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Coisne A, Scotti A, Granada JF, Grayburn PA, Mack MJ, Cohen DJ, Kar S, Lim DS, Lindenfeld J, Bax J, Kotinkaduwa LN, Redfors B, Weissman NJ, Asch FM, Stone GW. Regurgitant volume to LA volume ratio in patients with secondary MR: the COAPT trial. Eur Heart J Cardiovasc Imaging 2024; 25:616-625. [PMID: 38060997 DOI: 10.1093/ehjci/jead328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 05/01/2024] Open
Abstract
AIMS The conceptual framework of proportionate vs. disproportionate mitral regurgitation (MR) translates poorly to individual patients with heart failure (HF) and secondary MR. A novel index, the ratio of MR severity to left atrial volume (LAV), may identify patients with 'disproportionate' MR and a higher risk of events. The objectives, therefore, were to investigate the prognostic impact of MR severity to LAV ratio on outcomes among HF patients with severe secondary MR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip™ device plus guideline-directed medical therapy (GDMT) vs. GDMT alone in the COAPT trial. METHODS AND RESULTS The ratio of pre-procedural regurgitant volume (RVol) to LAV was calculated from baseline transthoracic echocardiograms. The primary endpoint was 2-year covariate-adjusted rate of HF hospitalization (HFH). Among 567 patients, the median RVol/LAV was 0.67 (interquartile range 0.48-0.91). In patients randomized to GDMT alone, lower RVol/LAV was independently associated with an increased 2-year risk of HFH (adjHR: 1.77; 95% CI: 1.20-2.63). RVol/LAV was a stronger predictor of adverse outcomes than RVol or LAV alone. Treatment with TEER plus GDMT compared with GDMT alone was associated with lower 2-year rates of HFH both in patients with low and high RVol/LAV (Pinteraction = 0.28). Baseline RVol/LAV ratio was unrelated to 2-year mortality, health status, or functional capacity in either treatment group. CONCLUSION Low RVol/LAV ratio was an independent predictor of 2-year HFH in HF patients with severe MR treated with GDMT alone in the COAPT trial. TEER improved outcomes regardless of baseline RVol/LAV ratio. CLINICAL TRIAL REGISTRATION Trial Name: Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (The COAPT Trial) (COAPT) ClinicalTrial.gov Identifier NCT01626079URL https://clinicaltrials.gov/ct2/show/NCT01626079.
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Affiliation(s)
- Augustin Coisne
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, F-59000 Lille, France
| | - Andrea Scotti
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan F Granada
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Paul A Grayburn
- Department of Internal Medicine, Division of Cardiology, Baylor Scott & White Heart and Vascular Hospitals, Plano, TX, USA
| | | | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Saint Francis Hospital, Roslyn, NY, USA
| | - Saibal Kar
- Los Robles Regional, Thousand Oaks, CA, USA
- Bakersfield Heart Hospital, Bakersfield, CA, USA
| | - D Scott Lim
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Neil J Weissman
- MedStar Health Research Institute, Georgetown University, Washington, DC, USA
| | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, DC, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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Bapat V, Weiss E, Bajwa T, Thourani VH, Yadav P, Thaden JJ, Lim DS, Reardon M, Pinney S, Adams DH, Yakubov SJ, Modine T, Redwood SR, Walton A, Spargias K, Zhang A, Mack M, Leon MB. 2-Year Clinical and Echocardiography Follow-Up of Transcatheter Mitral Valve Replacement With the Transapical Intrepid System. JACC Cardiovasc Interv 2024:S1936-8798(24)00527-2. [PMID: 38639690 DOI: 10.1016/j.jcin.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Thirty-day outcomes with the investigational Intrepid transapical (TA) transcatheter mitral valve replacement (TMVR) system have previously demonstrated good technical success, but longer-term outcomes in larger cohorts need to be evaluated. OBJECTIVES The authors sought to evaluate the 2-year safety and performance of the Intrepid TA-TMVR system in patients with symptomatic, ≥moderate-severe mitral regurgitation (MR) and high surgical risk. METHODS Patient eligibility was determined by local heart teams and approved by a central screening committee. Clinical events were adjudicated by an independent clinical events committee. Echocardiography was evaluated by an independent core laboratory. RESULTS The cohort included 252 patients that were enrolled at 58 international sites before February 2021 as part of the global Pilot Study (n = 95) or APOLLO trial (primary cohort noneligible + TA roll-ins, n = 157). Mean age was 74.2 years, mean STS-PROM was 6.3%, 60.3% were male, and 80.6% were in NYHA functional class III/IV. Most presented with secondary MR (70.1%), and nearly all had ≥moderate-severe MR (98.4%). All-cause mortality was 13.1% (30-day), 27.3% (1-year), and 36.2% (2-year). The 30-day ≥major bleeding event rate was 22.3%. Heart failure rehospitalization was 9.6% (30-day) and 36.2% (2-year). At 2 years, >50% of patients were alive with improvement in NYHA functional class (82.1%, class I/II), and all patients with available echocardiograms had ≤mild MR. CONCLUSIONS This analysis represents the largest reported TA-TMVR experience with the longest follow-up in high-risk ≥moderate-severe MR patients. Early mortality and heart failure rehospitalizations were significant, exacerbated by early TA-related bleeding events; however, meaningful improvements in clinical outcomes and marked reductions in MR severity were observed through 2 years.
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Affiliation(s)
- Vinayak Bapat
- St. Thomas' Hospital, London, United Kingdom; New York Presbyterian/Columbia University Medical Center, New York, New York, USA.
| | - Eric Weiss
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, New York, USA
| | | | | | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France
| | | | - Antony Walton
- Cardiology Department, The Alfred, Melbourne, Australia
| | | | | | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
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Wang J, Liu X, Pu Z, Chen M, Fang Z, Jin J, Dong J, Guo Y, Cheng B, Xiu J, Luo J, Tang Y, Wang Y, Chen X, Zhang G, Shao Y, Song G, Hong L, Jiang H, Wu Y, Yuan Y, Chen L, He B, Wang J, Xu K, Yang Y, Zhou D, Zhang Q, Li Y, Ma K, Lam YY, Han Y, Ge J, Lim DS, Pivotal Trial Investigators FTD. Safety and efficacy of the DragonFly system for transcatheter valve repair of degenerative mitral regurgitation: one-year results of the DRAGONFLY-DMR trial. EUROINTERVENTION 2024; 20:e239-e249. [PMID: 38389469 PMCID: PMC10870008 DOI: 10.4244/eij-d-23-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/20/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Severe degenerative mitral regurgitation (DMR) can cause a poor prognosis if left untreated. For patients considered at prohibitive surgical risk, transcatheter edge-to-edge repair (TEER) has become an accepted alternative therapy. The DragonFly transcatheter valve repair system is an innovative evolution of the mitral TEER device family to treat DMR. AIMS Herein we report on the DRAGONFLY-DMR trial (ClinicalTrials.gov: NCT04734756), which was a prospective, single-arm, multicentre study on the safety and effectiveness of the DragonFly system. METHODS A total of 120 eligible patients with prohibitive surgical risk and DMR ≥3+ were screened by a central eligibility committee for enrolment. The study utilised an independent echocardiography core laboratory and clinical event committee. The primary endpoint was the clinical success rate, which measured freedom from all-cause mortality, mitral valve reintervention, and mitral regurgitation (MR) >2+ at 1-year follow-up. RESULTS At 1 year, the trial successfully achieved its prespecified primary efficacy endpoint, with a clinical success rate of 87.5% (95% confidence interval: 80.1-92.3%). The rates of major adverse events, all-cause mortality, mitral valve reintervention, and heart failure hospitalisation were 9.0%, 5.0%, 0.8%, and 3.4%, respectively. MR ≤2+ was 90.4% at 1 month and 92.0% at 1 year. Over time, left ventricular reverse remodelling was observed (p<0.05), along with significant improvements in the patients' functional and quality-of-life outcomes, shown by an increase in the New York Heart Association Class I/II from 32.4% at baseline to 93.6% at 12 months (p<0.001) and increased Kansas City Cardiomyopathy Questionnaire (KCCQ) score of 31.1±18.2 from baseline to 12 months (p<0.001). CONCLUSIONS The DRAGONFLY-DMR trial contributes to increasing evidence supporting the safety and efficacy of TEER therapy, specifically the DragonFly system, for treating patients with chronic symptomatic DMR 3+ to 4+ at prohibitive surgical risk.
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Affiliation(s)
- Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoxia Pu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Jin
- Department of Cardiology, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jianzhen Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yansong Guo
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China
| | - Biao Cheng
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, China and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yida Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yan Wang
- Department of Medicine, Xiamen University Cardiovascular Hospital, Xiamen, China
| | - Xiaomen Chen
- Cardiology Center, Ningbo First Hospital, Ningbo, China
| | - Gejun Zhang
- Department of Cardiology, Fuwai Cardiovascular Hospital of Yunnan Province, Kunming, China
| | - Yibing Shao
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lang Hong
- Department of Cardiology, Jiangxi Provincial People's Hospital, Nanchang, China and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yangqin Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiqiang Yuan
- Department of Cardiology, Henan Chest Hospital, Zhengzhou, China
| | - Lianglong Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China and Shanghai Jiao Tong University, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Xu
- Department of Cardiology, General Hospital of the Northern Theater of the Chinese People's Liberation Army, Shenyang, China
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Shanghai, China and Tongji University, Shanghai, China
| | - Yi Li
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | | | - Yat-Yin Lam
- Hong Kong Asia Heart Centre, Canossa Hospital, Hong Kong, China
| | - Yaling Han
- Department of Cardiology, General Hospital of the Northern Theater of the Chinese People's Liberation Army, Shenyang, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - D Scott Lim
- Department of Medicine, University of Virginia Health System Hospital, Charlottesville, VA, USA
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Duggal NM, Engoren M, Chadderdon SM, Rodriguez E, Morse MA, Vannan MA, Yadav PK, Morcos M, Li F, Reisman M, Garcia-Sayan E, Raghunathan D, Sodhi N, Sorajja P, Chen L, Rogers JH, Calfon MA, Kovach CP, Gill EA, Zahr FE, Chetcuti SJ, Yuan Y, Mentz GB, Lim DS, Ailawadi G. Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry. Am J Cardiol 2024; 213:99-105. [PMID: 38110022 DOI: 10.1016/j.amjcard.2023.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
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Affiliation(s)
- Neal M Duggal
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Scott M Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Evelio Rodriguez
- Department of Cardiothoracic Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - M Andrew Morse
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Pradeep K Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael Morcos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Flora Li
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | - Enrique Garcia-Sayan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Deepa Raghunathan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nishtha Sodhi
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute, Abbott Northwestern Medical Center, Minneapolis, Minnesota
| | - Lily Chen
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Marcella A Calfon
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | | | - Edward A Gill
- Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Firas E Zahr
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yuan Yuan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
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Ma H, Gong W, Lim DS, Li J, Ta S, Hu R, Li X, Zheng M, Liu L. Echocardiography-guided percutaneous intramyocardial alginate hydrogel implants for heart failure: canine models with 6-month outcomes. Front Cardiovasc Med 2024; 11:1320315. [PMID: 38287986 PMCID: PMC10822984 DOI: 10.3389/fcvm.2024.1320315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
Background Echocardiography-guided percutaneous intramyocardial alginate-hydrogel implantation (PIMAHI) is a novel treatment approach for heart failure (HF). We validated PIMAHI safety and efficacy in canine HF models. Methods Fourteen canines with HF [produced by coronary artery ligation, left ventricular ejection fraction (LVEF) < 35%] were randomised to PIMAHI treatment (n = 8) or controls (n = 6). Echocardiography, two-dimensional speckle tracking echocardiography, and pathological examinations after a 6-month follow-up were performed. Repeated-measures analysis of variance was used for within-group comparisons. Results At 6-month follow-up, PIMAHI treatment reversed LV dilation and remodelling, increasing LV free wall thickness (LVFW, p = 0.002) and interventricular septum thickness (IVS, p < 0.001) and reducing LV end-diastolic volume (EDV, p = 0.008) and end-systolic volume (ESV, p = 0.004). PIMAHI significantly improved LV systolic function, increasing LVEF (EF, p = 0.004); enhanced LV myocardial contractility, including increased LV global longitudinal strain (GLS, p < 0.001), global circumferential strain (GCS, p = 0.006), and mitral annulus displacement (MAD, p = 0.001). Compared with controls at 6-month, PIMAHI group significantly increased LVFW thickness (8.5 ± 0.3 vs. 6.8 ± 0.2 mm, p = 0.002) and IVS (7.9 ± 0.1 vs. 6.1 ± 0.2 mm, p < 0.001); decreased LVEDV (30.1 ± 1.6 vs. 38.9 ± 4.5 ml, p = 0.049) and ESV (17.3 ± 1.2 vs. 28.7 ± 3.6 ml, p = 0.004); increased LV systolic function (42.7 ± 1.5 vs. 26.7 ± 1.1% in EF, p = 0.001); and enhanced LV myocardial contractility including GLS (13.5 ± 0.8 vs. 8.4 ± 0.6%, p = 0.002), GCS (16.5 ± 1.4 vs. 9.2 ± 0.6%, p = 0.001), and MAD (11.4 ± 3.5vs 4.6 ± 2.5 mm, p = 0.003). During PIMAHI treatment, no sustained arrhythmia, pericardial, or pleural effusion occurred. Conclusions PIMAHI in canine HF models was safe and effective. It reversed LV dilation and improved LV function.
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Affiliation(s)
- Hui Ma
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Wenqing Gong
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - D. Scott Lim
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, United States
| | - Jing Li
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Shengjun Ta
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Rui Hu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xiaojuan Li
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Minjuan Zheng
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Liwen Liu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
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Wong N, Fowler D, Lim DS. Mitral valve-in-valve with 4D intracardiac echocardiography: Procedural and imaging technique. Catheter Cardiovasc Interv 2024; 103:234-237. [PMID: 37890002 DOI: 10.1002/ccd.30897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Transcatheter mitral valve-in-valve (ViV) has emerged as a safe and effective therapeutic option for patients with a degenerated mitral bioprosthesis. As procedural techniques mature and operator experience improve, there is a push to adopt a "minimalist" approach of using conscious sedation instead of general anesthesia for faster recovery. The heavy reliance on fluoroscopy for ViV deployment makes feasible the use of intracardiac echocardiography (ICE) instead of transesophageal echocardiography for other procedural imaging requirements. We hereby use a case example to illustrate a step-by-step approach of using four-dimensional ICE to guide transcatheter mitral ViV under conscious sedation.
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Affiliation(s)
- Ningyan Wong
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Dale Fowler
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - D Scott Lim
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
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Kaneko T, Newell PC, Nisivaco S, Yoo SGK, Hirji SA, Hou H, Romano M, Lim DS, Chetcuti S, Shah P, Ailawadi G, Thompson M. Incidence, characteristics, and outcomes of reintervention after mitral transcatheter edge-to-edge repair. J Thorac Cardiovasc Surg 2024; 167:143-154.e6. [PMID: 35570022 DOI: 10.1016/j.jtcvs.2022.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/20/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The use of transcatheter edge-to-edge repair (TEER) is growing substantially, and reintervention after TEER by way of repeat TEER or mitral valve surgery (MVS) is increasing as a result. In this nationally representative study we examined the incidence, characteristics, and outcomes of reintervention after index TEER. METHODS Between July 2013 and November 2017, we reviewed 11,396 patients who underwent index TEER using Medicare beneficiary data. These patients were prospectively tracked and identified as having repeat TEER or MVS. Primary outcomes included 30-day mortality, 30-day readmission, 30-day composite morbidity, and cumulative survival. RESULTS Among 11,396 patients who underwent TEER, 548 patients (4.8%) required reintervention after a median time interval of 4.5 months. Overall 30-day mortality was 8.6%, 30-day readmission was 20.9%, and 30-day composite morbidity was 48.2%. According to reintervention type, 294 (53.7%) patients underwent repeat TEER, and 254 (46.3%) underwent MVS. Patients who underwent MVS were more likely to be younger and female, but had a similar comorbidity burden compared with the repeat TEER cohort. After adjustment, there were no differences in 30-day mortality (adjusted odds ratio [AOR], 1.26 [95% CI, 0.65-2.45]) or 30-day readmission (AOR, 1.14 [95% CI, 0.72-1.81]). MVS was associated with higher 30-day morbidity (AOR, 4.76 [95% CI, 3.17-7.14]) compared with repeat TEER. Requirement for reintervention was an independent risk factor for long-term mortality in a Cox proportional hazard model (hazard ratio, 3.26 [95% CI, 2.53-4.20]). CONCLUSIONS Reintervention after index TEER is a high-risk procedure that carries a significant mortality burden. This highlights the importance of ensuring procedural success for index TEER to avoid the morbidity of reintervention altogether.
