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Anker SD, Friede T, von Bardeleben RS, Butler J, Khan MS, Diek M, Heinrich J, Geyer M, Placzek M, Ferrari R, Abraham WT, Alfieri O, Auricchio A, Bayes-Genis A, Cleland JGF, Filippatos G, Gustafsson F, Haverkamp W, Kelm M, Kuck KH, Landmesser U, Maggioni AP, Metra M, Ninios V, Petrie MC, Rassaf T, Ruschitzka F, Schäfer U, Schulze PC, Spargias K, Vahanian A, Zamorano JL, Zeiher A, Karakas M, Koehler F, Lainscak M, Öner A, Mezilis N, Theofilogiannakos EK, Ninios I, Chrissoheris M, Kourkoveli P, Papadopoulos K, Smolka G, Wojakowski W, Reczuch K, Pinto FJ, Zmudka K, Kalarus Z, Adamo M, Santiago-Vacas E, Ruf TF, Gross M, Tongers J, Hasenfuß G, Schillinger W, Ponikowski P. Percutaneous repair of moderate-to-severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE-HF2 trial and comparison to COAPT and MITRA-FR trials. Eur J Heart Fail 2024; 26:1608-1615. [PMID: 38847420 DOI: 10.1002/ejhf.3286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 07/26/2024] Open
Abstract
AIM The RESHAPE-HF2 trial is designed to assess the efficacy and safety of the MitraClip device system for the treatment of clinically important functional mitral regurgitation (FMR) in patients with heart failure (HF). This report describes the baseline characteristics of patients enrolled in the RESHAPE-HF2 trial compared to those enrolled in the COAPT and MITRA-FR trials. METHODS AND RESULTS The RESHAPE-HF2 study is an investigator-initiated, prospective, randomized, multicentre trial including patients with symptomatic HF, a left ventricular ejection fraction (LVEF) between 20% and 50% with moderate-to-severe or severe FMR, for whom isolated mitral valve surgery was not recommended. Patients were randomized 1:1 to a strategy of delivering or withholding MitraClip. Of 506 patients randomized, the mean age of the patients was 70 ± 10 years, and 99 of them (20%) were women. The median EuroSCORE II was 5.3 (2.8-9.0) and median plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) was 2745 (1407-5385) pg/ml. Most patients were prescribed beta-blockers (96%), diuretics (96%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (82%) and mineralocorticoid receptor antagonists (82%). The use of sodium-glucose cotransporter 2 inhibitors was rare (7%). Cardiac resynchronization therapy (CRT) devices had been previously implanted in 29% of patients. Mean LVEF, left ventricular end-diastolic volume and effective regurgitant orifice area (EROA) were 31 ± 8%, 211 ± 76 ml and 0.25 ± 0.08 cm2, respectively, whereas 44% of patients had mitral regurgitation severity of grade 4+. Compared to patients enrolled in COAPT and MITRA-FR, those enrolled in RESHAPE-HF2 were less likely to have mitral regurgitation grade 4+ and, on average, HAD lower EROA, and plasma NT-proBNP and higher estimated glomerular filtration rate, but otherwise had similar age, comorbidities, CRT therapy and LVEF. CONCLUSION Patients enrolled in RESHAPE-HF2 represent a third distinct population where MitraClip was tested in, that is one mainly comprising of patients with moderate-to-severe FMR instead of only severe FMR, as enrolled in the COAPT and MITRA-FR trials. The results of RESHAPE-HF2 will provide crucial insights regarding broader application of the transcatheter edge-to-edge repair procedure in clinical practice.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Monika Diek
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Jutta Heinrich
- Clinical Trial Unit, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Geyer
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marius Placzek
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Roberto Ferrari
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Ottavio Alfieri
- Cardiac Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Auricchio
- Department of Cardiology, Cardiocentro Ticino Institute-EOC, Lugano, Switzerland
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Gerasimos Filippatos
- Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Wilhelm Haverkamp
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Vlasis Ninios
- European Interbalkan Medical Center, Thessaloniki, Greece
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Tienush Rassaf
- West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - P Christian Schulze
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Jena, Germany
| | | | - Alec Vahanian
- UFR Medecine, Université de Paris-Cité, site Bichat, GH Bichat, Paris, France
| | - Jose Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Andreas Zeiher
- Institute for Cardiovascular Regeneration, Goethe University Frankfurt, Frankfurt am Main, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Rhein-Main, Frankfurt am Main, Germany
| | - Mahir Karakas
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Friedrich Koehler
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany
- Center for Cardiovascular Telemedicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alper Öner
- Department of Cardiology, Rostock University Medical Centre, Rostock, Germany
| | - Nikolaos Mezilis
- Department of Cardiology, St Luke's Hospital, Thessaloniki, Greece
| | | | - Ilias Ninios
- European Interbalkan Medical Center, Thessaloniki, Greece
| | | | | | - Konstantinos Papadopoulos
- European Interbalkan Medical Center, Thessaloniki, Greece
- Department of Transcatheter Heart Valves, HYGEIA Hospital, Athens, Greece
| | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Reczuch
- Institute of Heart Diseases, Medical University and University Hospital, Wroclaw, Poland
| | - Fausto J Pinto
- Centro Academico de Medicina de Lisboa, CCUL@RISE, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Krzysztof Zmudka
- Clinic of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Katowice, Poland
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Tobias Friedrich Ruf
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael Gross
- Department of Medicine, Heart and Vascular Center, Division of Cardiology and Vascular Medicine, Johanniter Hospital Stendal, Stendal, Germany
| | - Joern Tongers
- Mid-German Heart Center, Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Halle/Saale, Halle, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wolfgang Schillinger
