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Coisne A, Ludwig S, Scotti A, Ben Ali W, Weimann J, Duncan A, Webb JG, Kalbacher D, Rudolph TK, Nickenig G, Hausleiter J, Ruge H, Adam M, Petronio AS, Dumonteil N, Sondergaard L, Adamo M, Regazzoli D, Garatti A, Schmidt T, Dahle G, Taramasso M, Walther T, Kempfert J, Obadia JF, Redwood S, Tang GHL, Goel S, Fam N, Metra M, Andreas M, Muller DW, Denti P, Praz F, von Bardeleben RS, Leroux L, Latib A, Granada JF, Conradi L, Modine T. Outcomes Following Transcatheter Mitral Valve Replacement Using Dedicated Devices in Patients With Mitral Annular Calcification. JACC Cardiovasc Interv 2024:S1936-8798(24)01035-5. [PMID: 39243262 DOI: 10.1016/j.jcin.2024.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Patients with mitral regurgitation (MR) and morphologic presence of relevant mitral annular calcification (MAC) represent a challenging phenotypic subset with limited treatment options. OBJECTIVES The aim of this study was to assess the feasibility of transcatheter mitral valve replacement (TMVR) using dedicated devices for the treatment of MAC patients. METHODS Consecutive patients with symptomatic MR receiving TMVR and with available computed tomography data from the CHOICE-MI (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) multicenter registry were stratified by the presence of none or mild mitral annular calcification (MACnone/mild) vs moderate or severe mitral annular calcification (MACmod/sev). RESULTS Among 279 eligible patients (median age = 76.0 years [Q1-Q3: 71.0-81.0 years], EuroSCORE II = 6.2% [Q1-Q3: 3.9%-12.1%]), 222 (79.6%) presented with MACnone/mild and 57 (20.4%) with MACmod/sev. Patients with MACmod/sev had a higher prevalence of extracardiac arteriopathy (P = 0.011) and primary MR (P < 0.001). Although the technical success rate and the extent of MR elimination did not differ, TMVR treatment in MACmod/sev patients was associated with higher rates of postprocedural bleeding complications (P = 0.02) and renal failure (P < 0.001). Functional improvement at the 1- and 2-year follow-up did not differ between groups. At the 2-year follow-up, there were no differences between patients with MACmod/sev and MACnone/mild regarding all-cause mortality (38.5% vs 37.7%; P = 0.76), cardiovascular mortality (21.3% vs 24.9%; P = 0.97), and all-cause mortality or heart failure hospitalization (52.4% vs 46.7%; P = 0.28) CONCLUSIONS: TMVR in patients with MACmod/sev is associated with higher rates of postprocedural complications but similar rates of survival, MR resolution, and functional improvement compared to MACnone/mild. Further studies are necessary to define the role of dedicated TMVR devices in this population. (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency Registry [CHOICE-MI]; NCT04688190).
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Affiliation(s)
- Augustin Coisne
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France; Cardiovascular Research Foundation, New York, New York, USA.
| | - Sebastian Ludwig
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrea Scotti
- Cardiovascular Research Foundation, New York, New York, USA; Montefiore Medical Center, Montefiore-Einstein Center for Heart and Vascular Care, New York, New York, USA
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montréal, Canada
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Tanja K Rudolph
- Department of Interventional and General Cardiology, Heart and Diabetes Center Nordrhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, University of Bielefeld, Bielefeld, Germany
| | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Anna S Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Gry Dahle
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | | | | | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Sachin Goel
- Houston Methodist Hospital, Houston, Texas, USA
| | - Neil Fam
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | | | - Lionel Leroux
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Azeem Latib
- Montefiore Medical Center, Montefiore-Einstein Center for Heart and Vascular Care, New York, New York, USA
| | - Juan F Granada
- Cardiovascular Research Foundation, New York, New York, USA
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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2
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Caneiro-Queija B, Guerreiro CE, Echarte-Morales J, Estévez-Loureiro R, Barreiro-Pérez M, González-Ferreiro R, Estévez-Cid F, Legarra JJ, Baz JA, Íñiguez-Romo A. Left ventricular outflow tract obstruction after transcatheter mitral valve replacement: a case report with a multifaceted approach. Front Cardiovasc Med 2024; 11:1431639. [PMID: 39234604 PMCID: PMC11371709 DOI: 10.3389/fcvm.2024.1431639] [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: 05/12/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
An 83-year-old woman was admitted to our center because of heart failure. Transthoracic echocardiography revealed severe mitral annular calcification resulting in a double mitral valve lesion. After discussion by the heart team, transcatheter mitral valve replacement with Tendyne (Abbott Structural, Santa Clara, CA, USA) was performed. Despite having a predicted neo-left ventricular outflow tract (LVOT) above the cut-off value, the patient developed clinically significant LVOT obstruction (LVOTO) refractory to medical treatment. This situation is often treated before the intervention, and dealing with LVOTO afterward can be challenging. After taking the patient's anatomy into consideration, we decided to perform alcohol septal ablation. Applying a combined strategy of medical treatment and intervention led to success. In this case report, we discuss this event and the strategies available for preventing and managing the condition.
