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Yeo KK, Tan JWC, Muller DW, Walters DL, Lindenfeld J, Lee MKY, Chui ASF, Satish S, Santoso T, Kubo S, Meng JCK, Sin KY, Ewe SH, Sim D, Tay E, Meemook K, Sung SH, Nguyen QN, Pan X, Amaki M, Izumo M, Hayashida K, Kim JS, Kang DY, Stone G, Matsumoto T. Asian Pacific Society of Cardiology Consensus Recommendations on the Use of MitraClip for Mitral Regurgitation. Eur Cardiol 2021; 16:e25. [PMID: 34163538 PMCID: PMC8218170 DOI: 10.15420/ecr.2021.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
Transcatheter mitral valve repair with the MitraClip, a catheter-based percutaneous edge-to-edge repair technique to correct mitral regurgitation (MR), has been demonstrated in Western studies to be an effective and safe MR treatment strategy. However, randomised clinical trial data on its use in Asian-Pacific patients is limited. Hence, the Asian Pacific Society of Cardiology convened an expert panel to review the available literature on MitraClip and to develop consensus recommendations to guide clinicians in the region. The panel developed statements on the use of MitraClip for the management of degenerative MR, functional MR, and other less common indications, such as acute MR, dynamic MR, hypertrophic obstructive cardiomyopathy, and MR after failed surgical repair. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted ‘agree’ or ‘neutral’. This consensus-building process resulted in 10 consensus recommendations to guide general cardiologists in the evaluation and management of patients in whom MitraClip treatment is being contemplated.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Edgar Tay
- National University Heart Centre Singapore
| | | | | | - Quang Ngoc Nguyen
- Department of Cardiology, Hanoi Medical University, Vietnam National Heart Institute Hanoi, Vietnam
| | - Xiangbin Pan
- Fuwai Hospital CAMS & PUMC, National Center for Cardiovascular Diseases Beijing, China
| | - Makoto Amaki
- National Cerebral and Cardiovascular Center Suita, Japan
| | - Masaki Izumo
- St Marianna University School of Medicine Kawasaki, Japan
| | | | | | | | - Gregg Stone
- Icahn School of Medicine at Mount Sinai New York, US
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Ma J, Liu J, Wei P, Yao X, Zhang Y, Fang L, Chen Z, Liu Y, Tan T, Wu H, Huang H, Xie B, Chen J, Zhuang J, Guo H. Quadrangular resection versus chordal replacement for degenerative posterior mitral leaflet prolapse. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:60. [PMID: 33553353 PMCID: PMC7859790 DOI: 10.21037/atm-20-7475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The aims of the present study was to compare midterm results of quadrangular leaflet resection versus chordal replacement for the repair of degenerative posterior mitral leaflet (PML) prolapse, and to explore the risk factors for recurrent severe mitral regurgitation (MR). Methods From January 2012 to December 2018, 1,423 consecutive patients underwent mitral valve (MV) repair. A total of 317 had degenerative PML prolapse and constituted the study population. Of these, 74 (23.3%) underwent quadrangular leaflet resection, and 243 (76.7%) underwent chordal replacement. Outcomes were compared by using unadjusted data and propensity score-matched analyses. Results Patients with multiple leaflet prolapse were more likely to undergo chordal replacement (18.4% vs. 41.9%, P<0.001), and performed as a minimally invasive approach (47.3% vs. 61.7%, P=0.027). Of the entire cohort, 1 death (0.3%) occurred due to intraoperative aortic dissection, and 1 patient who had undergone chordal replacement required reoperation before discharge for posterior leaflet tearing. There was no significant difference in the probability of freedom from recurrent severe MR at 82 months between the resection and neochordae groups in both the pre-matched (95.6% vs. 88.8%, P=0.105) and matched (95.2% vs. 88.5%, P=0.170) cohorts, which was consistent across all of the examined subgroups (P>0.05). Multivariate Cox regression indicated that dilated left ventricular end-systolic diameter (LVESD) was an independent risk factor for recurrent severe MR [<40 vs. >40 mm, hazards ratio (HR): 3.17, 95% confidence interval (CI): 1.20–8.39, P=0.020]; however, surgical technique was not (resection vs. neochordae, HR: 0.31, 95% CI: 0.07–1.37, P=0.122). Conclusions Chordal replacement for the repair of degenerative posterior MV prolapse yields similar satisfactory outcomes when compared with quadrangular resection, and is promising in minimally invasive cardiac surgery for various lesions. However, it is also associated with more recurrent severe MR, albeit non-significant, for which patients with dilated LVESD are at high risk.
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Affiliation(s)
- Jiexu Ma
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.,Medical College, Shantou University, Shantou, China
| | - Jian Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Peijian Wei
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.,Medical College, Shantou University, Shantou, China
| | - Ximeng Yao
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.,Medical College, Shantou University, Shantou, China
| | - Yuyuan Zhang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Liangzheng Fang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Zhao Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Yanjun Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Tong Tan
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.,Medical College, Shantou University, Shantou, China
| | - Hongxiang Wu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huanlei Huang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Bin Xie
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huiming Guo
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
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Pascual I, Carrasco-Chinchilla F, Benito-Gonzalez T, Li CH, Avanzas P, Nombela-Franco L, Pan M, Serrador Frutos A, Freixa X, Trillo-Nouche R, Hernández-Antolín RA, Andraka Ikazuriaga L, Cruz-Gonzalez I, López-Mínguez JR, Diez JL, Berenguer-Jofresa A, Sanchis J, Ruiz-Quevedo V, Urbano-Carrillo C, Dominguez JFO, Ortas-Nadal MR, Molina Navarro E, Carrillo X, Alonso-Briales JH, Fernández-Vázquez F, Asmarats Serra L, Hernandez-Vaquero D, Jimenez-Quevedo P, Mesa D, Rodríguez-Gabella T, Regueiro A, Martinez Monzonís A, Salido Tahoces L, Ruiz Gomez L, Trejo-Velasco B, Becerra-Muñoz VM, Garrote-Coloma C, Fernández Peregrina E, Lorca R, Agustín JAD, Romero M, Amat-Santos IJ, Sabaté M, Alvarez ABC, Hernandez-Garcia JM, Gualis J, Arzamendi D, Moris C, Tirado-Conte G, Sánchez-Recalde A, Estevez-Loureiro R. Transcatheter Mitral Repair for Functional Mitral Regurgitation According to Left Ventricular Function: A Real-Life Propensity-Score Matched Study. J Clin Med 2020; 9:E1792. [PMID: 32526978 PMCID: PMC7356666 DOI: 10.3390/jcm9061792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/24/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip® between two groups according to LVEF. METHODS In an observational registry study, we compared the outcomes in patients with FMR who underwent TMVR with and without LVEF <30%. The primary endpoint was the combined one-year all-cause mortality and unplanned hospital readmissions due to HF. The secondary end-points were New York Heart Association (NYHA) functional class and mitral regurgitation (MR) severity. Propensity-score matching was used to create two groups with the same baseline characteristics, except for baseline LVEF. RESULTS Among 535 FMR eligible patients, 144 patients with LVEF <30% (group 1) and 144 with LVEF >30% (group 2) had similar propensity scores and were included in the analyses. The primary study endpoint was significantlly higher in group 1 (33.3% vs. 9.4%, p = 0.002). There was a maintained improvement in secondary endpoints without significant differences among groups. CONCLUSION FMR patients with LVEF <30% treated with MitraClip® had higher mortality and readmissions than patients with LVEF ≥30% treated with the same device. However, both groups improved the NYHA functional class and MR severity.
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Affiliation(s)
- Isaac Pascual
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Fernando Carrasco-Chinchilla
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Tomas Benito-Gonzalez
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Chi Hion Li
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Pablo Avanzas
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Manuel Pan
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Ana Serrador Frutos
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Xavier Freixa
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Ramiro Trillo-Nouche
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Rosa A. Hernández-Antolín
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
| | - Leire Andraka Ikazuriaga
- Cardiology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (L.A.I.); (L.R.G.)
| | - Ignacio Cruz-Gonzalez
- Cardiology Department, University Hospital of Salamanca, IBSAL, Institute of Biomedical Research of Salamanca, University of Salamanca, CIBERCV, 37007 Salamanca, Spain; (I.C.-G.); (B.T.-V.)
| | | | - Jose L. Diez
- Cardiology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | | | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of Valencia, University of Valencia, INCLIVA, CIBERCV, 46010 Valencia, Spain;
| | | | | | - Juan F. Oteo Dominguez
- Cardiology Department, University Hospital Puerta de Hierro/Majadahonda, 28222 Madrid, Spain;
| | - Maria R. Ortas-Nadal
- Cardiology Department, University Hospital Miguel Servet, 50009 Zaragoza, Spain;
| | | | - Xavier Carrillo
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, 08916 Barcelona, Spain;
| | - Juan H. Alonso-Briales
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Felipe Fernández-Vázquez
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Luis Asmarats Serra
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Daniel Hernandez-Vaquero
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Dolores Mesa
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Tania Rodríguez-Gabella
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Amparo Martinez Monzonís
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Luisa Salido Tahoces
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
| | - Lara Ruiz Gomez
- Cardiology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (L.A.I.); (L.R.G.)
| | - Blanca Trejo-Velasco
- Cardiology Department, University Hospital of Salamanca, IBSAL, Institute of Biomedical Research of Salamanca, University of Salamanca, CIBERCV, 37007 Salamanca, Spain; (I.C.-G.); (B.T.-V.)
| | - Victor M. Becerra-Muñoz
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Carmen Garrote-Coloma
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | | | - Rebeca Lorca
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Jose A. De Agustín
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Miguel Romero
- Cardiology Department, Reina Sofía University Hospital, University of Córdoba (IMIBIC), 14004 Córdoba, Spain; (M.P.); (D.M.); (M.R.)
| | - Ignacio J. Amat-Santos
- CIBERCV, Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (A.S.F.); (T.R.-G.); (I.J.A.-S.)
| | - Manel Sabaté
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (X.F.); (A.R.); (M.S.)
| | - Ana B. Cid Alvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, 15706 Santiago de Compostela, Spain; (R.T.-N.); (A.M.M.); (A.B.C.A.)
| | - Jose M. Hernandez-Garcia
- Cardiology Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, CIBERCV, 29010 Málaga, Spain; (F.C.-C.); (J.H.A.-B.); (V.M.B.-M.); (J.M.H.-G.)
| | - Javier Gualis
- Cardiology Department. University Hospital of León, 24008 León, Spain; (T.B.-G.); (F.F.-V.); (C.G.-C.); (J.G.)
| | - Dabit Arzamendi
- Cardiology Department, Santa Creu i Sant Pau Hospital, 08041 Barcelona, Spain; (C.H.L.); (L.A.S.); (E.F.P.); (D.A.)
| | - Cesar Moris
- Heart Area, Asturias Central University Hospital, University of Oviedo, Instituto Investigación Sanitaria Principado de Asturias (ISPA), 33011 Oviedo, Spain; (I.P.); (P.A.); (R.L.); (C.M.)
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain; (L.N.-F.); (P.J.-Q.); (J.A.D.A.); (G.T.-C.)
| | - Angel Sánchez-Recalde
- Cardiology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (R.A.H.-A.); (L.S.T.); (A.S.-R.)
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