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Wang X, Ma Y, Liu Z, Zhu L, Wang J, Guan G, Pan S, Zhang Y, Hao Y. Comparison of Outcomes of Edge-to-Edge Mitral Valve Repair Versus Surgical Mitral Valve Repair for Functional Mitral Regurgitation. Clin Cardiol 2024; 47:e24313. [PMID: 38975623 PMCID: PMC11228827 DOI: 10.1002/clc.24313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024] Open
Abstract
AIMS Patients affected by functional mitral regurgitation represent an increasingly high-risk population. Edge-to-edge mitral valve repair (TEER) has emerged as a promising treatment option for these patients. However, there is limited research on the comparative outcomes of TEER versus surgical mitral valve repair (SMVr). This study seeks to compare the demographics, complications, and outcomes of TEER and SMVr based on a real-world analysis of the National Inpatient Sample (NIS) database. METHODS AND RESULTS In the NIS database, from the years 2016 to 2018, a total of 6233 and 2524 patients who underwent SMVr and TEER were selected, respectively. The mean ages of the patients were 65.68 years (SMVr) and 78.40 years (TEER) (p < 0.01). The mortality rate of patients who received SMVr was similar to that of patients who were treated with TEER (1.7% vs. 1.9%, p = 0.603). Patients who underwent SMVr more likely suffered from perioperative complications including cardiogenic shock (2.3% vs. 0.4%, p < 0.001), cardiac arrest (1.7% vs. 1.1%, p = 0.025), and cerebrovascular infarction (0.9% vs. 0.4%, p = 0.013). The average length of hospital stay was longer (8.59 vs. 4.13 days, p < 0.001) for SMVr compared to TEER; however, the average cost of treatment was higher ($218 728.25 vs. $215 071.74, p = 0.031) for TEER compared to SMVr. Multiple logistic regression analysis showed that SMVr was associated with worse adjusted cardiogenic shock (OR, 7.347 [95% CI, 3.574-15.105]; p < 0.01) and acute kidney injury (OR, 2.793 [95% CI, 2.356-3.311]; p < 0.01). CONCLUSION Patients who underwent TEER demonstrated a notable decrease in postoperative complications and a shorter hospitalization period when compared to those who underwent SMVr.
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Affiliation(s)
- Xiqiang Wang
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, Xi'an Key Laboratory of Functional Supramolecular Structure and Materials, College of Chemistry and Materials ScienceNorthwest UniversityXi'anShaanxiPeople's Republic of China
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Yanpeng Ma
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Zhongwei Liu
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Ling Zhu
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Junkui Wang
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Gongchang Guan
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Shuo Pan
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Yong Zhang
- Department of Cardiovascular MedicineShaanxi Provincial People's HospitalXi'anShaanxiPeople's Republic of China
| | - Yuanyuan Hao
- Department of Cardiovascular MedicineXi'an Central HospitalXi'anShaanxiPeople's Republic of China
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Kaddoura R, Bhattarai S, Abushanab D, Al-Hijji M. Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 207:159-169. [PMID: 37741106 DOI: 10.1016/j.amjcard.2023.08.097] [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: 05/19/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/25/2023]
Abstract
This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior with PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Sanket Bhattarai
- Department of hematology and oncology, Bhaktapur Cancer Hospital, Dudhpati, Bhaktapur, Nepal
| | - Dina Abushanab
- Drug Information Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Hijji
- Interventional Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Wang X, Ma Y, Liu J, Wang T, Zhu L, Fan X, Cui Q, Liu C, Guan G, Wang J, Pan S, Liu Z, Zhang Y. Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting. Front Cardiovasc Med 2022; 9:953875. [PMID: 36620639 PMCID: PMC9810628 DOI: 10.3389/fcvm.2022.953875] [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] [Received: 05/26/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Aims Patients with severe ischemic mitral regurgitation (IMR) may receive concurrent coronary artery bypass graft (CABG) with surgical mitral valve repair (SMVr) or percutaneous coronary stent implantation (PCI) with transcatheter edge-to-edge mitral valve repair (TMVr). However, there is no consensus on the management of severe IMR in this setting. We aimed to compare the outcomes of combined SMVr with CABG to concurrent TMVr with PCI among patients with IMR in the National Inpatient Sample (NIS) database. Methods and results The National Inpatient Sample was queried for all patients diagnosed with IMR who underwent SMVr with CABG or TMVr with PCI during the years 2016-2018. Study outcomes included all-cause in-hospital mortality, periprocedural complications, and resources used. A total of 1,360 potentially eligible patients were included in the study. After 1:5 propensity score matching, 133 patients were classified in the SMVr + CABG group and 29 patients in the TMVr + PCI group. Adjusted mortality was higher in the TMVr + PCI group compared with the SMVr + CABG group (13.8% vs. 4.5%, P = 0.034). Perioperative complications were higher among patients who underwent SMVr + CABG including blood transfusions (29.3% vs. 6.9%, P = 0.01) and post-procedural cardiogenic shock (11.3% vs. 0%, P = 0.044). The cost of care was higher (USD$783548.80 vs. USD$331846.523, P = 0.001) and the length of stay was longer (17.9 vs. 15.44 days, P < 0.001) in the TMVr + PCI group. On multivariable analysis, age (OR, 1.039 [95% CI, 1.006-1.072]; P = 0.032), renal failure (OR, 3.465 [95% CI, 1.867-6.433]; P < 0.001), and liver disease (OR, 5.012 [95% CI, 2.578-9.686]; P < 0.001) were associated with in-hospital mortality. Conclusion TMVr + PCI was associated with higher resource use and in-hospital mortality but with improved perioperative complications compared with SMVr + CABG.