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Affiliation(s)
- Berenice Caneiro-Queija
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Claudio E Guerreiro
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Julio Echarte-Morales
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Manuel Barreiro-Pérez
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Rocío González-Ferreiro
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Francisco Estévez-Cid
- Department of Cardiovascular Surgery, Álvaro Cunqueiro University Hospital, Vigo, Spain
| | - Juan José Legarra
- Department of Cardiovascular Surgery, Álvaro Cunqueiro University Hospital, Vigo, Spain
| | - Jose Antonio Baz
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Andrés Íñiguez-Romo
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain
- Cardiovascular Research Group, Department of Cardiology, Álvaro Cunqueiro University Hospital, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
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3
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Basman C, Landers D, Dudiy Y, Yoon SH, Batsides G, Faraz H, Anderson M, Kaple R. Multiple Valvular Heart Disease in the Transcatheter Era: A State-of-the-Art Review. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100301. [PMID: 39100585 PMCID: PMC11294895 DOI: 10.1016/j.shj.2024.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 08/06/2024]
Abstract
Although existing guidelines offer strong recommendations for single valvular dysfunction, the growing prevalence of multiple valvular heart disease (MVHD) in our aging population is challenging the clarity of clinical guidance. Traditional diagnostic modalities, such as echocardiography, face inherent constraints in precisely quantifying valvular dysfunction due to the hemodynamic interactions that occur with multiple valve involvement. Therefore, many patients with MVHD present at a later stage in their disease course and with an elevated surgical risk. The expansion of transcatheter therapy for the treatment of valvular heart disease has added new opportunities for higher-risk patients. However, the impact of isolated valve therapies on patients with MVHD is still not well understood. This review focuses on the etiology, diagnostic challenges, and therapeutic considerations for some of the most common concomitant valvular abnormalities that occur in our daily clinic population.
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Affiliation(s)
- Craig Basman
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - David Landers
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Yuriy Dudiy
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Sung-Han Yoon
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - George Batsides
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Haroon Faraz
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Mark Anderson
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Ryan Kaple
- Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA
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4
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Napoli F, Vella C, Ferri L, Ancona MB, Bellini B, Russo F, Agricola E, Esposito A, Montorfano M. Rheumatic and Degenerative Mitral Stenosis: From an Iconic Clinical Case to the Literature Review. J Cardiovasc Dev Dis 2024; 11:153. [PMID: 38786975 PMCID: PMC11122136 DOI: 10.3390/jcdd11050153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/05/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Mitral stenosis (MS) poses significant challenges in diagnosis and management due to its varied etiologies, such as rheumatic mitral stenosis (RMS) and degenerative mitral stenosis (DMS). While rheumatic fever-induced RMS has declined in prevalence, DMS is rising with aging populations and comorbidities. Starting from a complex clinical case of DMS, the aim of this paper is to review the literature on mitral stenosis by analyzing the available tools and the differences in terms of diagnosis and treatment for rheumatic and degenerative stenosis. Emerging transcatheter techniques, such as transcatheter mitral valve replacement (TMVR) and lithotripsy-facilitated percutaneous mitral commissurotomy (PMC), represent promising alternatives for DMS patients deemed unfit for surgery. In particular, intravascular lithotripsy (IVL) has shown potential in facilitating percutaneous interventions by fracturing calcific deposits and enabling subsequent interventions. However, larger prospective studies are warranted to validate these findings and establish IVL's role in DMS management. To further enhance this technique, research could focus on investigating the long-term outcomes and durability of mitral lithotripsy, as well as exploring its potential in combination with PMC or TMVR.