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Affiliation(s)
- Tsuyoshi Kaneko
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Paige C Newell
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sarah Nisivaco
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sang Gune K Yoo
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Sameer A Hirji
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Va
| | - Stan Chetcuti
- Department of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital, Boston, Mass
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Michael Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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8
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Garcia S, Elmariah S, Cubeddu RJ, Zahr F, Eleid MF, Kodali SK, Seshiah P, Sharma R, Lim DS. Mitral Transcatheter Edge-to-Edge Repair With the PASCAL Precision System: Device Knobology and Review of Advanced Steering Maneuvers. Struct Heart 2024; 8:100234. [PMID: 38283574 PMCID: PMC10818146 DOI: 10.1016/j.shj.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 10/08/2023] [Indexed: 01/30/2024]
Abstract
In 2022, the Food and Drug Administration approved a second mitral transcatheter edge-to-edge repair device for the treatment of primary mitral regurgitation (PASCAL Precision Transcatheter Valve Repair System, Edwards Lifesciences, Irvine, CA). The PASCAL Precision system consists of a guide sheath, implant system, and accessories. The implant system consists of a steerable catheter, an implant catheter, and the implant (PASCAL or PASCAL Ace). The guide sheath and steerable catheter move and flex independently from each other and are not keyed, allowing for freedom of rotation in three dimensions. This manuscript provides an overview of the PASCAL Precision system and describes the basic and advanced steering maneuvers to facilitate effective and safe mitral transcatheter edge-to-edge repair.
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Affiliation(s)
| | - Sammy Elmariah
- University of California, San Francisco, California, USA
| | | | - Firas Zahr
- Oregon Health Sciences University, Portland, Oregon, USA
| | | | | | - Puvi Seshiah
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | | | - D. Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
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9
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Haregu F, Wong N, McCulloch M, Lim DS. Percutaneous Mitral Valve Repair in Pediatric Patients. Pediatr Cardiol 2023:10.1007/s00246-023-03387-4. [PMID: 38150041 DOI: 10.1007/s00246-023-03387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
Rigorous clinical trials have demonstrated the safety and efficacy of Transcatheter Edge-to-Edge Repair to treat severe secondary mitral regurgitation (MR) in adults with primary cardiomyopathy who have failed guideline-directed medical therapy, as well as those with primary MR at high surgical risk. To date, there are only three case reports describing this procedure in the pediatric population. We report a case series of four pediatric patients, including the youngest and smallest reported, who underwent this procedure.
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Affiliation(s)
- Firezer Haregu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22908-0386, USA.
| | - Ningyan Wong
- Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Michael McCulloch
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22908-0386, USA
| | - D Scott Lim
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22908-0386, USA
- Cardiology, University of Virginia, Charlottesville, VA, USA
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10
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Smith RL, Lim DS, Gillam LD, Zahr F, Chadderdon S, Rassi AN, Makkar R, Goldman S, Rudolph V, Hermiller J, Kipperman RM, Dhoble A, Smalling R, Latib A, Kodali SK, Lazkani M, Choo J, Lurz P, O'Neill WW, Laham R, Rodés-Cabau J, Kar S, Schofer N, Whisenant B, Inglessis-Azuaje I, Baldus S, Kapadia S, Szerlip M, Kliger C, Boone R, Webb JG, Williams MR, von Bardeleben RS, Ruf TF, Guerrero M, Eleid M, McCabe JM, Davidson C, Hiesinger W, Kaneko T, Shah PB, Yadav P, Koulogiannis K, Marcoff L, Hausleiter J. 1-Year Outcomes of Transcatheter Edge-to-Edge Repair in Anatomically Complex Degenerative Mitral Regurgitation Patients. JACC Cardiovasc Interv 2023; 16:2820-2832. [PMID: 37905772 DOI: 10.1016/j.jcin.2023.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Favorable 6-month outcomes from the CLASP IID Registry (Edwards PASCAL transcatheter valve repair system pivotal clinical trial) demonstrated that mitral valve transcatheter edge-to-edge repair with the PASCAL transcatheter valve repair system is safe and beneficial for treating prohibitive surgical risk degenerative mitral regurgitation (DMR) patients with complex mitral valve anatomy. OBJECTIVES The authors sought to assess 1-year safety, echocardiographic and clinical outcomes from the CLASP IID Registry. METHODS Patients with 3+ or 4+ DMR who were at prohibitive surgical risk, had complex mitral valve anatomy based on the MitraClip Instructions for Use, and deemed suitable for treatment with the PASCAL system were enrolled prospectively. Safety, clinical, echocardiographic, functional, and quality-of-life outcomes were assessed at 1 year. Study oversight included a central screening committee, echocardiographic core laboratory, and clinical events committee. RESULTS Ninety-eight patients were enrolled. One-year Kaplan-Meier (KM) estimates of freedom from composite major adverse events, all-cause mortality, and heart failure hospitalization were 83.5%, 89.3%, and 91.5%, respectively. Significant mitral regurgitation (MR) reduction was achieved at 1 year (P < 0.001 vs baseline) including 93.2% at MR ≤2+ and 57.6% at MR ≤1+ with improvements in related echocardiographic measures. NYHA functional class and Kansas City Cardiomyopathy Questionnaire score also improved significantly (P < 0.001 vs baseline). CONCLUSIONS At 1 year, treatment with the PASCAL system demonstrated safety and significant MR reduction, with continued improvement in clinical, echocardiographic, functional, and quality-of-life outcomes, illustrating the value of the PASCAL system in the treatment of prohibitive surgical risk patients with 3+ or 4+ DMR and complex mitral valve anatomy.
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Affiliation(s)
- Robert L Smith
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA.
| | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Abhijeet Dhoble
- Memorial Hermann Heart and Vascular Institute/UT Health, Houston, Texas, USA
| | - Richard Smalling
- Memorial Hermann Heart and Vascular Institute/UT Health, Houston, Texas, USA
| | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Mohamad Lazkani
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | | | | | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | | | | | - Molly Szerlip
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | - Robert Boone
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
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11
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Wong N, Shorofsky M, Lim DS. Catheter-based Interventions in Tetralogy of Fallot Across the Lifespan. CJC Pediatr Congenit Heart Dis 2023; 2:339-351. [PMID: 38161670 PMCID: PMC10755836 DOI: 10.1016/j.cjcpc.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024]
Abstract
Surgical treatment of tetralogy of Fallot (TOF) involves surgical relief of right ventricular outflow tract (RVOT) obstruction and closure of ventricular septal defect. However, some patients may require staged palliation before surgical repair. This traditionally was achieved only with surgery but recently evolved to include catheter-based techniques. RVOT dysfunction occurs inevitably after the surgical repair of TOF and, depending on the surgical approach, manifests as either progressive stenosis, regurgitation, or a combination of both. This predisposes the individual to repeated RVOT interventions with the attendant risks of multiple open-heart surgeries. The advent of transcatheter pulmonary valve replacement has reduced the operative burden, and the expansion of transcatheter pulmonary valve replacement device platforms has widened the type and size of RVOT anatomies that can be treated. This review will discuss the transcatheter therapies available throughout the lifespan of the patient with TOF.
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Affiliation(s)
- Ningyan Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Shorofsky
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - D. Scott Lim
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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12
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Wong N, Lim DS, Yount K, Yarboro L, Ailawadi G, Ragosta M. Preemptive alcohol septal ablation prior to transcatheter mitral valve replacement. Catheter Cardiovasc Interv 2023; 102:1341-1347. [PMID: 37855165 DOI: 10.1002/ccd.30879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Alcohol septal ablation (ASA) has been shown to increase the neo-left ventricular outflow tract (LVOT) area before transcatheter mitral valve replacement (TMVR) but there is little literature on its success and use with dedicated devices. AIMS To describe our experience with preemptive ASA to increase the predicted neo-LVOT area and its utility with both dedicated TMVR devices and balloon-expandable valves. METHODS All patients who underwent ASA for TMVR candidacy in our center between May 2018 and October 2022 and had computed tomography (CT) scans done before and after ASA were included. Each CT was assessed for the minimum predicted neo-LVOT area at end-systole, using a virtual valve of the desired TMVR device for each patient. The primary outcome was an increase in the predicted neo-LVOT area after ASA that was deemed sufficient for safe implantation of the desired TMVR device. The secondary outcome was the absence of acute LVOT obstruction after TMVR. RESULTS A total of 12 patients underwent ASA and all but 1 (n = 11, 91.6%) achieved the primary outcome of having sufficient predicted neo-LVOT area to proceed with TMVR. The mean increase in neo-LVOT area after ASA was 126 ± 64 mm2 (median 119.5, interquartile range: 65.0-163.5 mm2 ). Two patients (16.7%) required a permanent pacemaker after ASA. Nine patients went on and underwent TMVR with their respective devices and none had LVOT obstruction after the procedure. Among the remaining three patients, one had insufficient neo-LVOT clearance after ASA, one had unrelated mortality before TMVR, and one had advanced heart failure before TMVR. CONCLUSION In appropriately selected patients and at centers experienced with ASA, preemptive ASA can achieve sufficient neo-LVOT clearance for TMVR with a variety of devices in approximately 90% of patients.
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Affiliation(s)
- Ningyan Wong
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
- Department of Cardiology, National Heart Centre Singapore, Singapore City, Singapore
| | - D Scott Lim
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Kenan Yount
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Leora Yarboro
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ragosta
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
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13
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Zahr F, Smith RL, Gillam LD, Chadderdon S, Makkar R, von Bardeleben RS, Ruf TF, Kipperman RM, Rassi AN, Szerlip M, Goldman S, Inglessis-Azuaje I, Yadav P, Lurz P, Davidson CJ, Mumtaz M, Gada H, Kar S, Kodali SK, Laham R, Hiesinger W, Fam NP, Keßler M, O'Neill WW, Whisenant B, Kliger C, Kapadia S, Rudolph V, Choo J, Hermiller J, Morse MA, Schofer N, Gafoor S, Latib A, Mahoney P, Kaneko T, Shah PB, Riddick JA, Muhammad KI, Boekstegers P, Price MJ, Praz F, Koulogiannis K, Marcoff L, Hausleiter J, Lim DS. One-Year Outcomes From the CLASP IID Randomized Trial for Degenerative Mitral Regurgitation. JACC Cardiovasc Interv 2023:S1936-8798(23)01358-4. [PMID: 37962288 DOI: 10.1016/j.jcin.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The CLASP IID (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical) trial is the first randomized controlled trial comparing the PASCAL system and the MitraClip system in prohibitive risk patients with significant symptomatic degenerative mitral regurgitation (DMR). OBJECTIVES The study sought to report primary and secondary endpoints and 1-year outcomes for the full cohort of the CLASP IID trial. METHODS Prohibitive-risk patients with 3+/4+ DMR were randomized 2:1 (PASCAL:MitraClip). One-year assessments included secondary effectiveness endpoints (mitral regurgitation [MR] ≤2+ and MR ≤1+), and clinical, echocardiographic, functional, and quality-of-life outcomes. Primary safety (30-day composite major adverse events [MAE]) and effectiveness (6-month MR ≤2+) endpoints were assessed for the full cohort. RESULTS Three hundred patients were randomized (PASCAL: n = 204; MitraClip: n = 96). At 1 year, differences in survival, freedom from heart failure hospitalization, and MAE were nonsignificant (P > 0.05 for all). Noninferiority of the PASCAL system compared with the MitraClip system persisted for the primary endpoints in the full cohort (For PASCAL vs MitraClip, the 30-day MAE rates were 4.6% vs 5.4% with a rate difference of -0.8% and 95% upper confidence bound of 4.6%. The 6-month MR≤2+ rates were 97.9% vs 95.7% with a rate difference of 2.2% and 95% lower confidence bound (LCB) of -2.5%, for, respectively). Noninferiority was met for the secondary effectiveness endpoints at 1 year (MR≤2+ rates for PASCAL vs MitraClip were 95.8% vs 93.8% with a rate difference of 2.1% and 95% LCB of -4.1%. The MR≤1+ rates were 77.1% vs 71.3% with a rate difference of 5.8% and 95% LCB of -5.3%, respectively). Significant improvements in functional classification and quality of life were sustained in both groups (P <0.05 for all vs baseline). CONCLUSIONS The CLASP IID trial full cohort met primary and secondary noninferiority endpoints, and at 1 year, the PASCAL system demonstrated high survival, significant MR reduction, and sustained improvements in functional and quality-of-life outcomes. Results affirm the PASCAL system as a beneficial therapy for prohibitive-surgical-risk patients with significant symptomatic DMR.
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Affiliation(s)
- Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA.
| | - Robert L Smith
- Baylor Scott and White the Heart Hospital Plano, Plano, Texas, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Molly Szerlip
- Baylor Scott and White the Heart Hospital Plano, Plano, Texas, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | - Hemal Gada
- UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | | | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | | | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | | | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | - Paul Mahoney
- Sentara Norfolk General Hospital, Norfolk, Virginia, USA
| | | | - Pinak B Shah
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John A Riddick
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
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14
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Guerrero ME, Grayburn P, Smith RL, Sorajja P, Wang DD, Ahmad Y, Blusztein D, Cavalcante J, Tang GHL, Ailawadi G, Lim DS, Blanke P, Eleid MF, Kaneko T, Thourani VH, Bapat V, Mack MJ, Leon MB, George I. Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement. JACC Cardiovasc Interv 2023; 16:2195-2210. [PMID: 37758378 DOI: 10.1016/j.jcin.2023.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 10/02/2023]
Abstract
Mitral annular calcium (MAC) with severe mitral valvular dysfunction presents a complex problem, as valve replacement, either surgical or transcatheter, is challenging because of anatomy, technical considerations, concomitant comorbidities, and advanced age. The authors review the clinical and anatomical features of MAC that are favorable (green light), challenging (yellow light), or prohibitive (red light) for surgical or transcatheter mitral valve interventions. Under the auspices of the Heart Valve Collaboratory, an expert working group of cardiac surgeons, interventional cardiologists, and interventional imaging cardiologists was formed to develop recommendations regarding treatment options for patients with MAC as well as a proposed grading and staging system using both anatomical and clinical features.
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Affiliation(s)
| | | | | | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Yousif Ahmad
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Blusztein
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - João Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Vinayak Bapat
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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15
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Pio SM, Medvedofsky D, Stassen J, Delgado V, Namazi F, Weissman NJ, Grayburn P, Kar S, Lim DS, Zhou Z, Alu MC, Redfors B, Kapadia S, Lindenfeld J, Abraham WT, Mack MJ, Asch FM, Stone GW, Bax JJ. Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial. J Am Heart Assoc 2023; 12:e029956. [PMID: 37646214 PMCID: PMC10547326 DOI: 10.1161/jaha.122.029956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023]
Abstract
Background Left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information over LV ejection fraction in patients with heart failure (HF) and secondary mitral regurgitation. We examined the prognostic impact of LV GLS improvement in this population. Methods and Results The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial randomized symptomatic patients with HF with severe (3+/4+) mitral regurgitation to transcatheter edge-to-edge repair with the MitraClip device plus maximally tolerated guideline-directed medical therapy (GDMT) versus GDMT alone. LV GLS was measured at baseline and 6-month follow-up. The relationship between the improvement in LV GLS from baseline to 6 months and the composite of all-cause death or HF hospitalization between 6- and 24-month follow-up were assessed. Among 383 patients, 174 (45.4%) had improved LV GLS at 6-month follow-up (83/195 [42.6%] with transcatheter edge-to-edge repair+GDMT and 91/188 [48.4%] with GDMT alone; P=0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (P<0.009), with similar risk reduction in both treatment arms (Pinteraction=0.40). By multivariable analysis, LV GLS improvement at 6 months was independently associated with a lower risk of death or HF hospitalization (hazard ratio [HR], 0.55 [95% CI, 0.36-0.83]; P=0.009), death (HR, 0.48 [95% CI, 0.29-0.81]; P=0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31-0.81]; P=0.005) between 6 and 24 months. Conclusions Among patients with HF and severe mitral regurgitation in the COAPT trial, improvement in LV GLS at 6-month follow-up was associated with improved outcomes after both transcatheter edge-to-edge repair and GDMT alone between 6 and 24 months. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.