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Affiliation(s)
- Xiqiang Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Yanpeng Ma
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Jing Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Ting Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Ling Zhu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiude Fan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qianwei Cui
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Chengfeng Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Shuo Pan
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China,*Correspondence: Shuo Pan,
| | - Zhongwei Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China,Zhongwei Liu,
| | - Yong Zhang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China,Yong Zhang,
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Okuno T, Praz F, Kassar M, Biaggi P, Mihalj M, Külling M, Widmer S, Pilgrim T, Grünenfelder J, Kadner A, Corti R, Windecker S, Wenaweser P, Reineke D. Surgical versus transcatheter repair for secondary mitral regurgitation: A propensity score-matched cohorts comparison. J Thorac Cardiovasc Surg 2021; 165:2037-2046.e4. [PMID: 34446288 DOI: 10.1016/j.jtcvs.2021.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare the efficacy and clinical outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) and surgical mitral valve repair (SMVr) among patients with secondary mitral regurgitation (SMR). METHODS Consecutive patients with SMR treated using either TMVr (n = 199) or SMVr (n = 222) at 2 centers were included and retrospectively analyzed. To account for differences in patient demographic characteristics, 1:1 propensity score matching was performed. The primary endpoint was all-cause death within 2 years after the procedure. RESULTS The study population consisted of 202 matched patients. At 2 years, all-cause mortality was 24.3% for TMVr and 23.0% for SMVr (hazard ratio, 0.97; 95% confidence interval, 0.55-1.71; P = .909). Severe heart failure symptoms at 2 years were less prevalent after SMVr (New York Heart Association functional class III or IV: 13.5% vs 29.5%; P = .032) than after TMVr. A higher proportion of the SMVr patients had SMR reduction to none or mild at discharge (90.8% vs 72.0%; P < .001) and 2 years (86.5% vs 59.6%; P < .001). Among patients who achieved none or mild MR at discharge, 7 patients (10.1%) in the SMVr group and 15 (34.9%) in the TMVr group had progression to moderate or greater MR at 2 years (P = .003). Left ventricular ejection fraction (LVEF) significantly improved (+10.1% ± 11.1%; P < .001) after SMVr (LVEF at 2 years: 45.7% ± 12.8%), whereas it remained unchanged (-1.3% ± 8.9%; P = .260) after TMVr (LVEF at 2 years: 34.0% ± 13.2%). CONCLUSIONS In this propensity score-matched analysis, there was no significant difference in 2-year survival between TMVr and SMVr, despite greater and more durable SMR reduction, as well as LVEF improvement in the surgical group.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
| | - Mohammad Kassar
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Patric Biaggi
- Department of Cardiology, Heart Clinic Zurich, Hirslanden Klinik, Zurich, Switzerland
| | - Maks Mihalj
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Mischa Külling
- Department of Cardiology, Heart Clinic Zurich, Hirslanden Klinik, Zurich, Switzerland
| | - Sonja Widmer
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jürg Grünenfelder
- Department of Cardiac Surgery, Heart Clinic Zurich, Hirslanden Klinik, Zurich, Switzerland
| | - Alexander Kadner
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Roberto Corti
- Department of Cardiology, Heart Clinic Zurich, Hirslanden Klinik, Zurich, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Heart Clinic Zurich, Hirslanden Klinik, Zurich, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
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Kang JJH, Bozso SJ, El-Andari R, Adams C, Nagendran J. Transcatheter mitral valve repair and replacement: the next frontier of transcatheter valve intervention. Curr Opin Cardiol 2021; 36:163-171. [PMID: 33044266 DOI: 10.1097/hco.0000000000000803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW We summarize the recent developments in transcatheter mitral valve repair (TMVr) and replacement (TMVR), discuss determinants of MitraClip outcomes in various mitral regurgitation causes, and highlight newly emerging devices and randomized trials. RECENT FINDINGS The discordant results published in the two recent randomized trials for MitraClip, the COAPT and the MITRA-FR trial have led to the emergence of a new conceptual framework such as the proportionate versus disproportionate mitral regurgitation and hemodynamics assessment tools like the real-time continuous left atrial pressure monitoring. Learning curve and volume-outcome analyses and studies examining the MitraClip usage in patients with degenerative mitral regurgitation are recent developments that have influenced MitraClip regulation and coverage. Several trials for TMVr devices that take an alternative approach to the edge-to-edge repair are underway and advancements in the TMVR technologies are continuing to progress to fill the unmet needs of treating high surgical risk patients whose complex valve anatomy make TMVr unfeasible. SUMMARY Evidence supports careful analysis of the valve area and left ventricular function in addition to the left atrial hemodynamics will improve the MitraClip outcome. Operator experience plays a greater effect when achieving excellent results with 1+ or less residual mitral regurgitation whereas surgical MVr volume did not influence TMVr outcome. Interventions on the complex primary mitral regurgitation remain under the surgical domain, but MITRA high risk (HR) and REPAIR mitral regurgitation trials are underway to evaluate the role of MitraClip in high to intermediate surgical risk patients with primary mitral regurgitation. Despite the slow developments in TMVR, the results of the early trials of its devices are promising.
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Affiliation(s)
| | - Sabin J Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton
| | | | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Khader AA, Allaf M, Lu OW, Lazopoulos G, Moscarelli M, Kendall S, Salmasi MY, Athanasiou T. Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation? J Card Surg 2021; 36:1103-1119. [PMID: 33428247 DOI: 10.1111/jocs.15298] [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: 09/02/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR. METHODS A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies). RESULTS The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009). Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63-4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77-0.99]; p < .001) with considerable heterogeneity (I2 > 90%; p < .001). The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188-0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19-0.46]; p < .001) during midterm follow up. Long term survival (4-5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35-1.41]; p = .323). CONCLUSIONS This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.
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Affiliation(s)
- Ashiq A Khader
- Department of Medicine, Imperial College London, London, UK
| | - Mohammed Allaf
- Department of Medicine, Imperial College London, London, UK
| | - Oscar W Lu
- Division of Biosciences, University College London, London, UK.,Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - George Lazopoulos
- Department of Cardio-thoracic Surgery, University Hospital of Heraklion, Crete, Greece
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Simon Kendall
- Deparment of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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Lipiecki J, Fahrat H, Monzy S, Caillot N, Siminiak T, Johnson T, Vogt S, Stark MA, Goldberg SL. Long-term prognosis of patients treated by coronary sinus-based percutaneous annuloplasty: single centre experience. ESC Heart Fail 2020; 7:3329-3335. [PMID: 33047896 PMCID: PMC7755003 DOI: 10.1002/ehf2.12955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/28/2020] [Accepted: 07/30/2020] [Indexed: 01/17/2023] Open
Abstract
AIMS This study aims to report long-term mortality, echocardiographic, and clinical outcomes of patients receiving treatment for functional mitral regurgitation (FMR) with the Carillon device. METHODS AND RESULTS This was a single centre analysis of prospectively collected data from patients treated with the Carillon Mitral Contour System for symptomatic congestive heart failure despite guideline-directed medical therapy, who were included from a single centre from the TITAN II study. All patients presented with New York Heart Association (NYHA) class 2 or greater symptoms, grade 2+ to 4+ FMR, left ventricular enlargement, and reduced ejection fraction. Surviving patients were evaluated for long-term follow-up post-procedure, averaging 6.9 years. Fifteen (15) patients (mean age 72 years, 60% male, 100% NYHA class III or IV, 50% MR grade 3+ or 4+) were treated with the Carillon device. The Kaplan-Meier mortality rate was 40% at 6 years of follow-up. Long-term survival through 6 years was associated with echocardiographic improvement in mitral regurgitation (change in effective regurgitant orifice area in survivors versus non-survivors from baseline to 1 year follow-up, -9.0 ± 5.6 vs. -1.7 ± 1.5, P = 0.02) and clinical status at 12 months (difference in NYHA at 1 year follow-up between survivors versus non-survivors, P = 0. 05) which was sustained throughout follow-up. All patients at 6 year follow-up had ≤2+ MR, with 6 of 7 having 0-1+ MR. Left ventricular end-diastolic volume was reduced from 154.0 ± 65.7 mL at baseline to 104.5 ± 59.2 mL at 6 year follow-up, P = 0.03 in survivors with both measurements. CONCLUSIONS Among patients with congestive heart failure treated with the Carillon device, long-term survival is associated with favourable 1 year and sustained improvements in mitral regurgitation, left ventricular volume, ejection fraction, and clinical status.