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Affiliation(s)
- Francesca Napoli
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Luca Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Marco B. Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Esposito
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
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5
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Chen L, Wang L, Petrossian G, Robinson N, Chung W, Henry M, Mihalatos D, Bano R, Weber J, Khan J, Cohen DJ, Berke A, Ali Z, Khalique OK. Etiologies and Impact of Exclusion Rates for Transcatheter Mitral and Tricuspid Valve Structural Heart Clinical Trials at a High-Volume Quaternary Care Hospital. Am J Cardiol 2024; 218:102-112. [PMID: 38432332 DOI: 10.1016/j.amjcard.2024.02.035] [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: 09/20/2023] [Revised: 01/31/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
There are various devices under clinical investigation for transcatheter mitral valve intervention and transcatheter tricuspid valve intervention (TTVI); however, the exclusion rates remain high. We aimed to investigate the exclusion rates for transcatheter mitral valve repair (TMVr), transcatheter mitral valve replacement (TMVR), transcatheter tricuspid valve repair (TTVr), and transcatheter tricuspid valve replacement (TTVR). There were 129 patients who were referred to St. Francis Hospital & Heart Center valve clinic and completed screening between January 2021 and July 2022. The causes for exclusion were classified into 4 categories: patient withdrawal, anatomic unsuitability, clinical criteria, and medical futility. In 129 patients, the exclusion rates for TMVr, TMVR, TTVr, and TTVR were 81%, 85%, 91%, and 87%, respectively. Patient withdrawal and medical futility were leading etiologies for exclusion, followed by anatomic unsuitability. TMVr had the highest rate of patient withdrawal (64%) and the lowest anatomic unsuitability (5%) because of short posterior leaflet length. Replacement interventions have a higher anatomic unsuitability (33%) than repair interventions (17%) (p = 0.04). Most exclusions of anatomic unsuitability were because of mitral stenosis or small annulus size for TMVR and large annulus size for TTVR. A total of 50% of exclusions from TTVr were because of the presence of pacemaker/defibrillator leads. In patients excluded from their respective trials, patients being referred for TMVr had the highest recurrent hospitalization and repair group had a higher mortality (p <0.01 and p = 0.01, respectively). In conclusion, the exclusion rates for transcatheter mitral valve intervention and TTVI trials remain high because of various reasons, limiting patient enrollment and treatment. This supports the need for further device improvement or exploring alternative means of therapy.
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Affiliation(s)
- Lu Chen
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York.
| | - Lin Wang
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - George Petrossian
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Newell Robinson
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - William Chung
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Matthew Henry
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Dennis Mihalatos
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Ruqiyya Bano
- Department of Nephrology and Hypertension, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Jonathan Weber
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Jaffar Khan
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - David J Cohen
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Andrew Berke
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
| | - Ziad Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York; New York Institute of Technology, Old Westbury, New York
| | - Omar K Khalique
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York; New York Institute of Technology, Old Westbury, New York
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6
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Zaid S, Tang GHL. Real-World Experience of Transcatheter Mitral Valve Replacement: A Promising Glimpse Into the Future? JACC Cardiovasc Interv 2024; 17:662-665. [PMID: 38385925 DOI: 10.1016/j.jcin.2024.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Syed Zaid
- Section of Cardiology, Baylor College of Medicine, Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas, USA.
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
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7
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Hell MM, Wild MG, Baldus S, Rudolph T, Treede H, Petronio AS, Modine T, Andreas M, Coisne A, Duncan A, Franco LN, Praz F, Ruge H, Conradi L, Zierer A, Anselmi A, Dumonteil N, Nickenig G, Piñón M, Barth S, Adamo M, Dubois C, Torracca L, Maisano F, Lurz P, von Bardeleben RS, Hausleiter J. Transapical Mitral Valve Replacement: 1-Year Results of the Real-World Tendyne European Experience Registry. JACC Cardiovasc Interv 2024; 17:648-661. [PMID: 38385922 DOI: 10.1016/j.jcin.2023.12.027] [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: 08/17/2023] [Revised: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Early studies of the Tendyne transcatheter mitral valve replacement (TMVR) showed promising results in a small selective cohort. OBJECTIVES The authors present 1-year data from the currently largest commercial, real-world cohort originating from the investigator-initiated TENDER (Tendyne European Experience) registry. METHODS All patients from the TENDER registry eligible for 1-year follow-up were included. The primary safety endpoint was 1-year cardiovascular mortality. Primary performance endpoint was reduction of mitral regurgitation (MR) up to 1 year. RESULTS Among 195 eligible patients undergoing TMVR (median age 77 years [Q1-Q3: 71-81 years], 60% men, median Society of Thoracic Surgeons Predicted Risk of Mortality 5.6% [Q1-Q3: 3.6%-8.9%], 81% in NYHA functional class III or IV, 94% with MR 3+/4+), 31% had "real-world" indications for TMVR (severe mitral annular calcification, prior mitral valve treatment, or others) outside of the instructions for use. The technical success rate was 95%. The cardiovascular mortality rate was 7% at 30 day and 17% at 1 year (all-cause mortality rates were 9% and 29%, respectively). Reintervention or surgery following discharge was 4%, while rates of heart failure hospitalization reduced from 68% in the preceding year to 25% during 1-year follow-up. Durable MR reduction to ≤1+ was achieved in 98% of patients, and at 1 year, 83% were in NYHA functional class I or II. There was no difference in survival and major adverse events between on-label use and "real-world" indications up to 1 year. CONCLUSIONS This large, real-world, observational registry reports high technical success, durable and complete MR elimination, significant clinical benefits, and a 1-year cardiovascular mortality rate of 17% after Tendyne TMVR. Outcomes were comparable between on-label use and "real-world" indications, offering a safe and efficacious treatment option for patients without alternative treatments. (Tendyne European Experience Registry [TENDER]; NCT04898335).