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Affiliation(s)
- Stephan M. Pio
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
| | | | - Jan Stassen
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of CardiologyJessa HospitalHasseltBelgium
| | - Victoria Delgado
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Hospital University Germans Trias i PujolBadalonaSpain
| | - Farnaz Namazi
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
| | | | | | - Saibal Kar
- Los Robles Regional Medical CenterThousand OaksCA
- Bakersfield Heart HospitalBakersfieldCA
| | | | | | | | - Björn Redfors
- Cardiovascular Research FoundationNew YorkNY
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
| | | | | | | | | | | | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
- Turku Heart Center, University of Turku and Turku University HospitalTurkuFinland
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16
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Kong J, Zaroff JG, Ambrosy AP, Fitzpatrick JK, Ku IA, Mishell JM, Kotinkaduwa LN, Redfors B, Beohar N, Ailawadi G, Lindenfeld J, Abraham WT, Mack MJ, Kar S, Lim DS, Whisenant BK, Stone GW. Incidence, Predictors, and Outcomes Associated With Worsening Renal Function in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial. J Am Heart Assoc 2023:e029504. [PMID: 37421291 PMCID: PMC10382100 DOI: 10.1161/jaha.123.029504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/12/2023] [Indexed: 07/10/2023]
Abstract
Background The incidence and implications of worsening renal function (WRF) after mitral valve transcatheter edge-to-edge repair (TEER) in patients with heart failure (HF) are unknown. Therefore, the aim of this study was to determine the proportion of patients with HF and secondary mitral regurgitation who develop persistent WRF within 30 days following TEER, and whether this development portends a worse prognosis. Methods and Results In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial, 614 patients with HF and severe secondary mitral regurgitation were randomized to TEER with the MitraClip plus guideline-directed medical therapy (GDMT) versus GDMT alone. WRF was defined as serum creatinine increase ≥1.5× or ≥0.3 mg/dL from baseline persisting to day 30 or requiring renal replacement therapy. All-cause death and HF hospitalization rates between 30 days and 2 years were compared in patients with and without WRF. WRF at 30 days was present in 11.3% of patients (9.7% in the TEER plus GDMT group and 13.1% in the GDMT alone group; P=0.23). WRF was associated with all-cause death (hazard ratio [HR], 1.98 [95% CI, 1.3-3.03]; P=0.001) but not HF hospitalization (HR, 1.47 [ 95% CI, 0.97-2.24]; P=0.07) between 30 days and 2 years. Compared with GDMT alone, TEER reduced both death and HF hospitalization consistently in patients with and without WRF (Pinteraction=0.53 and 0.57, respectively). Conclusions Among patients with HF and severe secondary mitral regurgitation, the incidence of WRF at 30 days was not increased after TEER compared with GDMT alone. WRF was associated with greater 2-year mortality but did not attenuate the treatment benefits of TEER in reducing death and HF hospitalization compared with GDMT alone. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.
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Affiliation(s)
- Jeremy Kong
- Kaiser Permanente Department of Cardiology San Francisco CA USA
| | | | - Andrew P Ambrosy
- Kaiser Permanente Department of Cardiology San Francisco CA USA
- Division of Research Kaiser Permanente Northern California Oakland CA USA
| | | | - Ivy A Ku
- Kaiser Permanente Department of Cardiology San Francisco CA USA
| | - Jacob M Mishell
- Kaiser Permanente Department of Cardiology San Francisco CA USA
| | - Lak N Kotinkaduwa
- Clinical Trials Center Cardiovascular Research Foundation New York City NY USA
| | - Björn Redfors
- Clinical Trials Center Cardiovascular Research Foundation New York City NY USA
- NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY USA
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Nirat Beohar
- Mount Sinai Medical Center Columbia University Division of Cardiology Miami Beach FL USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery University of Michigan Ann Arbor MI USA
| | | | - William T Abraham
- Division of Cardiovascular Medicine The Ohio State University Columbus OH USA
| | | | - Saibal Kar
- Cardiovascular Institute Los Robles Health System Thousand Oaks CA USA
| | - D Scott Lim
- Division of Cardiology University of Virginia Charlottesville VA USA
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai New York NY USA
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17
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Hamid N, Jorde UP, Reisman M, Latib A, Lim DS, Joseph SM, Kurlianskaya A, Polonetsky O, Neuzil P, Reddy V, Foerst J, Gada H, Grubb KJ, Silva G, Kereiakes D, Shreenivas S, Pinney S, Davidavicius G, Sorajja P, Boehmer JP, Kleber FX, Perier P, VAN Mieghem NM, Dumonteil N, Leon MB, Burkhoff D. Transcatheter Left Ventricular Restoration in Patients With Heart Failure. J Card Fail 2023; 29:1046-1055. [PMID: 36958391 DOI: 10.1016/j.cardfail.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Left ventricular (LV) volume reshaping reduces myocardial wall stress and may induce reverse remodeling in patients with heart failure with reduced ejection fraction. The AccuCinch Transcatheter Left Ventricular Restoration system consists of a series of anchors connected by a cable implanted along the LV base that is cinched to the basal free wall radius. We evaluated the echocardiographic and clinical outcomes following transcatheter left ventricular restoration. METHODS AND RESULTS We analyzed 51 heart failure patients with a left ventricular ejection fraction between 20% and 40%, with no more than 2+ mitral regurgitation treated with optimal medical therapy, who subsequently underwent transcatheter left ventricular restoration. Serial echocardiograms, Kansas City Cardiomyopathy Questionnaire scores, and 6-minute walk test distances were measured at baseline through 12 months. Primary analysis end point was change in end-diastolic volume at 12 months compared with baseline. Patients (n = 51) were predominantly male (86%) with a mean age of 56.3 ± 13.1 years. Fluoroscopy showed LV free wall radius decreased by a median of 9.2 mm amounting to a 29.6% decrease in the free wall arc length. At 12 months, the LV end-diastolic volume decreased by 33.6 ± 34.8 mL (P < .01), with comparable decreases in the LV end-systolic volume. These decreases were associated with significant improvements in the overall Kansas City Cardiomyopathy Questionnaire score (16.4 ± 18.7 points; P < .01) and 6-minute hall walk test distance (45.9 ± 83.9 m; P < .01). There were no periprocedural deaths; through the 1-year follow-up, 1 patient died (day 280) and 1 patient received a left ventricular assist device (day 13). CONCLUSIONS In patients with heart failure with reduced ejection fraction without significant mitral regurgitation receiving optimal medical therapy, the AccuCinch System resulted in decreases of LV volume, as well as improved quality of life and exercise endurance. A randomized trial is ongoing (NCT04331769).
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Affiliation(s)
- Nadira Hamid
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Ulrich P Jorde
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | | | - Azeem Latib
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | - D Scott Lim
- University of Virginia, Charlottesville, Virginia
| | - Susan M Joseph
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - Oleg Polonetsky
- Republican Scientific and Practical Center Cardiology, Minsk, Belarus
| | | | - Vivek Reddy
- Icahn School of Medicine Mount Sinai, New York, New York
| | - Jason Foerst
- Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Hemal Gada
- UPMC Heart and Vascular Institute, Pinnacle Health, Harrisburg, Pennsylvania
| | | | | | | | | | - Sean Pinney
- University of Chicago, Division of Cardiology, Chicago, Illinois
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, and Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Franz X Kleber
- Martin Luther Universität Halle-Wittenberg, PGS Wittenberg, Germany
| | - Patrick Perier
- Campus Bad Neustadt, Herzchirurgie, Bad Neustadt/Saale, Germany
| | - Nicolas M VAN Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Martin B Leon
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
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18
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Vincent F, Redfors B, Kotinkaduwa LN, Kar S, Lim DS, Mishell JM, Whisenant BK, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Cerebrovascular Events After Transcatheter Edge-to-Edge Repair and Guideline-Directed Medical Therapy in the COAPT Trial. JACC Cardiovasc Interv 2023; 16:1448-1459. [PMID: 37380226 DOI: 10.1016/j.jcin.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Little is known regarding the risk of cerebrovascular events (CVE) in patients with heart failure and severe secondary mitral regurgitation treated with transcatheter edge-to-edge repair (TEER). OBJECTIVES The study sought to examine the incidence, predictors, timing, and prognostic impact of CVE (stroke or transient ischemic attack) in the COAPT (Cardiovascular Outcomes Assessment of the Mitraclip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. METHODS A total of 614 patients with heart failure and severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) vs GDMT alone. RESULTS At 4-year follow-up, 50 CVEs occurred in 48 (7.8%) of the 614 total patients enrolled in the COAPT trial; Kaplan-Meier event rates were 12.3% in the TEER group and 10.2 in the GDMT alone group (P = 0.91). Within 30 days of randomization, CVE occurred in 2 (0.7%) patients randomized to TEER and 0% randomized to GDMT (P = 0.15). Baseline renal dysfunction and diabetes were independently associated with increased risk of CVE, while baseline anticoagulation was associated with a reduction of CVE. A significant interaction was present between treatment group and anticoagulation such that TEER compared with GDMT alone was associated with a reduced risk of CVE among patients with anticoagulation (adjusted HR: 0.24; 95% CI: 0.08-0.73) compared with an increased risk of CVE in patients without anticoagulation (adjusted HR: 2.27; 95% CI: 1.08-4.81; Pinteraction = 0.001). CVE was an independent predictor of death within 30 days after the event (HR: 14.37; 95% CI: 7.61, 27.14; P < 0.0001). CONCLUSIONS In the COAPT trial, the 4-year rate of CVE was similar after TEER or GDMT alone. CVE was strongly associated with mortality. Whether anticoagulation is effective at reducing CVE risk after TEER warrants further study. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT); NCT01626079).
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Affiliation(s)
- Flavien Vincent
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Regional Hospital ISSSTE Puebla, Puebla, Mexico
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob M Mishell
- Kaiser Permanente San Francisco Hospital, San Francisco, California, USA
| | | | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio, USA; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA; Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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19
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Stone GW, Abraham WT, Lindenfeld J, Kar S, Grayburn PA, Lim DS, Mishell JM, Whisenant B, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Asch FM, Mack MJ. Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation. N Engl J Med 2023; 388:2037-2048. [PMID: 36876756 DOI: 10.1056/nejmoa2300213] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Data from a 5-year follow-up of outcomes after transcatheter edge-to-edge repair of severe mitral regurgitation, as compared with outcomes after maximal doses of guideline-directed medical therapy alone, in patients with heart failure are now available. METHODS We randomly assigned patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy to undergo transcatheter edge-to-edge repair plus receive medical therapy (device group) or to receive medical therapy alone (control group) at 78 sites in the United States and Canada. The primary effectiveness end point was all hospitalizations for heart failure through 2 years of follow-up. The annualized rate of all hospitalizations for heart failure, all-cause mortality, the risk of death or hospitalization for heart failure, and safety, among other outcomes, were assessed through 5 years. RESULTS Of the 614 patients enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of hospitalization for heart failure through 5 years was 33.1% per year in the device group and 57.2% per year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.41 to 0.68). All-cause mortality through 5 years was 57.3% in the device group and 67.2% in the control group (hazard ratio, 0.72; 95% CI, 0.58 to 0.89). Death or hospitalization for heart failure within 5 years occurred in 73.6% of the patients in the device group and in 91.5% of those in the control group (hazard ratio, 0.53; 95% CI, 0.44 to 0.64). Device-specific safety events within 5 years occurred in 4 of 293 treated patients (1.4%), with all the events occurring within 30 days after the procedure. CONCLUSIONS Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite guideline-directed medical therapy, transcatheter edge-to-edge repair of the mitral valve was safe and led to a lower rate of hospitalization for heart failure and lower all-cause mortality through 5 years of follow-up than medical therapy alone. (Funded by Abbott; COAPT ClinicalTrials.gov number, NCT01626079.).
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Affiliation(s)
- Gregg W Stone
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - William T Abraham
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - JoAnn Lindenfeld
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Saibal Kar
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Paul A Grayburn
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - D Scott Lim
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Jacob M Mishell
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Brian Whisenant
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Michael Rinaldi
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Samir R Kapadia
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Vivek Rajagopal
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Ian J Sarembock
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Andreas Brieke
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Steven O Marx
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - David J Cohen
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Federico M Asch
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
| | - Michael J Mack
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai (G.W.S.), Columbia University Medical Center (S.O.M.), and the Cardiovascular Research Foundation (D.J.C.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; the Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus (W.T.A.), the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland (S.R.K.), and Lindner Clinical Research Center and the Christ Hospital, Cincinnati (I.J.S.); Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville (J.A.L.); the Division of Cardiology, HCA Healthcare, Los Angeles (S.K.), and Kaiser Permanente-San Francisco Hospital, San Francisco (J.M.M.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas (P.A.G.), and Baylor Scott and White Heart Hospital Plano, Plano (M.J.M.) - both in Texas; the Division of Cardiology, University of Virginia, Charlottesville (D.S.L.); Intermountain Medical Center, Murray, UT (B.W.); Carolinas Medical Center, Charlotte, NC (M.R.); Piedmont Hospital, Atlanta (V.R.); University of Colorado Hospital, Aurora (A.B.); and MedStar Health Research Institute, Hyattsville, MD (F.M.A.)
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20
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Scotti A, Coisne A, Granada JF, Driggin E, Madhavan MV, Zhou Z, Redfors B, Kar S, Lim DS, Cohen DJ, Lindenfeld J, Abraham WT, Mack MJ, Asch FM, Stone GW. Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial. J Am Coll Cardiol 2023:S0735-1097(23)05584-5. [PMID: 37306651 DOI: 10.1016/j.jacc.2023.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/06/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although malnutrition is associated with poor prognosis in several diseases, its prognostic impact in patients with heart failure (HF) and secondary mitral regurgitation (SMR) is not understood. OBJECTIVES The purpose of this study was to assess the prevalence and impact of malnutrition in HF patients with severe SMR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip plus guideline-directed medical therapy (GDMT) vs GDMT alone in the COAPT trial. METHODS Baseline malnutrition risk was calculated using the validated geriatric nutritional risk index (GNRI) score. Patients were categorized as having "malnutrition" (GNRI ≤98) vs "no malnutrition" (GNRI >98). Outcomes were assessed through 4 years. The primary endpoint of interest was all-cause mortality. RESULTS Among 552 patients, median baseline GNRI was 109 (IQR: 101-116); 94 (17.0%) had malnutrition. All-cause mortality at 4 years was greater in patients with vs those without malnutrition (68.3% vs 52.8%; P = 0.001). Using multivariable analysis, both baseline malnutrition (adjusted-HR [adj-HR]: 1.37; 95% CI: 1.03-1.82; P = 0.03) and randomization to TEER plus GDMT compared with GDMT alone (adj-HR: 0.65; 95% CI: 0.51-0.82; P = 0.0003) were independent predictors of 4-year mortality. In contrast, GNRI was unrelated to the 4-year rate of heart failure hospitalization (HFH), although TEER treatment reduced HFH (adj-HR: 0.46; 95% CI: 0.36-0.56). The reductions in death (adj-Pinteraction = 0.46) and HFH (adj-Pinteraction = 0.67) with TEER were consistent in patients with and without malnutrition. CONCLUSIONS Malnutrition was present in 1 of 6 patients with HF and severe SMR enrolled in COAPT and was independently associated with increased 4-year mortality (but not HFH). TEER reduced mortality and HFH in patients with and without malnutrition. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT]; NCT01626079).
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Affiliation(s)
- Andrea Scotti
- Cardiovascular Research Foundation, New York, New York, USA; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, New York, USA; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Juan F Granada
- Cardiovascular Research Foundation, New York, New York, USA
| | - Elissa Driggin
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mahesh V Madhavan
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, New York, USA
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgerenska University Hospital, Gothenburg, Sweden
| | - Saibal Kar
- Los Robles Regional, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Saint Francis Hospital, Roslyn, New York, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Federico M Asch
- MedStar Health Research Institute, Georgetown University, Washington, DC, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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21
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Ludwig S, Conradi L, Cohen DJ, Coisne A, Scotti A, Abraham WT, Ben Ali W, Zhou Z, Li Y, Kar S, Duncan A, Lim DS, Adamo M, Redfors B, Muller DWM, Webb JG, Petronio AS, Ruge H, Nickenig G, Sondergaard L, Adam M, Regazzoli D, Garatti A, Schmidt T, Andreas M, Dahle G, Walther T, Kempfert J, Tang GH, Redwood SR, Taramasso M, Praz F, Fam NP, Dumonteil N, Obadia JF, von Bardeleben RS, Rudolph TK, Reardon MJ, Metra M, Denti P, Mack MJ, Hausleiter J, Asch FM, Latib A, Lindenfeld J, Modine T, Stone GW, Granada JF. Transcatheter Mitral Valve Replacement versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison. Circ Cardiovasc Interv 2023. [PMID: 37194288 DOI: 10.1161/circinterventions.123.013045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone. Methods: The CHOICE-MI registry included patients with MR undergoing TMVR using dedicated devices. Patients with MR etiologies other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial. We compared outcomes between the TMVR and GDMT groups, using propensity score (PS)-matching to adjust for baseline differences. Results: After PS-matching, 97 patient pairs undergoing TMVR (72.9±8.7 years, 60.8% male, transapical access 91.8%) versus GDMT (73.1±11.0 years, 59.8% male) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared to 6.9% and 7.7%, respectively, in those receiving GDMT alone (both p<0.001). The 2-year rate of HF hospitalization was significantly lower in the TMVR group (32.8% vs. 54.4%, HR 0.59, 95% CI 0.35-0.99; p=0.04). Among survivors, a higher proportion of patients were in NYHA functional class I or II in the TMVR group at 1 year (78.2% vs. 59.7%, p=0.03) and at 2 years (77.8% vs. 53.2%, p=0.09). Two-year mortality was similar in the two groups (TMVR vs. GDMT, 36.8% vs. 40.8%, HR 1.01, 95% CI 0.62-1.64; p=0.98). Conclusions: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for HF and similar mortality compared with GDMT.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK): Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany; Cardiovascular Research Foundation, New York, NY
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY; St. Francis Hospital, Roslyn, NY
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
| | - Andrea Scotti
- Cardiovascular Research Foundation, New York, NY; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montréal, Canada
| | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, NY
| | - Yanru Li
- Cardiovascular Research Foundation, New York, NY
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA; Bakersfield Heart Hospital, Bakersfield, CA
| | | | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, VA
| | - 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
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden and Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - David W M Muller
- Cardiology Dept, St. Vincent's Hospital, Sydney, Australia and School of Clinical Medicine, UNSW Medicine and Health UNSW Sydney, NSW 2052, Australia
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Hendrik Ruge
- German Heart Center Munich, Department of Cardiovascular Surgery, Munich, Germany; INSURE Institute for Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Center Munich, Germany
| | | | | | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gry Dahle
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | - Gilbert Hl Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY
| | | | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | | | - Tanja Katharina Rudolph
- Department of Interventional and General Cardiology, Heart- and Diabetes Center Nordrhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany
| | | | - 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
| | | | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN
| | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Spargias K, Lim DS, Makkar R, Kar S, Kipperman RM, O Neill WW, Ng MKC, Smith RL, Fam NP, Rinaldi MJ, Raffel CO, Walters DL, Levisay J, Montorfano M, Latib A, Carroll JD, Nickenig G, Windecker S, Marcoff L, Cohen GN, Schäfer U, Webb JG, Szerlip M. Three-year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study. Catheter Cardiovasc Interv 2023. [PMID: 37178388 DOI: 10.1002/ccd.30686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/27/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair (M-TEER) is an effective option for treatment of mitral regurgitation (MR). We previously reported favorable 2-year outcomes for the PASCAL transcatheter valve repair system. OBJECTIVES We report 3-year outcomes from the multinational, prospective, single-arm CLASP study with analysis by functional MR (FMR) and degenerative MR (DMR). METHODS Patients with core-lab determined MR ≥ 3+ were deemed candidates for M-TEER by the local heart team. Major adverse events were assessed by an independent clinical events committee to 1 year and by sites thereafter. Echocardiographic outcomes were evaluated by the core laboratory to 3 years. RESULTS The study enrolled 124 patients, 69% FMR; 31% DMR (60% NYHA class III-IVa, 100% MR ≥ 3+). The 3-year Kaplan-Meier estimate for survival was 75% (66% FMR; 92% DMR) and freedom from heart failure hospitalization (HFH) was 73% (64% FMR; 91% DMR), with 85% reduction in annualized HFH rate (81% FMR; 96% DMR) (p < 0.001). MR ≤ 2+ was achieved and maintained in 93% of patients (93% FMR; 94% DMR) and MR ≤ 1+ in 70% of patients (71% FMR; 67% DMR) (p < 0.001). The mean left ventricular end-diastolic volume (181 mL at baseline) decreased progressively by 28 mL [p < 0.001]. NYHA class I/II was achieved in 89% of patients (p < 0.001). CONCLUSIONS The 3-year results from the CLASP study demonstrated favorable and durable outcomes with the PASCAL transcatheter valve repair system in patients with clinically significant MR. These results add to the growing body of evidence establishing the PASCAL system as a valuable therapy for patients with significant symptomatic MR.
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Affiliation(s)
| | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | - Martin K C Ng
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Robert L Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Justin Levisay
- Evanston Hospital, NorthShore University Health System, Evanston, Illinois, USA
| | - Matteo Montorfano
- Interventional Cardiology Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Gideon N Cohen
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ulrich Schäfer
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen, Bonn, Germany
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Molly Szerlip
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
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23
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Kodali SK, Hahn RT, Davidson CJ, Narang A, Greenbaum A, Gleason P, Kapadia S, Miyasaka R, Zahr F, Chadderdon S, Smith RL, Grayburn P, Kipperman RM, Marcoff L, Whisenant B, Gonzales M, Makkar R, Makar M, O'Neill W, Wang DD, Gray WA, Abramson S, Hermiller J, Mitchel L, Lim DS, Fowler D, Williams M, Pislaru SV, Dahou A, Mack MJ, Leon MB, Eleid MF. 1-Year Outcomes of Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol 2023; 81:1766-1776. [PMID: 37137586 DOI: 10.1016/j.jacc.2023.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Surgical management of isolated tricuspid regurgitation (TR) is associated with high morbidity and mortality, thereby creating a significant need for a lower-risk transcatheter solution. OBJECTIVES The single-arm, multicenter, prospective CLASP TR (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study) evaluated 1-year outcomes of the PASCAL transcatheter valve repair system (Edwards Lifesciences) to treat TR. METHODS Study inclusion required a previous diagnosis of severe or greater TR and persistent symptoms despite medical treatment. An independent core laboratory evaluated echocardiographic results, and a clinical events committee adjudicated major adverse events. The study evaluated primary safety and performance outcomes, with echocardiographic, clinical, and functional endpoints. Study investigators report 1-year all-cause mortality and heart failure hospitalization rates. RESULTS Sixty-five patients were enrolled: mean age of 77.4 years; 55.4% female; and 97.0% with severe to torrential TR. At 30 days, cardiovascular mortality was 3.1%, the stroke rate was 1.5%, and no device-related reinterventions were reported. Between 30 days and 1 year, there were an additional 3 cardiovascular deaths (4.8%), 2 strokes (3.2%), and 1 unplanned or emergency reintervention (1.6%). One-year postprocedure, TR severity significantly reduced (P < 0.001), with 31 of 36 (86.0%) patients achieving moderate or less TR; 100% had at least 1 TR grade reduction. Freedom from all-cause mortality and heart failure hospitalization by Kaplan-Meier analyses were 87.9% and 78.5%, respectively. Their New York Heart Association functional class significantly improved (P < 0.001) with 92% in class I or II, 6-minute walk distance increased by 94 m (P = 0.014), and overall Kansas City Cardiomyopathy Questionnaire scores improved by 18 points (P < 0.001). CONCLUSIONS The PASCAL system demonstrated low complication and high survival rates, with significant and sustained improvements in TR, functional status, and quality of life at 1 year. (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study [CLASP TR EFS]; NCT03745313).
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Affiliation(s)
- Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | - Firas Zahr
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Scott Chadderdon
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Robert L Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Leo Marcoff
- Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Lucas Mitchel
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
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Cox ZL, Zalawadiya SK, Simonato M, Redfors B, Zhou Z, Kotinkaduwa L, Zile MR, Udelson JE, Lim DS, Grayburn PA, Mack MJ, Abraham WT, Stone GW, Lindenfeld J. Guideline-Directed Medical Therapy Tolerability in Patients With Heart Failure and Mitral Regurgitation: The COAPT Trial. JACC Heart Fail 2023:S2213-1779(23)00139-7. [PMID: 37115135 DOI: 10.1016/j.jchf.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial, a central committee of heart failure (HF) specialists optimized guideline-directed medical therapies (GDMT) and documented medication and goal dose intolerances before patient enrollment. OBJECTIVES The authors sought to assess the rates, reasons, and predictors of GDMT intolerance in the COAPT trial. METHODS Baseline use, dose, and intolerances of angiotensin-converting enzyme inhibitors (ACEIs) angiotensin II receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) were analyzed in patients with left ventricular ejection fraction (LVEF) ≤40%, in whom maximally tolerated doses of these agents as assessed by an independent HF specialist were required before enrollment. RESULTS A total of 464 patients had LVEF ≤40% and complete medication information. At baseline, 38.8%, 39.4%, and 19.8% of patients tolerated 3, 2, and 1 GDMT classes, respectively (any dose); only 1.9% could not tolerate any GDMT. Beta-blockers were the most frequently tolerated GDMT (93.1%), followed by ACEIs/ARBs/ARNIs (68.5%), and then MRAs (55.0%). Intolerances differed by GDMT class, but hypotension and kidney dysfunction were most common. Goal doses were uncommonly achieved for beta-blockers (32.3%) and ACEIs/ARBs/ARNIs (10.2%) due to intolerances limiting titration. Only 2.2% of patients tolerated goal doses of all 3 GDMT classes. CONCLUSIONS In a contemporary trial population with HF, severe mitral regurgitation, and systematic HF specialist-directed GDMT optimization, most patients had medical intolerances prohibiting 1 or more GDMT classes and achieving goal doses. The specific intolerances noted and methods used for GDMT optimization provide important lessons for the implementation of GDMT optimization in future clinical trials. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] [COAPT]; NCT01626079).
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Affiliation(s)
- Zachary L Cox
- Lipscomb University College of Pharmacy, Nashville, Tennessee, USA; Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Sandip K Zalawadiya
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matheus Simonato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Bjorn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Lak Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Michael R Zile
- Medical University of South Carolina, RJH Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - James E Udelson
- Division of Cardiology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Michael J Mack
- Department of Cardiovascular Surgery, Baylor Scott and White Health, Plano, Texas, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - JoAnn Lindenfeld
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lim DS, Kim D, Aboulhosn J, Levi D, Fleming G, Hainstock M, Sommer R, Torres AJ, Zhao Y, Shirali G, Babaliaros V. Congenital Pulmonic Valve Dysfunction Treated With SAPIEN 3 Transcatheter Heart Valve (from the COMPASSION S3 Trial). Am J Cardiol 2023; 190:102-109. [PMID: 36608435 DOI: 10.1016/j.amjcard.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/11/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
Significant pulmonary regurgitation (PR) and pulmonary stenosis are common after surgical repair of some congenital heart defects. This prospective, single-arm, multicenter trial enrolled patients who underwent transcatheter heart valve (THV) implantation with a SAPIEN 3 valve to treat dysfunctional right ventricular outflow tract (RVOT) conduits or pulmonic surgical valves (≥ moderate PR and/or mean RVOT gradient ≥35 mm Hg). The primary end point was a nonhierarchical composite of THV dysfunction at 1 year comprising RVOT reintervention, ≥ moderate total PR, and mean RVOT gradient >40 mm Hg. A performance goal of <25% of upper confidence interval (CI) was prespecified for the primary end point, using a 95% exact binomial CI. Patients (n = 58) were enrolled between July 5, 2016 and July 17, 2018, with mean age of 32 years. Prestenting was performed in 53.4%. At discharge, the device success was 98.1% (single valve without explant, < moderate PR, gradient <35 mm Hg). At 30 days, there were no major adjudicated adverse clinical events. At 1 year, the primary end point composite was 4.3% (95% CI 0.5 to 14.5). The composite components were 0% (0 of 56) RVOT reintervention, 2.1% (1 of 47) ≥ moderate PR, and 2.1% (1 of 48) mean RVOT gradient >40 mm Hg. No mortality, endocarditis, thrombosis, or stent fracture were reported at 1 year. In conclusion, the SAPIEN 3 THV was safe and effective in patients with dysfunctional RVOT conduits or previously implanted valves in the pulmonic position to 1 year. Clinical trial registration: NCT02744677; https://clinicaltrials.gov/ct2/show/NCT02744677.
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Affiliation(s)
- D Scott Lim
- Departments of Medicine & Pediatrics, University of Virginia, Charlottesville, Virginia.
| | - Dennis Kim
- Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jamil Aboulhosn
- Department of Pediatrics, University of California, Los Angeles, California
| | - Daniel Levi
- Department of Pediatrics, University of California, Los Angeles, California
| | - Greg Fleming
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Michael Hainstock
- Departments of Medicine & Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Robert Sommer
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Alejandro J Torres
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Yanglu Zhao
- Department of Biostatistics, Edwards Lifesciences, Irvine, California
| | - Girish Shirali
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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Shahim B, Cohen DJ, Ben-Yehuda O, Redfors B, Kar S, Lim DS, Arnold SV, Li Y, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Impact of Peripheral Artery Disease in Patients With Heart Failure Undergoing Transcatheter Mitral Valve Repair: The COAPT Trial. J Am Heart Assoc 2023; 12:e028444. [PMID: 36752227 PMCID: PMC10111500 DOI: 10.1161/jaha.122.028444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background Peripheral artery disease (PAD) and heart failure (HF) often coexist. Whether PAD influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF and severe secondary mitral regurgitation is unknown. The objectives are to assess the impact of PAD on outcomes of TMVr plus guideline-directed medical therapy (GDMT) versus GDMT alone in patients with HF and secondary mitral regurgitation. Methods and Results The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) randomized patients with HF with ≥moderate-to-severe secondary mitral regurgitation to TMVr with MitraClip implant plus GDMT versus GDMT alone. We evaluated the relationship between PAD and 2-year outcomes in the COAPT trial and examined whether PAD modified the benefits of TMVr. Among 614 patients enrolled, 109 (17.8%) had PAD. By multivariable analysis, PAD was independently associated with 2-year mortality (adjusted hazard ratio [adjHR], 1.51 [95% CI, 1.07-2.15]) but not HF hospitalizations. Compared with GDMT alone, TMVr reduced the 2-year risk of death in patients without PAD (adjHR, 0.42 [95% CI, 0.30-0.60]) but not those with PAD (adjHR, 1.27 [95% CI, 0.72-2.27]; Pinteraction=0.001). In contrast, TMVr reduced HF hospitalizations consistently in patients with (adjHR, 0.65 [95% CI, 0.35-1.23]) and without (adjHR, 0.42 [95% CI, 0.31-0.57]) PAD (Pinteraction=0.22). Improvements in health status and exercise capacity at 2 years with TMVr compared with GDMT alone were similar in degree, irrespective of PAD status (Pinteraction=0.76 and 0.64, respectively). Conclusions In patients with HF and severe secondary mitral regurgitation, the reduced mortality with TMVr in the overall COAPT study population was not observed in the subgroup of patients with PAD. However, TMVr reduced HF hospitalizations and improved health status and exercise capacity consistently in patients with and without PAD. Registration Clinical Trial Name: Cardiovascular Outocmes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (The COAPT Trial); URL: https://www.clinicaltrials.gov/; Unique identifier: NCT01626079. https://clinicaltrials.gov/ct2/show/NCT01626079.
