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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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Ali M, Shreenivas SS, Pratt DN, Lynch DR, Kereiakes DJ. Percutaneous Interventions for Secondary Mitral Regurgitation. Circ Cardiovasc Interv 2020; 13:e008998. [PMID: 32757659 DOI: 10.1161/circinterventions.120.008998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mitral regurgitation is frequently associated with ventricular dysfunction and carries a high mortality. Guideline-directed medical therapy, surgical mitral valve repair or replacement, and, in the setting of advanced heart failure, heart transplant and left ventricular assist devices have been the mainstay of treatment. However, rapid advancement in the field has resulted in approval of edge-to-edge mitral valve repair with the MitraClip, and there are several novel catheter-based percutaneous options in clinical trials. Percutaneous options, while promising, must be deployed in patients who are most likely to benefit, and thus, understanding the pathophysiology of specific subgroups of patients with functional mitral regurgitation (eg, disproportionate versus proportionate mitral regurgitation) is key to the success of new devices. We review the pathophysiology, percutaneous therapeutic treatment options, and ongoing clinical trials for functional mitral regurgitation.
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Affiliation(s)
- Mahboob Ali
- University of Cincinnati, OH (M.A., D.N.P., D.R.L.)
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Mangieri A, Laricchia A, Giannini F, Gallo F, Kargoli F, Ladanyi A, Testa L, Colombo A, Latib A. Emerging Technologies for Percutaneous Mitral Valve Repair. Front Cardiovasc Med 2019; 6:161. [PMID: 31781576 PMCID: PMC6851532 DOI: 10.3389/fcvm.2019.00161] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022] Open
Abstract
Mitral regurgitation (MR) is a common disease affecting more than 4 million people in the United States and the European Union. A significant number of percutaneous valves have been developed recently, specifically designed for the mitral anatomy, and with a promising evidence of good procedural and echocardiographic outcomes. However, even if transcatheter mitral valve replacement (TMVR) will have a role in the future of percutaneous treatment of both functional and degenerative mitral regurgitation, percutaneous mitral valve repair will always play a vital role in the treatment of MR because of the favorable safety profile and the fact that it respects the native anatomy. In this review, we will discuss the new emerging technologies under development to treat mitral regurgitation focusing on different devices that aim to target different components of the mitral anatomy.
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Affiliation(s)
| | | | | | - Francesco Gallo
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Faraj Kargoli
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Annamaria Ladanyi
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States.,San Raffaele University Hospital, Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Giannini F, Baldetti L, Gallone G, Tzanis G, Latib A, Colombo A. Transcatheter Valve Replacement in Asia Pacific: Current Practice and Perspectives. J Am Coll Cardiol 2019; 72:3189-3199. [PMID: 30545457 DOI: 10.1016/j.jacc.2018.09.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
Although the field of transcatheter therapies for valvular heart disease (VHD) is continuously expanding in western countries, uptake of this treatment in Asia has been slow, mainly due to the high cost of devices, need for specific training programs, and lack of specialized heart teams and dedicated structures. Moreover, anatomic considerations of the Asian population, such as smaller aorta and peripheral vessel size, high prevalence of bicuspid aortic valves, high calcium burden of stenotic aortic valve leaflets, low coronary ostia, and high prevalence of rheumatic etiology, might raise concerns about feasibility, risk of procedural complications, prosthesis durability, and long-term outcomes after transcatheter treatment of VHD. Asia Pacific and China's medical communities and manufacturer companies are setting up to address this unmet clinical need. The aim of this review is to summarize the landscape of currently available devices for transcatheter valve interventions and the clinical experience to date in China and Asian Pacific countries, with a specific focus on new, locally designed, and/or manufactured devices.
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Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Luca Baldetti
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guglielmo Gallone
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Georgios Tzanis
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, New York. https://twitter.com/azeemlatib
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
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Curio J, Demir OM, Pagnesi M, Mangieri A, Giannini F, Weisz G, Latib A. Update on the Current Landscape of Transcatheter Options for Tricuspid Regurgitation Treatment. ACTA ACUST UNITED AC 2019; 14:54-61. [PMID: 31178930 PMCID: PMC6545971 DOI: 10.15420/icr.2019.5.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/21/2019] [Indexed: 11/04/2022]
Abstract
Most patients with severe tricuspid regurgitation lack treatment options because of prohibitive surgical risk. New transcatheter treatments under development and investigation might be able to address this unmet clinical need. This article gives an update on the landscape of devices for transcatheter tricuspid regurgitation treatment including different approaches (i.e. repair with leaflet approximation or annuloplasty and replacement using orthotopic or heterotopic valves) at different stages of development, from experimental to clinical trial. Repair devices such as the Cardioband or the MitraClip are leading the field with promising preliminary data and further trials are ongoing. However, with implantations of the Gate bioprosthesis, replacement devices are catching up. Potential advantages of different approaches and most recent data are discussed.