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Göttingen, Germany
- Heart Center, Department of Cardiology, Georg-August-University Göttingen, Göttingen, Germany
| | - Piotr Ponikowski
- Centro Academico de Medicina de Lisboa, CCUL@RISE, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Chen CY, Chang FC, Lin CP, Chan YH, Wu VCC, Cheng YT, Chu PH, Chou AH, Yeh CH, Chen SW. Effects of mitral valve disease etiology on the outcomes of mechanical and biological valve replacement: retrospective cohort study. Int J Surg 2024; 110:3495-3503. [PMID: 38498356 PMCID: PMC11175751 DOI: 10.1097/js9.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The choice of an artificial mitral valve (MV) is a crucial clinical decision that affects the long-term survival and quality of life of patients. However, current guidelines recommend selecting MV based on patient age and life expectancy at the time of mitral valve replacement (MVR), without considering the etiology of MV disease. This study aimed to investigate whether MV disease etiology should be considered when choosing a valve for MVR and to evaluate the impact of MV disease etiology on long-term patient survival. METHODS Using data (2002-2018) from Taiwan's National Health Insurance Research Database, the authors conducted a nationwide retrospective cohort study to compare the biological and mechanical valves in terms of all-cause mortality as the primary outcome. The inverse probability of the treatment weighting method was used to reduce the effects of the confounding factors. The following etiologies were assessed: infective endocarditis, rheumatic heart disease, ischemic mitral regurgitation, and degenerative mitral regurgitation. RESULTS In patients aged below 70 years, it was observed that mechanical valves demonstrated an association with benefits compared to biological valves in the context of survival. In patients with infective endocarditis aged below 72 years, mechanical valves were associated with survival benefits, but not in those with stroke during hospitalization. These valves were also found to be linked with survival advantages for patients with rheumatic heart disease aged below 60 years and for those with degenerative mitral regurgitation aged below 72 years. However, no age-dependent effects of valve type on all-cause mortality were observed in patients with ischemic mitral regurgitation. CONCLUSION The etiology of MV disease appears to be important in the selection of a suitable MV and determination of a cutoff age for mechanical and biological MVR.
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Affiliation(s)
- Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
- School of Medicine, Collage of Medicine, Chang Gung University
| | - Feng-Cheng Chang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Chia-Pin Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
- School of Medicine, Collage of Medicine, Chang Gung University
| | - Chi-Hsiao Yeh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
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Ramsay J, Tang Y, Kim JK, Frangieh AH. Transcatheter Treatment of Mitral Valve Regurgitation in the Setting of Concomitant Coronary or Multivalvular Heart Disease: A Focused Review. Interv Cardiol Clin 2024; 13:279-289. [PMID: 38432770 DOI: 10.1016/j.iccl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Treatment for mixed valve disease has historically been limited, often surgery being the only option. With the recent advancement of transcatheter therapies, percutaneous approaches are quickly becoming viable therapeutic considerations in inoperable or high-risk patients, also offering the option for a staged or same-session treatment. Guidelines are primarily focused on single-valve disease. However, patients often present with multiple pathologies. This review summarizes the data and literature on transcatheter treatment of patients with mitral regurgitation who concomitantly have aortic stenosis or regurgitation, tricuspid regurgitation, or ischemic cardiomyopathy. Pathophysiology, hemodynamics, available therapies as well as order and timing of interventions are discussed.
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Affiliation(s)
- Jay Ramsay
- Department of Internal Medicine, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Yicheng Tang
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Jin Kyung Kim
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Antonio H Frangieh
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA.
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Arafat AA, Alghamdi R, Alfonso JJ, Shalaby MA, Alotaibi K, Pragliola C. Concomitant Mitral Valve Repair vs Replacement During Surgical Ventricular Restoration for Ischemic Cardiomyopathy. Angiology 2024; 75:331-339. [PMID: 36710003 DOI: 10.1177/00033197231154353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is no consensus regarding mitral valve management during surgical ventricular restoration (SVR) for ischemic cardiomyopathy. We compared the impact of SVR with mitral valve repair (MVr) vs replacement (MVR) on postoperative outcomes and long-term survival in ischemic cardiomyopathy and mitral regurgitation patients. This study included 112 patients who underwent SVR from 2009 to 2018 with MVr (n = 75) or MVR (n = 37). Patients who had MVR had higher Euro SCORE II, dyspnea class, a lower ejection fraction, higher pulmonary artery systolic pressure, higher grade of preoperative mitral and tricuspid regurgitation, and higher end-diastolic and end-systolic diameters. Intra-aortic balloon pump was more commonly used in patients with MVR. Hospital mortality occurred in 7 (9.33%) patients in the MVr group vs 3 (8.11%) in the MVR group (P > .99). Freedom from rehospitalization at 1, 5, and 7 years was 87%, 76%, and 70% in the MVr group and 83%, 61%, and 52% in the MVR group (P = .191). Survival at 1, 5, and 7 years was 88%, 78%, and 74% in the MVr group and 88%, 56%, and 56% in the MVR group (P = .027). Adjusted survival did not differ between groups.MVr or MVR are valid options in patients undergoing SVR, with good long-term outcomes.
