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Mesnier J, Simard T, Jung RG, Lehenbauer KR, Piayda K, Pracon R, Jackson GG, Flores-Umanzor E, Faroux L, Korsholm K, Chun JKR, Chen S, Maarse M, Montrella K, Chaker Z, Spoon JN, Pastormerlo LE, Meincke F, Sawant AC, Moldovan CM, Qintar M, Aktas MK, Branca L, Radinovic A, Ram P, El-Zein RS, Flautt T, Ding WY, Sayegh B, Benito-González T, Lee OH, Badejoko SO, Paitazoglou C, Karim N, Zaghloul AM, Agarwal H, Kaplan RM, Alli O, Ahmed A, Suradi HS, Knight BP, Alla VM, Panaich SS, Wong T, Bergmann MW, Chothia R, Kim JS, Pérez de Prado A, Bazaz R, Gupta D, Valderrábano M, Sanchez CE, El Chami MF, Mazzone P, Adamo M, Ling F, Wang DD, O'Neill W, Wojakowski W, Pershad A, Berti S, Spoon DB, Kawsara A, Jabbour G, Boersma LVA, Schmidt B, Nielsen-Kudsk JE, Freixa X, Ellis CR, Fauchier L, Demkow M, Sievert H, Main ML, Hibbert B, Holmes DR, Alkhouli M, Rodés-Cabau J. Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes. JACC Cardiovasc Interv 2023; 16:2722-2732. [PMID: 38030358 DOI: 10.1016/j.jcin.2023.09.017] [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: 06/14/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). OBJECTIVES This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. METHODS Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. RESULTS DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). CONCLUSIONS About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.
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Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Richard G Jung
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kyle R Lehenbauer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kerstin Piayda
- CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | - Radoslaw Pracon
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Eduardo Flores-Umanzor
- Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Moniek Maarse
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Kristi Montrella
- Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Zakeih Chaker
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Jocelyn N Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Luigi E Pastormerlo
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Carmen M Moldovan
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mohammed Qintar
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA; Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan
| | - Mehmet K Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Luca Branca
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Radinovic
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Pradhum Ram
- Emory University Hospital, Atlanta, Georgia, USA
| | - Rayan S El-Zein
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Bassel Sayegh
- Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA
| | | | - Oh-Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Solomon O Badejoko
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | | | - Nabeela Karim
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ahmed M Zaghloul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Rachel M Kaplan
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Oluseun Alli
- Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aamir Ahmed
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Bradley P Knight
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Venkata M Alla
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Rashaad Chothia
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Carlos E Sanchez
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Fred Ling
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ashish Pershad
- Chandler Regional Medical Center, Chandler, Arizona, USA
| | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel B Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - George Jabbour
- Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Lucas V A Boersma
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | | | - Xavier Freixa
- Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Horst Sievert
- Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA
| | - Michael L Main
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Benjamin Hibbert
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
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Benito-González T, Ellis C, Sawant A, Jabbour G, Torres-Saura F, Suradi H, Cruz-Gonzalez I, D'Angelo G, Ruiz-Nodar J, Valero E, Alli S, Pershad A, Nielsen-Kudsk JE, Adamo M, Bazaz R, Perez GC, Piayda K, El Chami M, Agarwal H, Sanchez C, Estevez-Loureiro R, Millán X, Aktas M, Pérez de Prado A. CRT-700.55 Left Atrial Appendage Occlusion With Watchman® Device in Patients With Non-Valvular Atrial Fibrillation and End-Stage Chronic Kidney Disease on Hemodialysis (EPIC06 - WATCH-HD). JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.323] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Adamo M, Inciardi RM, Tomasoni D, Dallapellegrina L, Estévez-Loureiro R, Stolfo D, Lupi L, Pancaldi E, Popolo Rubbio A, Giannini C, Benito-González T, Fernández-Vázquez F, Caneiro-Queija B, Godino C, Munafò A, Pascual I, Avanzas P, Frea S, Boretto P, Moñivas Palomero V, Del Trigo M, Biagini E, Berardini A, Nombela-Franco L, Jimenez-Quevedo P, Lipsic E, Saia F, Petronio AS, Bedogni F, Sinagra G, Guazzi M, Voors A, Metra M. Changes in Right Ventricular-to-Pulmonary Artery Coupling After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation. JACC Cardiovasc Imaging 2022; 15:2038-2047. [PMID: 36481071 DOI: 10.1016/j.jcmg.2022.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 04/06/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preprocedural right ventricular-to-pulmonary artery (RV-PA) coupling is a major predictor of outcome in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER). However, clinical significance of changes in RV-PA coupling after M-TEER is unknown. OBJECTIVES The aim of this study was to evaluate changes in RV-PA coupling after M-TEER, their prognostic value, and predictors of improvement. METHODS This was a retrospective observational study, including patients undergoing successful M-TEER (residual mitral regurgitation ≤2+ at discharge) for SMR at 13 European centers and with complete echocardiographic data at baseline and short-term follow-up (30-180 days). RV-PA coupling was assessed with the use of echocardiography as the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). All-cause death was assessed at the longest available follow-up starting from the time of the echocardiographic reassessment. RESULTS Among 501 patients included, 331 (66%) improved their TAPSE/PASP after M-TEER (responders) at short-term follow-up (median: 89 days; IQR: 43-159 days), whereas 170 (34%) did not (nonresponders). Lack of previous cardiac surgery, low postprocedural mitral mean gradient, low baseline TAPSE, high baseline PASP, and baseline tricuspid regurgitation were independently associated with TAPSE/PASP improvement after M-TEER. Compared with nonresponders, responders had lower New York Heart Association functional class and less heart failure hospitalizations at short-term follow-up. Improvement in TAPSE/PASP was independently associated with reduced risk of mortality at long-term follow-up (584 days; IQR: 191-1,243 days) (HR: 0.65 [95% CI: 0.42-0.92]; P = 0.017). CONCLUSIONS In patients with SMR, improvement in TAPSE/PASP after successful M-TEER is predicted by baseline clinical and echocardiographic variables and postprocedural mitral gradient, and is associated with a better outcome.
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Affiliation(s)
- Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Maria Inciardi
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Lucia Dallapellegrina
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Davide Stolfo
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Lupi
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | | | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Andrea Munafò
- Division of Cardiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Simone Frea
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Paolo Boretto
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | | | - Maria Del Trigo
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Elena Biagini
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Alessandra Berardini
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Erik Lipsic
- University Medical Center Groningen, Groningen, the Netherlands
| | - Francesco Saia
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy
| | - Marco Guazzi
- University Medical Center Groningen, Groningen, the Netherlands
| | - Adriaan Voors
- University Medical Center Groningen, Groningen, the Netherlands
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
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Barrero A, Carrasco-Chinchilla F, Benito-González T, Pascual I, Arzamendi D, Estévez-Loureiro R, Nombela-Franco L, Pan M, Freixa X, Trillo-Nouche R, Sánchez-Recalde Á, Andraka L, Cruz-González I, López-Mínguez JR, Diez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchis J, Bosa F, Ruiz V, Del Trigo M, Molina E, Serrador AM, Alonso-Briales JH, Garrote C, Avanzas P, Li CH, Baz JA, Jiménez-Quevedo P, Mesa D, Regueiro A, Cid B, Carrasco-Moraleja M, Rodríguez-Gabella T, Hernández-García JM, Fernández-Vázquez F, Amat-Santos IJ. Temporal trend and potential impact of angiotensin receptor neprilysin inhibitors on transcatheter edge-to-edge mitral valve repair. Rev Esp Cardiol (Engl Ed) 2022; 75:1001-1010. [PMID: 35272968 DOI: 10.1016/j.rec.2022.02.001] [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] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter edge-to-edge repair (TEER) should be considered in patients with heart failure and secondary mitral regurgitation (MR). Angiotensin receptor-neprilysin inhibitors (ARNIs) have been demonstrated to improve prognosis in heart failure. We aimed to evaluate the impact ARNIs on patient selection and outcomes. METHODS The population of the Spanish TEER prospective registry (March 2012 to January 2021) was divided into 2 groups: a) TEER before the ARNI era (n=450) and b) TEER after the recommendation of ARNIs by European Guidelines (n=639), with further analysis according to intake (n=52) or not (n=587) of ARNIs. RESULTS A total of 1089 consecutive patients underwent TEER for secondary MR. In the ARNI era, there was a reduction in left ventricle dilation (82mL vs 100mL, P=.025), and better function (35% vs 38%, P=.011). At 2 years of follow-up, mortality (10.6% vs 17.3%, P <.001) and heart failure readmissions (16.6% vs 27.8%, P <.001) were lower in the ARNI era, but not recurrent MR. In the ARNI era, 1- and 2-year mortality were similar irrespective of ARNI intake but patients on ARNIs had a lower risk of readmission+mortality at 2 years (OR, 0.369; 95%CI, 0.137-0.992; P=.048), better NYHA class, and lower recurrence of MR III-IV (1.9% vs 14.3%, P=.011). CONCLUSIONS Better patient selection for TEER has been achieved in the last few years with a parallel improvement in outcomes. The use of ARNIs was associated with a significant reduction in overall events, better NYHA class, and lower MR recurrence.
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Affiliation(s)
- Alejandro Barrero
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Fernando Carrasco-Chinchilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Tomás Benito-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Isaac Pascual
- Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Dabit Arzamendi
- Departamento de Cardiología, Hospital Sant Pau, Barcelona, Spain
| | | | | | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Xavier Freixa
- Departamento de Cardiología, Hospital Clinic, Barcelona, Spain
| | - Ramiro Trillo-Nouche
- Departamento de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Leire Andraka
- Departamento de Cardiología, Hospital Civil de Basurto, Bilbao, Vizcaya, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | - José Luis Diez Gil
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Francisco Bosa
- Departamento de Cardiología, Hospital Universitario, Canarias, Spain
| | - Valeriano Ruiz
- Departamento de Cardiología, Complejo Hospitalario, Navarra, Spain
| | - María Del Trigo
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Eduardo Molina
- Departamento de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Ana M Serrador
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Juan H Alonso-Briales
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Carmen Garrote
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Pablo Avanzas
- Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Chi Hion Li
- Departamento de Cardiología, Hospital Sant Pau, Barcelona, Spain
| | - José Antonio Baz
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Dolores Mesa
- Departamento de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clinic, Barcelona, Spain
| | - Belén Cid
- Departamento de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuel Carrasco-Moraleja
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Tania Rodríguez-Gabella
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José M Hernández-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Felipe Fernández-Vázquez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Adamo M, Pagnesi M, Ghizzoni G, Estévez-Loureiro R, Raposeiras-Roubin S, Tomasoni D, Stolfo D, Sinagra G, Popolo Rubbio A, Bedogni F, De Marco F, Giannini C, Petronio AS, Stazzoni L, Benito-González T, Fernández-Vázquez F, Garrote-Coloma C, Godino C, Agricola E, Munafò A, Pascual I, Avanzas P, Léon V, Montefusco A, Boretto P, Pidello S, Moñivas-Palomero V, Del Trigo M, Biagini E, Berardini A, Saia F, Nombela-Franco L, Tirado-Conte G, De Augustin A, Caneiro-Queija B, De Luca A, Branca L, Zaccone G, Lupi L, Lipsic E, Voors A, Metra M. Evolution of tricuspid regurgitation after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation and its impact on mortality. Eur J Heart Fail 2022; 24:2175-2184. [PMID: 36482160 PMCID: PMC10086984 DOI: 10.1002/ejhf.2637] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/21/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 01/18/2023] Open
Abstract
AIM To evaluate short-term changes in tricuspid regurgitation (TR) after transcatheter edge-to-edge mitral valve repair (M-TEER) in secondary mitral regurgitation (SMR), their predictors and impact on mortality. METHODS AND RESULTS This is a retrospective analysis of SMR patients undergoing successful M-TEER (post-procedural mitral regurgitation ≤2+) at 13 European centres. Among 503 patients evaluated 79 (interquartile range [IQR] 40-152) days after M-TEER, 173 (35%) showed ≥1 degree of TR improvement, 97 (19%) had worsening of TR, and 233 (46%) remained unchanged. Smaller baseline left atrial diameter and residual mitral regurgitation 0/1+ were independent predictors of TR ≤2+ after M-TEER. There was a significant association between TR changes and New York Heart Association class and pulmonary artery systolic pressure decrease at echocardiographic re-assessment. At a median follow-up of 590 (IQR 209-1103) days from short-term echocardiographic re-assessment, all-cause mortality was lower in patients with improved compared to those with unchanged/worsened TR (29.6% vs. 42.3% at 3 years; log-rank p = 0.034). Baseline TR severity was not associated with mortality, whereas TR 0/1+ and 2+ at short-term follow-up was associated with lower all-cause mortality compared to TR 3/4+ (30.6% and 35.6% vs. 55.6% at 3 years; p < 0.001). A TR ≤2+ after M-TEER was independently associated with a 42% decreased risk of mortality (p = 0.011). CONCLUSION More than one third of patients with SMR undergoing successful M-TEER experienced an improvement in TR. Pre-procedural TR was not associated with outcome, but a TR ≤2+ at short-term follow-up was independently associated with long-term mortality. Optimal M-TEER result and a small left atrium were associated with a higher likelihood of TR ≤2+ after M-TEER.
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Affiliation(s)
- Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Ghizzoni
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Stolfo
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy
| | | | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Laura Stazzoni
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | | | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Eustachio Agricola
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Andrea Munafò
- Division of Cardiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Victor Léon
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Antonio Montefusco
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Paolo Boretto
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | - Stefano Pidello
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Torino, Italy
| | | | - Maria Del Trigo
- Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elena Biagini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Berardini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Alberto De Augustin
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Antonio De Luca
- Department of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and Univeristy Hospital of Trieste, Trieste, Italy
| | - Luca Branca
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gregorio Zaccone
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Laura Lupi
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Erik Lipsic
- University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan Voors
- University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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6
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Witberg G, Landes U, Talmor-Barkan Y, Richter I, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Codner P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Bunc M, Tarantini G, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Center Valve Preference and Outcomes of Transcatheter Aortic Valve Replacement: Insights From the AMTRAC Registry. JACC Cardiovasc Interv 2022; 15:1266-1274. [PMID: 35738747 DOI: 10.1016/j.jcin.2022.05.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Data on outcomes of transcatheter aortic valve replacement (TAVR) using balloon-expandable valves (BEVs) or self-expandable valves (SEVs) as well as the impact of center valve preference on these outcomes are limited. OBJECTIVES The aim of this study was to compare outcomes of TAVR procedures using third-generation BEVs and SEVs stratified by center valve preference. METHODS In a multicenter registry (n = 17), 13 centers exhibited valve preference (66.6%-90% of volume) and were included. Outcomes were compared between BEVs and SEVs stratified by center valve preference. RESULTS In total, 7,528 TAVR procedures (3,854 with SEVs and 3,674 with BEVs) were included. The mean age was 81 years, and the mean Society of Thoracic Surgeons score was 5.2. Baseline characteristics were similar between BEVs and SEVs. Need for pacemaker implantation was higher with SEVs at BEV- and SEV-dominant centers (17.8% vs 9.3% [P < 0.001] and 12.7% vs 10.0% [P = 0.036], respectively; HR: 1.51; P for interaction = 0.021), risk for cerebrovascular accident was higher with SEVs at BEV-dominant but not SEV-dominant centers (3.6% vs 1.1% [P < 0.001] and 2.2% vs 1.4% [P = 0.162]; HR: 2.08; P for interaction < 0.01). Aortic regurgitation greater than mild was more frequent with SEVs at BEV-dominant centers and similar with BEVs regardless of center dominance (5.2% vs 2.8% [P < 0.001] and 3.4% vs 3.7% [P = 0.504], respectively). Two-year mortality was higher with SEVs at BEV-dominant centers but not at SEV-dominant centers (21.9% vs 16.9% [P = 0.021] and 16.8% vs 16.5% [P = 0.642], respectively; HR: 1.20; P for interaction = 0.032). CONCLUSIONS Periprocedural outcomes, aortic regurgitation greater than mild, and 2-year mortality are worse when TAVR is performed using SEVs at BEV-dominant centers. Outcomes are similar regardless of valve type at SEV-dominant centers. The present results stress the need to account for this factor when comparing BEV and SEV outcomes. (The Aortic+Mitral Transcatheter [AMTRAC] Valve Registry; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Uri Landes
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Richter
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carmelo Grasso
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Matjaz Bunc
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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7
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Barrero A, Carrasco-Chinchilla F, Benito-González T, Pascual I, Arzamendi D, Estévez-Loureiro R, Nombela-Franco L, Pan M, Freixa X, Trillo-Nouche R, Sánchez-Recalde Á, Andraka L, Cruz-González I, López-Mínguez JR, Diez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchis J, Bosa F, Ruiz V, del Trigo M, Molina E, Serrador AM, Alonso-Briales JH, Garrote C, Avanzas P, Li CH, Baz JA, Jiménez-Quevedo P, Mesa D, Regueiro A, Cid B, Carrasco-Moraleja M, Rodríguez-Gabella T, Hernández-García JM, Fernández-Vázquez F, Amat-Santos IJ. Cambios en la selección e impacto potencial de los inhibidores de neprilisina y del receptor de la angiotensina en los pacientes sometidos a reparación mitral percutánea borde a borde. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.02.001] [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: 11/16/2022]
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8
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Vega B, de Prado AP, Rondán J, Cuellas-Ramón C, Miguel Vegas J, López Benito M, Benito-González T, Segovia E, Fernández-Vázquez e F, Lozano Í. Velocidad de desinflado del sistema de liberaci�n del <i>stent</i> en la angioplastia primaria: estudio aleatorizado. RECIC 2022. [DOI: 10.24875/recic.m21000230] [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: 11/17/2022] Open
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9
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Cepas-Guillen PL, López-Mínguez JR, García JCN, Nombela-Franco L, Benito-González T, Cruz-González I, Freixa X. Left atrial appendage occlusion in hereditary haemorrhagic telangiectasia patients (Rendu Osler Syndrome) with non-valvular atrial fibrillation: Prevention of cardioembolic events while avoiding the long-term risks of oral anticoagulation. Cardiovascular Revascularization Medicine 2022; 43:140-142. [DOI: 10.1016/j.carrev.2022.04.005] [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] [Received: 10/26/2021] [Revised: 03/26/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
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10
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Fernández-Peregrina E, Pascual I, Freixa X, Tirado-Conte G, Estévez-Loureiro R, Carrasco-Chinchilla F, Benito-González T, Asmarats L, Sanchís L, Jiménez-Quevedo P, Avanzas P, Caneiro-Queija B, Molina-Ramos AI, Fernández-Vázquez F, Li CH, Flores-Umanzor E, Sans-Roselló J, Nombela-Franco L, Arzamendi D. Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification. EUROINTERVENTION 2022; 17:1300-1309. [PMID: 34483091 PMCID: PMC9743252 DOI: 10.4244/eij-d-21-00205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/23/2022]
Abstract
BACKGROUND MAC is commonly found in patients affected with MR, and it is associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge repair could be an alternative treatment, although there is little evidence in this population. AIMS The aim of this study was to analyse the safety, efficacy and durability of MitraClip implantation in patients affected with mitral regurgitation (MR) and mitral annulus calcification (MAC). METHODS We analysed the outcomes of 61 suitable patients affected with severe MR and moderate or severe MAC (the "MAC" group) and 791 patients with no or mild MAC (the "NoMAC" group) treated with the MitraClip device. RESULTS Procedural success was similar (91.8% vs 95.1%, p=0.268, in MAC and NoMAC, respectively), with a very low rate of complications. At one-year follow-up, 90.6% of MAC and 79.5% of NoMAC patients had MR grade ≤2 (p=0.129), 80% in both groups remained in NYHA Functional Class ≤II, and a significant reduction in cardiac readmissions was observed (65% vs 78% in MAC vs NoMAC, p=0.145). One-year mortality tended to be higher in MAC patients (19.7% vs 11.3%, p=0.050), with no difference in cardiovascular mortality (15.3% vs 9.2%, p=0.129). CONCLUSIONS MitraClip use in selected patients with moderate or severe MAC is safe, feasible and achieves good clinical and echocardiographic results at one-year follow-up.
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Affiliation(s)
- Estefanía Fernández-Peregrina
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Xavier Freixa
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | | | | | | | - Lluis Asmarats
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Sanchís
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Chi-Hion Li
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jordi Sans-Roselló
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
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11
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Echarte-Morales J, Minguito-Carazo C, Cepas-Guillén PL, Vallejo García V, Poveda Pinedo ID, Martínez Gómez E, Sánchez Muñoz E, López Benito M, Salazar Rodríguez A, Cruz-González I, Arbas Redondo E, Benito-González T, Guzmán-Bofarull J, Tebar Márquez D, Viana Tejedor A, Sánchez Fernández PL, Sabaté y M, Fernández-Vázquez F. Incidencia, morbimortalidad y manejo del s�ndrome coronario agudo durante el confinamiento por COVID-19. RECIC 2022. [DOI: 10.24875/recic.m22000267] [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: 11/17/2022] Open
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12
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Benito-González T, Quirós A, Torres-Saura F, Cruz-González I, Ruiz-Nodar JM, Pérez de Prado A. Diseño y resultados intermedios del registro de cierre de orejuela izquierda con el dispositivo Watchman en pacientes en hemodiálisis, EPIC06-WATCH-HD. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.07.016] [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: 10/20/2022]
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13
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Benito-González T, Quirós A, Torres-Saura F, Cruz-González I, Ruiz-Nodar JM, Pérez de Prado A. Design and interim results of a registry of left atrial appendage occlusion with the Watchman device in patients on hemodialysis: EPIC06-WATCH-HD. Rev Esp Cardiol (Engl Ed) 2022; 75:179-180. [PMID: 34475001 DOI: 10.1016/j.rec.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Alicia Quirós
- Departamento de Matemáticas, Universidad de León, León, Spain
| | - Francisco Torres-Saura
- Servicio de Cardiología, Hospital Universitario de Elche-Vinalopó, Elche, Alicante, Spain
| | - Ignacio Cruz-González
- Servicio de Cardiología, Hospital Universitario de Salamanca, IBSAL, Instituto de Biomedicina Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Juan M Ruiz-Nodar
- Servicio de Cardiología, Hospital General de Alicante, Alicante, Spain
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14
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Benito-González T, Carrasco-Chinchilla F, Estévez-Loureiro R, Pascual I, Arzamendi D, Garrote-Coloma C, Nombela-Franco L, Pan M, Serrador A, Freixa X, Cid Alvarez AB, Hernández Antolín RA, Andraka L, Cruz-González I, López-Minguez JR, Díez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchís J, Bosa F, Ruíz V, Molina E, Becerra-Muñoz VM, Gualis J, Avanzas P, Li CH, Baz JA, Jimenez-Quevedo P, Mesa D, Amat-Santos IJ, Regueiro A, Trillo R, Domínguez Franco AJ, Alonso-Briales JH, Fernández-Vázquez F. Clinical and echocardiographic outcomes of transcatheter mitral valve repair in atrial functional mitral regurgitation. Int J Cardiol 2021; 345:29-35. [PMID: 34610357 DOI: 10.1016/j.ijcard.2021.09.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/09/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Isolated atrial fibrillation can cause mitral regurgitation (MR) in patients with normal left ventricular systolic function and no organic disease of the mitral valve. Little information is available regarding outcomes of Mitraclip in patients with atrial functional mitral regurgitation (AFMR). We aimed to evaluate 12-month clinical and echocardiographic outcomes of transcatheter mitral valve repair (TMVR) with MitraClip in patients with AFMR compared to those with ventricular functional or degenerative/mixed MR. METHODS Registry-based analysis of all consecutive patients who underwent TMVR and were included in the Spanish Registry of Mitraclip. Changes in MR and NYHA functional class, and a combined endpoint including all-cause mortality and hospitalizations due to heart failure were the main outcomes. RESULTS Overall, 1074 (69.1% male, 73.3 ± 10.2 years-old) patients were analyzed in this report. 48 patients (4.5%) presented AFMR. AFMR was significantly reduced after TMVR, with a procedural success rate of 91.7%, and this reduction persisted at 12-month (p < 0.001). Patients with AFMR showed a significant functional improvement at 6- and 12-month follow-up in our series (baseline: NYHA III 70.8% IV 18.8% vs. 1-year: NYHA III 21.7% IV 0%; p < 0.001). The probability of survival free of readmission for heart failure and all-cause mortality within the first year after TMVR was 74.9%. Procedural and clinical outcomes, as well as recurrent rates of MR were similar acutely and at 1-year compared to other etiologies. CONCLUSION TMVR in patients with AFMR showed no significant differences compared to ventricular functional or degenerative/mixed MR regarding MR reduction or clinical outcomes.
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Affiliation(s)
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | | | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Dabit Arzamendi
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Manuel Pan
- Department of Cardiology, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Ana Serrador
- Department of Cardiology, University Clinic Hospital, CIBERCV, Valladolid, Spain
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Ana Belén Cid Alvarez
- Department of Cardiology, University Clinic Hospital, CIBERCV, Santiago de Compostela, Spain
| | | | - Leire Andraka
- Department of Cardiology, Hospital Universitario de Basurto, Bilbao, Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Hospital Universitario de Salamanca, CIBERCV, IBSAL, Salamanca, Spain
| | | | - José Luis Díez Gil
- Department of Cardiology, Hospital Universitario y Politécnico La FE, Valencia, Spain
| | | | - Darío Sanmiguel Cervera
- Unidad de Hemodinámica y Cardiologia Intervencionista, Hospital General de Valencia, Valencia, Spain
| | - Juan Sanchís
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Francisco Bosa
- Department of Cardiology, Hospital Universitario de Canarias, Islas Canarias, Spain
| | - Valeriano Ruíz
- Department of Cardiology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Eduardo Molina
- Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Javier Gualis
- Department of Cardiology, University Hospital of León, León, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Chi Hion Li
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José Antonio Baz
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Dolores Mesa
- Department of Cardiology, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | - Ander Regueiro
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Ramiro Trillo
- Department of Cardiology, University Clinic Hospital, CIBERCV, Santiago de Compostela, Spain
| | - Antonio Jesús Domínguez Franco
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
| | - Juan Horacio Alonso-Briales
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, CIBERCV, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain
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15
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Hidalgo F, Gonzalez-Manzanares R, Ojeda S, Benito-González T, Gutiérrez-Barrios A, De la Torre Hernández JM, Minguito-Carazo C, Izaga-Torralba E, Cabrera-Rubio I, Flores-Vergara G, de Lezo JS, Romero-Moreno M, de Prado AP, Pan M. Instantaneous wave-free ratio for guiding treatment of nonculprit lesions in patients with acute coronary syndrome: A retrospective study. Catheter Cardiovasc Interv 2021; 99:489-496. [PMID: 34862839 DOI: 10.1002/ccd.30025] [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: 06/05/2021] [Revised: 10/25/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave-free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized. METHODS A multicenter registry including patients of four high-volume PCI centers with ACS and underwent successful revascularization of the culprit vessel and had other nonculprit lesions that were physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, probable or definitive stent thrombosis and new revascularization (MACEs). RESULTS A total of 356 patients with 472 nonculprit lesions were included. The mean age was 66 ± 11 years. The clinical presentation was ACS without persistent ST-segment elevation (NSTE-ACS) in 235 patients (66%) and ST-segment elevation myocardial infarction (STEMI) in 121 patients (34%). After a median follow-up period of 21 (14-30) months, the primary endpoint occurred in 32 patients (9%). There were no differences in outcomes regarding clinical presentation (NSTEMI vs. NSTE-ACS, 9.1 vs. 8.9%, padj = 0.570) or iFR induced treatment strategy (patients with all lesions revascularized vs. patients with at least one lesion with an iFR > 0.89 deferred for revascularization, 10.5 vs. 8.4%, padj = 0.476). CONCLUSIONS The use of the iFR to guide percutaneous coronary intervention decision making in nonculprit lesions seems to be feasible, with an acceptable percentage of MACEs at the mid-term follow-up. Patients with deferred revascularization of lesions without physiological significance and patients undergoing complete revascularization had a similar risk of MACEs.
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Affiliation(s)
- Francisco Hidalgo
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Rafael Gonzalez-Manzanares
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Soledad Ojeda
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Tomás Benito-González
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | | | | | - Carlos Minguito-Carazo
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | | | - Indira Cabrera-Rubio
- Department of Cardiology, IDIVAL, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Guisela Flores-Vergara
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Javier Suárez de Lezo
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Miguel Romero-Moreno
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Armando Pérez de Prado
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | - Manuel Pan
- Reina Sofía Hospital, Department of Cardiology, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
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16
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Piayda K, Sievert K, Della Rocca D, Adeola O, Alkhouli M, Yoo D, Benito-González T, Cruz-Gonzalez I, Galea R, Skurk C, De Backer O, Nielsen-Kudsk JE, Grygier M, Beaty E, Newton J, Perez de Prado A, Raber L, Gibson D, Van Niekerk C, Ellis C, Horton R, Natale A, Grunwald I, Zeus T, Sievert H. TCT-310 Percutaneous Peridevice Leakage Closure After Insufficient Left Atrial Appendage Occlusion: Results From a Worldwide Collaborative Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1163] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Benito-González T, Carrasco F, Loureiro RE, Pascual I, Arzamendi D, Garrote C, Nombela-Franco L, Pan M, Serrador A, Freixa X, Andraka L, Cruz-Gonzalez I, Lopez-Minguez JR, Diez-Gil JL, Urbano Carrillo CA, Sanmiguel D, Fores JS, Quevedo VR, Navarro EM, Becerra-Muñoz V, Avanzas P, Li CH, Jimenez-Quevedo P, Rubio DM, Amat-Santos I, Regueiro A, Nouche RT, Brailes JA, Fernandez-Vazquez F. TCT-291 Clinical and Echocardiographic Outcomes of Transcatheter Mitral Valve Repair in Atrial Functional Mitral Regurgitation. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Witberg G, Sedaghat A, Mauri V, Arzamendi D, Estevez-Loureiro R, Benito-González T, Andreas M, Ruile P, Bunc M, Mylotte D, Tarantini G, Nombela-Franco L, Barbanti M, Sondergaard L, Van Mieghem N, Finkelstein A, Kornowski R. TCT-271 Outcomes of Transcatheter Aortic Valve Replacement Using Balloon vs Self-Expandable Valves Stratified by Center Valve Preference – Insights From the Multicenter Aortic+Mitral TRAnsCatheter (AMTRAC) Registry. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Rodríguez-Santamarta M, Estévez-Loureiro R, Pérez Martínez C, R. Altónaga J, Regueiro Purriños M, Cuellas Ramón C, López Benito M, Benito-González T, Alonso Rodríguez D, Viñuela Baragaño D, Gualis Cardona J, Gonzalo Orden JM, Minguito-Carazo C, Tundidor-Sanz E, Castillo García SD, de Prado AP, Castaño Ruiz M, Fernández-Vázquez F. Modelo experimental de insuficiencia mitral en modelo animal porcino. RECIC 2021. [DOI: 10.24875/recic.m20000122] [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: 11/17/2022] Open
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Witberg G, Codner P, Landes U, Barbanti M, Valvo R, De Backer O, Ooms JF, Sievert K, El Sabbagh A, Jimenez-Quevedo P, Brennan PF, Sedaghat A, Masiero G, Werner P, Overtchouk P, Watanabe Y, Montorfano M, Bijjam VR, Hein M, Fiorina C, Arzamendi D, Rodriguez-Gabella T, Fernández-Vázquez F, Baz JA, Laperche C, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat Santos IJ, Ruile P, Mylotte D, Buzzatti N, Piazza N, Andreas M, Tarantini G, Sinning JM, Spence MS, Nombela-Franco L, Guerrero M, Sievert H, Sondergaard L, Van Mieghem NM, Tchetche D, Webb JG, Kornowski R. Transcatheter Treatment of Residual Significant Mitral Regurgitation Following TAVR: A Multicenter Registry. JACC Cardiovasc Interv 2021; 13:2782-2791. [PMID: 33303117 DOI: 10.1016/j.jcin.2020.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 04/23/2020] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to describe baseline characteristics, and periprocedural and mid-term outcomes of patients undergoing transcatheter mitral valve interventions post-transcatheter aortic valve replacement (TAVR) and examine their clinical benefit. BACKGROUND The optimal management of residual mitral regurgitation (MR) post-TAVR is challenging. METHODS This was an international registry of 23 TAVR centers. RESULTS In total, 106 of 24,178 patients (0.43%) underwent mitral interventions post-TAVR (100 staged, 6 concomitant), most commonly percutaneous edge-to-edge mitral valve repair (PMVR). The median interval post-TAVR was 164 days. Mean age was 79.5 ± 7.2 years, MR was >moderate in 97.2%, technical success was 99.1%, and 30-day device success rate was 88.7%. There were 18 periprocedural complications (16.9%) including 4 deaths. During a median follow-up of 464 days, the cumulative risk for 3-year mortality was 29.0%. MR grade and New York Heart Association (NYHA) functional class improved dramatically; at 1 year, MR was moderate or less in 90.9% of patients (mild or less in 69.1%), and 85.9% of patients were in NYHA functional class I/II. Staged PMVR was associated with lower mortality versus medical treatment (57.5% vs. 30.8%) in a propensity-matched cohort (n = 156), but this was not statistically significant (hazard ratio: 1.75; p = 0.05). CONCLUSIONS For patients who continue to have significant MR, remain symptomatic post-TAVR, and are anatomically suitable for transcatheter interventions, these interventions are feasible, safe, and associated with significant improvement in MR grade and NYHA functional class. These results apply mainly to PMVR. A staged PMVR strategy was associated with markedly lower mortality, but this was not statistically significant. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | | | - Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Pavel Overtchouk
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Venu Reddy Bijjam
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Clemence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Nicola Buzzatti
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan Italy
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Martin Andreas
- Division of Cardiac Surgery Medical University of Vienna, Vienna, Austria
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Luis Nombela-Franco
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom; University of California San Francisco, San Francisco, California, USA; Yunnan Hospital Fuwai, Kunming, China
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Tchetche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Centre, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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21
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Echarte-Morales J, Benito-González T, Minguito-Carazo C, Castillo García SD, Prado y APD, Fernández-Vázquez F. Disección coronaria espontánea y crisis de migraña: una combinación excepcional en varones. RECIC 2021. [DOI: 10.24875/recic.m20000150] [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: 11/17/2022] Open
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22
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Simard T, Jung RG, Lehenbauer K, Piayda K, Pracoń R, Jackson GG, Flores-Umanzor E, Faroux L, Korsholm K, Chun JKR, Chen S, Maarse M, Montrella K, Chaker Z, Spoon JN, Pastormerlo LE, Meincke F, Sawant AC, Moldovan CM, Qintar M, Aktas MK, Branca L, Radinovic A, Ram P, El-Zein RS, Flautt T, Ding WY, Sayegh B, Benito-González T, Lee OH, Badejoko SO, Paitazoglou C, Karim N, Zaghloul AM, Agrawal H, Kaplan RM, Alli O, Ahmed A, Suradi HS, Knight BP, Alla VM, Panaich SS, Wong T, Bergmann MW, Chothia R, Kim JS, Pérez de Prado A, Bazaz R, Gupta D, Valderrabano M, Sanchez CE, El Chami MF, Mazzone P, Adamo M, Ling F, Wang DD, O'Neill W, Wojakowski W, Pershad A, Berti S, Spoon D, Kawsara A, Jabbour G, Boersma LVA, Schmidt B, Nielsen-Kudsk JE, Rodés-Cabau J, Freixa X, Ellis CR, Fauchier L, Demkow M, Sievert H, Main ML, Hibbert B, Holmes DR, Alkhouli M. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion. J Am Coll Cardiol 2021; 78:297-313. [PMID: 34294267 DOI: 10.1016/j.jacc.2021.04.098] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [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: 02/01/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. OBJECTIVES This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. METHODS Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. RESULTS A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. CONCLUSIONS DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. https://twitter.com/tjsimard
| | - Richard G Jung
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kyle Lehenbauer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kerstin Piayda
- CardioVascular Center Frankfurt, Frankfurt, Germany; Heinrich-Heine-University, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Radoslaw Pracoń
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Eduardo Flores-Umanzor
- Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Moniek Maarse
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Kristi Montrella
- University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Zakeih Chaker
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Jocelyn N Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Luigi E Pastormerlo
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Carmen M Moldovan
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mohammed Qintar
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mehmet K Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Luca Branca
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Andrea Radinovic
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Pradhum Ram
- Emory University Hospital, Atlanta, Georgia, USA
| | - Rayan S El-Zein
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Bassel Sayegh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Heart, Lung and Vascular Institute, Excela Health, Pittsburgh, Pennsylvania, USA
| | | | - Oh-Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Solomon O Badejoko
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | | | - Nabeela Karim
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ahmed M Zaghloul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Rachel M Kaplan
- Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA
| | - Oluseun Alli
- Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aamir Ahmed
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Bradley P Knight
- Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA
| | - Venkata M Alla
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Rashaad Chothia
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Carlos E Sanchez
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Patrizio Mazzone
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Marianna Adamo
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Fred Ling
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - George Jabbour
- University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Lucas V A Boersma
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Xavier Freixa
- Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Michael L Main
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Benjamin Hibbert
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
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23
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Benito-González T. A debate: Cierre percutáneo de la orejuela izquierda. Perspectiva desde el intervencionismo. RECIC 2021. [DOI: 10.24875/recic.m20000197] [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: 11/17/2022] Open
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Witberg G, Codner P, Landes U, Schwartzenberg S, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Werner P, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Andreas M, Bunc M, Tarantini G, Sinning JM, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. JACC Cardiovasc Interv 2021; 14:1181-1192. [PMID: 33992550 DOI: 10.1016/j.jcin.2021.02.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. METHODS The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared. RESULTS In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). CONCLUSIONS Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Schwartzenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | - Sandra Santos-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Martin Andreas
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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25
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Coromilas EJ, Kochav S, Goldenthal I, Biviano A, Garan H, Goldbarg S, Kim JH, Yeo I, Tracy C, Ayanian S, Akar J, Singh A, Jain S, Zimerman L, Pimentel M, Osswald S, Twerenbold R, Schaerli N, Crotti L, Fabbri D, Parati G, Li Y, Atienza F, Zatarain E, Tse G, Leung KSK, Guevara-Valdivia ME, Rivera-Santiago CA, Soejima K, De Filippo P, Ferrari P, Malanchini G, Kanagaratnam P, Khawaja S, Mikhail GW, Scanavacca M, Abrahão Hajjar L, Rizerio B, Sacilotto L, Mollazadeh R, Eslami M, Laleh Far V, Mattioli AV, Boriani G, Migliore F, Cipriani A, Donato F, Compagnucci P, Casella M, Dello Russo A, Coromilas J, Aboyme A, O'Brien CG, Rodriguez F, Wang PJ, Naniwadekar A, Moey M, Kow CS, Cheah WK, Auricchio A, Conte G, Hwang J, Han S, Lazzerini PE, Franchi F, Santoro A, Capecchi PL, Joglar JA, Rosenblatt AG, Zardini M, Bricoli S, Bonura R, Echarte-Morales J, Benito-González T, Minguito-Carazo C, Fernández-Vázquez F, Wan EY. Worldwide Survey of COVID-19-Associated Arrhythmias. Circ Arrhythm Electrophysiol 2021; 14:e009458. [PMID: 33554620 PMCID: PMC7982128 DOI: 10.1161/circep.120.009458] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Supplemental Digital Content is available in the text. Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic.
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Affiliation(s)
- Ellie J Coromilas
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Stephanie Kochav
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Isaac Goldenthal
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Seth Goldbarg
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Joon-Hyuk Kim
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Ilhwan Yeo
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Cynthia Tracy
- The George Washington University School of Medicine & Health Sciences, The GW Medical Faculty Associates, Washington, DC (C.T., S.A.)
| | - Shant Ayanian
- The George Washington University School of Medicine & Health Sciences, The GW Medical Faculty Associates, Washington, DC (C.T., S.A.)
| | - Joseph Akar
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Avinainder Singh
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Shashank Jain
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Leandro Zimerman
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (L.Z., M.P.)
| | - Maurício Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (L.Z., M.P.)
| | - Stefan Osswald
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Raphael Twerenbold
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Nicolas Schaerli
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Daniele Fabbri
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Yi Li
- Wuhan Asia General Hospital, China (Y.L.)
| | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (F.A., E.Z.).,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (F.A., E.Z.)
| | - Eduardo Zatarain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (F.A., E.Z.).,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (F.A., E.Z.)
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, China (G.T.).,School of Life Sciences. The Hospital Authority of Hong Kong, Hong Kong, China (G.T.).,Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China (G.T.)
| | - Keith Sai Kit Leung
- Aston Medical School, Aston University, Birmingham, United Kingdom (K.C.K.L.)
| | - Milton E Guevara-Valdivia
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret CMN La Raza IMSS, CDMX, Mexico (M.E.G.-V., C.A.R.-S.)
| | - Carlos A Rivera-Santiago
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret CMN La Raza IMSS, CDMX, Mexico (M.E.G.-V., C.A.R.-S.)
| | - Kyoko Soejima
- Kyorin University School of Medicine, Tokyo, Japan (K.S.)
| | - Paolo De Filippo
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Paola Ferrari
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Giovanni Malanchini
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Saud Khawaja
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Ghada W Mikhail
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Mauricio Scanavacca
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Ludhmila Abrahão Hajjar
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Brenno Rizerio
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Luciana Sacilotto
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Reza Mollazadeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | - Masoud Eslami
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | - Vahideh Laleh Far
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | | | - Giuseppe Boriani
- University of Modena & Reggio Emilia, Modena, Italy (V.M., G.B.)
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Filippo Donato
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Paolo Compagnucci
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - Michela Casella
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - Antonio Dello Russo
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - James Coromilas
- Division of Cardiovascular Disease & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C., A. Aboyme)
| | - Andrew Aboyme
- Division of Cardiovascular Disease & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C., A. Aboyme)
| | - Connor Galen O'Brien
- Department of Medicine, Division of Cardiology, University of California San Francisco School of Medicine (C.G.O.)
| | | | - Paul J Wang
- Division of Cardiology, Stanford University, CA (F.R., P.J.W.)
| | | | - Melissa Moey
- East Carolina University, Greenville, NC (A.N., M.M.)
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur (C.S.K.)
| | - Wee Kooi Cheah
- Department of Medicine & Clinical Research Center, Taiping Hospital, Perak, Malaysia (W.K.C.)
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A. Auricchio, G.C.)
| | - Giulio Conte
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A. Auricchio, G.C.)
| | - Jongmin Hwang
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (J.H., S.H.)
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (J.H., S.H.)
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Federico Franchi
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Amato Santoro
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Jose A Joglar
- University of Texas Southwestern Medical Center, Dallas (J.A.G., A.G.R.)
| | - Anna G Rosenblatt
- University of Texas Southwestern Medical Center, Dallas (J.A.G., A.G.R.)
| | - Marco Zardini
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Serena Bricoli
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Rosario Bonura
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Julio Echarte-Morales
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Tomás Benito-González
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Carlos Minguito-Carazo
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Felipe Fernández-Vázquez
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
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Echarte-Morales J, Minguito-Carazo C, Del Castillo-García S, Borrego-Rodríguez J, Rodríguez-Santamarta M, Sánchez-Muñoz E, Bergel-García R, González-Maniega C, Prieto-González S, Menéndez-Suarez P, Tundidor-Sanz E, Benito-González T, Fernández-Vázquez F. Effect of hydroxychloroquine, azithromycin and lopinavir/ritonavir on the QT corrected interval in patients with COVID-19. J Electrocardiol 2020; 64:30-35. [PMID: 33307378 PMCID: PMC7698653 DOI: 10.1016/j.jelectrocard.2020.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/03/2020] [Revised: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022]
Abstract
Background Administration of Hydroxychloroquine and Azithromycin in patients with coronavirus disease 2019 (COVID-19) prolongs QTc corrected interval (QTc). The effect and safety of Lopinavir/Ritonavir in combination with these therapies have seldom been studied. Objectives Our aim was to evaluate changes in QTc in patients receiving double (Hydroxychloroquine + Azithromycin) and triple therapy (Hydroxychloroquine + Azithromycin + Lopinavir/Ritonavir) to treat COVID-19. Secondary outcome was the incidence of in-hospital all-cause mortality. Methods Patients under treatment with double (DT) and triple therapy (TT) for COVID-19 were consecutively included in this prospective observational study. Serial in-hospital electrocardiograms were performed to measure QTc at baseline and during therapy. Results 168 patients (±66.2 years old) were included: 32.1% received DT and 67.9% received TT. The mean baseline QTc was 410.33 ms. Patients under DT and TT prolonged QTc interval respect baseline values (p < 0.001), without significant differences between both therapy groups (p = 0.748). Overall, 33 patients (19.6%) had a peak QTc and/or an increase QTc 60 ms from baseline, with a higher prevalence among those with hypokalemia (p = 0.003). All-cause mortality was similar between both strategy groups (p = 0.093) and high risk QTc prolongation was no related to clinical events in this series. Conclusions DT and TT prolong the QTc in patients with COVID-19. Addition of Lopinavir/Ritonavir on top of Hydroxychloroquine and Azithromycin did not increase QTc compared to DT.
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Minguito-Carazo C, Benito-González T, Echarte-Morales JC, Rodríguez-Santamarta M, Castaño-Ruiz M, Fernández-Vázquez F. Thrombus in transit through a patent foramen ovale: An unusual cause of cardiac embolism. J Saudi Heart Assoc 2020; 32:118-122. [PMID: 33154904 PMCID: PMC7640599 DOI: 10.37616/2212-5043.1021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022] Open
Abstract
A 78-year-old woman with a history of transient ischemic attack was admitted for sudden aphasia. In order to assess the potential cardioembolic source an echocardiogram was performed, which revealed a large mass consistent with a thrombus in transit through a patent foramen ovale. Because of the high risk of systemic embolism, emergent surgical thrombectomy was performed with the intention to discharge the patient safely without any new embolic events. This case report highlights the importance of echocardiography in the evaluation of cardioembolic stroke and the requirement of an emergent approach in case of impending paradoxical embolism.
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Jung RG, Simard T, Kovach C, Flint K, Don C, Di Santo P, Adamo M, Branca L, Valentini F, Benito-González T, Fernández-Vázquez F, Estévez-Loureiro R, Berardini A, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Manovel A, Cardenal-Piris R, Diaz Fernandez J, Shuvy M, Haberman D, Sala A, Alkhouli MA, Marini C, Bargagna M, Schiavi D, Denti P, Markovic S, Buzzatti N, Chan V, Hynes M, Mesana T, Labinaz M, Pappalardo F, Taramasso M, Hibbert B. Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. JACC Cardiovasc Interv 2020; 14:1-11. [PMID: 33069653 DOI: 10.1016/j.jcin.2020.08.037] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [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: 06/25/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR). BACKGROUND Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown. METHODS A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success. RESULTS Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03). CONCLUSIONS TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher Kovach
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Kelsey Flint
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Medicine Services, Cardiology, Aurora, Colorado, USA
| | - Creighton Don
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marianna Adamo
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Luca Branca
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Francesca Valentini
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Alessandra Berardini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicolina Conti
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Cardiological Center, Universitario di Ferrara, University of Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Elena Biagini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- University of Ottawa Health Sciences Library, Ottawa, Ontario, Canada
| | - Amos Levi
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ana Manovel
- Juan Ramon Jimenez University Hospital, Huelva, Spain
| | | | | | - Mony Shuvy
- Cardiovascular Research Centre, Heart Institute, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Dan Haberman
- Heart Center, Kaplan Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alessandra Sala
- Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Marini
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Bargagna
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mark Hynes
- Department of Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Maurizio Taramasso
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy; University Heart Center Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Jung R, Simard T, Don C, Di Santo P, Adamo M, Valentini F, Benito-González T, Fernandez-Vazquez F, Estevez-Loureiro R, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Diaz Fernandez JF, Haberman D, Alessandra S, Alkhouli M, Marini C, Bargagna M, Schiavi D, Denti P, Buzzatti N, Hynes M, Mesana T, Labinaz M, Markovic S, Pappalardo F, Taramasso M, Hibbert B. TCT CONNECT-336 Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.357] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Benito-González T, Freixa X, Godino C, Taramasso M, Estévez-Loureiro R, Hernandez-Vaquero D, Serrador A, Nombela-Franco L, Grande-Prada D, Cruz-González I, San Antonio R, Galasso M, Gavazzoni M, Garrote C, Portolés-Hernández A, Avanzas P, Fernández-Vázquez F, Pascual I. Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip ®. Ann Transl Med 2020; 8:956. [PMID: 32953756 PMCID: PMC7475388 DOI: 10.21037/atm.2020.02.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 01/14/2023]
Abstract
Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction (LVEF), functional mitral regurgitation (FMR) grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results Ninety-three patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-month follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0±17.8 vs. 2.7±13.5, P=0.002), sustained VT or ventricular fibrillation (0.9±2.5 vs. 0.5±2.9, P=0.012) and ICD antitachycardia therapies (2.5±12.0 vs. 0.9±5.0, P=0.033) were observed. Conclusions PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.
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Affiliation(s)
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Cosmo Godino
- Department of Cardiology, San Raffaele Hospital, Milan, Italy
| | - Maurizio Taramasso
- Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, University Hospital of León, León, Spain.,Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain.,Department of Cardiology, University Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Daniel Hernandez-Vaquero
- Heart Área, Hospital Universitario Central de Asturias, Faculty of Medicine, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ana Serrador
- Department of Cardiology. Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), University Clinic Hospital of Valladolid, Valladolid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Grande-Prada
- Department of Cardiology, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Ignacio Cruz-González
- Department of Cardiology, University Hospital Clínico de Salamanca, Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Rodolfo San Antonio
- Department of Cardiology, Cardiovascular Clinic Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Michele Galasso
- Department of Cardiology, San Raffaele Hospital, Milan, Italy
| | - Mara Gavazzoni
- Heart Valve Clinic, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Carmen Garrote
- Department of Cardiology, University Hospital of León, León, Spain
| | | | - Pablo Avanzas
- Heart Área, Hospital Universitario Central de Asturias, Faculty of Medicine, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | | | - Isaac Pascual
- Heart Área, Hospital Universitario Central de Asturias, Faculty of Medicine, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Jurado-Román A, Rodríguez O, Amat I, Romani SA, García-Touchard A, Cruz-González I, Benito-González T, Fernández-Cisnal A, Córdoba-Soriano JG, Subinas A, Hernández-Antolín R, Bayón J, García-Tejada J, Salinas P, Cortés C, Lozano F, Bastante T, Núñez-Gil IJ, Moreno R, López-Sendón JL. Clinical Outcomes After Implantation of Polyurethane-Covered Cobalt-Chromium Stents: Insights from the Papyrus-Spain Registry. Cardiovasc Revasc Med 2020; 29:22-28. [PMID: 32859538 DOI: 10.1016/j.carrev.2020.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/17/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND/PURPOSE The main indication of covered stents (CS) is coronary artery perforation (CAP), but, they have been increasingly used in other scenarios. Data on the long-term follow-up of CS is limited, and no studies have been conducted specifically using new-generation polyurethane-covered cobalt-chromium Papyrus CS. PURPOSE to evaluate the clinical outcomes after hospital discharge of Papyrus CS and to compare their outcome after implantation in CAP or coronary artery aneurysms (CAA). METHODS/MATERIALS We evaluated the baseline clinical characteristics, lesion subsets, procedural features and the outcomes after initial discharge of Papyrus CS implanted in 17 high-PCI-volume centers. RESULTS 127 Papyrus CS were implanted in 108 patients (68 ± 1 years; 82.8% male) admitted for stable coronary disease (32.3%), NSTEMI (42.4%) or STEMI (25.3%). The number of CS per patient was 1.2 ± 0.6 (diameter: 3.5 ± 1.7 mm; length: 18.5 ± 3.7 mm). Angiographic success rate was 96%. CS diameter was larger in CAA (CAP:3.04 ± 0.5 mm vs CAA:4.1 ± 2.7 mm; p = .022). Intracoronary imaging techniques were used more frequently in CAA (p < .0001). After a mean follow-up of 22 ± 16 months, the major cardiovascular adverse events (MACE) rate was 7.1% [cardiac death: 2%, Myocardial infarction: 5%, Target Lesion Revascularization: 5% and Stent Thrombosis (ST): 3%]. MACE rate was similar in CAP (7.7%) and CAA (7.1%) (p = .9). However, CAA showed a higher ST rate (CAP: 0% vs CA: 7.1%; p = .04). CONCLUSION After hospital discharge, clinical outcomes after Papyrus CS implantation are acceptable (considering the clinical scenario and compared with other treatment alternatives) with no significant differences in the MACE rate between those implanted in CAA or in CAP. However, CAA group showed a higher ST rate.
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Affiliation(s)
| | - Oriol Rodríguez
- Cardiology Department, Germans Trias I Pujol Hospital, Badalona, Spain
| | - Ignacio Amat
- Cardiology Department, Hospital Clínico de Valladolid, Spain
| | | | | | | | | | | | | | - Asier Subinas
- Cardiology Department, University Hospital Galdakao, Spain
| | | | - Jeremías Bayón
- Cardiology Department, University Hospital Lucus Augusti, Lugo, Spain
| | | | - Pablo Salinas
- Cardiology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Cortés
- Cardiology Department, Hospital San Pedro de Logroño, Logroño, Spain
| | - Fernando Lozano
- Cardiology Department, University Hospital of Ciudad Real, Ciudad Real, Spain
| | - Teresa Bastante
- Cardiology Department, University Hospital La Princesa, Madrid, Spain
| | - Iván J Núñez-Gil
- Cardiology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Raúl Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
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Pascual I, Benito-González T, Hernandez-Vaquero D, Estévez-Loureiro R, Lorca R, Garrote-Coloma C, Avanzas P, Gualis J, Adeba A, Pérez de Prado A, Morís C, Fernández-Vázquez F. Percutaneous treatment with Mitraclip for functional mitral regurgitation: medium-term follow up according to left ventricular function. Ann Transl Med 2020; 8:959. [PMID: 32953759 PMCID: PMC7475438 DOI: 10.21037/atm.2020.02.122] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Functional mitral regurgitation (FMR) is a bad prognosis condition despite optimal medical treatment. Nowadays there is an open debate about the surgical versus percutaneous treatment. The main objective of this study is to evaluate the mid-term follow up clinical outcomes of patients with FMR treated with MitraClip® system, according to their left ventricular ejection fraction (LVEF). Methods Data was obtained from two experienced centers in transcatheter mitral valve repair (TMVR). All consecutive cases of severe FMR undergoing TMVR in both centers with the same inclusion criteria were included prospectively in this study and followed-up. Periodical follow-ups with clinical and echocardiographic evaluation were scheduled from the baseline procedure, at 3 months and then yearly. Results From October 2015 to October 2019, a total of 119 patients with FMR at 2 centers in Spain underwent TMVR with the MitraClip® procedure and were included in this study. The mean age was 73.8±8.9 years old and 32 patients (26.9%) were female. A 39.5% of cases [47] had a LVEF ≤30% (group 1) and 60.5% (72 cases) had a LVEF >30% (group 2). There was a similar distribution in cardiovascular risk factors, age and other diseases. All MitraClip® implantations were elective and procedural success was achieved in 110 patients (92.4%) with a similar distribution between the groups. There were no differences in procedural time and the number of implanted clips. The median follow-up was 22.6 months (IQR, 11.43–34.98 months). The primary combined endpoint occurred in the 41.6% of the global cohort, 57.5% in group 1 and 30.99% in group 2 (P=0.036). LVEF was associated to the main event in the multivariate analysis (HR 2.09, 95% CI: 1.12–3.89; P=0.02). Conclusions The MitraClip edge-to-edge technique is a safe and effective procedure for the treatment of FMR. In this study, patients with LVEF >30% treated with Mitraclip presented better clinical cardiovascular outcomes than those with a LVEF ≤30%. Regardless clinical outcomes, at the end of the follow-up, there was a sustained reduction in MR grades and an important improvement in NYHA functional class.
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Affiliation(s)
- Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Functional Biology Department, University of Oviedo, Oviedo, Spain
| | | | - Daniel Hernandez-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Functional Biology Department, University of Oviedo, Oviedo, Spain
| | | | - Rebeca Lorca
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Medicine Department, University of Oviedo, Oviedo, Spain
| | - Javier Gualis
- Department of Cardiac Surgery, University Hospital of León, León, Spain
| | - Antonio Adeba
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - César Morís
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Medicine Department, University of Oviedo, Oviedo, Spain
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Estévez-Loureiro R, Benito-González T, Garrote-Coloma C, Fernández-Vázquez F, Avanzas P, Piñón M, Pascual I. Percutaneous mitral repair: current and future devices. Ann Transl Med 2020; 8:963. [PMID: 32953763 PMCID: PMC7475444 DOI: 10.21037/atm.2020.03.154] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mitral regurgitation (MR) is the second most common valvular heart disease and its prevalence is increasing with population ageing. In the recent years we have witnessed the development of several transcatheter devices to correct MR in patients at high-risk for surgery. The majority of evidence regarding safety and efficacy of this new therapy comes from MitraClip studies. However, new alternatives on the field of valve repair have emerged with promising results. The aim of this review is to portrait the landscape of transcatheter mitral repair alternatives, from currently used devices to those that will have a role in the near future.
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Affiliation(s)
| | | | | | | | - Pablo Avanzas
- Interventional Cardiology Unit, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Miguel Piñón
- Cardiac Surgery Department, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Isaac Pascual
- Interventional Cardiology Unit, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
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Benito-González T, Estévez-Loureiro R, Rodríguez-Santamarta M, Tundidor-Sanz E, Garrote-Coloma C, Fernández-Vázquez F. MitraClip or Cardiac Replacement Therapy in Patients with Advanced Heart Failure? Cardiovascular Revascularization Medicine 2020; 21:432-433. [DOI: 10.1016/j.carrev.2019.12.016] [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] [Received: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
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Benito-González T, Estévez-Loureiro R, Garrote-Coloma C, Fernández-Vázquez F. To Clip, Or Not To Clip, In Patients With Functional Mitral Regurgitation. Cardiovasc Revasc Med 2020; 21:249-250. [PMID: 31982326 DOI: 10.1016/j.carrev.2019.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 11/25/2022]
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Benito-González T, Estévez-Loureiro R, Garrote-Coloma C, Arellano-Serrano C, Tundidor-Sanz E, Fernández-Lozano I, Toquero J, Pérez de Prado A, Goicolea J, Fernández-Vázquez F. Effect of Successful Edge-to-Edge Mitral Valve Repair on Ventricular Arrhythmic Burden in Patients With Functional Mitral Regurgitation and Implantable Cardiac Devices. Am J Cardiol 2019; 124:1113-1119. [PMID: 31376913 DOI: 10.1016/j.amjcard.2019.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/12/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 12/29/2022]
Abstract
Significant mitral regurgitation (MR) may be present in up to half of patients with heart failure (HF) and it is associated with adverse cardiac remodeling and myocardial stretch. These are potential triggers for ventricular arrhythmias (VA) in patients with HF, and therefore MR may enhance electrical ventricular vulnerability. Our aim was to evaluate VA burden before and after percutaneous mitral valve repair (PMVR) in patients with implantable cardiac devices. We conducted a prospective registry of all consecutive patients (n = 34, age 69.0 ± 12.2 years, 77% male) with significant functional mitral regurgitation (FMR) who underwent MitraClip implantation in 2 centers between June 2014 and July 2018. VA burden was defined as the total number of events during device follow-up before and after PMVR. Among patients presenting VA during follow-up before or after PMVR, device success at hospital discharge was related to a significant reduction in the incidence of Nonsustained ventricular tachycardia (VT, p = 0.002) and any sustained VT or rapid VT/ventricular fibrillation (p = 0.034). Regarding implantable cardiac defibrillator (ICD) therapies, successful PMVR was related to a reduction in incidence of either antitachycardia pacing or appropriate shocks (p = 0.045) and in the occurrence of any defibrillation shocks (p = 0.045). Overall, effective repair lead to a significant reduction in the VA burden, with a significant decrease in the occurrence of any VA (p = 0.004) and any ICD therapies (p = 0.045). In conclusion, device success after PMVR was related to a reduction in overall arrhythmic burden and ICD therapies in our cohort.
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Affiliation(s)
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, University Hospital of León, León, Spain; Department of Cardiology, University Hospital of Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | - Carlos Arellano-Serrano
- Department of Cardiology, University Hospital of Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | | | - Jorque Toquero
- Department of Cardiology, University Hospital of Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Javier Goicolea
- Department of Cardiology, University Hospital of Puerta de Hierro, Majadahonda, Madrid, Spain
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Benito-González T, Estévez-Loureiro R, Villablanca PA, Armeni P, Iglesias-Gárriz I, Minguito C, Garrote C, de Prado AP, Tundidor-Sanz E, Gualis J, Fernández-Vázquez F. Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure. Cardiovasc Revasc Med 2019; 21:52-60. [PMID: 31326258 DOI: 10.1016/j.carrev.2019.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Functional mitral regurgitation (FMR) is a common finding among patients with heart failure (HF) and it is related to adverse events. Outcomes in patients undergoing transcatheter mitral valve repair (TMVR) are still a matter of debate. We performed a meta-analysis to assess mid- and long-term outcomes of patients with FMR treated with MitraClip® compared to medical management. METHODS We conducted an electronic database search of all published data PubMed Central, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar databases. The primary end-point was all-cause mortality. The secondary end-points were hospitalizations for HF, need for heart transplantation or left ventricular assist device, unplanned mitral valve surgery, myocardial infarction and stroke. RESULTS Five studies (n = 1513 patients) were included in the analysis. The summary estimate including all the available studies showed a statistically significant reduction in all-cause mortality favoring MitraClip® (HR 0.56, CI 95% [0.38-0.84]) and HF hospitalizations (HR 0.65; CI 95% [0.46-0.92]). A significant reduction in the indication for advanced HF therapies (OR 0.48; CI 95% [0.25-0.90]) or the need for unplanned mitral valve surgery (OR 0.20; CI 95% [0.07-0.57]) was also found in the group of patients that underwent TMVR. No differences in the incidence of myocardial infarction or stroke were found between both groups of treatment. No publication bias was detected. CONCLUSION TMVR with MitraClip® system was related to a significant reduction in all-cause mortality, hospitalizations for HF and the need for HF transplant, left ventricular assist device or unplanned surgery beyond 1-year follow up.
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Affiliation(s)
| | | | - Pedro A Villablanca
- Department of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, United States of America
| | | | | | - Carlos Minguito
- Department of Cardiology, University Hospital of León, León, Spain
| | - Carmen Garrote
- Department of Cardiology, University Hospital of León, León, Spain
| | | | | | - Javier Gualis
- Department of Cardiac Surgery, University Hospital of León, León, Spain
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Benito-González T, Estévez-Loureiro R, Garrote-Coloma C, Iglesias Garriz I, Gualis J, Álvarez-Roy L, Rodriguez-Santamarta M, Pérez de Prado A, Fernández-Vázquez F. MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation. ESC Heart Fail 2019; 6:867-873. [PMID: 31184443 PMCID: PMC6676649 DOI: 10.1002/ehf2.12457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/14/2018] [Revised: 04/11/2019] [Accepted: 04/28/2019] [Indexed: 12/03/2022] Open
Abstract
Aims The aim of this study is to evaluate changes in cardiopulmonary exercise test (CPET) after percutaneous mitral valve repair (PMVR) with MitraClip in patients with heart failure with reduced ejection fraction who are potentially candidates for heart transplantation or destination left ventricular assist device. Methods and results Prospective registry of all consecutive patients with heart failure with reduced ejection fraction and functional mitral regurgitation (MR) underwent elective PMVR between October 2015 and March 2018 in our institution. Patients with preserved or mid‐range left ventricular ejection fraction (>40%), advanced age (>75 years old), or severe co‐morbidities (end‐stage organ damage) were not included. Treadmill exercise testing with respiratory gas exchange analysis was carried out in 11 patients (male, 72.7%; median age, 67 years old) within the month prior to the procedure and at 6 month follow‐up. PMVR was successfully performed in all patients. At 6 month follow‐up, PMVR was associated with an improvement in New York Heart Association functional class (P = 0.021) and a reduction in MR severity (P = 0.013) and N‐terminal pro‐brain natriuretic peptide levels (2805 [1878–5022] vs. 1485 [654–3032] pg/mL; P = 0.012). All patients completed pre‐procedural and post‐procedural CPET, and all the studies showed a respiratory exchange ratio ≥1 and were consistent with sufficient exercise effort. Compared with pre‐procedural CPET, patients showed a significant increase in exercise time (295 [110–335] vs. 405 [261–540] s; P = 0.047), VO2 (9.8 [9.1–13.4] vs. 13.5 [12.1–16.8] mL/kg/min; P = 0.033), ventilatory anaerobic threshold (510 [430–950] vs. 850 [670–1070] mL/kg/min; P = 0.033), peak O2 pulse (7.2 [4.3–8.6] vs. 8.3 [6.2–11.8] mL/beat; P = 0.033), and workload (5 [3–6] vs. 6 [5–8] metabolic equivalents; P = 0.049). Conclusions Percutaneous mitral valve repair with MitraClip was associated with an enhancement in cardiopulmonary performance in patients with systolic heart failure and secondary MR.
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Affiliation(s)
- Tomás Benito-González
- Department of Cardiology, University Hospital of León, Altos de Nava SN, 24071, León, Spain
| | | | - Carmen Garrote-Coloma
- Department of Cardiology, University Hospital of León, Altos de Nava SN, 24071, León, Spain
| | | | - Javier Gualis
- Department of Cardiovascular Surgery, University Hospital of León, León, Spain
| | - Laura Álvarez-Roy
- Department of Cardiology, University Hospital of León, Altos de Nava SN, 24071, León, Spain
| | | | - Armando Pérez de Prado
- Department of Cardiology, University Hospital of León, Altos de Nava SN, 24071, León, Spain
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Gualis J, Benito-González T, Martínez-Comendador JM, Martín E, Perez A, Estévez-Loureiro R, Castillo L, Maiorano P, Pérez-Blanco I, Castaño M. Internal Banding to Reduce Paravalvular Leaks for Open Transcatheter Valve Implantation. Ann Thorac Surg 2018; 107:e365-e367. [PMID: 30578778 DOI: 10.1016/j.athoracsur.2018.11.040] [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] [Received: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Transcatheter valve implantation has become an alternative to open-heart conventional surgery in high-risk patients. We describe a new surgical technique that allows the implantation of a transcatheter valvular prosthesis through an open surgical approach to prevent the appearance of paravalvular leaks in patients with large native rings.
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Affiliation(s)
- Javier Gualis
- Department of Cardiac Surgery, University Hospital of León, León, Spain.
| | - Tomás Benito-González
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | | | - Elio Martín
- Department of Cardiac Surgery, University Hospital of León, León, Spain
| | - Armando Perez
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | - Rodrigo Estévez-Loureiro
- Interventional Cardiology Unit, Department of Cardiology, University Hospital of León, León, Spain
| | - Laura Castillo
- Department of Cardiac Surgery, University Hospital of León, León, Spain
| | - Pascuale Maiorano
- Department of Cardiac Surgery, University Hospital of León, León, Spain
| | | | - Mario Castaño
- Department of Cardiac Surgery, University Hospital of León, León, Spain
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40
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Estévez-Loureiro R, Benito-González T, Gualis J, Pérez de Prado A, Rodríguez-Santamarta M, Fernández-Vázquez F. Reparación transcatéter de tricúspide con MitraClip en paciente con anuloplastia de De Vega fallida. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.07.011] [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: 10/19/2022]
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41
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Benito-González T, Estévez-Loureiro R, de Prado AP, Minguito-Carazo C, Del Castillo García S, Garrote-Coloma C, Iglesias-Gárriz I, Alonso-Rodríguez D, Cardona JG, Ramón CC, Benito ML, Estévez JV, Fernández-Vázquez F. Incidence and prognostic implications of late bleeding events after percutaneous mitral valve repair. Int J Cardiol Heart Vasc 2018; 21:16-21. [PMID: 30255126 PMCID: PMC6148729 DOI: 10.1016/j.ijcha.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/19/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 11/26/2022]
Abstract
Objectives MitraClip is an established therapy for patients with mitral regurgitation (MR) that are considered of high-risk or inoperable. However, late bleeding events (BE) after hospital discharge and their impact on prognosis in this cohort of patients have been poorly investigated. Our purpose is to address the incidence, related factors and clinical implications of BE after hospital discharge in patients treated with MitraClip. Methods Prospective registry of all consecutive patients (n = 80) who underwent MitraClip implantation in our Institution between June 2014 and December 2017. BE were defined according to MVARC definitions. A combined clinical end-point including admission for heart failure (HF) and all-cause mortality was established to analyze prognostic implications of BE. Results During a median follow up of 523.5 days, 41 BE were reported in 21 patients. Atrial fibrillation (AF, HR 4.54, CI95% 1.20–17.10) and combined antithrombotic therapy at discharge (HR 3.52, CI95% 1.03–11.34) were independently associated with BE. In the study period, 15 (18.8%) patients died, 20 (25%) were admitted for HF and 29 (36.3%) presented the combined end-point. After multivariable adjustment BE remained independently associated with an adverse outcome (HR 3.80, CI 95% 1.66–8.72). In the subgroup of patients with AF, HAS-BLED score was higher among subjects with BE (3.1 ± 1.3 vs 2.1 ± 0.9, p = 0.003). HAS-BLED score had a significant discrimination power for the occurrence BE (AUC: 0.677 [0.507–0.848]) in this subgroup. Conclusions BE are common after MitraClip and are associated with an impaired outcome. Strategies to reduce bleeding events are paramount in this cohort of patients.
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Affiliation(s)
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, University Hospital of León, León, Spain.,Department of Cardiology, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
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42
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Alvarez-Roy L, Benito-González T, Pérez de Prado A, Gualis Cardona J, del Castillo S, Fernández-Vázquez F. Transbrachial intra-aortic balloon pump before urgent coronary artery bypass graft in a patient with severe peripheral atherosclerosis. Revista Portuguesa de Cardiologia (English Edition) 2018. [DOI: 10.1016/j.repce.2018.03.006] [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: 10/17/2022] Open
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43
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Alvarez-Roy L, Benito-González T, Pérez de Prado A, Gualis Cardona J, Del Castillo S, Fernández-Vázquez F. Transbrachial intra-aortic balloon pump before urgent coronary artery bypass graft in a patient with severe peripheral atherosclerosis. Rev Port Cardiol 2018; 37:205-207. [PMID: 29310913 DOI: 10.1016/j.repc.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/20/2017] [Accepted: 03/03/2017] [Indexed: 10/18/2022] Open
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44
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Benito-González T, Estevez-Loureiro R, Garrote-Coloma C, Alonso-Rodriguez D, Romero-Roche L, Gualis J, Perez de Prado A, Fernandez-Vazquez F. