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Cammalleri V, Carpenito M, De Stefano D, Ussia GP, Bono MC, Mega S, Nusca A, Cocco N, Nobile E, De Filippis A, Vitez L, Quattrocchi CC, Grigioni F. Novel Computed Tomography Variables for Assessing Tricuspid Valve Morphology: Results from the TRIMA (Tricuspid Regurgitation IMAging) Study. J Clin Med 2022; 11:jcm11102825. [PMID: 35628951 PMCID: PMC9143522 DOI: 10.3390/jcm11102825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/01/2022] [Accepted: 05/16/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Computed tomography (CT) is the recommended imaging technique for defining the anatomical suitability for current transcatheter technologies and planning tricuspid valve (TV) intervention. The aim of the Tricuspid Regurgitation IMAging (TRIMA) study was to assess the geometrical characteristics of the TV complex using novel CT parameters. METHODS This prospective, single-center study enrolled 22 consecutive patients with severe tricuspid regurgitation, who underwent a cardiac CT study dedicated to the right chambers. The following variables were obtained: annulus area and perimeter, septal-lateral and antero-posterior diameters, tenting height, and anatomical regurgitant orifice area. Moreover, the following novel annular parameters were assessed: distance between commissures, distance between TV centroid and commissures, and angles between centroid and commissures. RESULTS A significant phasic variability during the cardiac cycle existed for all variables except for eccentricity, angles, and distance between the postero-septal and antero-posterior commissure and distance between the centroid and antero-posterior commissure. There was a significant relationship between the TV annulus area and novel annular parameters, except for annular angles. Additionally, novel annular variables were found to predict the annulus area. CONCLUSIONS These novel additional variables may provide an initial platform from which the complexity of the TV annular morphology can continue to be better understood for further improving transcatheter therapies.
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Affiliation(s)
- Valeria Cammalleri
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
- Correspondence: or ; Tel.: +39-06225-411-612
| | - Myriam Carpenito
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Domenico De Stefano
- Unit of Diagnostic Imaging and Interventional Radiology, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Gian Paolo Ussia
- Unit of Interventional Cardiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (G.P.U.); (C.C.Q.)
| | - Maria Caterina Bono
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Simona Mega
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Annunziata Nusca
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Nino Cocco
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Edoardo Nobile
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Aurelio De Filippis
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
| | - Luka Vitez
- Department of Cardiology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia;
| | - Carlo Cosimo Quattrocchi
- Unit of Interventional Cardiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (G.P.U.); (C.C.Q.)
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy; (M.C.); (M.C.B.); (S.M.); (A.N.); (N.C.); (E.N.); (A.D.F.); (F.G.)
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Thirty-Day Outcomes Following Transfemoral Transseptal Transcatheter Mitral Valve Replacement: Intrepid TMVR Early Feasibility Study Results. JACC Cardiovasc Interv 2021; 15:80-89. [PMID: 34747699 DOI: 10.1016/j.jcin.2021.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate outcomes of transcatheter mitral valve replacement (TMVR) with transfemoral access in patients at prohibitive or high surgical risk. BACKGROUND Prohibitive surgical risk may preclude MVR surgery in some patients. The investigational Intrepid TMVR system (Medtronic, Minneapolis, MN) has previously been evaluated using transapical access for delivery of a self-expanding bioprosthetic valve. METHODS This prospective, multi-center, non-randomized early feasibility study (EFS) evaluated safety and performance of the Intrepid valve using transfemoral/transseptal access in patients with moderate-severe/severe, symptomatic mitral regurgitation (MR) at high surgical risk. Candidacy was determined by heart teams with approval by a central screening committee. Echocardiographic data were evaluated by an independent core laboratory. Clinical events were adjudicated by a clinical events committee. RESULTS Fifteen patients were enrolled at 6 sites from Feb 2020-May 2021. Median age was 80 years and STS-PROM was 4.7%; 87% were male and 53% had prior sternotomy. Fourteen implants were successful. One patient converted to surgery during the index procedure. Patients stayed a median 5 days post-procedure. There were 6 (40%) access site bleeds and 11 (73%) iatrogenic ASD closures. At 30 days, there were no deaths, strokes, or reinterventions. All implanted patients had trace/no valvar or paravalvar MR and mean gradient was 4.7±1.8 mmHg. CONCLUSIONS Thirty-day results from the Intrepid transfemoral TMVR EFS demonstrate excellent valve function and no mortality or stroke. Additional patients and longer follow-up are needed to confirm these findings.
