaneous procedures should be viewed as complements to treat a wider spectrum of patients affected by this entity. Future directions from multidisciplinary innovation and cooperation will consolidate this therapeutic option.
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Affiliation(s)
- Daniel Perez-Camargo
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,Fundación Interhospitalaria Para la Investigación Cardiovascular, Madrid, Spain
| | - Mi Chen
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,HerzZentrum Hirlsanden Zurich, Zurich, Switzerland
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De Backer O, Wong I, Taramasso M, Maisano F, Franzen O, Søndergaard L. Transcatheter mitral valve repair: an overview of current and future devices. Open Heart 2021; 8:openhrt-2020-001564. [PMID: 33911022 PMCID: PMC8094333 DOI: 10.1136/openhrt-2020-001564] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
The field of transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR) is rapidly evolving. Besides the well-established transcatheter mitral edge-to-edge repair approach, there is also growing evidence for therapeutic strategies targeting the mitral annulus and mitral valve chordae. A patient-tailored approach, careful patient selection and an experienced interventional team is crucial in order to optimise procedural and clinical outcomes. With further data from ongoing clinical trials to be expected, consensus in the Heart Team is needed to address these complexities and determine the most appropriate TMVr therapy, either single or combined, for patients with severe MR.
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Affiliation(s)
| | - Ivan Wong
- Cardiology, Rigshospitalet, Kobenhavn, Denmark
| | - Maurizio Taramasso
- Department of Cardiothoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Levi N, Meerkin D. Transcatheter Repair of the Mitral Valve: Relevant Pathophysiology, Investigation, and Management. Can J Cardiol 2021; 37:1027-1040. [PMID: 33753201 DOI: 10.1016/j.cjca.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022] Open
Abstract
Mitral regurgitation (MR) is a common condition causing significant morbidity and mortality in the Western world. Although surgical therapy has developed over 5 decades to provide solutions, only a minority of patients undergo surgery. The last decade has seen the emergence and application of multiple transcatheter techniques in attempts to address this undertreated population with the large clinical experience of MitraClip providing the most insight. Clear understanding of the pathophysiology of different MR types as well as the role of particularly secondary MR on patient's clinical syndrome allow for better prediction as to which patient subgroups will benefit from different repair techniques or intervention at all. Most of the techniques are based on surgical technique and are applied as single-device/technique solutions, whether leaflet, chordal, or annular solutions, but with broadening experience, combination therapies are likely to find a place in creating a more complete and surgical-like solution.
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Affiliation(s)
- Nir Levi
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Meerkin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Kang JJH, Bozso SJ, El-Andari R, Adams C, Nagendran J. Transcatheter mitral valve repair and replacement: the next frontier of transcatheter valve intervention. Curr Opin Cardiol 2021; 36:163-171. [PMID: 33044266 DOI: 10.1097/hco.0000000000000803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW We summarize the recent developments in transcatheter mitral valve repair (TMVr) and replacement (TMVR), discuss determinants of MitraClip outcomes in various mitral regurgitation causes, and highlight newly emerging devices and randomized trials. RECENT FINDINGS The discordant results published in the two recent randomized trials for MitraClip, the COAPT and the MITRA-FR trial have led to the emergence of a new conceptual framework such as the proportionate versus disproportionate mitral regurgitation and hemodynamics assessment tools like the real-time continuous left atrial pressure monitoring. Learning curve and volume-outcome analyses and studies examining the MitraClip usage in patients with degenerative mitral regurgitation are recent developments that have influenced MitraClip regulation and coverage. Several trials for TMVr devices that take an alternative approach to the edge-to-edge repair are underway and advancements in the TMVR technologies are continuing to progress to fill the unmet needs of treating high surgical risk patients whose complex valve anatomy make TMVr unfeasible. SUMMARY Evidence supports careful analysis of the valve area and left ventricular function in addition to the left atrial hemodynamics will improve the MitraClip outcome. Operator experience plays a greater effect when achieving excellent results with 1+ or less residual mitral regurgitation whereas surgical MVr volume did not influence TMVr outcome. Interventions on the complex primary mitral regurgitation remain under the surgical domain, but MITRA high risk (HR) and REPAIR mitral regurgitation trials are underway to evaluate the role of MitraClip in high to intermediate surgical risk patients with primary mitral regurgitation. Despite the slow developments in TMVR, the results of the early trials of its devices are promising.
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Affiliation(s)
| | - Sabin J Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton
| | | | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Liu Y, Lutter G, Knueppel P, Frank D, Lozonschi L, Berndt R, Attmann T, Puehler T. Transcatheter Mitral Valve Replacement: A Novel Anchor Technology. Thorac Cardiovasc Surg 2021; 70:126-132. [PMID: 33540424 DOI: 10.1055/s-0041-1722976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mitral valved stents tend to migrate or to develop paravalvular leakage due to high-left ventricular pressure in this cavity. Thus, this study describes a newly developed mitral valved stent anchoring technology. METHODS Based on an existing mitral valved stent, four anchoring units with curved surgical needles were designed and fabricated using three-dimensional (3D) software and print technology. Mitral nitinol stents assembled with four anchoring units were successively fixed on 10 porcine annuli. Mechanical tests were performed with a tensile force test system and recorded the tension forces of the 10 nitinol stents on the annulus. RESULTS The average maximum force was 28.3 ± 5.21 N, the lowest was 21.7 N, and the highest was 38.6 N until the stent lost contact with the annulus; for the break force (zero movement of stent from annulus), the average value was 18.5 ± 6.7 N with a maximum value of 26.9 N and a minimum value of 6.07 N. It was additionally observed that the puncture needles of the anchoring units passed into the mitral annulus in all 10 hearts and further penetrated the myocardium in only one additional heart. The anchoring units enhanced the tightness of the mitral valved stent and did not destroy the circumflex coronary artery, coronary sinus, right atrium, aortic root, or the left ventricular outflow tract. CONCLUSION The new anchoring units for mitral nitinol stents were produced with 3D software and printing technology; with this new type of anchoring technology, the mitral valved stent can be tightly fixed toward the mitral annulus.
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Affiliation(s)
- Yazhou Liu
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiothoracic Surgery, The First People's Hospital of Jingmen, Hubei Minzu University, Jingmen, Hubei, China
| | - Georg Lutter
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Philipp Knueppel
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Derk Frank
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Lucian Lozonschi
- Department of Cardiothoracic Surgery, Tampa University, Tampa, Florida, United States
| | - Rouven Berndt
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Tim Attmann
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Thomas Puehler
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
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11
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Denti P, Sala A, Belluschi I, Alfieri O. Over 15 years: the advancement of transcatheter mitral valve repair. Ann Cardiothorac Surg 2021; 10:15-27. [PMID: 33575172 DOI: 10.21037/acs-2020-mv-18] [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] [Indexed: 12/12/2022]
Abstract
Patients with severe symptomatic mitral regurgitation, if left untreated, have a poor prognosis. In those patients not eligible for mitral valve (MV) surgery, percutaneous repair may improve clinical outcomes. In the past 15 years several devices have been developed to address different MV lesions. This manuscript will review the advancement of transcatheter MV repair through the years, focusing on technologies for which consistent clinical data is available.
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Affiliation(s)
- Paolo Denti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Alessandra Sala
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Igor Belluschi
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
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12
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Singh GD, Kiaii B. Direct annuloplasty: where are we at and where are we heading? Ann Cardiothorac Surg 2021; 10:170-171. [PMID: 33575190 DOI: 10.21037/acs-2020-mv-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
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13
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Edelman JJ, Meduri CU, Yong G, Thourani VH. Transcatheter devices for direct annuloplasty and chordal replacement in degenerative mitral regurgitation. Ann Cardiothorac Surg 2021; 10:164-166. [PMID: 33575188 DOI: 10.21037/acs-2020-mv-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Christopher U Meduri
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Gerald Yong
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
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Donatelle M, Ailawadi G. Transcatheter tricuspid valve repair: Bringing the forgotten valve into the spotlight. J Thorac Cardiovasc Surg 2020; 160:1467-1473. [DOI: 10.1016/j.jtcvs.2020.04.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/08/2020] [Accepted: 04/02/2020] [Indexed: 01/18/2023]
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15
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Brescia AA, Bolling SF. Tricuspid Repair: Put a Ring on It. Ann Thorac Surg 2020; 111:2010-2011. [PMID: 33238107 DOI: 10.1016/j.athoracsur.2020.08.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery, University of Michigan, Frankel Cardiovascular Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Frankel Cardiovascular Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
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- Department of Cardiac Surgery, University of Michigan, Frankel Cardiovascular Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109
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Minimally invasive and transcatheter approaches for mitral valve surgery. Indian J Thorac Cardiovasc Surg 2020; 36:492-501. [PMID: 33061160 DOI: 10.1007/s12055-019-00901-3] [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: 07/29/2019] [Revised: 10/22/2019] [Accepted: 11/07/2019] [Indexed: 10/24/2022] Open
Abstract
Mitral valve surgery has evolved through the ages, in response to prevalent epidemiology of mitral pathologies. In the modern era, advances in technology has allowed physicians to help a wider spectrum on increasingly sicker patients. This review summarises these advances and its associated evidence base for safety and efficacy.
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Heitzinger G, Hülsmann M, Mascherbauer J, Kastl S, Hengstenberg C, Goliasch G, Bartko PE. Current Insights Into Secondary Mitral Regurgitation—Workup and Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00826-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Fernando RJ, Shah R, Yang Y, Goeddel LA, Villablanca PA, Núñez-Gil IJ, Ramakrishna H. Transcatheter Mitral Valve Repair and Replacement: Analysis of Recent Data and Outcomes. J Cardiothorac Vasc Anesth 2020; 34:2793-2806. [DOI: 10.1053/j.jvca.2020.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 12/27/2022]
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Donatelle M, Ailawadi G. Transcatheter Mitral Valve Repair and Replacement: What's on the Horizon? Semin Thorac Cardiovasc Surg 2020; 33:291-298. [PMID: 32980535 DOI: 10.1053/j.semtcvs.2020.09.018] [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: 05/16/2020] [Revised: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 11/11/2022]
Abstract
There are more than 4 million people affected by mitral regurgitation in both the United States and Europe. Prior to the last decade the only options for treatment of MR were medical therapy and open-heart surgery which left many high risk patients with little option once medically optimized. However, we saw a flood in innovative transcatheter mitral valve interventions. As the technologies are refined these new approaches are considerably less invasive and for some high-risk patients may represent a superior option to conventional open-heart surgery. There are 3 main approaches currently being considered for transcatheter mitral valve repair, edge to edge repair, indirect annuloplasty and direct annuloplasty. There have also been large advancements in recent years in transcatheter replacement of the mitral valve. Although many of these devices are under investigation still, we sought to examine the current state of innovative transcatheter mitral valve technologies.
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Affiliation(s)
- Marissa Donatelle
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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Ali M, Shreenivas SS, Pratt DN, Lynch DR, Kereiakes DJ. Percutaneous Interventions for Secondary Mitral Regurgitation. Circ Cardiovasc Interv 2020; 13:e008998. [PMID: 32757659 DOI: 10.1161/circinterventions.120.008998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mitral regurgitation is frequently associated with ventricular dysfunction and carries a high mortality. Guideline-directed medical therapy, surgical mitral valve repair or replacement, and, in the setting of advanced heart failure, heart transplant and left ventricular assist devices have been the mainstay of treatment. However, rapid advancement in the field has resulted in approval of edge-to-edge mitral valve repair with the MitraClip, and there are several novel catheter-based percutaneous options in clinical trials. Percutaneous options, while promising, must be deployed in patients who are most likely to benefit, and thus, understanding the pathophysiology of specific subgroups of patients with functional mitral regurgitation (eg, disproportionate versus proportionate mitral regurgitation) is key to the success of new devices. We review the pathophysiology, percutaneous therapeutic treatment options, and ongoing clinical trials for functional mitral regurgitation.
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Affiliation(s)
- Mahboob Ali
- University of Cincinnati, OH (M.A., D.N.P., D.R.L.)
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Baldus S, v. Bardeleben RS, Eggebrecht H, Elsässer A, Hausleiter J, Ince H, Kelm M, Kuck KH, Lubos E, Nef H, Raake P, Rillig A, Rudolph V, Schulze PC, Schlitt A, Stellbrink C, Möllmann H. Interventionelle Therapie von AV-Klappenerkrankungen – Kriterien für die Zertifizierung von Mitralklappenzentren. KARDIOLOGE 2020. [DOI: 10.1007/s12181-020-00409-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Webb J, Hensey M, Fam N, Rodés-Cabau J, Daniels D, Smith R, Szeto W, Boone R, Ye J, Moss R, Peterson M, Ong G, Paradis JM, Dagenais F, Wintzer-Wehekind J, Shafi B, Nair D, Szerlip M, Grayburn P, Silvestry F, Koulogiannis K, Hermiller J, Guyton R, Herrmann H. Transcatheter Mitral Valve Replacement With the Transseptal EVOQUE System. JACC Cardiovasc Interv 2020; 13:2418-2426. [PMID: 33092713 DOI: 10.1016/j.jcin.2020.06.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to examine the initial experience with a novel transseptal transcatheter mitral valve replacement (TMVR) system. BACKGROUND Transseptal TMVR may offer a less invasive option than surgery for mitral regurgitation (MR) with greater efficacy and fewer anatomic limitations than transcatheter repair. METHODS Patients were treated with the EVOQUE TMVR system from September 2018 to October 2019. Key inclusion criteria were moderate or greater MR, New York Heart Association functional class ≥II, and high or prohibitive surgical risk. The primary outcome was technical success, defined by Mitral Valve Academic Research Consortium criteria. RESULTS Fourteen patients were treated, all with at least moderate to severe MR. The median age was 84 years, and the median Society of Thoracic Surgeons score was 4.6%. MR was degenerative in 4 (28.6%), functional in 3 (21.4%), and mixed in 7 (50%). Technical success was achieved in 13 patients (92.9%), and 1 patient was converted to surgery. At 30 days there was 1 noncardiovascular mortality (7.1%), 2 strokes (14.3%), no myocardial infarctions, and no rehospitalizations. Two patients (14.3%) underwent paravalvular leak closure. One patient (7.1%) underwent alcohol septal ablation for left ventricular outflow tract obstruction. Including the 2 patients with paravalvular leak closure, MR was mild or less in all implanted patients at 30 days, with no MR in 10 (83.3%). Mean mitral gradient was 5.8 mm Hg (median). New York Heart Association functional class improved to ≤II in 9 patients (81.8%). CONCLUSIONS This first-in-human experience has demonstrated the feasibility of the transseptal EVOQUE TMVR system. Further clinical studies are required to establish safety and clinical outcomes.
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Affiliation(s)
- John Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Mark Hensey
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Neil Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Daniels
- Sutter-Mills Peninsula Medical Center, Burlingame, California
| | | | | | - Robert Boone
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jian Ye
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Robert Moss
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Dagenais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Bilal Shafi
- Sutter-Mills Peninsula Medical Center, Burlingame, California
| | - Deepu Nair
- Sutter-Mills Peninsula Medical Center, Burlingame, California
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Winkel MG, Praz F, Wenaweser P. Mitral and Tricuspid Transcatheter Interventions Current Indications and Future Directions. Front Cardiovasc Med 2020; 7:61. [PMID: 32500083 PMCID: PMC7242641 DOI: 10.3389/fcvm.2020.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
Valvular heart disease is responsible for a high rate of morbidity and mortality, especially in the elderly population. With the emergence of new transcatheter treatment options, the therapeutic spectrum for patients with valvular heart disease has considerably expanded during the past years. Interventional treatment of the mitral and tricuspid valve requires an individualized and versatile approach owing to the different etiologies of valvular dysfunction and the complex anatomy of the atrioventricular valves. This article aims to review recent developments, summarize the evidence, indications and limitations of the available systems, and provide a glimpse into the future of transcatheter interventions for the treatment of mitral and tricuspid valve disease.
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Affiliation(s)
- Mirjam Gauri Winkel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Heart Clinic Hirslanden Zurich, Zurich, Switzerland
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24
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Voci D, Pozzoli A, Miura M, Gavazzoni M, Gülmez G, Scianna S, Zuber M, Maisano F, Taramasso M. Developments in transcatheter tricuspid valve therapies. Expert Rev Cardiovasc Ther 2019; 17:841-856. [PMID: 31795771 DOI: 10.1080/14779072.2019.1699056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Transcatheter tricuspid valve (TV) procedures emerged as an alternative to surgery for symptomatic high-risk patients with severe tricuspid regurgitation.Areas covered: A literature search was performed using PubMed. Authors review clinical evidence in this field, the imaging features and the developments in TV transcatheter technologies. Currently, transcatheter devices for TV procedures can be allocated into four main groups: 1) those ones targeting leaflet malcoaptation, 2) those addressing annular dilatation, 3) those performing heterotopic valve implantation and 4) those onesaccomplishing a complete transcatheter replacement of the valve.Expert opinion: Actually, encouraging results are provided by initial experience in the field of transcatheter TV procedures. However, this field remains full of challenges that faced could lead to better results and prognosis for the patients. The next steps in this emerging field will need to focus on accurate patient selection, an early patient referral and on studies comparable and providing long-term data.
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Affiliation(s)
- Davide Voci
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Alberto Pozzoli
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Mizuki Miura
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Mara Gavazzoni
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Gökhan Gülmez
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Salvatore Scianna
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Michel Zuber
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Francesco Maisano
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
| | - Maurizio Taramasso
- Heart Center, Zürich University Hospital, University of Zürich, Zürich, Switzerland
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25
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Williams AM, Brescia AA, Watt TMF, Romano MA, Bolling SF. Transcatheter therapy for tricuspid regurgitation: The surgical perspective. Prog Cardiovasc Dis 2019; 62:473-478. [PMID: 31801700 DOI: 10.1016/j.pcad.2019.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
Tricuspid regurgitation (TR) remains a complex valve pathology affecting nearly two million people in the United States. Although it can present as a primary valve pathology, TR often presents as a late finding in patients with severe pulmonary disease or end-stage chronic heart failure. Surgical repair of isolated TR or TR from left-sided pathology has been associated with high morbidity and mortality. Furthermore, surgery for patients with TR and advanced cardiac disease has been associated with poor long-term outcomes. In recent years, transcatheter technology has emerged to target high-risk surgical patients with TR. Currently, multiple new transcatheter strategies to treat TR have shown initial benefit. However, further development of this technology is required. The aim of this perspective is to provide an overview of TR pathophysiology and to highlight the successful aspects of surgery for TR that provide insight for further translation of transcatheter strategies for patients with TR. These include replication of successful surgical techniques (ring-based annuloplasty and valve replacement) and the goal of achieving no to minimal residual TR following intervention. Earlier implementation of transcatheter valve repair to minimize TR progression and further development of transcatheter valve replacement strategies are also next steps in the translation of this technology.
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Affiliation(s)
- Aaron M Williams
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.
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26
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Abstract
New developments in transcatheter valve technologies including aortic valve replacement and mitral valve and tricuspid valve interventions are described. Recent studies evaluating the success rate, patient outcomes, and anesthesiologic management of the procedures are discussed.
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Affiliation(s)
- Michael A Ackermann
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany
| | - Jörg K Ender
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany.
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27
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Williams AM, Bolling SF, Latib A. The five Ws of transcatheter tricuspid valve repair: Who, What, When, Where, and Why. EUROINTERVENTION 2019; 15:841-845. [PMID: 31746749 DOI: 10.4244/eijv15i10a159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Aaron M Williams
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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28
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Evans AS, Weiner MM, Shaefi S, Patel PA, Townsley MM, Kumaresan A, Feinman JW, Fritz AV, Martin AK, Steinberg TB, Renew JR, Gui JL, Radvansky B, Bhatt H, Subramani S, Sharma A, Gutsche JT, Augoustides JG, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2019; 34:1-11. [PMID: 31759862 DOI: 10.1053/j.jvca.2019.10.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022]
Abstract
This highlights in our specialty for 2019 begin with the ongoing major developments in transcatheter valve interventions. Thereafter, the advances in left ventricular assist devices are reviewed. The recent focus on conduit selection and robotic options in coronary artery bypass surgery are then explored. Finally, this special articles closes with a discussion of pulmonary hypertension in noncardiac surgery, anesthetic technique in cardiac surgery, as well as postoperative pneumonia and its outcome consequences.
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Affiliation(s)
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine Beth Israel, Deaconess Medical Center, Boston, MA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Abirami Kumaresan
- Department of Anesthesiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Ashley V Fritz
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Toby B Steinberg
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - J Ross Renew
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jane L Gui
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian Radvansky
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - Himani Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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29
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Mangieri A, Laricchia A, Giannini F, Gallo F, Kargoli F, Ladanyi A, Testa L, Colombo A, Latib A. Emerging Technologies for Percutaneous Mitral Valve Repair. Front Cardiovasc Med 2019; 6:161. [PMID: 31781576 PMCID: PMC6851532 DOI: 10.3389/fcvm.2019.00161] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022] Open
Abstract
Mitral regurgitation (MR) is a common disease affecting more than 4 million people in the United States and the European Union. A significant number of percutaneous valves have been developed recently, specifically designed for the mitral anatomy, and with a promising evidence of good procedural and echocardiographic outcomes. However, even if transcatheter mitral valve replacement (TMVR) will have a role in the future of percutaneous treatment of both functional and degenerative mitral regurgitation, percutaneous mitral valve repair will always play a vital role in the treatment of MR because of the favorable safety profile and the fact that it respects the native anatomy. In this review, we will discuss the new emerging technologies under development to treat mitral regurgitation focusing on different devices that aim to target different components of the mitral anatomy.
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Affiliation(s)
| | | | | | - Francesco Gallo
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Faraj Kargoli
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Annamaria Ladanyi
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States.,San Raffaele University Hospital, Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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30
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Tabata N, Sinning JM, Kaikita K, Tsujita K, Nickenig G, Werner N. Current status and future perspective of structural heart disease intervention. J Cardiol 2019; 74:1-12. [DOI: 10.1016/j.jjcc.2019.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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