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Affiliation(s)
- Janusz Lipiecki
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Hicham Fahrat
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Séverine Monzy
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Nicolat Caillot
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Tomasz Siminiak
- Poznan University of Medical Sciences, HCP Medical CenterPoznanPoland
| | | | | | | | - Steven L. Goldberg
- Cardiac DimensionsKirklandWAUSA
- Tyler Heart Institute at Community Hospital of the Monterey PeninsulaMontereyCAUSA
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O'Meara E, McDonald M, Chan M, Ducharme A, Ezekowitz JA, Giannetti N, Grzeslo A, Heckman GA, Howlett JG, Koshman SL, Lepage S, Mielniczuk LM, Moe GW, Swiggum E, Toma M, Virani SA, Zieroth S, De S, Matteau S, Parent MC, Asgar AW, Cohen G, Fine N, Davis M, Verma S, Cherney D, Abrams H, Al-Hesayen A, Cohen-Solal A, D'Astous M, Delgado DH, Desplantie O, Estrella-Holder E, Green L, Haddad H, Harkness K, Hernandez AF, Kouz S, LeBlanc MH, Lee D, Masoudi FA, McKelvie RS, Rajda M, Ross HJ, Sussex B. CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis. Can J Cardiol 2020; 36:159-169. [PMID: 32036861 DOI: 10.1016/j.cjca.2019.11.036] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022] Open
Abstract
In this update, we focus on selected topics of high clinical relevance for health care providers who treat patients with heart failure (HF), on the basis of clinical trials published after 2017. Our objective was to review the evidence, and provide recommendations and practical tips regarding the management of candidates for the following HF therapies: (1) transcatheter mitral valve repair in HF with reduced ejection fraction; (2) a novel treatment for transthyretin amyloidosis or transthyretin cardiac amyloidosis; (3) angiotensin receptor-neprilysin inhibition in patients with HF and preserved ejection fraction (HFpEF); and (4) sodium glucose cotransport inhibitors for the prevention and treatment of HF in patients with and without type 2 diabetes. We emphasize the roles of optimal guideline-directed medical therapy and of multidisciplinary teams when considering transcatheter mitral valve repair, to ensure excellent evaluation and care of those patients. In the presence of suggestive clinical indices, health care providers should consider the possibility of cardiac amyloidosis and proceed with proper investigation. Tafamidis is the first agent shown in a prospective study to alter outcomes in patients with transthyretin cardiac amyloidosis. Patient subgroups with HFpEF might benefit from use of sacubitril/valsartan, however, further data are needed to clarify the effect of this therapy in patients with HFpEF. Sodium glucose cotransport inhibitors reduce the risk of incident HF, HF-related hospitalizations, and cardiovascular death in patients with type 2 diabetes and cardiovascular disease. A large clinical trial recently showed that dapagliflozin provides significant outcome benefits in well treated patients with HF with reduced ejection fraction (left ventricular ejection fraction ≤ 40%), with or without type 2 diabetes.
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Affiliation(s)
- Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael Chan
- University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Adam Grzeslo
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - George A Heckman
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan G Howlett
- Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | | | - Serge Lepage
- Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | | | - Elizabeth Swiggum
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Mustafa Toma
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | - Sylvain Matteau
- Université de Sherbrooke, Sherbrooke, Québec, Canada; Chaleur Regional Hospital, Bathurst, New Brunswick, Canada
| | - Marie-Claude Parent
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Anita W Asgar
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Gideon Cohen
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nowell Fine
- University of Calgary, Calgary, Alberta, Canada
| | - Margot Davis
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Subodh Verma
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Cherney
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Lee Green
- University of Alberta, Edmonton, Alberta, Canada
| | - Haissam Haddad
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Simon Kouz
- Centre Intégré de Santé et de Services Sociaux de Lanaudière - Centre Hospitalier de Lanaudière, Joliette, Québec, Canada
| | - Marie-Hélène LeBlanc
- Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Université Laval, Québec, Québec, Canada
| | - Douglas Lee
- University Health Network, Toronto, Ontario, Canada
| | | | - Robert S McKelvie
- St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Miroslaw Rajda
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Heather J Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Bruce Sussex
- Memorial University, St John's, Newfoundland and Labrador, Canada
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Piazza N, Overtchouk P, Ben-Shoshan J. Predicting TMVR outcomes – the Tendyne experience. EUROINTERVENTION 2019; 15:e1033-e1034. [DOI: 10.4244/eijv15i12a193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Grinberg D, Donal E, Obadia JF. What do MITRA-FR and COAPT teach us about the percutaneous treatment of secondary mitral regurgitation? EUROINTERVENTION 2019; 14:1713-1715. [DOI: 10.4244/eijv14i17a295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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