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Chen Y, Hu J, Wu S, Zhang S, Wu K, Wang W, Zhou Y. Transcatheter Mitral Valve Replacement for Treating Native Mitral Valve Disease: Current Status. Tex Heart Inst J 2021; 47:271-279. [PMID: 33472225 DOI: 10.14503/thij-18-6650] [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: 12/24/2022]
Abstract
Transcatheter mitral valve replacement is increasingly being used as a treatment for high-risk patients who have native mitral valve disease; however, no comprehensive studies on its effectiveness have been reported. We therefore searched the literature for reports on patients with native mitral valve disease who underwent transcatheter access treatment. We found 40 reports, published from September 2013 through April 2017, that described the cases of 66 patients (mean age, 71 ± 12 yr; 30 women; 30 patients with mitral stenosis, 34 with mitral regurgitation, and 2 mixed) who underwent transcatheter mitral valve replacement. We documented their baseline clinical characteristics, comorbidities, diagnostic imaging results, procedural details, and postprocedural results. Access was transapical in 41 patients and transseptal in 25. The 30-day survival rate was 82.5%. The technical success rate (83.3% overall) was slightly but not significantly better in patients who had mitral regurgitation than in those who had mitral stenosis. Transapical access procedures resulted in fewer valve-in-valve implantations than did transseptal access procedures (P=0.026). These current results indicate that transcatheter mitral valve replacement is feasible in treating native mitral disease. The slightly higher technical success rate in patients who had mitral regurgitation suggests that a valve with a specific anchoring system is needed when treating mitral stenosis. Our findings indicate that transapical access is more reliable than transseptal access and that securely anchoring the valve is still challenging in transseptal access.
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Affiliation(s)
- Yan Chen
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Junjie Hu
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Shunqiang Wu
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - San Zhang
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Kaiqin Wu
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Wenli Wang
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Yongxin Zhou
- Department of Thoracic Cardiovascular Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
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Alarfaj M, Jain T, Krepp J. Transcatheter mitral valve thrombosis: A case report and literature review. Catheter Cardiovasc Interv 2021; 97:E887-E892. [PMID: 33175473 DOI: 10.1002/ccd.29374] [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: 06/17/2020] [Revised: 09/28/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022]
Abstract
Transcatheter mitral valve replacement (TMVR) is an exciting alternative therapy for complex patients with mitral valve disease. Experience with TMVR is new and there is a lot yet to discover about their durability, long-term outcomes, and complications including mitral transcatheter heart valve (THV) thrombosis. Many factors have been speculated to increased risk of THV thrombosis. Here, we report a case of a 72-year-old woman who developed mitral THV thrombosis after undergoing TMVR for severe mitral regurgitation with mitral annular calcification. We reviewed 42 TMVR papers with 1,484 patients, including 60 with mitral THV thrombosis. We discussed the most common strategies used for mitral THV thromboprophylaxis and treatment.
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Affiliation(s)
- Mohammad Alarfaj
- Division of Cardiology, Department of Medicine, The George Washington University, Washington, District of Columbia, USA
- Internal Medicine Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tushina Jain
- Division of Cardiology, Department of Medicine, The George Washington University, Washington, District of Columbia, USA
| | - Joseph Krepp
- Division of Cardiology, Department of Medicine, The George Washington University, Washington, District of Columbia, USA
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Del Val D, Ferreira-Neto AN, Wintzer-Wehekind J, Dagenais F, Paradis JM, Bernier M, O'Connor K, Beaudoin J, Freitas-Ferraz AB, Rodés-Cabau J. Early Experience With Transcatheter Mitral Valve Replacement: A Systematic Review. J Am Heart Assoc 2019; 8:e013332. [PMID: 31441371 PMCID: PMC6755858 DOI: 10.1161/jaha.119.013332] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Transcatheter mitral valve replacement (TMVR) has emerged as an alternative therapeutic option for the treatment of severe mitral regurgitation in patients with prohibitive or high surgical risk. The aim of this systematic review is to evaluate the clinical procedural characteristics and outcomes associated with the early TMVR experience. Methods and Results Published studies and international conference presentations reporting data on TMVR systems were identified. Only records including clinical characteristics, procedural results, and 30‐day and midterm outcomes were analyzed. A total of 16 publications describing 308 patients were analyzed. Most patients (65.9%) were men, with a mean age of 75 years (range: 69–81 years) and Society for Thoracic Surgery Predicted Risk of Mortality score of 7.7% (range: 6.1–8.6%). The etiology of mitral regurgitation was predominantly secondary or mixed (87.1%), and 81.5% of the patients were in New York Heart Association class III or IV. A transapical approach was used in 81.5% of patients, and overall technical success was high (91.7%). Postprocedural mean transmitral gradient was 3.5 mm Hg (range: 3–5.5 mm Hg), and only 4 cases (1.5%) presented residual moderate to severe mitral regurgitation. Procedural and all‐cause 30‐day mortality were 4.6% and 13.6%, respectively. Left ventricular outflow obstruction and conversion to open heart surgery were reported in 0.3% and 4% of patients, respectively. All‐cause and cardiovascular‐related mortality rates were 27.6% and 23.3%, respectively, after a mean follow‐up of 10 (range: 3 to 24) months. Conclusions TMVR was a feasible, less invasive alternative for treating severe mitral regurgitation in patients with high or prohibitive surgical risk. TMVR was associated with a high rate of successful valve implantation and excellent hemodynamic results. However, periprocedural complications and all‐cause mortality were relatively high.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | | | | | - François Dagenais