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Affiliation(s)
- Bahira Shahim
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,Division of Cardiology, Department of Medicine Solna Karolinska Institutet, Karolinska University Hospital Stockholm Sweden
| | - David J Cohen
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,St. Francis Hospital Roslyn NY
| | - Ori Ben-Yehuda
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,New York-Presbyterian Hospital/Columbia University Irving Medical Center NY New York.,Division of Cardiology University of California - San Diego San Diego CA
| | - Björn Redfors
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,New York-Presbyterian Hospital/Columbia University Irving Medical Center NY New York.,Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Saibal Kar
- Los Robles Regional Medical Center Thousand Oaks CA.,Bakersfield Heart Hospital Bakersfield CA
| | - D Scott Lim
- Division of Cardiology University of Virginia Charlottesville VA
| | - Suzanne V Arnold
- University of Missouri-Kansas City School of Medicine Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Yanru Li
- Clinical Trials Center Cardiovascular Research Foundation New York NY
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section Vanderbilt Heart and Vascular Institute Nashville TN
| | - William T Abraham
- Division of Cardiovascular Medicine The Ohio State University Columbus OH
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
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Hausleiter J, Lim DS, Gillam LD, Zahr F, Chadderdon S, Rassi AN, Makkar R, Goldman S, Rudolph V, Hermiller J, Kipperman RM, Dhoble A, Smalling R, Latib A, Kodali SK, Lazkani M, Choo J, Lurz P, O'Neill WW, Laham R, Rodés-Cabau J, Kar S, Schofer N, Whisenant B, Inglessis-Azuaje I, Baldus S, Kapadia S, Koulogiannis K, Marcoff L, Smith RL. Transcatheter Edge-to-Edge Repair in Patients With Anatomically Complex Degenerative Mitral Regurgitation. J Am Coll Cardiol 2023; 81:431-442. [PMID: 36725171 DOI: 10.1016/j.jacc.2022.11.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair is safe and effective in treating degenerative mitral regurgitation (DMR) patients at prohibitive surgical risk, but outcomes in complex mitral valve anatomy patients vary. OBJECTIVES The PASCAL IID registry assessed safety, echocardiographic, and clinical outcomes with the PASCAL system in prohibitive risk patients with significant symptomatic DMR and complex mitral valve anatomy. METHODS Patients in the prospective, multicenter, single-arm registry had 3+ or 4+ DMR, were at prohibitive surgical risk, presented with complex anatomic features based on the MitraClip instructions for use, and were deemed suitable for the PASCAL system by a central screening committee. Enrolled patients were treated with the PASCAL system. Safety, effectiveness, and functional and quality-of-life outcomes were assessed. Study oversight also included an echocardiographic core laboratory and clinical events committee. RESULTS The study enrolled 98 patients (37.2% ≥2 independent significant jets, 15.0% severe bileaflet/multi scallop prolapse, 13.3% mitral valve orifice area <4.0 cm2, and 10.6% large flail gap and/or large flail width). The implant success rate was 92.9%. The 30-day composite major adverse event rate was 11.2%. At 6 months, 92.4% patients achieved MR ≤2+ and 56.1% achieved MR ≤1+ (P < 0.001 vs baseline). The Kaplan-Meier estimates for survival, freedom from major adverse events, and heart failure hospitalization at 6 months were 93.7%, 85.6%, and 92.6%, respectively. Patients experienced significant symptomatic improvement compared with baseline (P < 0.001). CONCLUSIONS The outcomes of the PASCAL IID registry establish the PASCAL system as a useful therapy for prohibitive surgical risk DMR patients with complex mitral valve anatomy. (PASCAL IID Registry within the Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID] NCT03706833).
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Affiliation(s)
| | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Abhijeet Dhoble
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Richard Smalling
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Mohamad Lazkani
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | | | | | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | | | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert L Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
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28
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Lim DS, Smith RL, Gillam LD, Zahr F, Chadderdon S, Makkar R, von Bardeleben RS, Kipperman RM, Rassi AN, Szerlip M, Goldman S, Inglessis-Azuaje I, Yadav P, Lurz P, Davidson CJ, Mumtaz M, Gada H, Kar S, Kodali SK, Laham R, Hiesinger W, Fam NP, Keßler M, O'Neill WW, Whisenant B, Kliger C, Kapadia S, Rudolph V, Choo J, Hermiller J, Morse MA, Schofer N, Gafoor S, Latib A, Koulogiannis K, Marcoff L, Hausleiter J. Randomized Comparison of Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC Cardiovasc Interv 2022; 15:2523-2536. [PMID: 36121247 DOI: 10.1016/j.jcin.2022.09.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe symptomatic degenerative mitral regurgitation (DMR) has a poor prognosis in the absence of treatment, and new transcatheter options are emerging. OBJECTIVES The CLASP IID (Edwards PASCAL Transcatheter Valve Repair System Pivotal Clinical Trial) randomized trial (NCT03706833) is the first to evaluate the safety and effectiveness of the PASCAL system compared with the MitraClip system in patients with significant symptomatic DMR. This report presents the primary safety and effectiveness endpoints for the trial. METHODS Patients with 3+ or 4+ DMR at prohibitive surgical risk were assessed by a central screening committee and randomized 2:1 (PASCAL:MitraClip). Study oversight also included an echocardiography core laboratory and a clinical events committee. The primary safety endpoint was the composite major adverse event rate at 30 days. The primary effectiveness endpoint was the proportion of patients with mitral regurgitation (MR) ≤2+ at 6 months. RESULTS A prespecified interim analysis in 180 patients demonstrated noninferiority of the PASCAL system vs the MitraClip system for the primary safety and effectiveness endpoints of major adverse event rate (3.4% vs 4.8%) and MR ≤2+ (96.5% vs 96.8%), respectively. Functional and quality-of-life outcomes significantly improved in both groups (P < 0.05). The proportion of patients with MR ≤1+ was durable in the PASCAL group from discharge to 6 months (PASCAL, 87.2% and 83.7% [P = 0.317 vs discharge]; MitraClip, 88.5% and 71.2% [P = 0.003 vs discharge]). CONCLUSIONS The CLASP IID trial demonstrated safety and effectiveness of the PASCAL system and met noninferiority endpoints, expanding transcatheter treatment options for prohibitive surgical risk patients with significant symptomatic DMR.
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Affiliation(s)
- D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA.
| | - Robert L Smith
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Molly Szerlip
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | - Hemal Gada
- UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | | | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | | | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | | | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
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Giustino G, Camaj A, Kapadia SR, Kar S, Abraham WT, Lindenfeld J, Lim DS, Grayburn PA, Cohen DJ, Redfors B, Zhou Z, Pocock SJ, Asch FM, Mack MJ, Stone GW. Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure. J Am Coll Cardiol 2022; 80:1857-1868. [DOI: 10.1016/j.jacc.2022.08.803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022]
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Kim JH, Franchin L, Hong SJ, Cha JJ, Lim S, Joo HJ, Park JH, Yu CW, Ahn TH, Lim DS, Dascenzo F. The long-term cardiac events after coronary bifurcation stenting with second-generation drug-eluting stents in elderly patients are comparable to those of younger patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Elderly patients undergoing percutaneous coronary intervention (PCI) generally have a high risk of adverse clinical outcomes. We investigated the long-term clinical impact of PCI on coronary bifurcation disease in elderly patients in Korea and Italy.
Methods
From the BIFURCAT (comBined Insights from the Unified RAIN and COBIS bifurcAtion regisTries) data, we evaluated 5,537 patients who underwent PCI for coronary bifurcation disease. The primary outcome was major adverse cardiac events (MACEs), defined as the composite of target vessel myocardial infarction, target lesion revascularisation, and stent thrombosis. Kaplan–Meier estimates and Cox proportional hazard models were used to compare elderly patients (aged ≥75 years) and younger patients (aged <75 years).
Results
A total of 1,415 patients (26%) were aged ≥75 years. Elderly patients were more frequently female, had higher rates of hypertension and chronic kidney disease (CKD), and presented more frequently with left main (LM) disease. After a median follow-up of 2.1 years, MACEs were comparable between elderly and younger patients. In multivariable analysis, old age was not an independent predictor of MACEs (p=0.977). In elderly patients, CKD and LM disease were independent predictors of MACEs, whereas in younger patients, hypertension, diabetes, CKD, reduced left ventricular ejection fraction, LM disease, and two-stent strategy usage were independent predictors.
Conclusions
Elderly patients who underwent coronary bifurcation PCI with second-generation drug-eluting stents demonstrated similar clinical outcomes to those of younger patients. Both CKD and LM disease were independent predictors of MACEs, regardless of age after coronary bifurcation PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J H Kim
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - L Franchin
- University of Turin, Cardiovascular and Thoracic , Turin , Italy
| | - S J Hong
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - J J Cha
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - S Lim
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - H J Joo
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - J H Park
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - T H Ahn
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - D S Lim
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - F Dascenzo
- University of Turin, Cardiovascular and Thoracic , Turin , Italy
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Lim S, Yu CW, Kim JH, Cha JJ, Kook HD, Joo HJ, Park JH, Choi CU, Hong SJ, Lim DS. The differential effects of antihypertensive drugs on central blood pressure: nebivolol versus telmisartan (ATD-CBP). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Central blood pressure and central pulse pressure have a better correlation with the risk of cardiovascular disease compared to those of peripheral measurement. In a previous study, a second-generation beta-blocker showed poor CBP-lowering effects. However, the effect on CBP by third-generation beta-blockers is not fully elucidated. Thus, this randomised study investigated whether nebivolol-based hypertension treatment may confer advantages over telmisartan, an angiotensin II receptor-blocker, in reducing CBP.
Methods
This was a prospective, randomised, multicentre, open-label, controlled trial that evaluated 98 hypertensive patients. Patients received either nebivolol- (N=49) or telmisartan-based (N=49) treatment for hypertension for 12 weeks with a target BP of ≤140/80. The primary outcome was the difference in change from baseline central systolic BP (cSBP) after 12 weeks.
Results
There were no significant differences between the two groups in baseline central and peripheral SBP. The mean change in cSBP from baseline (ΔcSBP) was −17.2±3 mmHg for nebivolol group (P<0.001) and −29.9±3 mmHg for telmisartan group (P<0.001). The difference in ΔcSBP between the two groups was significant (12.7mmHg, 95% confidence interval [CI], 4.13 to 21.2; P=0.004). Peripheral SBP (pSBP) decreased less in nebivolol group compared to telmisartan group (−18.0±3 in nebivolol group vs. −26.3±3 in telmisartan group, P=0.032). After adjusting for reduction in pSBP, reduction in cSBP was higher in telmisartan group compared to nebivolol group, as shown by the ratio of changes in cSBP and pSBP (ΔcSBP/ΔpSBP; 0.67 for nebivolol group vs. 1.11 for telmisartan group, P=0.080), albeit without statistical significance.
Conclusions
Nebivolol-based hypertension treatment may have less potent CBP-lowering effects compared to telmisartan. However, larger-scale studies are warranted to further elaborate our findings.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Lim
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - J H Kim
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - J J Cha
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - H D Kook
- Hanyang university medical center , Seoul , Korea (Republic of)
| | - H J Joo
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - J H Park
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - C U Choi
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - S J Hong
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - D S Lim
- Korea University Anam Hospital , Seoul , Korea (Republic of)
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Bae SA, Cha JJ, Kim SW, Lim S, Kim JH, Joo HJ, Park JH, Park SM, Hong SJ, Yu CW, Lim DS, Jeong MH, Ahn TH. Effect of an early invasive strategy based on time of symptom onset in patients with non-ST elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A limitation of the current guidelines of the timing of invasive coronary angiography (ICA) for patients with non-ST-segment elevation (NSTE) acute coronary syndrome is based on randomization time. So far, no study has reported the clinical outcomes of invasive strategy timing based on the time of symptom onset. Herein, we aimed to investigate the effect of invasive strategy timing from the time of symptom onset on the 3-year clinical outcomes of patients with NSTE myocardial infarction (MI).
Methods and results
Among 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health, we evaluated 5,856 patients with NSTEMI. The patients were categorized according to symptom-to-catheter (StC) time (<48 h and ≥48 h). The primary outcome was 3-year all-cause mortality, and the secondary outcome was a 3-year composite of all-cause mortality, recurrent MI, and hospitalization for heart failure. Overall, 3,919 (66.9%) patients were classified into the StC time <48 h group. This group had lower all-cause mortality than the StC time ≥48 h group (7.3% vs. 13.4%, p<0.001). The continuous association of StC time and risk of primary and secondary endpoints showed shorter StC time (reference: 48 h), and lower adjusted hazard ratio reduction was observed. In multivariable analysis, independent predictors of delayed ICA were older age, non-specific symptoms, no use of emergency medical services, no ST-segment deviation, chronic kidney disease, and Global Registry of Acute Coronary Events score >140.
Conclusion
Early invasive strategy based on the StC time improves all-cause mortality in patients with NSTEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S A Bae
- Yongin Severance Hospital, Yonsei University College of Medicine , Yongin , Korea (Republic of)
| | - J J Cha
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - S W Kim
- Chung-Ang University Gwangmyeong Hospital, Department of Cardiology , Gwangmyeong , Korea (Republic of)
| | - S Lim
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - J H Kim
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - H J Joo
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - J H Park
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - S M Park
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - S J Hong
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - D S Lim
- Korea University Anam Hospital, Department of Cardiology , Seoul , Korea (Republic of)
| | - M H Jeong
- Chonnam National University Medical School, Department of Cardiovascular Medicine , Gwangju , Korea (Republic of)
| | - T H Ahn
- Chung-Ang University Gwangmyeong Hospital, Department of Cardiology , Gwangmyeong , Korea (Republic of)
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Cox Z, Zalawadiya S, Simonato M, Redfors B, Zhou Z, Kotinkaduwa L, Zile M, Udelson J, Lim DS, Grayburn PA, Mack MJ, Abraham WT, Stone GW, Lindenfeld J. Maximally tolerated guideline-directed medical therapy and barriers to optimization in patients with heart failure with reduced ejection fraction: the COAPT trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COAPT trial of MitraClip therapy employed a central screening eligibility committee (CSEC) of heart failure (HF) experts to ensure the use of maximally tolerated guideline-directed medical therapy (GDMT) and systematically document intolerances in all potential patients prior to approval for randomization.
Purpose
To describe the percentage of GDMT classes, doses tolerated, predictors of intolerance, and specific intolerances limiting GDMT among patients approved for randomization by the CSEC.
Methods
We analyzed baseline use, dose, and intolerances of i) angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) or angiotensin receptor neprilysin inhibitor (ARNI); ii) beta-blockers (BB); and iii) mineralocorticoid receptor antagonists (MRA) in the CSEC-approved COAPT population with HF with reduced ejection fraction (HFrEF; LVEF ≤40%). We analyzed variables associated with GDMT tolerance.
Results
In COAPT, 464 patients had HFrEF and complete screening medication information. Any dose of all 3, 2 or 1 GDMT classes were tolerated in 39%, 39% and 20% of patients respectively; only 2% of patients (n=9) could not tolerate any GDMT (Figure 1). BB were prescribed in the most (93%) patients followed by ACEI/ARB/ARNI (69%) and MRA (55%). Intolerances limiting each GDMT class differed, but hypotension and kidney dysfunction were most common (Figure 2). No patients tolerated goal doses of all 3 GDMT classes. For BB, only 32% tolerated ≥50% of the goal dose; while for ACEI/ARB/ARNI, no patients achieved goal doses, and only 1% tolerated ≥50% of the goal dose. For MRA, 86% of patients tolerated 25mg/day or less. Patients intolerant of BB were less likely to tolerate an ACEI/ARB/ARNI (OR 0.39, 95% CI 0.20–0.76; p=0.004) but not a MRA (p=0.21) compared with patients tolerating a low dose BB. Patients intolerant of MRA were less likely to tolerate ACEI/ARB/ARNI therapy (OR 0.37, 95% CI 0.25–0.57; p<0.0001) but not a BB (p=0.31) compared with patients tolerating MRA. Patients tolerating low dose ACEI/ARB/ARNI had a higher baseline mean eGFR (52±21 versus 40±21 ml/min/m2; p<0.0001) compared with patients intolerant of ACEI/ARB/ARNI. Likewise, patients tolerating MRA had a higher baseline mean eGFR (52±21 versus 42±21 ml/min/m2; p<0.0001) compared with patients intolerant of MRA.
