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Al-kaisey A, Parameswaran R, Anderson R, Hawson J, Chieng D, Sugumar H, Nam M, Tonchev I, Watts T, McLellan A, Kistler P, Lee G, Kalman J. Left and Right Atrial Septal Phase Mapping of Persistent Atrial Fibrillation: Marked Electrical Dissociation and Heterogeneous Activation Patterns. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kistler P, Chieng D, Tonchev I, Sugumar H, McLellan A, Prabhu S, Voskoboinik A, Schwartz L, Parameswaran R, Anderson R, Al-Kaisey A, Ling L, Lee G, Kalman J. P-wave Morphology in Focal Atrial Tachycardia: An Updated 2021 Algorithm to Predict Site of Origin. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Turyan Medvedovsky A, Tahiroglu I, Tonchev I, Planer D, Danenberg H, Beeri R, Shuvy M. MitraClip therapy in patients with acute severe mitral regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1956] [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
There is a lack of data to support the optimal management of high-risk patients with acute severe mitral regurgitation (MR). The role of the MitraClip implantation in treatment of acute severe mitral regurgitation (MR) is undetermined.
Methods
We screened all patients who underwent MitraClip implantation at the Hadassah Medical Center between October 2015 and December 2019. We evaluated immediate, 30-day and 1-year outcomes after the procedure. We evaluated patients with severe MR due to ruptured cord because of degenerative disease and acute-on-chronic functional MR due to ischemic (after a recent myocardial infarction (MI)) or non-ischemic etiology (secondary to decompensated HF).
Results
From a cohort of 151 patients, who underwent MitraClip implantation in our center, we identified 35 patients (23.2%) with acute severe mitral regurgitation (4+) and decompensated refractory heart failure. Patients' mean age was 74.15 years, 66.9% - were males. One, 2, or 3 clips were implanted. Reduction of MR from 4+ to 1+ was achieved in 34 patients (66.7%). Twenty-eight patients (80%) had acute-on-chronic severe MR and refractory heart failure including 6 cases after recent MI, other 7 patients presented with heart failure and acute severe MR secondary to ruptured cord due to degenerative disease. After MitraClip implantation, reduction of MR severity was achieved in all patients. Seven patients were withdrawn from intravenous therapy and intra-aortic balloon pump 2–3 days after the procedure. Four patients died during hospitalization, three of them due to sepsis. 30-day follow-up showed improvement of NYHA functional class and a tendency toward improvement in left ventricle systolic function with signs of reverse remodeling. Nevertheless, we observed high 30-day and 1-year mortality rate (11.4 and 23.8% respectively).
Conclusions
MitraClip therapy could be an alternative option for treatment of patients with acute and acute-on-chronic severe MR of ischemic and non-ischemic etiology.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - I Tahiroglu
- Hadassah University Medical Center, Heart Institute, Jerusalem, Israel
| | - I Tonchev
- Hadassah University Medical Center, Heart Institute, Jerusalem, Israel
| | - D Planer
- Hadassah University Medical Center, Heart Institute, Jerusalem, Israel
| | - H.D Danenberg
- Hadassah University Medical Center, Heart Institute, Jerusalem, Israel
| | - R Beeri
- Hadassah University Medical Center, Heart Institute, Jerusalem, Israel
| | - M Shuvy
- Hadassah University Medical Center, Heart Institute, Jerusalem, Israel
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Rashi Y, Turyan Medvedovsky A, Tonchev I, Perez A, Elioz R, Lotan C, Gilon D, Planer D, Danenberg H, Beeri R, Shuvy M. Echocardiographic and clinical outcomes of MitraClip therapy in patients with severe mitral regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2648] [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
MitraClip implantation improves mitral regurgitation (MR), however its impact on pulmonary hypertension (PHT) is not fully elucidated. Our hypothesis was that changes in pulmonary pressure after MitraClip implantation might predict outcomes.
Methods
We studied a cohort of 149 consecutive patients who underwent MitraClip implantation between August 2015 and September 2019. We compared echocardiographic and clinical variables between a group with not-severe PHT and a group with severe PHT according to Pulmonary artery systolic pressure (PASP) >55 mmHg.
Results
Mean age of the cohort was 73±10 years, 75% were men, and 80% had functional MR. There are no differences in baseline characteristics between the two groups. There was a significant reduction of 13.6 mmHg in PASP at the severe PHT group from 68.2±10.9 mmHg before the procedure to 54.6±14.9 after (P=0.001) compared to the absence of a significant change in the second group. This reduction was maintained in the 6 months follow-up. Although PHT is considered a poor prognostic measure, and the severe PHT group had a baseline PASP higher than the not-severe group (P<0.001), however the Kaplan Meier curve did not show any significant difference in overall survival (p=0.468), and there is also no difference in one-year survival.
Conclusions
MitraClip therapy improves PASP in patients with severe MR and severe PHT. These patients showed the same survival as patients with not-severe PHT. MitraClip is a safety and effective procedure even for patients with severe PHT, that should not be excluded.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Rashi
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | | | - I Tonchev
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - A Perez
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - R Elioz
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - C Lotan
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - D Gilon
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - D Planer
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - H.D Danenberg
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - R Beeri
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
| | - M Shuvy
- Hadassah - Hebrew University Medical Center Jerusalem, Jerusalem, Israel
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