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Affiliation(s)
- Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Rawan Alghamdi
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mostafa A Shalaby
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Khaled Alotaibi
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Claudio Pragliola
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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Marghalani YO, Al Rahimi J, Baeshen OK, Alhaddad AM, Alserihi AR, Aldahlawi AK, Acosta LZ, Abushouk A, Ahmed F, Ahmed M, Ismail YM, Elsheikh AH, Haneef A. Predictors of Outcomes After Coronary Artery Bypass Grafting: The Effect of Concomitant Mitral Repair. Cureus 2023; 15:e37561. [PMID: 37193475 PMCID: PMC10183146 DOI: 10.7759/cureus.37561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/18/2023] Open
Abstract
Background Ischemic mitral regurgitation (IMR) or functional MR intensity with or without repair increases the risk of coronary artery bypass grafting (CABG), and if the contaminant is undertaken, it doubles the risk of the surgery. This study aimed to characterize patients with concomitant CABG and mitral valve repair (MVR) and assess the surgical and long-term outcomes. Methods We conducted a cohort study from 2014 to 2020 on 364 patients who underwent CABG. A total of 364 patients were enrolled and divided into two groups. Group I (n= 349) included patients with isolated CABG, and Group II included patients who underwent CABG with concomitant mitral valve repair (MVR) (n= 15). Results Regarding preoperative presentation, most patients were male: 289 (79.40%), hypertensive 306 (84.07%), diabetic 281 (77.20%), dyslipidemic 246 (67.58%), presenting with NYHA classes III-IV: 200 (54.95%), and upon angiography, found to have the three-vessel disease: 265 (73%). Regarding their age mean± SD and Log EuroSCORE median (Q1-Q3), they had a mean age of 60.94± 10.60 years and a median score of 1.87 (1.13-3.19). The most prevalent postoperative complications were low cardiac output 75 (20.66%), acute kidney injury (AKI) 63 (17.45%), respiratory complications 55 (15.32%), and atrial fibrillation (AF) 55 (15.15%). Regarding long-term outcomes, most patients reported class I NYHA 271 (83.13%) and an echocardiographic decrease in MR severity. Patients with a CABG + MVR were significantly younger (53.93± 15.02 vs. 61.24± 10.29 years; P= 0.009), had a lower ejection fraction (33.6 [25-50] vs. 50 [43-55] %; p= 0.032), and had a higher prevalence of LV dilation (32 [9.17%]). EuroSCORE was significantly higher in patients with mitral repair (3.59 [1.54-8.63] vs. 1.78 (1.13-3.11); P= 0.022). The mortality percentage was higher with MVR but did not attain statistical significance. Intraoperative CPB and ischemic durations were longer in the CABG + MVR group. Furthermore, neurological complications were higher in patients with mitral repair (4 (28.57%) vs. 30 (8.65%), P= 0.012). The study's follow-up duration median was 24 (9-36) months. The composite endpoint occurred more frequently in older patients (HR: 1.05 [95% CI: 1.02-1.09]; 0.001), patients with low ejection fraction (HR: 0.96 [95% CI: 0.93-0.99]; P= 0.006) and in patients with preoperative myocardial infarction (MI) (HR: 2.3 [95%: 1.14- 4.68]; P= 0.021). Conclusion Most IMR patients benefited from CABG and CABG + MVR, as evident by NYHA class and echocardiographic follow-up. CABG + MVR had a higher Log EuroSCORE risk with increased intraoperative cardiopulmonary bypass (CPB) and ischemic durations, which may have played a role in increasing the incidence of postoperative neurological complications. On follow-up, no differences were reported between the two groups. However, age, ejection fraction, and a history of preoperative MI were identified as factors affecting the composite endpoint.