Conclusion
In a contemporary trial in which HF specialists ensured GDMT optimization, many patients had medical intolerances prohibiting use of one or more GDMT classes, and few patients tolerated target doses. These findings indicate medical intolerances are the primary cause of low GDMT prescription rates in patients with moderate to severe HFrEF. Yet, use of GDMT in this very ill population was much better than “real world” registries of HFrEF suggesting that mandating careful CSEC review prior to study enrollment is important for clinical trials having the objective of randomizing a maximally treated patient cohort.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Z Cox
- Lipscomb University College of Pharmacy , Nashville , United States of America
| | - S Zalawadiya
- Vanderbilt University Medical Center , Nashville , United States of America
| | - M Simonato
- Cardiovascular Research Foundation , New York , United States of America
| | - B Redfors
- Cardiovascular Research Foundation , New York , United States of America
| | - Z Zhou
- Cardiovascular Research Foundation , New York , United States of America
| | - L Kotinkaduwa
- Cardiovascular Research Foundation , New York , United States of America
| | - M Zile
- Ralph H. Johnson Department of Veteran's Affairs Medical Center , Charleston , United States of America
| | - J Udelson
- Tufts Medical Center, Inc. , Boston , United States of America
| | - D S Lim
- University of Virginia , Charlottesville , United States of America
| | - P A Grayburn
- Baylor University Medical Center , Dallas , United States of America
| | - M J Mack
- Baylor Scott and White The Heart Hospital , Plano , United States of America
| | - W T Abraham
- The Ohio State University , Columbus , United States of America
| | - G W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute , New York , United States of America
| | - J Lindenfeld
- Vanderbilt University Medical Center , Nashville , United States of America
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Sodhi N, Asch FM, Ruf T, Petrescu A, von Bardeleben RS, Lim DS, Maisano F, Kar S, Price MJ. Clinical Outcomes With Transcatheter Edge-to-Edge Repair in Atrial Functional MR From the EXPAND Study. JACC Cardiovasc Interv 2022; 15:1723-1730. [PMID: 36075643 DOI: 10.1016/j.jcin.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although transcatheter edge-to-edge repair (TEER) has been shown to improve clinical outcomes and improve quality of life in patients with symptomatic secondary mitral regurgitation (SMR) and left ventricular dysfunction, its effect in patients with atrial SMR (aSMR) has not been well described. OBJECTIVES The aim of this study was to assess the safety, echocardiographic outcomes, and clinical effectiveness of TEER for aSMR. METHODS Patients with aSMR in the prospective, observational, multicenter EXPAND (A Contemporary, Prospective, Multi-Center Study Evaluating Real-World Experience of Performance and Safety for the Next Generation of MitraClip Devices) study were identified by an echocardiography core laboratory. Follow-up occurred at discharge, 30 days, and 1 year. Key endpoints included mitral regurgitation (MR) severity, functional class, heart failure hospitalizations, mortality, and 30-day major adverse events. RESULTS Among 1,041 patients enrolled in EXPAND, 835 patients had evaluable echocardiograms at baseline. Of these, 53 patients had aSMR and 360 had ventricular SMR (vSMR). In the aSMR cohort, TEER resulted in a significant reduction in MR through 1 year (MR grade ≤2 in 100.0%), significantly increased 1-year Kansas City Cardiomyopathy Questionnaire score (+26.6 ± 30.5 points; P < 0.0001), and improved functional class from baseline, similar to the effects among patients with vSMR (MR grade ≤2 in 99.5% at 1 year, 1-year increase in Kansas City Cardiomyopathy Questionnaire score 21.23 ± 24.92 points). Major adverse events at 30 days and leaflet adverse events at 1 year were infrequent in both groups. CONCLUSIONS In a prospective, real-world, global registry, TEER for aSMR was associated with significant MR reduction and improvement in quality of life and functional class, similar to patients with vSMR. This suggests that TEER may provide clinical benefit in patients with atrial fibrillation with SMR in the setting of heart failure with preserved ejection fraction. (The MitraClip® EXPAND Study of the Next Generation of MitraClip® Devices; NCT03502811).
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Affiliation(s)
- Nishtha Sodhi
- Department of Cardiology, University of Virginia Medical Center, Charlottesville, Virginia, USA.
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Tobias Ruf
- University Medical Center of Mainz, Mainz, Germany
| | | | | | - D Scott Lim
- Department of Cardiology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
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Chadderdon SM, Eleid MF, Thaden JJ, Makkar R, Nakamura M, Babaliaros V, Greenbaum A, Gleason P, Kodali S, Hahn RT, Koulogiannis KP, Marcoff L, Grayburn P, Smith RL, Song HK, Lim DS, Gray WA, Hawthorne K, Deuschl F, Narang A, Davidson C, Zahr FE. Three-Dimensional Intracardiac Echocardiography for Tricuspid Transcatheter Edge-to-Edge Repair. Struct Heart 2022; 6:100071. [PMID: 37288338 PMCID: PMC10242583 DOI: 10.1016/j.shj.2022.100071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 06/09/2023]
Abstract
Patients with severe symptomatic tricuspid regurgitation face a significant dilemma in treatment options, as the yearly mortality with medical therapy and the surgical mortality for tricuspid repair or replacement are high. Transcatheter edge-to-edge repair (TEER) for the tricuspid valve is becoming a viable option in patients, although procedural success is dependent on high-quality imaging. While transesophageal echocardiography remains the standard for tricuspid TEER procedures, intracardiac echocardiography (ICE) with three-dimensional (3D) multiplanar reconstruction (MPR) has many theoretical and practical advantages. The aim of this article was to describe the in vitro wet lab-based imaging work done to facilitate the best approach to 3D MPR ICE imaging and the procedural experience gained with 3D MPR ICE in tricuspid TEER procedures with the PASCAL device.
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Affiliation(s)
- Scott M. Chadderdon
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy J. Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Adam Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Susheel Kodali
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T. Hahn
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Konstantinos P. Koulogiannis
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA
| | - Leo Marcoff
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Howard K. Song
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - D. Scott Lim
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - William A. Gray
- Department of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Katie Hawthorne
- Department of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | | | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles Davidson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas E. Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
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Liu X, Chen M, Han Y, Pu Z, Lin X, Feng Y, Xu K, Lam YY, Lim DS, Wang J. First-in-Human Study of the Novel Transcatheter Mitral Valve Repair System for Mitral Regurgitation. JACC Asia 2022; 2:390-394. [PMID: 36338402 PMCID: PMC9627920 DOI: 10.1016/j.jacasi.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 06/16/2023]
Abstract
Transcatheter mitral valve intervention treatment is a promising alternative therapy for patients with severe mitral regurgitation (MR). This is a multicenter, prospective, first-in-human study of transcatheter edge-to-edge repair (TEER) using a novel device for severe MR. Safety and efficacy were assessed immediately after the procedure and at 30-day follow-up. Twenty-three patients (age 70.0 ± 5.2 years) who were at high/prohibitive surgical risk underwent successful procedures without major periprocedural complications. All patients achieved residual MR ≤2+ at discharge, with 73.9% with 1+ residual MR. The left ventricular end-systolic diameter improved from 4.1 cm at baseline to 3.4 cm at 30-day follow-up. New York Heart Association functional class I/II after TEER was achieved in 87% of patients. This study demonstrated that TEER with the device was feasible and safe for the treatment of patients with severe MR. (Dragonfly-M Transcatheter Mitral Valve Repair System Early Feasibility Study; NCT04528576).
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Affiliation(s)
- Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhaoxia Pu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yat-Yin Lam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
- Centre Medical Hong Kong, Hong Kong SAR, China
| | - D. Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jian’an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Medicine, Zhejiang University School of Medicine, Hangzhou, China
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Kodali S, Hahn RT, George I, Davidson CJ, Narang A, Zahr F, Chadderdon S, Smith R, Grayburn PA, O'Neill WW, Wang DD, Herrmann H, Silvestry F, Elmariah S, Inglessis I, Passeri J, Lim DS, Salerno M, Makar M, Mack MJ, Leon MB, Makkar R. Transfemoral Tricuspid Valve Replacement in Patients With Tricuspid Regurgitation: TRISCEND Study 30-Day Results. JACC Cardiovasc Interv 2022; 15:471-480. [PMID: 35272771 DOI: 10.1016/j.jcin.2022.01.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The TRISCEND study (Edwards EVOQUE Tricuspid Valve Replacement: Investigation of Safety and Clinical Efficacy after Replacement of Tricuspid Valve with Transcatheter Device) is evaluating the safety and performance of transfemoral transcatheter tricuspid valve replacement in patients with clinically significant tricuspid regurgitation (TR) and elevated surgical risk. BACKGROUND Transcatheter valve replacement could lead to a paradigm shift in treating TR and improving patient quality of life. METHODS In the prospective, single-arm, multicenter TRISCEND study, patients with symptomatic moderate or greater TR, despite medical therapy, underwent percutaneous transcatheter tricuspid valve replacement with the EVOQUE system. A composite rate of major adverse events, echocardiographic parameters, and clinical, functional, and quality-of-life measures were assessed at 30 days. RESULTS Fifty-six patients (mean age of 79.3 years, 76.8% female, 91.1% TR severe or greater, 91.1% atrial fibrillation, and 87.5% New York Heart Association functional class III or IV) were treated. At 30 days, TR was reduced to mild or less in 98%. The composite major adverse events rate was 26.8% at 30 days caused by 1 cardiovascular death in a patient with a failed procedure, 2 reinterventions after device embolization, 1 major access site or vascular complication, and 15 severe bleeds, of which none were life-threatening or fatal. No myocardial infarction, stroke, renal failure, major cardiac structural complications, or device-related pulmonary embolism were observed. New York Heart Association significantly improved to functional class I or II (78.8%; P < 0.001), 6-minute walk distance improved 49.8 m (P < 0.001), and Kansas City Cardiomyopathy Questionnaire score improved 19 points (P < 0.001). CONCLUSIONS Early experience with the transfemoral EVOQUE system in patients with clinically significant TR demonstrated technical feasibility, acceptable safety, TR reduction, and symptomatic improvement at 30 days. The TRISCEND II randomized trial (NCT04482062) is underway.
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Affiliation(s)
- Susheel Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Robert Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Paul A Grayburn
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | | | | | - Howard Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frank Silvestry
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, VA, USA
| | | | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael J Mack
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Song C, Madhavan MV, Lindenfeld J, Abraham WT, Kar S, Lim DS, Grayburn PA, Kapadia SR, Kotinkaduwa LN, Mack MJ, Stone GW. Age-Related Outcomes After Transcatheter Mitral Valve Repair in Patients With Heart Failure: Analysis From COAPT. JACC Cardiovasc Interv 2022; 15:397-407. [PMID: 35093278 DOI: 10.1016/j.jcin.2021.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of age on outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. BACKGROUND In the COAPT trial, TEER with the MitraClip device in patients with heart failure (HF) and moderate to severe or severe secondary mitral regurgitation (SMR) reduced the risk for HF hospitalization (HFH) and all-cause mortality compared with maximally tolerated guideline-directed medical therapy (GDMT) alone. There are limited data regarding the effectiveness of MitraClip therapy in elderly patients. METHODS Patients (n = 614) were grouped by median age at randomization (74 years) and by MitraClip treatment vs GDMT alone. The primary endpoint was the 2-year rate of death or HFH assessed by multivariable Cox regression. RESULTS Death or HFH within 2 years occurred less frequently after treatment with the MitraClip vs GDMT alone in patients <74 years of age (37.3% vs 64.5%; adjusted HR: 0.41; 95% CI: 0.29-0.59) and ≥74 years of age (51.7% vs 69.6%; adjusted HR: 0.58; 95% CI: 0.42-0.81) (Pint = 0.17). Mortality was also consistently reduced with MitraClip treatment in young and elderly patients (Pint = 0.42). In contrast, elderly patients treated with the MitraClip vs GDMT alone tended to have a lesser reduction of HFH than younger patients (Pint = 0.03). Younger and older patients had similar improvements in quality of life after treatment with the MitraClip compared with GDMT alone. CONCLUSIONS In the COAPT trial, MitraClip treatment of moderate to severe and severe SMR reduced the composite risk for death or HFH and improved survival and quality of life regardless of age. As such, young and elderly patients with HF and severe SMR benefit from TEER, although elderly patients may not have as great a benefit from the MitraClip device in reducing HFH.
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Affiliation(s)
- Chris Song
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mahesh V Madhavan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, Texas, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Michael J Mack
- Baylor Scott and White Heart Hospital - Plano, Dallas, Texas, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.
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Vincent F, Redfors B, Kotinkaduwa LN, Kar S, Lim DS, Mishell JM, Whisenant BK, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Cerebrovascular events after transcatheter mitral valve repair or guideline-directed medical therapy in patients with mitral regurgitation and heart failure in the COAPT trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Our knowledge regarding the risk of cerebrovascular events (CVE) in patients with heart failure (HF) and severe secondary mitral regurgitation (SMR) treated by transcatheter mitral valve repair (TMVr) is limited.
Purpose
To examine the incidence, predictors, timing, and prognostic impact of CVE in patients with heart failure and SMR treated with TMVr vs guideline-directed medical therapy (GDMT) alone.
Methods
In the COAPT trial, 614 patients with HF with moderate-to-severe or severe SMR were randomized to TMVr with the MitraClip + GDMT vs GDMT alone. After 2 years, patients who were randomized to GDMT alone could crossover and undergo TMVr. CVE (defined as stroke or TIA) were adjudicated by an independent clinical events committee.
Results
A total of 43 CVE occurred in 42 patients within 3-year follow-up (34 strokes and 9 TIAs; 1 patient had both). CVE occurred in 10.0% (n=20) of patients randomized to TMVR and 11.3% (n=22) of patients randomized to GDMT alone (p=0.53) (Figure). Of the 22 CVE in the GDMT alone group, 3 occurred after the patient had crossed over to TMVr. The incidence rates in the TMVr and GDMT groups were similar within the first 3 months (incidence rate ratio [IRR] 0.78, 95% CI 0.17–3.48, p=0.74) and between 3 months and 3 years (IRR 0.83, 95% CI 0.43–1.60, p=0.58) after randomization. After multivariable adjustment, baseline estimated glomerular filtration rate (eGFR) was associated with CVE in the overall population (HR per 5 ml/min increase in eGFR 0.91, 95% CI 0.84–0.99, p=0.03). Peripheral vascular disease was associated with CVE in patients treated by GDMT (HR=3.21, 95% CI [1.35, 7.67]) but not TMVr (HR 0.53 95% CI 0.12–2.24; p-interaction=0.04). In contrast, baseline chronic oral anticoagulation use was associated with a reduced risk of CVE in patients in the TMVr group (HR 0.18, 95% CI 0.05–0.63) but not in the GDMT alone group (HR 1.66, 95% CI 0.70–3.94; p-interaction=0.004). In a time-adjusted multivariable analysis, CVE was associated with a higher risk of death (HR 2.51, 95% CI 1.54–4.08; p=0.0002), a risk that was marked in the first 30 days after the event (HR 14.21, 95% CI 7.30–27.97, p<0.0001), and declined thereafter (HR 1.37, 95% CI 0.72–2.59, p=0.34).