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Affiliation(s)
- Jonathan Curio
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute Milan, Italy.,Charité University Medical Care Berlin, Germany
| | - Ozan M Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust London, UK
| | - Matteo Pagnesi
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital Cotignola, Italy
| | - Giora Weisz
- Department of Cardiology, Montefiore Medical Center New York, NY, US
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center New York, NY, US
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Lee KE, Kim KT, Lee JH, Jung S, Kim JH, Shim EB. Computational analysis of the electromechanical performance of mitral valve cerclage annuloplasty using a patient-specific ventricular model. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2019; 23:63-70. [PMID: 30627011 PMCID: PMC6315091 DOI: 10.4196/kjpp.2019.23.1.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/19/2023]
Abstract
We aimed to propose a novel computational approach to predict the electromechanical performance of pre- and post-mitral valve cerclage annuloplasty (MVCA). Furthermore, we tested a virtual estimation method to optimize the left ventricular basement tightening scheme using a pre-MVCA computer model. The present model combines the three-dimensional (3D) electromechanics of the ventricles with the vascular hemodynamics implemented in a lumped parameter model. 3D models of pre- and post-MVCA were reconstructed from the computed tomography (CT) images of two patients and simulated by solving the electromechanical-governing equations with the finite element method. Computed results indicate that reduction of the dilated heart chambers volume (reverse remodeling) appears to be dependent on ventricular stress distribution. Reduced ventricular stresses in the basement after MVCA treatment were observed in the patients who showed reverse remodeling of heart during follow up over 6 months. In the case who failed to show reverse remodeling after MVCA, more virtual tightening of the ventricular basement diameter than the actual model can induce stress unloading, aiding in heart recovery. The simulation result that virtual tightening of the ventricular basement resulted in a marked increase of myocardial stress unloading provides in silico evidence for a functional impact of MVCA treatment on cardiac mechanics and post-operative heart recovery. This technique contributes to establishing a pre-operative virtual rehearsal procedure before MVCA treatment by using patient-specific cardiac electromechanical modeling of pre-MVCA.
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Affiliation(s)
- Kyung Eun Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24340, Korea
| | - Ki Tae Kim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24340, Korea
| | - Jong Ho Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24340, Korea
| | - Sujin Jung
- Department of Cardiology, College of Medicine, Pusan National University, Busan 46241, Korea
| | - June-Hong Kim
- Department of Cardiology, College of Medicine, Pusan National University, Busan 46241, Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24340, Korea
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Park YH, Chon MK, Lederman RJ, Sung SC, Je HG, Choo KS, Lee SH, Shin ES, Kim JS, Hwang KW, Lee SY, Chun KJ, Kim CM, Kim JH. Mitral Loop Cerclage Annuloplasty for Secondary Mitral Regurgitation: First Human Results. JACC Cardiovasc Interv 2017; 10:597-610. [PMID: 28335897 DOI: 10.1016/j.jcin.2016.12.282] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/24/2016] [Accepted: 12/29/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This is an early feasibility clinical test of mitral loop cerclage annuloplasty to treat secondary mitral valve regurgitation. BACKGROUND Secondary mitral regurgitation is characterized by cardiomyopathy, mitral annular enlargement, and leaflet traction contributing to malcoaptation. Transcatheter mitral loop cerclage applies circumferential compression to the mitral annulus by creating a loop through the coronary sinus across the interventricular septum, protecting entrapped coronary arteries from compression, and interactive annular reduction under echocardiographic guidance. This is the first human test of mitral loop annuloplasty. METHODS Five subjects with severe symptomatic secondary mitral regurgitation underwent mitral loop cerclage, with echocardiographic and computed tomography follow-up over 6 months. RESULTS Mitral loop cerclage was successful in 4 of 5 subjects and aborted in 1 of the 5 because of unsuitable septal coronary vein anatomy. Immediately and over 6 months, measures of both mitral valve regurgitation (effective orifice area and regurgitation fraction) and chamber dimensions (left atrial and left ventricular volumes) were reduced progressively and ejection fractions increased. Two with persistent and permanent atrial fibrillation spontaneously reverted to sinus rhythm during follow-up. One subject experienced a small myocardial infarction from an unrecognized small branch coronary occlusion. Another, experiencing cardiogenic shock at baseline, died of intractable heart failure after 6 weeks. CONCLUSIONS In this first human test, mitral loop cerclage annuloplasty was successful in 4 of 5 attempts, caused reverse remodeling (reduction in secondary mitral regurgitation and heart chamber volumes), and suggested electrical remodeling (reversion of atrial fibrillation). Further evaluation is warranted.
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Affiliation(s)
- Yong-Hyun Park
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Min-Ku Chon
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Robert J Lederman
- Cardiovascular and pulmonary branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Si-Chan Sung
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Hyung-Gon Je
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Ki-Seok Choo
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Sang-Hyun Lee
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jeong-Su Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Ki-Won Hwang
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Soo-Yong Lee
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Kook-Jin Chun
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea
| | - Cheol-Min Kim
- Research Center for Anti-Aging Technology Development, Pusan National University, Pusan, Korea
| | - June-Hong Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan & Pusan National University, Yangsan, Korea.
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