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Affiliation(s)
- Yasir O Marghalani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Jamilah Al Rahimi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Cardiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- Cardiology, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Osama K Baeshen
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | | | - Anas R Alserihi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Abdulaziz K Aldahlawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Luis Z Acosta
- Cardiothoracic Surgery, King Abdullah International Medical Research Center, Jeddah, SAU
- Cardiothoracic Surgery, Ministry of the National Guard Health Affairs, Jeddah, SAU
- Cardiothoracic Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Amir Abushouk
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Fatima Ahmed
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine, Ministry of the National Guard Health Affairs, Jeddah, SAU
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mohammed Ahmed
- Emergency Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
- Emergency Medicine, Ministry of the National Guard Health Affairs, Jeddah, SAU
- Emergency Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Yasir M Ismail
- Cardiology, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Cardiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | | | - Ali Haneef
- Cardiothoracic Surgery, Ministry of the National Guard Health Affairs, Jeddah, SAU
- Cardiothoracic Surgery, King Abdullah International Medical Research Center, Jeddah, SAU
- Cardiothoracic Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Avila-Vanzzini N, Lancellotti P, Fernandez Calix LA, De León López W, Berrios-Bárcenas E, Aranda-Fraustro A, Jordan-Rios A, Herrera-Bello H, Rivera-Lara P, Arias-Godínez JA, Vannan MA. Histopathological maladaptive changes in the explanted human mitral leaflets correlate with changes in echocardiographic leaflet morphology and the severity of ischaemic mitral regurgitation. Eur Heart J Cardiovasc Imaging 2023; 24:392-400. [PMID: 35348652 DOI: 10.1093/ehjci/jeac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Several changes of the mitral valve (MV) morphology have been previously documented in ischaemic mitral regurgitation (IMR) upon macro and microscopic examination. This study aimed to correlate echocardiographic MV thickening with IMR severity and to delineate the histopathological basis of valve thickening from the explanted leaflets. METHODS AND RESULTS Two hundred and fifty patients were included in the echo-group; of these, 48 patients (19.2%) underwent surgical mitral valve replacement (MVR), including them in the histology-group. By echocardiography, the thickness of the anterior and posterior leaflet was more extensive in moderate to severe IMR, P < 0.001. Histology-group: patients were divided into two groups based on the median thickness: those with cusp thickness <0.42 cm in Group 1, and ≥0.42 cm in Group 2. The thickness of the base and cusp was more significant in Group 2, P < 0.05 in both. Group 2 biopsies were characterized by involvement of the three leaflet segments, myxoid tissue, and fibrosis deposition. Thicker leaflets were associated with a greater degree of mitral regurgitation (MR), P < 0.0001. In the echo-group, a median leaflet thickness of 3.5 mm of the anterior and posterior MV was independently associated with moderate to severe ischaemic MR [odds ratio (OR) 2.88, P < 0.01] and (OR 10.8, P < 0.001), respectively. CONCLUSION In ischaemic MR, the thicker the cusps, the worse the MR. Leaflet thickening was due to the myxoid and fibrosis deposition and was detected by echocardiography. Therefore, this method can be helpful in the evaluation of valve remodelling.
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Affiliation(s)
- Nydia Avila-Vanzzini
- Department of Out-Patient Care, National Institute of Cardiology Ignacio Chavez, Juan Badiano No.1, Colonia Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liege, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy.,Anthea Hospital, Bari, Italy
| | - Luis Alberto Fernandez Calix
- Department of Out-Patient Care, National Institute of Cardiology Ignacio Chavez, Juan Badiano No.1, Colonia Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Wilman De León López
- Department of Out-Patient Care, National Institute of Cardiology Ignacio Chavez, Juan Badiano No.1, Colonia Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Enrique Berrios-Bárcenas
- Department of Out-Patient Care, National Institute of Cardiology Ignacio Chavez, Juan Badiano No.1, Colonia Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | | | - Antonio Jordan-Rios
- Department of Out-Patient Care, National Institute of Cardiology Ignacio Chavez, Juan Badiano No.1, Colonia Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | | | - Pedro Rivera-Lara
- Coronary Unit department, Coronary Unit CMN siglo XXI, Mexico City, Mexico
| | | | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
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7
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Acute Ischaemic Mitral Valve Regurgitation. J Clin Med 2022; 11:jcm11195526. [PMID: 36233410 PMCID: PMC9571705 DOI: 10.3390/jcm11195526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Acute ischaemic mitral regurgitation (IMR) is an increasingly rare and challenging complication following acute myocardial infarction. Despite recent technical advances in both surgical and percutaneous interventions, a poor prognosis is often associated with this challenging patient cohort. In this review, we revisit the diagnosis and typical echocardiographic features, and evaluate current surgical and percutaneous treatment options for patients with acute IMR.
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8
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Gamal MA, El-Fiky MM, Gamea MM, Ali I. Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta-analysis. J Card Surg 2022; 37:1591-1598. [PMID: 35366026 DOI: 10.1111/jocs.16477] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/18/2022] [Accepted: 03/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Ischemic mitral regurgitation (IMR) is a serious consequence of coronary artery disease. The choice of the optimal surgical strategy remains debatable. The aim of the present meta-analysis is to compare the outcomes of mitral valve repair (RPR) versus replacement (RPL) regarding perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. METHODS Electronic searches were performed using the searchable databases of Google Scholar, Pubmed, and Embase, and the search terms mitral valve, IMR, RPR, RPL, and coronary artery bypass grafting. The main outcomes of interest are perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. Perioperative mortality was defined as death during the surgery or within 30 days after the operation. RESULTS There was a trend towards better perioperative survival in the RPR arm. However, the difference fell short of statistical significance [odds ratio (OR) (95% confidence interval [CI]): 0.66 (0.41-1.07), p = 0.09]. Patients submitted to RPR experienced a significantly higher MR recurrence rate when compared with their counterparts submitted to RPL [OR (95% CI): 16.8 (5.07-55.7, p = 0.00001)]. CONCLUSION There is a trend towards lower perioperative mortality in RPR in comparison to RPL. On the other hand, RPL was associated with significantly lower recurrence rates.