Conclusions
In patients with HF and severe SMR, CVE at 3 years was not infrequent, increased linearly over time, was similar after treatment with the MitraClip and GDMT alone, and was associated with a marked increase in all-cause death. Whether anticoagulation is especially effective at preventing CVE in patients treated by TMVr, as suggested by this report, warrants further study.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Figure 1
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Affiliation(s)
- F Vincent
- Cardiovascular Research Foundation, New York, United States of America
| | - B Redfors
- Cardiovascular Research Foundation, New York, United States of America
| | - L N Kotinkaduwa
- Cardiovascular Research Foundation, New York, United States of America
| | - S Kar
- Los Robles Regional Medical Center, Thousand Oaks, United States of America
| | - D S Lim
- University of Virginia, Charlottesville, United States of America
| | - J M Mishell
- Kaiser Permanente, San Francisco Medical Center, San Francisco, United States of America
| | - B K Whisenant
- Intermountain Medical Center, Salt Lake City, United States of America
| | - J Lindenfeld
- Vanderbilt University Medical Center, Nashville, United States of America
| | - W T Abraham
- The Ohio State University, Columbus, United States of America
| | - M J Mack
- Baylor Scott and White The Heart Hospital, Plano, United States of America
| | - G W Stone
- Mount Sinai School of Medicine, New York, United States of America
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Saxon JT, Cohen DJ, Chhatriwalla AK, Kotinkaduwa LN, Kar S, Lim DS, Abraham WT, Lindenfeld J, Mack MJ, Arnold SV, Stone GW. Impact of COPD on Outcomes After MitraClip for Secondary Mitral Regurgitation: The COAPT Trial. JACC Cardiovasc Interv 2021; 13:2795-2803. [PMID: 33303119 DOI: 10.1016/j.jcin.2020.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to examine the relationship between chronic obstructive pulmonary disease (COPD) and outcomes after transcatheter mitral valve repair (TMVr) for severe secondary mitral regurgitation. BACKGROUND TMVr with the MitraClip improves clinical and health-status outcomes in patients with heart failure and severe (3+ to 4+) secondary mitral regurgitation. Whether these benefits are modified by COPD is unknown. METHODS COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) was an open-label, multicenter, randomized trial of TMVr plus guideline-directed medical therapy (GDMT) versus GDMT alone. Patients on corticosteroids or continuous oxygen were excluded. Multivariable models were used to examine the associations of COPD with mortality, heart failure hospitalization (HFH), and health status and to test whether COPD modified the benefit of TMVr compared with GDMT. RESULTS Among 614 patients, 143 (23.2%) had COPD. Among patients treated with TMVr, unadjusted analyses demonstrated increased 2-year mortality in those with COPD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.33 to 3.26), but this association was attenuated after risk adjustment (adjusted HR: 1.48; 95% CI: 0.87 to 2.52). Although TMVr led to reduced 2-year mortality among patients without COPD (adjusted HR: 0.47; 95% CI: 0.33 to 0.67), for patients with COPD, 2-year all-cause mortality was similar after TMVr versus GDMT alone (adjusted HR: 0.94; 95% CI: 0.54 to 1.65; pint = 0.04), findings that reflect offsetting effects on cardiovascular and noncardiovascular mortality. In contrast, TMVr reduced HFH (adjusted HR: 0.48 [95% CI: 0.28 to 0.83] vs. 0.46 [95% CI: 0.34 to 0.63]; pint = 0.89) and improved both generic and disease-specific health status to a similar extent compared with GDMT alone in patients with and without COPD (pint >0.30 for all scales). CONCLUSIONS In the COAPT trial, COPD was associated with attenuation of the survival benefit of TMVr versus GDMT compared with patients without COPD. However, the benefits of TMVr on both HFH and health status were similar regardless of COPD. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] [COAPT]; NCT01626079).
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | | | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Kodali S, Hahn RT, Eleid MF, Kipperman R, Smith R, Lim DS, Gray WA, Narang A, Pislaru SV, Koulogiannis K, Grayburn P, Fowler D, Hawthorne K, Dahou A, Deo SH, Vandrangi P, Deuschl F, Mack MJ, Leon MB, Feldman T, Davidson CJ. Feasibility Study of the Transcatheter Valve Repair System for Severe Tricuspid Regurgitation. J Am Coll Cardiol 2021; 77:345-356. [PMID: 33509390 DOI: 10.1016/j.jacc.2020.11.047] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a prevalent disease with limited treatment options. OBJECTIVES This is the first 30-day report of the U.S. single-arm, multicenter, prospective CLASP TR early feasibility study of the PASCAL transcatheter valve repair system in the treatment of TR. METHODS Patients with symptomatic TR despite optimal medical therapy, reviewed by the local heart team and central screening committee, were eligible for the study. Data were collected at baseline, discharge, and the 30-day follow-up and were reviewed by an independent clinical events committee and echocardiographic core laboratory. Feasibility endpoints included safety (composite major adverse event [MAE] rate), echocardiographic, clinical, and functional endpoints. RESULTS Of the 34 patients enrolled in the study, the mean age was 76 years, 53% were women, the mean Society of Thoracic Surgeons score was 7.3%, 88% had atrial fibrillation/flutter, 97% had severe or greater TR, and 79% had New York Heart Association (NYHA) functional class III/IV symptoms. Twenty-nine patients (85%) received implants; at 30 days, 85% of them achieved a TR severity reduction of at least 1 grade, with 52% with moderate or less TR (p < 0.001). The MAE rate was 5.9%, and none of the patients experienced cardiovascular mortality, stroke, myocardial infarction, renal complication, or reintervention. Eighty-nine percent of the patients improved to NYHA functional class I/II (p < 0.001), the mean 6-min walk distance improved by 71 m (p < 0.001), and the mean Kansas City Cardiomyopathy Questionnaire score improved by 15 points (p < 0.001). CONCLUSIONS In this early experience, the repair system performed as intended, with substantial TR reduction, favorable safety results with a low MAE rate, no mortality or reintervention, and significant improvements in functional status, exercise capacity, and quality of life. (Edwards CLASP TR EFS [CLASP TR EFS]; NCT03745313).
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Affiliation(s)
- Susheel Kodali
- Columbia University Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Robert Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Shahim B, Ben-Yehuda O, Chen S, Redfors B, Madhavan MV, Kar S, Lim DS, Asch FM, Weissman NJ, Cohen DJ, Arnold SV, Liu M, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Impact of Diabetes on Outcomes After Transcatheter Mitral Valve Repair in Heart Failure: COAPT Trial. JACC Heart Fail 2021; 9:559-567. [PMID: 34325886 DOI: 10.1016/j.jchf.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This paper sought to determine whether diabetes influences the outcomes of transcatheter mitral valve repair (TMVr) in patients with heart failure (HF) and secondary mitral regurgitation (SMR). BACKGROUND Diabetes is associated with worse outcomes in patients with HF. METHODS The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With functional Mitral Regurgitation) trial randomized HF patients with 3+ or 4+ SMR to MitraClip plus guideline-directed medical therapy (GDMT) versus GDMT alone. Two-year outcomes were evaluated in patients with versus without diabetes. RESULTS Of 614 patients, 229 (37.3%) had diabetes. Diabetic patients had higher 2-year rates of death than those without diabetes (40.8% vs 32.3%, respectively; adjusted P = 0.04) and tended to have higher rates of HF hospitalization (HFH) (HFH: 50.1% vs 43.0%, respectively; adjusted P = 0.07). TMVr reduced the 2-year rate of death consistently in patients with (30.3% vs 49.9%, respectively; adjusted HR: 0.51; 95% CI: 0.32 to 0.81) and without (27.0% vs 38.3%, respectively; adjusted HR: 0.57; 95% CI: 0.39-0.84) diabetes (Pinteraction = 0.72). TMVr also consistently reduced the 2-year rates of HFH in patients with (32.2% vs 54.8%, respectively; adjusted HR: 0.41; 95% CI: 0.28-0.58) and without (41.5% vs 59.0%, respectively; adjusted HR: 0.54: 95% CI 0.35-0.82) diabetes (Pinteraction = 0.33). Greater movements in quality-of-life (QOL) and exercise capacity occurred with TMVr than with GDMT alone, regardless of diabetic status. CONCLUSIONS Among HF patients with severe SMR in the COAPT trial, those with diabetes had a worse prognosis. Nonetheless, diabetic and nondiabetic patients had consistent reductions in the 2-year rates of death and HFH and improvements in QOL and functional capacity following TMVr treatment using the MitraClip than with maintenance on GDMT alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079).
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Affiliation(s)
- Bahira Shahim
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Division of Cardiology, University of California San Diego, San Diego, California, USA
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mahesh V Madhavan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Federico M Asch
- MedStar Health Research Institute, Washington, DC, USA; Georgetown University, Washington, DC, USA
| | - Neil J Weissman
- MedStar Health Research Institute, Washington, DC, USA; Georgetown University, Washington, DC, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, New York, USA
| | - Suzanne V Arnold
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, the Ohio State University, Columbus, Ohio, USA
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Malik UI, Ambrosy AP, Ku IA, Mishell JM, Kar S, Lim DS, Whisenant BK, Cohen DJ, Arnold SV, Kotinkaduwa LN, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation. JACC Cardiovasc Interv 2021; 13:2331-2341. [PMID: 33092707 DOI: 10.1016/j.jcin.2020.07.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to determine the prognostic utility of baseline functional status and its impact on the outcomes of transcatheter mitral valve repair (TMVr) in patients with heart failure (HF) with secondary mitral regurgitation (SMR). BACKGROUND The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial demonstrated that TMVr with the MitraClip in patients with HF with moderate to severe or severe SMR improved health-related quality of life. The clinical utility of a baseline assessment of functional status for evaluating prognosis and identifying candidates likely to derive a robust benefit from TMVr has not been previously studied in patients with HF with SMR. METHODS The COAPT study was a multicenter, randomized, controlled, parallel-group, open-label trial of TMVr with the MitraClip plus guideline-directed medical therapy (GDMT) versus GDMT alone in patients with HF, left ventricular ejection fraction 20% to 50%, and moderate to severe or severe SMR. Baseline functional status was assessed by 6-min walk distance (6MWD). RESULTS Patients with 6MWD less than the median (240 m) were older, were more likely to be female, and had more comorbidities. After multivariate modeling, age (p = 0.005), baseline hemoglobin (p = 0.007), and New York Heart Association functional class III/IV symptoms (p < 0.0001) were independent clinical predictors of 6MWD. Patients with 6MWD <240 m versus ≥240 m had a higher unadjusted and adjusted rate of the 2-year composite of all-cause death or HF hospitalization (64.4% vs. 48.6%; adjusted hazard ratio: 1.53; 95% confidence interval: 1.19 to 1.98; p = 0.001). However, there was no interaction between baseline 6MWD and the relative effectiveness of TMVr plus GDMT versus GDMT alone with respect to the composite endpoint (p = 0.633). CONCLUSIONS Baseline assessment of functional capacity by 6MWD was a powerful discriminator of prognosis in patients with HF with SMR. TMVr with the MitraClip provided substantial improvements in clinical outcomes for this population irrespective of baseline functional capacity.
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Affiliation(s)
- Umar I Malik
- Department of Cardiology, The Permanente Medical Group, San Francisco, California
| | - Andrew P Ambrosy
- Department of Cardiology, The Permanente Medical Group, San Francisco, California; Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Ivy A Ku
- Department of Cardiology, The Permanente Medical Group, San Francisco, California
| | - Jacob M Mishell
- Department of Cardiology, The Permanente Medical Group, San Francisco, California
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California; Bakersfield Heart Hospital, Bakersfield, California
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia
| | | | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Suzanne V Arnold
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | | | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Webb JG, Hensey M, Szerlip M, Schäfer U, Cohen GN, Kar S, Makkar R, Kipperman RM, Spargias K, O'Neill WW, Ng MKC, Fam NP, Rinaldi MJ, Smith RL, Walters DL, Raffel CO, Levisay J, Latib A, Montorfano M, Marcoff L, Shrivastava M, Boone R, Gilmore S, Feldman TE, Lim DS. 1-Year Outcomes for Transcatheter Repair in Patients With Mitral Regurgitation From the CLASP Study. JACC Cardiovasc Interv 2021; 13:2344-2357. [PMID: 33092709 DOI: 10.1016/j.jcin.2020.06.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The authors report the CLASP (Edwards PASCAL Transcatheter Mitral Valve Repair System Study) expanded experience, 1-year outcomes, and analysis by functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR). BACKGROUND The 30-day results from the CLASP study of the PASCAL transcatheter valve repair system for clinically significant mitral regurgitation (MR) have been previously reported. METHODS Eligible patients had symptomatic MR ≥3+, were receiving optimal medical therapy, and were deemed candidates for transcatheter mitral repair by the local heart team. Primary endpoints included procedural success, clinical success, and major adverse event rate at 30 days. Follow-up was continued to 1 year. RESULTS One hundred nine patients were treated (67% FMR, 33% DMR); the mean age was 75.5 years, and 57% were in New York Heart Association functional class III or IV. At 30 days, there was 1 cardiovascular death (0.9%), MR ≤1+ was achieved in 80% of patients (77% FMR, 86% DMR) and MR ≤2+ in 96% (96% FMR, 97% DMR), 88% of patients were in New York Heart Association functional class I or II, 6-min walk distance had improved by 28 m, and Kansas City Cardiomyopathy Questionnaire score had improved by 16 points (p < 0.001 for all). At 1 year, Kaplan-Meier survival was 92% (89% FMR 96% DMR) with 88% freedom from heart failure hospitalization (80% FMR, 100% DMR), MR was ≤1+ in 82% of patients (79% FMR, 86% DMR) and ≤2+ in 100% of patients, 88% of patients were in New York Heart Association functional class I or II, and Kansas City Cardiomyopathy Questionnaire score had improved by 14 points (p < 0.001 for all). CONCLUSIONS The PASCAL transcatheter valve repair system demonstrated a low complication rate and high survival, with robust sustained MR reduction accompanied by significant improvements in functional status and quality of life at 1 year. (The CLASP Study Edwards PASCAL Transcatheter Mitral Valve Repair System Study [CLASP]; NCT03170349).
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Affiliation(s)
- John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada.
| | - Mark Hensey
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Molly Szerlip
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas
| | | | - Gideon N Cohen
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey
| | | | | | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Robert L Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas
| | | | | | - Justin Levisay
- NorthShore University Health System, Evanston Hospital, Evanston, Illinois
| | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey
| | | | - Robert Boone
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Ted E Feldman
- NorthShore University Health System, Evanston Hospital, Evanston, Illinois; Edwards Lifesciences, Irvine, California
| | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia
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Davidson CJ, Lim DS, Smith RL, Kodali SK, Kipperman RM, Eleid MF, Reisman M, Whisenant B, Puthumana J, Abramson S, Fowler D, Grayburn P, Hahn RT, Koulogiannis K, Pislaru SV, Zwink T, Minder M, Dahou A, Deo SH, Vandrangi P, Deuschl F, Feldman TE, Gray WA. Early Feasibility Study of Cardioband Tricuspid System for Functional Tricuspid Regurgitation: 30-Day Outcomes. JACC Cardiovasc Interv 2021; 14:41-50. [PMID: 33413863 DOI: 10.1016/j.jcin.2020.10.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The study reports for the first time the 30-day outcomes of the first U.S. study with the Cardioband tricuspid valve reconstruction system for the treatment of functional tricuspid regurgitation (TR). BACKGROUND Increasing severity of TR is associated with progressively higher morbidity and mortality; however, treatment options for isolated significant disease are limited. METHODS In this single-arm, multicenter, prospective Food and Drug Administration-approved early feasibility study (EFS), 30 patients with severe or greater symptomatic functional TR were enrolled who were deemed candidates for transcatheter tricuspid repair with the Cardioband tricuspid system by the local heart team and multidisciplinary screening committee. RESULTS The mean patient age was 77 years, 80% were women, 97% had atrial fibrillation, 70% were in New York Heart Association functional class III to IV with mean left ventricular ejection fraction of 58%, and 27% had severe, 20% massive, and 53% torrential TR. Device success was 93% and all patients were alive at 30 days. Between baseline and 30 days, septolateral tricuspid annular diameter was reduced by 13% (p < 0.001), 85% of patients had ≥1 grade TR reduction and 44% had ≤moderate TR, 75% were in New York Heart Association functional class I to II (p < 0.001), and overall Kansas City Cardiomyopathy Questionnaire score improved by 16 points (p < 0.001). CONCLUSIONS In patients with severe symptomatic functional TR, this is the first study in the United States with the Cardioband tricuspid system for direct transcatheter annular reduction. This early feasibility study demonstrates high procedural feasibility with no 30-day mortality. There is significant reduction of functional TR with clinically significant improvements in functional status and quality of life. (Edwards Cardioband Tricuspid Valve Reconstruction System Early Feasibility Study; NCT03382457).
