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Scotti A, Munafò A, Margonato A, Godino C. Transcatheter therapies for secondary mitral regurgitation in advanced heart failure: what are we aiming for? Heart Fail Rev 2022; 27:1193-1200. [PMID: 34291400 PMCID: PMC9197887 DOI: 10.1007/s10741-021-10148-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/26/2022]
Abstract
A severe secondary mitral regurgitation (SMR) can be found in a significant portion of patients affected by advanced heart failure (AHF). Conventional therapies (optimal medical therapy, devices, surgery) present restricted clinical efficacy in this stage of the left ventricle disease which is burdened by high mortality and morbidity rates. Although the treatment of choice is represented by heart transplantation (HTx), there is an unmet need related to the limited supply of donor hearts (as opposed to the growing prevalence of AHF) and the low eligibility of highly symptomatic patients. In case of concomitant severe SMR, transcatheter mitral valve therapies (repair and replacement) may play a crucial role in this setting. While a direct prognostic improvement after correction of SMR has yet to be proved, AHF patients can benefit from the following: hemodynamic stabilization, symptomatic relief, normalization of pulmonary arterial pressures, and reduction in hospitalizations for acute heart failure. Obtaining these results may lead to the clinical consequences of reaching the HTx in good enough clinical status (bridge to heart transplantation), becoming eligible for the HTx (bridge to HTx candidacy), and being delisted for clinical improvement (bridge to recovery). Therefore, achieving traditional secondary endpoints in patients with AHF and SMR can translate into significant clinical implications.
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Affiliation(s)
- Andrea Scotti
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128, Padua, Italy.
| | - Andrea Munafò
- Division of Cardiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alberto Margonato
- Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy
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2
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Gill H, Adams HSL, Chehab O, Allen C, Hancock J, Lamata P, Lucchese G, Prendergast B, Redwood S, Patterson T, Rajani R. Anatomy of a Transcatheter Mitral Valve Service. Front Cardiovasc Med 2022; 9:862471. [PMID: 35497993 PMCID: PMC9051038 DOI: 10.3389/fcvm.2022.862471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Transcatheter mitral therapies offer treatment options to selected patients who are unable to undergo open procedures due to prohibitive surgical risk. Data detailing the design and structure of transcatheter mitral services to ensure appropriate patient selection and tailored management strategies is lacking. We report our initial experience of developing and running a purpose-built transcatheter mitral service. The nature and number of referral sources, the multi-disciplinary make-up of the dedicated Mitral Heart Team and the use of integrative imaging assessment with incorporation of computational solutions are discussed. In addition, a summary of the clinical decision-making process is presented. This report sets out a framework from which future clinics can evolve to improve and streamline the delivery of transcatheter mitral therapies.
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Affiliation(s)
- Harminder Gill
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Heath S. L. Adams
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Omar Chehab
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Christopher Allen
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Jane Hancock
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Gianluca Lucchese
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Simon Redwood
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Tiffany Patterson
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ronak Rajani
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
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3
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Gavazzoni M, Taramasso M, PozzoliZ A, Euscher D, Kuck KH, Bohnen S, Zuber M, Voci D, Maisano F, Alessandrini H. Outcomes of Transcatheter Mitral Valve Repair With Edge-to-Edge Technique in Patients With Barlow Disease. JACC Cardiovasc Interv 2021; 14:2308-2310. [PMID: 34674871 DOI: 10.1016/j.jcin.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
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4
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Russo G, Gennari M, Gavazzoni M, Pedicino D, Pozzoli A, Taramasso M, Maisano F. Transcatheter Mitral Valve Implantation: Current Status and Future Perspectives. Circ Cardiovasc Interv 2021; 14:e010628. [PMID: 34407621 DOI: 10.1161/circinterventions.121.010628] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mitral transcatheter therapies represent the treatment of choice for all patients deemed unsuitable for cardiac surgery. So far, the largest clinical experience has been limited to percutaneous repair techniques. However, given the complexity and heterogeneity of mitral valve anatomy and pathology, transcatheter mitral valve implantation will widen the mitral valve therapies horizon, toward a patient-tailored approach. Current data about transcatheter mitral valve implantation is still limited and, although some data are promising, there are still some issues to be addressed. This review provides a comprehensive insight into the available devices and describes potential advantages and limitations of transcatheter mitral valve implantation.