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Affiliation(s)
- Mohamed A Gamal
- Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed M El-Fiky
- Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud M Gamea
- Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ihab Ali
- Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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9
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Stephens SE, Kammien AJ, Paris JC, Applequist AP, Ingels NB, Jensen HK, Rodgers DE, Cole CR, Wenk JF, Jensen MO. In Vitro Mitral Valve Model with Unrestricted Ventricular Access: Using Vacuum to Close the Valve and Enable Static Trans-Mitral Pressure. J Cardiovasc Transl Res 2022; 15:845-854. [PMID: 34993757 PMCID: PMC9256857 DOI: 10.1007/s12265-021-10199-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022]
Abstract
Current in vitro models of the left heart establish the pressure difference required to close the mitral valve by sealing and pressurizing the ventricular side of the valve, limiting important access to the subvalvular apparatus. This paper describes and evaluates a system that establishes physiological pressure differences across the valve using vacuum on the atrial side. The subvalvular apparatus is open to atmospheric pressure and accessible by tools and sensors, establishing a novel technique for experimentation on atrioventricular valves. Porcine mitral valves were excised and closed by vacuum within the atrial chamber. Images were used to document and analyze closure of the leaflets. Papillary muscle force and regurgitant flow rate were measured to be 4.07 N at 120 mmHg and approximately 12.1 ml/s respectively, both of which are within clinically relevant ranges. The relative ease of these measurements demonstrates the usefulness of improved ventricular access at peak pressure/force closure.
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Affiliation(s)
- Sam E Stephens
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Alexander J Kammien
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Jacob C Paris
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Alexis P Applequist
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Neil B Ingels
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA
| | - Hanna K Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.,Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Drew E Rodgers
- Department of Anesthesiology, Washington Regional Medical Center, Fayetteville, AR, USA
| | - Charles R Cole
- Department of Cardiovascular Surgery, Washington Regional Medical Center, Fayetteville, AR, USA
| | - Jonathan F Wenk
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY, USA
| | - Morten O Jensen
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, AR, USA.
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10
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Galili L, White Zeira A, Marom G. Numerical biomechanics modelling of indirect mitral annuloplasty treatments for functional mitral regurgitation. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211464. [PMID: 35242347 PMCID: PMC8753151 DOI: 10.1098/rsos.211464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/14/2021] [Indexed: 05/03/2023]
Abstract
Mitral valve regurgitation (MR) is a common valvular heart disease where an improper closure leads to leakage from the left ventricle into the left atrium. There is a need for less-invasive treatments such as percutaneous repairs for a large inoperable patient population. The aim of this study is to compare several indirect mitral annuloplasty (IMA) percutaneous repair techniques by finite-element analyses. Two types of generic IMA devices were considered, based on coronary sinus vein shortening (IMA-CS) to reduce the annulus perimeter and based on shortening of the anterior-posterior diameter (IMA-AP). The disease, its treatments, and the heart function post-repair were modelled by modifying the living heart human model (Dassault Systèmes). A functional MR pathology that represents ischaemic MR was generated and the IMA treatments were simulated in it, followed by heart function simulations with the devices and leakage quantification from blood flow simulations. All treatments were able to reduce leakage, the IMA-AP device achieved better sealing, and there was a correlation between the IMA-CS device length and the reduction in leakage. The results of this study can help in bringing IMA-AP to market, expanding the use of IMA devices, and optimizing future designs of such devices.
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Affiliation(s)
- Lee Galili
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Adi White Zeira
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
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11
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Vajapey R, Kwon D. Guide to functional mitral regurgitation: a contemporary review. Cardiovasc Diagn Ther 2021; 11:781-792. [PMID: 34295705 PMCID: PMC8261742 DOI: 10.21037/cdt-20-277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022]
Abstract
Functional mitral regurgitation (FMR) occurs in the absence of organic mitral valve (MV) disease and is a result of LV dysfunction due to ischemic vs. non ischemic etiologies. The prevalence of FMR is increasing, as 2.0-2.5 million people in the USA were diagnosed with FMR in 2000-and this number is expected to double to 4 million by 2030. FMR tends to develop in a significant number of patients after myocardial infarction (MI) and many develop heart failure (HF) subsequently with mortality rates ranging from 15-40% at 1 year. Therefore, there has been much interest and effort to develop optimized methods for quantifying and classifying the severity of FMR, as well as developing effective therapeutic interventions to improve outcomes in patients with significant FMR. Echocardiogram is typically the primary diagnostic method of assessment, however, there have been various technological advances including cardiac CT and cardiac MRI that can better guide quantification and management of this disease. Management of this disease is mostly aimed at optimizing left ventricular (LV) remodeling with surgical and transcatheter management gaining more popularity with recent times. The purpose of this paper is to provide a comprehensive review of the current evaluation methods and interventional strategies for FMR.
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Affiliation(s)
- Ramya Vajapey
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Deborah Kwon
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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12
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Koren O, Darawsha H, Rozner E, Benhamou D, Turgeman Y. Tricuspid regurgitation in ischemic mitral regurgitation patients: prevalence, predictors for outcome and long-term follow-up. BMC Cardiovasc Disord 2021; 21:199. [PMID: 33882853 PMCID: PMC8058984 DOI: 10.1186/s12872-021-01982-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known.
Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was 5 years. The primary outcome is defined as FTR developing at any stage.
Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N = 40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7 ± 9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3 ± 6.45 [%], LA area 46.4 ± 8.06 (mm2), LV internal diastolic diameter (LVIDD) 59.6 ± 3.94 (mm), RV fractional area change 22.3 ± 4.36 (%), systolic pulmonary artery pressure (SPAP) 48.4 ± 9.45 (mmHg). Independent variables associated with FTR development were age ≥ 65y [OR 1.2], failed revascularization, LA area ≥ 42.5 (mm2) [OR 17.1], LVEF ≤ 24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p = 0.06 and p = 0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01982-y.
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Affiliation(s)
- Ofir Koren
- Heart Institute, Emek Medical Center, Afula, Israel. .,Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
| | | | - Ehud Rozner
- Heart Institute, Emek Medical Center, Afula, Israel
| | | | - Yoav Turgeman
- Heart Institute, Emek Medical Center, Afula, Israel.,Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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13
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Ahmed R, Botezatu B, Nanthakumar M, Kaloti T, Harky A. Surgery for heart failure: Treatment options and implications. J Card Surg 2021; 36:1511-1519. [PMID: 33527493 DOI: 10.1111/jocs.15384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
Heart failure is considered one of the leading causes of death worldwide. Over the years, etiological risk factors, diagnostic criteria, and classifications have been revised to create guide management needed to alleviate the global health burden caused by heart failure. Pharmacological treatments have progressed over time but are insufficient in reducing mortality. This leads to many patients developing advanced heart failure who will require surgical intervention often in the form of the gold standard, a heart transplant. However, the number of patients requiring a transplant far exceeds the number of donors. Other surgical inventions have been utilized, yet the rate of patients being diagnosed with heart failure is still increasing. Future developments in the surgical field of heart failure include the 77SyncCardia and atrial shunting but long-term clinical trials involving larger cohorts of patients have not yet taken place to view how effective these approaches can be.
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Affiliation(s)
- Rukhsana Ahmed
- Medical School, St George's, University of London, Cranmer Terrace, UK
| | - Bianca Botezatu
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Tamara Kaloti
- Department of Epidemiology and Healthcare, University College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiac surgery, Alder Hey NHS Foundation Trust, Liverpool, UK
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14
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Anatomy of Mitral Valve Complex as Revealed by Non-Invasive Imaging: Pathological, Surgical and Interventional Implications. J Cardiovasc Dev Dis 2020; 7:jcdd7040049. [PMID: 33158082 PMCID: PMC7712333 DOI: 10.3390/jcdd7040049] [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: 09/27/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
Knowledge of mitral valve (MV) anatomy has been accrued from anatomic specimens derived by cadavers, or from direct inspection during open heart surgery. However, today two-dimensional and three-dimensional transthoracic (2D/3D TTE) and transesophageal echocardiography (2D/3D TEE), computed tomography (CT) and cardiac magnetic resonance (CMR) provide images of the beating heart of unprecedented quality in both two and three-dimensional format. Indeed, over the last few years these non-invasive imaging techniques have been used for describing dynamic cardiac anatomy. Differently from the “dead” anatomy of anatomic specimens and the “static” anatomy observed during surgery, they have the unique ability of showing “dynamic” images from beating hearts. The “dynamic” anatomy gives us a better awareness, as any single anatomic arrangement corresponds perfectly to a specific function. Understanding normal anatomical aspects of MV apparatus is of a paramount importance for a correct interpretation of the wide spectrum of patho-morphological MV diseases. This review illustrates the anatomy of MV as revealed by non-invasive imaging describing physiological, pathological, surgical and interventional implications related to specific anatomical features of the MV complex.
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15
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Hussein MA, Abdelrehim AR, Mubarak YSM. Multicenter experience: early outcome of mitral valve repair in patients with ischemic mitral regurgitation. Asian Cardiovasc Thorac Ann 2020; 29:84-90. [PMID: 33100022 DOI: 10.1177/0218492320970018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ischemic mitral regurgitation is associated with poor outcomes. The optimal surgical strategy for management of ischemic mitral regurgitation is still debated. The objective of this study was to evaluate the early mortality and morbidity of mitral valve repair in patients with ischemic mitral regurgitation undergoing coronary artery bypass grafting. METHODS We performed a retrospective, observational, cohort study on prospectively collected data on 136 consecutive coronary artery bypass graft patients with ischemic mitral regurgitation undergoing mitral valve repair between January 2016 and January 2020. Perioperative echocardiogram findings, operative procedures, and outcomes were analyzed. RESULTS The overall mortality rate was 4.4%. Mitral valve repair with a low ejection fraction had a 4-fold increase in the risk of death compared to mitral valve repair with preserved ejection fraction > 30%. However, after adjusting for preoperative risk factors, the number of grafts was not an independent risk factor for mortality (odds ratio = 0.18, 95% confidence interval: 0.03-2.81, p = 0.84). Multivariable analysis showed that preoperative ejection fraction (odds ratio = 1.14, 95% confidence interval: 0.82-4.86, p < 0.01), preoperative left ventricular end-systolic dimension (odds ratio = 1.03, 95% confidence interval: 0.65-3.51, p < 0.01) and preoperative left ventricular end-diastolic dimension (odds ratio = 0.99, 95% confidence interval: 0.64-3.28, p = 0.04) were independent risk factors for mortality. CONCLUSIONS Mitral valve repair can be performed safely concomitantly with coronary artery bypass grafting in patients with moderate, moderately severe, and severe ischemic mitral regurgitation.