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Affiliation(s)
- Charles J Davidson
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - D Scott Lim
- Department of Medicine, University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Robert L Smith
- Department of Cardiothoracic Surgery, The Heart Hospital Baylor, Texas, USA
| | - Susheel K Kodali
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Robert M Kipperman
- Department of Cardiovascular Surgery, Morristown Medical Center, Morristown, New Jersey, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Reisman
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Brian Whisenant
- Division of Cardiovascular Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Jyothy Puthumana
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandra Abramson
- Division of Cardiology, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Dale Fowler
- Department of Medicine, University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Paul Grayburn
- Department of Cardiothoracic Surgery, The Heart Hospital Baylor, Texas, USA
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd Zwink
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael Minder
- Division of Cardiovascular Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | | | | | | | | | - William A Gray
- Division of Cardiology, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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Li J, Sun Y, Zheng S, Li G, Dong H, Fu M, Mo Y, Li Y, Liu H, Xu Z, Zhang L, Cao Y, Fan R, Lim DS, Luo J. Anatomical Predictors of Valve Malposition During Self-Expandable Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2021; 8:600356. [PMID: 34322521 PMCID: PMC8311434 DOI: 10.3389/fcvm.2021.600356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The consequence of valve malposition (VM) during transcatheter aortic valve replacement (TAVR) can be severe, but the determinants of VM with self-expandable TAVR have not been thoroughly evaluated. We aimed to investigate the anatomical predictors of VM during self-expandable TAVR. Methods: In this multicenter retrospective study, TAVR was performed using the Venus A-Valve. The baseline, computed tomography, and procedural characteristics along with clinical outcomes were collected. Multivariate logistic regression model and receiver operating characteristic (ROC) curve analyses were performed. Results: A total of 84 consecutive patients (23 with VM) were included. Stepwise regression showed that annulus perimeter/left ventricular outflow tract perimeter (AL ratio) and sinotubular junction (STJ) height were predictors of VM. The ROC curve indicated a moderate strength of AL ratio [area under the curve (AUC) 0.71, cutoff 0.96] and a weak strength of STJ height (AUC 0.69, cutoff 23.8 mm) to predict VM. The combination of both predictors revealed a higher predictive value of VM (AUC 0.77). In multivariate analysis, AL ratio <0.96 [odds ratio (OR) 3.98, p = 0.015] and STJ height ≥23.8 mm (OR 4.63, p = 0.008) were strong independent predictors of VM. The presence of both predictors was associated with a very high risk of VM (OR 10.67, p = 0.002). The rate of moderate-to-severe paravalvular regurgitation was higher in patients with VM at 30 days (26.1 vs. 4.9%, p = 0.011). Conclusions: A conical left ventricular outflow tract and tall aortic sinuses were strong anatomical predictors of VM during self-expandable TAVR.
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Affiliation(s)
- Jie Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yinghao Sun
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shengneng Zheng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guang Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haojian Dong
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Fu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yujing Mo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi Li
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Zhaoyan Xu
- The First People Hospital of Foshan, Foshan, China
| | - Liting Zhang
- Zhongshan City People's Hospital, Zhongshan, China
| | - Yong Cao
- Gaozhou People's Hospital, Gaozhou, China
| | - Ruixin Fan
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - D Scott Lim
- University of Virginia Health System Hospital, Virginia, NV, United States
| | - Jianfang Luo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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47
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Lim DS, Herrmann HC, Grayburn P, Koulogiannis K, Ailawadi G, Williams M, Ng VG, Chau KH, Sorajja P, Smith RL, Guerrero M, Daniels D, Granada JF, Mack MJ, Leon MB, McCarthy P. Consensus Document on Non-Suitability for Transcatheter Mitral Valve Repair by Edge-to-Edge Therapy. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1902595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- D. Scott Lim
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Howard C. Herrmann
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Grayburn
- Department of Medicine, Baylor, Scott, & White Health, Dallas, Texas, USA
| | | | - Gorav Ailawadi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mathew Williams
- Department of Surgery, New York University, New York, New York, USA
| | - Vivian G. Ng
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Katherine H. Chau
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Paul Sorajja
- Department of Medicine, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Robert L. Smith
- Department of Surgery, Baylor Scott & White: The Heart Hospital Plano, Plano, Texas, USA
| | - Mayra Guerrero
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David Daniels
- Department of Medicine, Bay Area Structural Heart (BASH), San Francisco, California, USA
| | - Juan F. Granada
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Michael J. Mack
- Department of Medicine, Baylor, Scott, & White Health, Dallas, Texas, USA
| | - Martin B. Leon
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Patrick McCarthy
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
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48
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Kar S, Mack MJ, Lindenfeld J, Abraham WT, Asch FM, Weissman NJ, Enriquez-Sarano M, Lim DS, Mishell JM, Whisenant BK, Rogers JH, Arnold SV, Cohen DJ, Grayburn PA, Stone GW. Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure: COAPT Trial. Circulation 2021; 144:426-437. [PMID: 34039025 DOI: 10.1161/circulationaha.120.053061] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the randomized COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), among 614 patients with heart failure with 3+ or 4+ secondary mitral regurgitation (MR), transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR, heart failure hospitalizations, and mortality and improved quality of life compared with guideline-directed medical therapy (GDMT) alone. We aimed to examine the prognostic relationship between MR reduction and outcomes after TMVr and GDMT alone. METHODS Outcomes in COAPT between 30 days and 2 years were examined on the basis of the severity of residual MR at 30 days. RESULTS TMVr-treated patients had less severe residual MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%, 19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively [P<0.0001]). The rate of composite death or heart failure hospitalizations between 30 days and 2 years was lower in patients with 30-day residual MR of 0/1+ and 2+ compared with patients with 30-day residual MR of 3+/4+ (37.7% versus 49.5% versus 72.2%, respectively [P<0.0001]). This relationship was consistent in the TMVr and GDMT arms (Pinteraction=0.92). The improvement in Kansas City Cardiomyopathy Questionnaire score from baseline to 30 days was maintained between 30 days and 2 years in patients with 30-day MR ≤2+ but deteriorated in those with 30-day MR 3+/4+ (-0.3±1.7 versus -9.4±4.6 [P=0.0008]) consistently in both groups (Pinteraction=0.95). CONCLUSIONS In the COAPT trial, reduced MR at 30 days was associated with greater freedom from death or heart failure hospitalizations and improved quality of life through 2-year follow-up whether the MR reduction was achieved by TMVr or GDMT. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.
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Affiliation(s)
- Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.).,Bakersfield Heart Hospital, CA (S.K.)
| | | | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.)
| | - Federico M Asch
- MedStar Health Research Institute, Washington, DC (F.M.A., N.J.W.).,Georgetown University, Washington, DC (F.M.A., N.J.W.)
| | - Neil J Weissman
- MedStar Health Research Institute, Washington, DC (F.M.A., N.J.W.).,Georgetown University, Washington, DC (F.M.A., N.J.W.)
| | | | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville (D.S.L.)
| | | | | | - Jason H Rogers
- University of California Davis Medical Center, Sacramento (J.H.R.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A.)
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine (S.V.A.).,St Francis Hospital, Roslyn, NY (D.J.C.)
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.A.G.)
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (D.J.C., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
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49
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Szerlip M, Spargias KS, Makkar R, Kar S, Kipperman RM, O'Neill WW, Ng MKC, Smith RL, Fam NP, Rinaldi MJ, Raffel OC, Walters DL, Levisay J, Montorfano M, Latib A, Carroll JD, Nickenig G, Windecker S, Marcoff L, Cohen GN, Schäfer U, Webb JG, Lim DS. 2-Year Outcomes for Transcatheter Repair in Patients With Mitral Regurgitation From the CLASP Study. JACC Cardiovasc Interv 2021; 14:1538-1548. [PMID: 34020928 DOI: 10.1016/j.jcin.2021.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study reports 2-year outcomes from the multicenter, prospective, single-arm CLASP study with functional mitral regurgitation (FMR) and degenerative MR (DMR) analysis. BACKGROUND Transcatheter repair is a favorable option to treat MR. Long-term prognostic impact of the PASCAL transcatheter valve repair system in patients with clinically significant MR remains to be established. METHODS Patients had clinically significant MR ≥3+ as evaluated by the echocardiographic core laboratory and were deemed candidates for transcatheter repair by the heart team. Assessments were performed by clinical events committee to 1 year (site-reported thereafter) and core laboratory to 2 years. RESULTS A total of 124 patients (69% FMR, 31% DMR) were enrolled with a mean age of 75 years, 56% were male, 60% were New York Heart Association functional class III to IVa, and 100% had MR ≥3+. At 2 years, Kaplan-Meier estimates showed 80% survival (72% FMR, 94% DMR) and 84% freedom from heart failure (HF) hospitalization (78% FMR, 97% DMR), with 85% reduction in annualized HF hospitalization rate (81% FMR, 98% DMR). MR ≤1+ was achieved in 78% of patients (84% FMR, 71% DMR) and MR ≤2+ was achieved in 97% (95% FMR, 100% DMR) (all p < 0.001). Left ventricular end-diastolic volume decreased by 33 ml (p < 0.001); 93% of patients were in New York Heart Association functional class I to II (p < 0.001). CONCLUSIONS The PASCAL repair system demonstrated sustained favorable outcomes at 2 years in FMR and DMR patients. Results showed high survival and freedom from HF rehospitalization rates with a significantly reduced annualized HF hospitalization rate. Durable MR reduction was achieved with evidence of left ventricular reverse remodeling and significant improvement in functional status. The CLASP IID/IIF randomized pivotal trial is ongoing.
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Affiliation(s)
- Molly Szerlip
- Department of Cardiology, Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA.
| | | | - Raj Makkar
- Department of Interventional Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Saibal Kar
- Department of Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Robert M Kipperman
- Department of Cardiology, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - William W O'Neill
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Martin K C Ng
- Department of Interventional Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Robert L Smith
- Department of Cardiology, Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Neil P Fam
- Department of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael J Rinaldi
- Department of Interventional Cardiology, Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - O Christopher Raffel
- Department of Interventional Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Darren L Walters
- Department of Interventional Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Justin Levisay
- Department of Interventional Cardiology, NorthShore University Health System, Evanston Hospital, Evanston, Illinois, USA
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele Institute, Milan, Italy
| | - Azeem Latib
- Department of Interventional Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - John D Carroll
- Department of Interventional Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Georg Nickenig
- Department of Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Leo Marcoff
- Department of Cardiology, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Gideon N Cohen
- Department of Cardiac Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ulrich Schäfer
- Department of Internal Medicine, Marienkrankenhaus, Hamburg, Germany
| | - John G Webb
- Department of Interventional Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Scott Lim
- Department of Cardiovascular Medicine, University of Virginia Health System Hospital, Charlottesville, Virginia, USA
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50
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Lim DS, Smith RL, Zahr F, Dhoble A, Laham R, Lazkani M, Kodali S, Kliger C, Hermiller J, Vora A, Sarembock IJ, Gray W, Kapadia S, Greenbaum A, Rassi A, Lee D, Chhatriwalla A, Shah P, Rodés-Cabau J, Ibrahim H, Satler L, Herrmann HC, Mahoney P, Davidson C, Petrossian G, Guerrero M, Koulogiannis K, Marcoff L, Gillam L. Early outcomes from the CLASP IID trial roll-in cohort for prohibitive risk patients with degenerative mitral regurgitation. Catheter Cardiovasc Interv 2021; 98:E637-E646. [PMID: 34004077 DOI: 10.1002/ccd.29749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/21/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We report the 30-day outcomes from the roll-in cohort of the CLASP IID trial, representing the first procedures performed by each site. BACKGROUND The currently enrolling CLASP IID/IIF pivotal trial is a multicenter, prospective, randomized trial assessing the safety and effectiveness of the PASCAL transcatheter valve repair system in patients with clinically significant MR. The trial allows for up to three roll-in patients per site. METHODS Eligibility criteria were: DMR ≥3+, prohibitive surgical risk, and deemed suitable for transcatheter repair by the local heart team. Trial oversight included a central screening committee and echocardiographic core laboratory. The primary safety endpoint was a 30-day composite MAE: cardiovascular mortality, stroke, myocardial infarction (MI), new need for renal replacement therapy, severe bleeding, and non-elective mitral valve re-intervention, adjudicated by an independent clinical events committee. Thirty-day echocardiographic, functional, and quality of life outcomes were assessed. RESULTS A total of 45 roll-in patients with mean age of 83 years and 69% in NYHA class III/IV were treated. Successful implantation was achieved in 100%. The 30-day composite MAE rate was 8.9% including one cardiovascular death (2.2%) due to severe bleeding from a hemorrhagic stroke, one MI, and no need for re-intervention. MR≤1+ was achieved in 73% and ≤2+ in 98% of patients. 89% of patients were in NYHA class I/II (p < .001) with improvements in 6MWD (30 m; p = .054) and KCCQ (17 points; p < .001). CONCLUSIONS Early results representing sites with first experience with the PASCAL repair system showed favorable 30-day outcomes in patients with DMR≥3+ at prohibitive surgical risk.
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Affiliation(s)
- D Scott Lim
- Department of Medicine, Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Robert L Smith
- Department of Surgery, Division of Cardiovascular Surgery, Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Firas Zahr
- Department of Medicine, Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Abhijeet Dhoble
- Department of Medicine, Division of Cardiovascular Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Roger Laham
- Department of Medicine, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohamad Lazkani
- Department of Medicine, Division of Cardiovascular Medicine, UCHealth Medical Center of the Rockies, Loveland, Colorado, USA
| | - Susheel Kodali
- Department of Medicine, Division of Cardiovascular Medicine, Columbia University Medical Center, New York, New York, USA
| | - Chad Kliger
- Department of Medicine, Division of Cardiovascular Medicine, Northwell-Lenox Hill, New York, New York, USA
| | - James Hermiller
- Department of Medicine, Division of Cardiovascular Medicine, St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Amit Vora
- Department of Medicine, Division of Cardiovascular Medicine, UPMC Pinnacle Health Harrisburg, Harrisburg, Pennsylvania, USA
| | - Ian J Sarembock
- Department of Medicine, Division of Cardiovascular Medicine, The Christ Hospital and Lindner Clinical Research Center, Cincinnati, Ohio, USA
| | - William Gray
- Department of Medicine, Division of Cardiovascular Medicine, Lankenau Heart Institute, Wynnewood, Pennsylvania, USA
| | - Samir Kapadia
- Department of Medicine, Division of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Adam Greenbaum
- Department of Medicine, Division of Cardiovascular Medicine, Emory University, Atlanta, Georgia, USA
| | - Andrew Rassi
- Department of Medicine, Division of Cardiovascular Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - David Lee
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Adnan Chhatriwalla
- Department of Medicine, Division of Cardiovascular Medicine, Saint Luke's Hospital of Kansas City, Kansas City, Missouri, USA
| | - Pinak Shah
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Josep Rodés-Cabau
- Department of Medicine, Division of Cardiovascular Medicine, Laval Hospital, Quebec City, Quebec, Canada
| | - Homam Ibrahim
- Department of Medicine, Division of Cardiovascular Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Lowell Satler
- Department of Medicine, Division of Cardiovascular Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Howard C Herrmann
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Mahoney
- Department of Medicine, Division of Cardiovascular Medicine, Sentara Norfolk General Hospital, Norfolk, Virginia, USA
| | - Charles Davidson
- Department of Medicine, Division of Cardiovascular Medicine, Northwestern University, Chicago, Illinois, USA
| | - George Petrossian
- Department of Medicine, Division of Cardiovascular Medicine, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Mayra Guerrero
- Department of Medicine, Division of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Konstantinos Koulogiannis
- Department of Medicine, Division of Cardiovascular Medicine, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Leo Marcoff
- Department of Medicine, Division of Cardiovascular Medicine, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Linda Gillam
- Department of Medicine, Division of Cardiovascular Medicine, Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
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