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Affiliation(s)
- Giulio Russo
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Marco Gennari
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,IRCCS Centro Cardiologico Monzino, Milan, Italy (M. Gennari)
| | - Mara Gavazzoni
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Alberto Pozzoli
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland (A.P.)
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5
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Perez-Camargo D, Chen M, Taramasso M. Devices for transcatheter mitral valve repair: current technology and a glimpse into the future. Expert Rev Med Devices 2021; 18:609-628. [PMID: 34092173 DOI: 10.1080/17434440.2021.1940141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Due to a large unmet need for the treatment of mitral regurgitation, transcatheter mitral valve repair devices have emerged in the last decade as an alternative therapeutic option. Given the complexity of this disease, several device systems for transcatheter mitral valve repair have been developed and are categorized according to its mechanism of action; each device has advantages and disadvantages for certain clinical and pathophysiologic characteristics, and in order to improve outcomes, proper patient selection among other key points are fundamental.Areas covered: The purpose of this article is to review the current state-of-the-art technologies available for transcatheter mitral valve repair, patient suitability, outcomes, and future perspectives.Expert opinion: Transcatheter therapy for mitral regurgitation improves outcomes and pushes the boundaries of biomedical technology while maintaining scientific rigor for device development. Surgical and percutaneous procedures should be viewed as complements to treat a wider spectrum of patients affected by this entity. Future directions from multidisciplinary innovation and cooperation will consolidate this therapeutic option.
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Affiliation(s)
- Daniel Perez-Camargo
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,Fundación Interhospitalaria Para la Investigación Cardiovascular, Madrid, Spain
| | - Mi Chen
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,HerzZentrum Hirlsanden Zurich, Zurich, Switzerland
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6
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Chen M, Sun L. What Is the Next Generation of Transcatheter Mitral Valve Repair Devices? Front Cardiovasc Med 2021; 8:641691. [PMID: 33718460 PMCID: PMC7943436 DOI: 10.3389/fcvm.2021.641691] [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: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
In the evolving scenario of the transcatheter mitral valve repair (TMVr), TMVr devices constitute a rapidly expanding field. The standard classification includes edge-to-edge repair, direct annuloplasty, indirect annuloplasty, chordal/papillary muscular repair, and the others. However, the unknowns and uncertainties to innovate a high-performing device are addressed. In this viewpoint, the authors discuss the potential future of the next generation and the challenges of TMVr devices.
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Affiliation(s)
- Mi Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Cardiac Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Lizhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Damian I, Kellermair J, Grund M, Zierer A. First in Human: Transcatheter, Transapical Double Valve Replacement. Ann Thorac Surg 2021; 112:968-969. [PMID: 33482159 DOI: 10.1016/j.athoracsur.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/01/2021] [Indexed: 11/27/2022]
Abstract
Transcatheter aortic valve replacement is a well-established therapy for severe aortic stenosis in patients with high surgical risk. Transcatheter mitral valve replacement just recently emerged as a novel modality to treat severe mitral regurgitation. We present the first case of a transcatheter, transapical native double valve replacement for severe aortic stenosis and mitral regurgitation. Our case shows that it is a safe and effective method, not requiring cardiopulmonary bypass and drastically reducing the procedural time. Therefore, patients with significant comorbidities that portend a high surgical risk with poor long-term outcome, may stand to benefit from this minimally invasive procedure.
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Affiliation(s)
- Ilinca Damian
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty Johannes Kepler University Linz, Linz, Austria.
| | - Joerg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty Johannes Kepler University Linz, Linz, Austria
| | - Michael Grund
- Department of Cardiology, Kepler University Hospital, Medical Faculty Johannes Kepler University Linz, Linz, Austria
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty Johannes Kepler University Linz, Linz, Austria
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8
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Denti P, Sala A, Belluschi I, Alfieri O. Over 15 years: the advancement of transcatheter mitral valve repair. Ann Cardiothorac Surg 2021; 10:15-27. [PMID: 33575172 DOI: 10.21037/acs-2020-mv-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with severe symptomatic mitral regurgitation, if left untreated, have a poor prognosis. In those patients not eligible for mitral valve (MV) surgery, percutaneous repair may improve clinical outcomes. In the past 15 years several devices have been developed to address different MV lesions. This manuscript will review the advancement of transcatheter MV repair through the years, focusing on technologies for which consistent clinical data is available.
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Affiliation(s)
- Paolo Denti
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Alessandra Sala
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Igor Belluschi
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiovascular and Thoracic Surgery, San Raffaele University Hospital, Milan, Italy
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9
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Abstract
Transcatheter mitral valve (MV) repair, specifically the edge-to-edge leaflet repair, is a less invasive treatment of symptomatic mitral regurgitation (MR) in patients with high or prohibitive surgical risk. In cases with severe leaflet calcification, small mitral orifice area, and/or extremely wide regurgitation across the entire MV commissure, transcatheter MV repair may rather cause suboptimal or potentially hazardous outcomes. In these cases, MV replacement can be a more suitable option. Recently, percutaneous transcatheter MV replacement has emerged as an acceptable therapeutic option for the treatment of degenerated surgical bioprosthetic disease. Moreover, several transcatheter devices for native MV replacement are under evaluation with a hope to provide more complete and reproducible restoration of MV function. In this article, we will review current status, applications, clinical outcomes, and limitations that need to be overcome for transcatheter MV replacement for both degenerated surgical bioprosthetic disease and native MV disorders.
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Affiliation(s)
- Yusuke Enta
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
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10
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Isogai T, Saad AM, Shekhar S, Ahuja KR, Abdelfattah OM, Gad MM, Kapadia SR. Peri-Procedural Adverse Event Risk of Transcatheter Mitral Valve Repair and Replacement. JACC Cardiovasc Interv 2020; 13:2450-2452. [PMID: 33092719 DOI: 10.1016/j.jcin.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
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11
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Fraccaro C, Tence N, Masiero G, Karam N. Management of Valvular Disease During Pregnancy: Evolving Role of Percutaneous Treatment. ACTA ACUST UNITED AC 2020; 15:e10. [PMID: 32905129 PMCID: PMC7463339 DOI: 10.15420/icr.2020.06] [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: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
Valvular heart disease (VHD) is encountered in approximately 1% of pregnancies, significantly increasing both maternal and foetal risk. Rheumatic VHD remains the most common form in non-Western countries, whereas congenital heart disease dominates in the Western world. The risk of complications varies according to the type and severity of the underlying VHD. Moreover, pregnancy is a hypercoagulable state associated with increased risk of thromboembolism. The authors review the main VHDs encountered during pregnancy, and suggest management strategies based on the 2018 European Society of Cardiology recommendations for the management of pregnant women with VHD, providing an overview of classical and new transcatheter structural therapeutic options with a special focus on radiation exposure and anticoagulation drug management.
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Affiliation(s)
- Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Padua, Italy
| | - Noemie Tence
- Medico-Surgical Heart Valve Unit, Georges Pompidou European Hospital, University of Paris Paris, France
| | - Giulia Masiero
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Padua, Italy
| | - Nicole Karam
- Medico-Surgical Heart Valve Unit, Georges Pompidou European Hospital, University of Paris Paris, France
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12
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Mitral valve regurgitation: a disease with a wide spectrum of therapeutic options. Nat Rev Cardiol 2020; 17:807-827. [DOI: 10.1038/s41569-020-0395-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 12/30/2022]
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