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16
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Sarkar K, Patra S. Ischemic mitral regurgitation: the way ahead is a step back. Indian J Thorac Cardiovasc Surg 2020; 36:344-346. [PMID: 33061141 DOI: 10.1007/s12055-019-00903-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/18/2019] [Accepted: 11/07/2019] [Indexed: 01/12/2023] Open
Abstract
Ischemic mitral regurgitation (IMR) has a profound negative effect on survival of patients following myocardial infarction. It occurs when the closing forces are overpowered by the tethering forces as a consequence of ventricular remodeling. Surgeons sought to correct moderate and severe IMR by mitral annuloplasty. Though short-term results were encouraging, survival after 2 years were not so. Higher recurrence rates were also noted with severe mitral regurgitation (MR). Parameters defining severity of IMR were initially formulated in 2003. These were revised enabling intervention in moderate MR in 2014. With the lack of positive medium and long-term evidence, 2017 guidelines have raised the bar, discouraging intervention in moderate IMR. Current guidelines have taken a conservative stance in advocating repair only for severe MR and very symptomatic patients. Till emergence of fresh evidence surgical enthusiasm for repair of IMR has to be restrained.
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Affiliation(s)
- Kunal Sarkar
- Medica Superspecialty Hospital, Kolkata, 700099 India
| | - Soumya Patra
- Medica Superspecialty Hospital, Kolkata, 700099 India
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17
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Mėlinytė K, Mizarienė V, Jurkevičius R. Long-term ischemic mitral regurgitation: which parameters predict decrease or increase in the degree after five years? Minerva Cardioangiol 2020; 68:237-245. [DOI: 10.23736/s0026-4725.20.05021-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Ji Q, Zhao Y, Shen J, Ding W, Xia L, Wang C. Predictors of ischemic mitral regurgitation improvement after surgical revascularization plus mitral valve repair for moderate ischemic mitral regurgitation. J Card Surg 2020; 35:528-535. [DOI: 10.1111/jocs.14455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery, Zhongshan HospitalFudan University Shanghai China
| | - Yun Zhao
- Cardiovascular SurgeryShanghai Municipal Institute for Cardiovascular Diseases Shanghai China
| | - JinQiang Shen
- Department of Cardiovascular Surgery, Zhongshan HospitalFudan University Shanghai China
| | - WenJun Ding
- Department of Cardiovascular Surgery, Zhongshan HospitalFudan University Shanghai China
| | - LiMin Xia
- Department of Cardiovascular Surgery, Zhongshan HospitalFudan University Shanghai China
- Department of Cardiovascular Surgery, Zhongshan Hospital, Xiamen BranchFudan University Xiamen China
| | - ChunSheng Wang
- Cardiovascular SurgeryShanghai Municipal Institute for Cardiovascular Diseases Shanghai China
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19
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Dufendach K, Aranda‐Michel E, Sultan I, Gleason TG, Navid F, Thoma F, Kilic A. Outcomes of mitral valve surgery for severe ischemic mitral regurgitation. J Card Surg 2019; 35:390-396. [DOI: 10.1111/jocs.14395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Keith Dufendach
- Division of Cardiac SurgeryUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Edgar Aranda‐Michel
- Division of Cardiac SurgeryUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac SurgeryUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Thomas G. Gleason
- Division of Cardiac SurgeryUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Forozan Navid
- Division of Cardiac SurgeryUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Floyd Thoma
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Arman Kilic
- Division of Cardiac SurgeryUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
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20
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Komarova IS, Karova LB, Andreeva NV, Cherkasova NA, Zhelnov VV. [Effect of Myocardial Reperfusion on Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction]. KARDIOLOGIYA 2019; 59:18-25. [PMID: 31131764 DOI: 10.18087/cardio.2019.5.2607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11-19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood. OBJECTIVE To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion. MATERIALS AND METHODS We included in this study 68 patients with AMI and IMR aged 36-79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV). RESULTS Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 - patients who had a decrease in IMR (n=23, 33.8 %), group 2 - patients with increase of IMR (n=28, 41.1 %), group 3 - patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24). CONCLUSION Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.