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Affiliation(s)
- Michaela M Hell
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Mirjam G Wild
- Medizinische Klinik I, LMU University Hospital, Munich, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Tanja Rudolph
- Department of Cardiology, Heart- und Diabetes Center Northrhine-Westfalia, Bad Oeynhausen, Ruhr-University Bochum, Bochum, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, Universitätsmedizin Mainz of the Johannes Gutenberg University, Mainz, Germany
| | | | - Thomas Modine
- CHU Bordeaux, Hopital Cardiologique Haut Leveque, Pessac, France
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Augustin Coisne
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Alison Duncan
- Heart Division, Royal Brompton Hospital, London, United Kingdom
| | - Luis Nombela Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria, San Carlos (IdISSC), Madrid, Spain
| | - Fabien Praz
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Lenard Conradi
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andreas Zierer
- Department for Cardiac, Vascular, and Thoracic Surgery, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, University Hospital of Rennes, University of Rennes, Rennes, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Miguel Piñón
- Servicio Cirugía Cardíaca. Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Sebastian Barth
- Klinik für Kardiologie, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospital Leuven and Department of Cardiovascular Sciences, Leuven, Belgium
| | - Lucia Torracca
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Maisano
- Valve Center, IRCCS Ospedale San Raaffaele and University Vita Salute, Milan, Italy
| | - Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany; Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | | | - Jörg Hausleiter
- Medizinische Klinik I, LMU University Hospital, Munich, Germany; German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
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8
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Mustafa A, Basman C, Cinelli MP, Goldberg Y, Wang D, Patel V, Kaur A, Singh P, Wei C, Paliwoda E, Kodra A, Pirelli L, Thampi S, Maniatis G, Rutkin B, Kalimi R, Koss E, Trost B, Supariwala AA, Jacob Scheinerman S, Kliger CA. Contemporary experience of mitral transcatheter edge-to-edge repair technology in patients with mitral annular calcification. Catheter Cardiovasc Interv 2024; 103:618-625. [PMID: 38436540 DOI: 10.1002/ccd.30988] [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: 08/08/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mitral annular calcification (MAC) has been an exclusion for many of the earlier pivotal trials that were instrumental in gaining device approval and indications for mitral transcatheter edge-to-edge repair (M-TEER). AIMS To evaluate the impact of MAC on the procedural durability and success of newer generation MitraClip® systems (G3 and G4 systems). METHODS Data were collected from Northwell TEER registry. Patients that underwent M-TEER with third or fourth generation MitraClip device were included. Patients were divided into -MAC (none-mild) and +MAC (moderate-severe) groups. Procedural success was defined as ≤ grade 2 + mitral regurgitation (MR) postprocedure, and durability was defined as ≤ grade 2 + MR retention at 1 month and 1 year. Univariate analysis compared outcomes between groups. RESULTS Of 260 M-TEER patients, 160 were -MAC and 100 were +MAC. Procedural success was comparable; however, there were three patients who required conversion to cardiac surgery during the index hospitalization in the +MAC group versus none in the -MAC group (though this was not statistically significant). At 1-month follow-up, there were no significant differences in MR severity. At 1-year follow-up, +MAC had higher moderate-severe MR (22.1% vs. 7.5%; p = 0.002) and higher mean transmitral gradients (5.3 vs. 4.0 mmHg; p = 0.001) with no differences in mortality, New York Heart Association functional class or ejection fraction. CONCLUSION In selective patients with high burden of MAC, contemporary M-TEER is safe, and procedural success is similar to patients with none-mild MAC. However, a loss of procedural durability was seen in +MAC group at 1-year follow-up. Further studies with longer follow-ups are required to assess newer mTEER devices and their potential clinical implications in patients with a high burden of MAC.