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | | | - Mathieu Bernier
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | - Kim O'Connor
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | - Jonathan Beaudoin
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada
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Padula MS, D'Ambrosio GG, Tocci M, D'Amico R, Banchelli F, Angeli L, Scarpa M, Capelli O, Cricelli C, Boriani G. Home care for heart failure: can caregiver education prevent hospital admissions? A randomized trial in primary care. J Cardiovasc Med (Hagerstown) 2019; 20:30-38. [PMID: 30394960 DOI: 10.2459/jcm.0000000000000722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To assess the feasibility and effectiveness of a low-complexity, low-cost model of caregiver education in primary care, targeted to reduce hospitalizations of heart failure patients. METHODS A cluster-randomized, controlled, open trial was proposed to general practitioners, who were invited to identify patients with heart failure, exclusively managed at home and continuously attended by a caregiver. Participating general practitioners were then randomized to: usual treatment; caregiver education (educational session for recognizing early symptoms/signs of heart failure, with recording in a diary of a series of patient parameters, including body weight, blood pressure, heart rate). The patients were observed at baseline and during a 12-month follow-up. RESULTS Three hundred and thirteen patients were enrolled (163 in the intervention, 150 in the usual care group), 63% women, mean age 85.3 ± 7.7 years. At the end of the 12-month follow-up, a trend towards a lower incidence of hospitalizations was observed in the intervention group (hazard ratio 0.73; 95% CI 0.53-1.01 P = 0.061). Subgroup analysis showed that for patients with persistent/permanent atrial fibrillation, age less than 90 years or Barthel score equal to or greater than 50 a significant lower hospital admission rate occurred in the intervention group (hazard ratio 0.63; 95% CI 0.39-0.99; P = 0.048, hazard ratio 0.66; 95% CI 0.45-0.97; P = 0.036 and hazard ratio 0.61; 95% CI 0.41-0.89; P = 0.011, respectively). CONCLUSION Caregivers training for early recognition of symptoms/signs of worsening heart failure may be effective in reducing hospitalizations, although the benefit was evident only in specific patient subgroups (with persistent/permanent atrial fibrillation, age <90 years or Barthel score ≥ 50), with only a positive trend in the whole cohort. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03389841.
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Affiliation(s)
- Maria S Padula
- Family Medicine Teaching Unit, University of Modena and Reggio Emilia, Modena.,Italian College of General Practitioners and Primary Care, Florence
| | | | - Marina Tocci
- Italian College of General Practitioners and Primary Care, Florence
| | - Roberto D'Amico
- Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - Federico Banchelli
- Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - Letizia Angeli
- Italian College of General Practitioners and Primary Care, Florence
| | - Marina Scarpa
- Italian College of General Practitioners and Primary Care, Florence
| | - Oreste Capelli
- Clinical Governance Unit, Local Health Authority, Modena
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
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Flynn CD, Wilson-Smith AR, Yan TD. Novel mitral valve technologies-transcatheter mitral valve implantation: a systematic review. Ann Cardiothorac Surg 2018; 7:716-723. [PMID: 30598884 DOI: 10.21037/acs.2018.11.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Valvular heart disease is an important cause of morbidity and mortality throughout the world; in industrialized nations, mitral regurgitation (MR) is the most common valvular lesion. Untreated, severe MR has a poor prognosis, with a 5-year mortality rate of up to 50%. Surgical repair of symptomatic, severe primary MR has been demonstrated to improve survival. The aim of this review is to assess the early outcomes of newly developed transcatheter mitral valve implantation technologies for the treatment of secondary native valve disease. Furthermore, the outcomes of patients receiving transcatheter treatment of regurgitant failure of surgically repaired or replaced mitral valve has also been addressed. Methods A systematic review of twenty-five studies assessing the outcomes of patients undergoing transcatheter mitral valve implantation for native mitral regurgitation or failed prior surgical repair or bioprosthetic replacement was carried out. Results The outcomes of 112 patients undergoing transcatheter mitral valve replacement for secondary mitral regurgitation using six different valve systems were assessed. There were 15 early deaths and 24 deaths over the follow-up period. The outcomes of 44 patients undergoing transcatheter valve-in-valve replacement were assessed with an overall mortality of ten patients. There were 20 patients included who had valve-in-ring transcatheter mitral replacement for previous failed repair. The total mortality was five patients during the follow-up period. Conclusions Transcatheter mitral valve implantation represents a new evolution in management of valvular disease and affords management options to patients who historically may not have been offered treatment. Early results have demonstrated some promise and improvements in technology, imaging modalities and patient selection will surely result in a reliable and durable valve.
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Affiliation(s)
- Campbell D Flynn
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, St Leonards, Australia.,CORE Research Group, Macquarie University, Sydney, Australia
| | - Ashley R Wilson-Smith
- CORE Research Group, Macquarie University, Sydney, Australia.,School of Medicine, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Tristan D Yan
- CORE Research Group, Macquarie University, Sydney, Australia.,School of Medicine, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia.,Sydney Adventist Hospital, University of Sydney, Sydney, Australia
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Transcatheter Mitral Valve Intervention for Chronic Mitral Regurgitation: A Plethora of Different Technologies. Can J Cardiol 2018; 34:1200-1209. [DOI: 10.1016/j.cjca.2018.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023] Open
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