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Affiliation(s)
- I S Komarova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - L B Karova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - N V Andreeva
- Sechenov First Moscow State Medical University (Sechenov University)
| | - N A Cherkasova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Zhelnov
- Sechenov First Moscow State Medical University (Sechenov University)
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21
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Memon MKY, Amanullah M, Atiq M. Anomalous Left Coronary Artery from Pulmonary Artery: An Important Cause of Ischemic Mitral Regurgitation in Children. Cureus 2019; 11:e4441. [PMID: 31245227 PMCID: PMC6559683 DOI: 10.7759/cureus.4441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual presentation in infancy is inconsolable crying or congestive cardiac failure, both due to myocardial ischemia. Survivors after infancy have improved left ventricular function but continue to have mitral regurgitation due to papillary muscle ischemia. The present study emphasizes the importance of unexplained mitral regurgitation as a clue to the diagnosis. Patients and Methods: Patients with the diagnosis of ALCAPA operated between June 2017 and May 2018 were enrolled. Their ages at diagnosis, electrocardiography, and echocardiography findings were noted. A selective angiogram of the right coronary artery was done in all. Results of surgical reimplantation were analyzed. Postoperative data were collected, including ventricular function and mitral regurgitation. Results: Six patients were included. Clinical signs of cardiac failure were present in two patients, and a systolic murmur was heard in all. The mean left ventricular ejection fraction was 52 ± 12%. Mitral regurgitation was present in all of the patients. The right coronary artery was dilated (Z score > 2.5) in all except one. Selective right coronary angiogram and cardiac computerized tomography angiogram (CTA) were performed in all. Coronary reimplantation was successfully done. Follow-up echocardiography showed improved left ventricular ejection fraction and degree of mitral regurgitation in all patients. Conclusion: ALCAPA is an uncommon congenital anomaly, the diagnosis of which can be missed, particularly in late presenters. Unexplained mitral regurgitation should always raise the suspicion of this anomaly. Surgical intervention has excellent results with an improvement of left ventricular function and mitral regurgitation.
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Affiliation(s)
| | - Muneer Amanullah
- Pediatric Cardiac Surgery, National Institute of Cardiovascular Disease, Karachi, PAK
| | - Mehnaz Atiq
- Pediatric Cardiology, Liaquat National Hospital, Karachi, PAK
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Wang W, Li B, Wang Y, Piao H, Zhu Z, Xu R, Li D, Liu K. Experience of the management of coronary artery bypass graft only on moderate ischemic mitral regurgitation: A single-center retrospective study. Medicine (Baltimore) 2019; 98:e14969. [PMID: 31027050 PMCID: PMC6831358 DOI: 10.1097/md.0000000000014969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To summary the impact of off-pump coronary artery bypass grafting (CABG) only on patients with moderate ischemic mitral regurgitation and survival.We retrospectively analyzed 109 patients with coronary artery disease (CAD) complicated by moderate mitral regurgitation, from January, 2008 to December, 2014, in the Department of Cardiovascular Surgery at the No. 2 Hospital of Jilin University undergoing off pump CABG only. Preoperative clinical characteristics, complications after surgery, and outcome (survivor or death) were assessed. We observed the degree of mitral valve regurgitation, left ventricular ejection fraction (LVEF), left ventricular and left atrial size, left ventricular end-diastolic volume (LVEDV) preoperative, and New York Heart Association (NYHA) functional class, postoperative 10 days before discharge, and 6 months and longer after surgery. The statistical data were processed by SPSS 19 software with computer; statistical significant difference with P < .05.Overall in-hospital mortality was 2.75% (3 patients). Patients had lower mean LVEF in the postoperative compared with the preoperative period, but all the patients had higher LVEF since 6 months than preoperative period (P < .001). Compared with the preoperative dates, postoperative valvular regurgitation, left ventricular and atrial size and LVEDV postoperative 10 days before discharge, 6 months and more longer after surgery reduced significantly (P < .001). Rapid atrial fibrillation occurred in 19 cases during perioperative and returned to normal before discharge. The symptom of angina was disappeared in all patients before discharge. The mean follow-up time was 60.16 ± 17.98 months (range 36-96 months). Two patients died of major adverse cardiac events including heart failure and ventricular fibrillation. Three patients died of lung cancer, and 2 patients died of stroke during the longer follow-up.Off-pump CABG can be performed safely in patients with CAD complicated by moderate mitral regurgitation. The efficacy of CABG only is well demonstrated by the significant improvement of LVEF and NYHA functional class, and by the decrease of left ventricular and atrial size, LVEDV, and mitral regurgitation grade.
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Altarabsheh SE, Deo SV, Rababa’h A, Obeidat YM, Haddad O. Chronic ischemic mitral valve regurgitation and surgical perspectives. World J Cardiol 2018; 10:141-144. [PMID: 30386491 PMCID: PMC6205849 DOI: 10.4330/wjc.v10.i10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Chronic ischemic mitral valve regurgitation is a result of disturbed left ventricular geometry secondary to myocardial ischemia in the absence of intrinsic mitral valve pathology. It is a common complication after myocardial infarction, and patients who have ischemic mitral regurgitation (IMR) have a worse prognosis compared to patients who have ischemic heart disease alone, and this is directly related to the severity of IMR. Medical therapy has limited efficacy, and surgical options including various repair techniques and valve replacement had been tried with variable success. Still there is intense debate among surgeons whether to interfere with moderate degree IMR at the time of coronary artery revascularization.
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Affiliation(s)
| | - Salil V Deo
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Abeer Rababa’h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Yagthan M Obeidat
- Department of Cardiac Surgery, AlMana General Hospital, AL Khobar 31952, Saudi Arabia
| | - Osama Haddad
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, United States
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24
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Jose RL, Varma PK. Rationale for change in the criteria for defining severe ischemic mitral regurgitation in 2017 American College of Cardiology/American heart association guidelines. Ann Card Anaesth 2018; 21:464-465. [PMID: 30333353 PMCID: PMC6206781 DOI: 10.4103/aca.aca_51_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Reshmi Liza Jose
- Division of Anesthesiology, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, Kerala, India
| | - Praveen Kerala Varma
- Division of Cardio-Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, Kerala, India
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