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Affiliation(s)
- Ahmad Mustafa
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Craig Basman
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Michael P Cinelli
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Ythan Goldberg
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Denny Wang
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Vidhi Patel
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Arpanjeet Kaur
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Priyanka Singh
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Chapman Wei
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Ethan Paliwoda
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Arber Kodra
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Luigi Pirelli
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Shankar Thampi
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Gregory Maniatis
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Bruce Rutkin
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Robert Kalimi
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Biana Trost
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Azhar A Supariwala
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Samuel Jacob Scheinerman
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Chad A Kliger
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
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9
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Tanaka T, Sugiura A, Schulz M, Wilde N, Vogelhuber J, Sudo M, Zimmer S, Nickenig G, Weber M. Cardiac computed tomography-based assessment of mitral annular calcification in patients undergoing mitral transcatheter edge-to-edge repair. J Cardiovasc Comput Tomogr 2024; 18:26-32. [PMID: 38105119 DOI: 10.1016/j.jcct.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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The role of assessment of mitral annular calcification (MAC) using cardiac computed tomography (CCT) in mitral transcatheter edge-to-edge repair (TEER) remains unclear. The aim of this study was to investigate the association of MAC assessed by CCT with procedural and clinical outcomes in patients undergoing TEER. METHODS We retrospectively analyzed 275 patients who underwent pre-procedural CCT prior TEER. Mitral calcium volume (MCV) and MAC score were measured by CCT. Functional procedural success was defined as residual mitral regurgitation of ≤2+ with mean transmitral gradient of <5 mmHg at discharge. All-cause mortality within two years after TEER was collected. RESULTS MAC was present in 115 of 275 patients (41.8 %). The median MCV was 198 mm3 (interquartile range [IQR]: 84 to 863 mm3), and the median MAC score was 3 (IQR: 2 to 4). Higher MCV and MAC score were inversely related to the rate of functional procedural success, independently of anatomical features of mitral valve. Patients with moderate/severe MAC, defined as MAC score of ≥4, had a lower rate of functional procedural success than those without MAC (56.1 % vs. 81.3 %; p = 0.002). Moreover, higher MCV and MAC score were associated with a higher risk of all-cause mortality within two years, irrespective of baseline characteristics and functional procedural success. CONCLUSIONS The presence and burden of MAC assessed by CCT were associated with procedural and clinical outcomes in patients undergoing TEER. The CCT-based assessment of MAC may improve patient selection for TEER.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany.
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Max Schulz
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
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10
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Ahmed A, Aziz TAA, AlAsaad MMR, Majthoob M, Toema A. Transcatheter mitral valve implantation with Tendyne System Ten Years since the First In-Human Implant A systematic review. J Cardiothorac Surg 2023; 18:315. [PMID: 37950282 PMCID: PMC10638771 DOI: 10.1186/s13019-023-02446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) using the Tendyne™ valve is regarded as one of the most studied TMVR systems. The first human experience with the procedure was reported in 2013. The present study aims to systemically revise the published literature to document the global experience with TMVR using the Tendyne™ valve. METHODS The present review was conducted in line with the PRISMA statement on systematic reviews. Database included in the search process were Scopus, Web of Science and Pubmed. Search was processed using multiple keywords combinations and was adjusted to English literature only. RESULTS We included 26 articles in the final analysis reporting data from 319 patients. Patients recruited by the included studies comprised 192 males (60.2%) and 127 females (39.8%). In the studied patients, mitral annular calcification (MAC) was reported in 107 patients (33.5%). Preoperatively, MR grades 1,2 and 3-4 were reported in 3,5 and 307 patients respectively. Postoperatively, MR grades 1, 2 and 4 were reported in only 12, 3 and 1 patients respectively. Technical success was achieved in 309 patients (96.9%). Follow up durations widely varied among different studies from just days before discharge to 6 years. At the end of follow up, 79 patients died (24.8%) including 52 patients (16.3%) due to cardiovascular causes. CONCLUSIONS Management of mitral valve disease using the Tendyne system appears to be a promising minimally invasive option for many high-risk patients with accepted procedural feasibility and safety profile.
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Affiliation(s)
- Ahmed Ahmed
- Department of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt.
| | | | | | | | - Ahmed Toema
- Department of Cardiothoracic Surgery, Faculty of Medicine, Helwan University, Cairo, Egypt
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11
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Hatab T, Zaid S, Wessly P, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100206. [PMID: 38046865 PMCID: PMC10692344 DOI: 10.1016/j.shj.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/07/2023] [Accepted: 05/25/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Priscilla Wessly
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Nadeen Faza
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Stephen H. Little
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Marvin D. Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - William A. Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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12
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Zientara A, Duncan A, Heng EL, Quarto C. Concomitant Transapical Aortic/Mitral Transcatheter Valve Replacement for Severe Aortic Stenosis and Mitral Annular Calcification. JACC Case Rep 2023; 24:102025. [PMID: 37869211 PMCID: PMC10589442 DOI: 10.1016/j.jaccas.2023.102025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/08/2023] [Indexed: 10/24/2023]
Abstract
Mitral regurgitation (MR) associated with mitral annular calcification (MAC) is surgically challenging, and valve-in-MAC procedures using transcatheter aortic valve replacement (TAVR) devices have poor outcomes. Transcatheter mitral valve replacement (TMVR) may be an option. Concomitant TAVR and TMVR are limited to 2 reports. We describe the first case of concomitant TAVR and TMVR-in-MAC procedures. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Guy’s and St Thomas’ NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom
| | - Alison Duncan
- Institute of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom
| | - Ee Ling Heng
- Institute of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom
| | - Cesare Quarto
- Department of Cardiac Surgery, Guy’s and St Thomas’ NHS Foundation Trust, Royal Brompton Hospital, London, United Kingdom
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13
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Awtry JA, Shi WY, McGurk S, Louis C, Ailawadi G, George I, Smith RL, Sabe AA, Kaneko T. National trends in utilization of transatrial transcatheter mitral valve replacement and postoperative outcomes. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00966-2. [PMID: 37839658 DOI: 10.1016/j.jtcvs.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/09/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Transatrial transcatheter mitral valve replacement reduces complexity during mitral valve replacements involving high-risk patients with mitral annular calcification. This study examines trends in transatrial transcatheter mitral valve replacement use and outcomes. METHODS Patients in the Society of Thoracic Surgeons database from 2014 to 2021 with mitral annular calcification undergoing transatrial transcatheter mitral valve replacement were included. Exclusion criteria were hypertrophic cardiomyopathy, congenital mitral valve disease, ventricular assist device placement, or prior mitral valve surgery. Primary outcomes were operative mortality and major adverse cardiac events compared between the Early (2014-2017, N = 71) and Recent (2018-2021, N = 151) eras. Parsimonious multivariable regression assessed select possible confounders for trends in major adverse cardiac events. RESULTS Overall, 222 transatrial transcatheter mitral valve replacements at 104 hospitals were identified. Annual volume increased from 6 in 2014 to 43 in 2021. Median hospital volume was 1, maximum hospital volume was 17, and 10 or more replacements were performed at 4 hospitals. Mortality and major adverse cardiac events occurred in 10.4% and 22.5% of patients, respectively. Compared with the Early era patients, Recent era patients were more often elective (79.5% vs 64.8%) and were approached via sternotomy (90.1% vs 80.3%, all P < .05). Despite similar predicted risk of mortality (9.6% ± 11.1% vs 11.0% ± 6.0%; P = .61), Recent patients had reduced mortality (3.3% vs 25.4%, P < .001) and major adverse cardiac events (18.5% vs 31.0%; P = .057). On univariate and multivariable analyses, the Recent surgical era was significantly associated with lower mortality (0.10 [0.04-0.29]; P < .001) and lower major adverse cardiac events (0.48 [0.25-0.94]; P = .032), respectively. There were no preoperative characteristics that were significant confounders for the difference in major adverse cardiac events. CONCLUSIONS Mortality and major adverse cardiac events after transatrial transcatheter mitral valve replacement have decreased significantly in the contemporary era independent of changes in major patient and operative characteristics. Transatrial transcatheter mitral valve replacement will have a future role in patients with mitral annular calcification.
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Affiliation(s)
- Jake A Awtry
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - William Y Shi
- Division of Cardiovascular and Thoracic Surgery, Northwell Health System, New York, NY
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Clauden Louis
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Gorav Ailawadi
- Division of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Isaac George
- Division of Cardiac Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Robert L Smith
- Department of Cardiothoracic Surgery, Baylor Scott and White, The Heart Hospital, Plano, Tex
| | - Ashraf A Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St Louis/Barnes-Jewish Hospital, St Louis, Mo
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14
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Demal TJ, Conradi L. Management of valve dysfunction in patients with mitral annular calcification. Heart 2023; 109:1639-1646. [PMID: 37137678 DOI: 10.1136/heartjnl-2022-321572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Deschka H, Orwat S, Bleiziffer S, Kaleschke G. Alternative access for transapical transcatheter mitral valve implantation. JTCVS Tech 2023; 21:102-105. [PMID: 37854798 PMCID: PMC10580168 DOI: 10.1016/j.xjtc.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Heinz Deschka
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Stefan Orwat
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Gerrit Kaleschke
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
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16
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Alperi A, Avanzas P, Leon V, Silva I, Hernández-Vaquero D, Almendárez M, Álvarez R, Fernández F, Moris C, Pascual I. Current status of transcatheter mitral valve replacement: systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1130212. [PMID: 37234369 PMCID: PMC10206247 DOI: 10.3389/fcvm.2023.1130212] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Mitral Regurgitation (MR) has a strong impact on quality of life and on mid-term survival. Transcatheter mitral valve replacement (TMVR) is rapidly expanding and a growing number of studies have been published recently. Methods A systematic review of studies reporting on clinical data for patients with symptomatic severe MR undergoing TMVR was performed. Early- and mid-term outcomes (clinical and echocardiographic) were evaluated. Overall weighted means and rates were calculated. Risk ratios or mean differences were calculated for pre- and post-procedural comparisons. Results A total of 12 studies and 347 patients who underwent TMVR with devices clinically available or under clinical evaluation were included. Thirty-day mortality, stroke and major bleeding rates were 8.4%, 2.6%, and 15.6%, respectively. Pooled random-effects demonstrated a significant reduction of ≥ grade 3+ MR (RR: 0.05; 95% CI: 0.02-0.11; p < 0.001) and in the rates of patients in NYHA class 3-4 after the intervention (RR: 0.27; 95% CI: 0.22-0.34; p < 0.001). Additionally, the pooled fixed-effect mean difference for quality of life based on the KCCQ score yielded an improvement in 12.9 points (95% CI:7.4-18.4, p < 0.001), and exercise capacity improved by a pooled fixed-effect mean difference of 56.8 meters in the 6-minute walk test (95% CI 32.2-81.3, p < 0.001). Conclusions Among 12 studies and 347 patients comprising the updated evidence with current TMVR systems there was a statistically significant reduction in ≥ grade 3+ MR and in the number of patients exhibiting poor functional class (NYHA 3 or 4) after the intervention. Overall rate of major bleeding was the main shortcoming of this technique.
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Affiliation(s)
- Alberto Alperi
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Pablo Avanzas
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Victor Leon
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Iria Silva
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Daniel Hernández-Vaquero
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Marcel Almendárez
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
| | - Rut Álvarez
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Félix Fernández
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Cesar Moris
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Isaac Pascual
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
- Health Research Institute of Asturias (Instituto de Investigación Sanitaria del Principado de Asturias), Oviedo, Spain
- Department of Medicine, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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17
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Agrawal A, Reardon MJ, Goel SS. Transcatheter Mitral Valve Replacement in Patients with Mitral Annular Calcification: A Review. Heart Int 2023; 17:19-26. [PMID: 37456353 PMCID: PMC10339466 DOI: 10.17925/hi.2023.17.1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/31/2023] [Indexed: 07/18/2023] Open
Abstract
Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
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18
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Samanidis G, Kanakis M, Perreas K. Outcomes after Transcatheter Mitral Valve Implantation: A Literature Review. J Pers Med 2022; 12:jpm12122074. [PMID: 36556294 PMCID: PMC9783604 DOI: 10.3390/jpm12122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Mitral valve disease is the most common heart valve disease worldwide. Surgical mitral valve replacement or repair has been an established therapy in patients with severe mitral valve disease for many years. On the other hand, many patients with advanced mitral valve disease and severe comorbidities are treated conservatively and are excluded from the surgical procedure. Furthermore, in patients with severe comorbidities, transcatheter mitral valve repair by edge-to-edge technique with MitraClip or transcatheter mitral valve repair with a non-absorbable ring have been added as therapeutic options over the last few years. Alternative procedures for the treatment of patients with advanced prosthetic or native mitral valve diseases include transcatheter access for replacement or implantation of a new prosthetic valve in the diseased mitral valve. Promising results were published about short-term outcomes of patients who underwent the transcatheter mitral valve replacement. The current view and results of the transcatheter mitral valve implantation in patients with advanced native or prosthetic mitral valve disease are briefly discussed.
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Affiliation(s)
- George Samanidis
- Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674 Athens, Greece
- Correspondence: ; Tel.: +30-0032109493832
| | - Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674 Athens, Greece
| | - Konstantinos Perreas
- Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674 Athens, Greece
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19
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Ascione G, Denti P. Mitral annular calcification in patients with significant mitral valve disease: An old problem with new solutions. Front Cardiovasc Med 2022; 9:1033565. [PMID: 36479573 PMCID: PMC9719907 DOI: 10.3389/fcvm.2022.1033565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 08/27/2023] Open
Abstract
Mitral annular calcification (MAC) is a chronic process involving mitral valve annulus, linked with an increased cardiovascular mortality and morbidity. Since its first autoptic description, a progressive evolution in diagnostic tools brought cardiac computed tomography (CT) scan to become the gold standard in MAC detection and classification. The treatment of significant mitral valve disease in patients with annular calcifications has always represented an issue for cardiac surgeons, being it linked with an increased risk of atrioventricular groove rupture, circumflex artery injury, or embolism. As a consequence, different surgical techniques have been developed over time in order to reduce the incidence of these fearsome complications. Recently, transcatheter mitral valve replacement (TMVR) has emerged as a valid alternative to surgery in high-risk patients. Both hybrid transatrial, transfemoral, or transapical approaches have been described to deliver balloon-expandable or self-expanding aortic transcatheter valves into the calcified annulus, with conflicting early and long-term results. Tendyne (Abbott Structural Heart, Santa Clara, CA, USA) is a promising transapical-delivered option. Early results have shown effectiveness and safety of this device in patients with MAC and severe mitral valve disease, with the lowest rate of embolization, mortality, and left ventricular outflow tract obstruction (LVOTO) reported so far.
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Affiliation(s)
- Guido Ascione
- Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Turi ZG. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100087. [PMID: 37288059 PMCID: PMC10242581 DOI: 10.1016/j.shj.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/09/2023]
Abstract
Percutaneous balloon mitral valvuloplasty (PBMV), once the most complex of percutaneous cardiac procedures and essentially the first adult structural heart intervention, set the stage for a host of new technologies. Randomized studies comparing PBMV to surgery were the first to provide a high-level evidence base in structural heart. The devices used have changed little in 40 years, but the advent of improved imaging and the expertise gained in interventional cardiology has provided some additional procedural safety. However, with the decline in rheumatic heart disease, PBMV is being performed in fewer patients in industrialized nations; in turn, these patients have more comorbidities, less favorable anatomy, and thus a higher rate of procedure-related complications. There remain relatively few experienced operators, and the procedure is distinct enough from the rest of the structural heart intervention world that it has its own steep learning curve. This article reviews the use of PBMV in a variety of clinical settings, the influence of anatomic and physiologic factors on outcomes, the changes in the guidelines, and alternative approaches. PBMV remains the procedure of choice in patients with mitral stenosis with ideal anatomy and a useful tool in patients with less than ideal anatomy who are poor surgical candidates. In the 40 years since its first performance, PBMV has revolutionized the care of mitral stenosis patients in developing countries and remains an important option for suitable patients in industrialized nations.
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Affiliation(s)
- Zoltan G. Turi
- Address correspondence to: Zoltan G. Turi, MD, Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ 07601.
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Chehab O, Roberts-Thomson R, Bivona A, Gill H, Patterson T, Pursnani A, Grigoryan K, Vargas B, Bokhary U, Blauth C, Lucchese G, Bapat V, Guerrero M, Redwood S, Prendergast B, Rajani R. Management of Patients With Severe Mitral Annular Calcification: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:722-738. [PMID: 35953138 DOI: 10.1016/j.jacc.2022.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Mitral annular calcification (MAC) is a common and challenging pathologic condition, especially in the context of an aging society. Surgical mitral valve intervention in patients with MAC is difficult, with varying approaches to the calcified annular anatomy, and the advent of transcatheter valve interventions has provided additional treatment options. Advanced imaging provides the foundation for heart team discussions and management decisions concerning individual patients. This review focuses on the prognosis of, preoperative planning for, and management strategies for patients with MAC.
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Affiliation(s)
- Omar Chehab
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Ross Roberts-Thomson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Antonio Bivona
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tiffany Patterson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Amit Pursnani
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Karine Grigoryan
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Bernardo Vargas
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Ujala Bokhary
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Christopher Blauth
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Gianluca Lucchese
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Vinayak Bapat
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Redwood
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Bernard Prendergast
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom.
| | - Ronak Rajani
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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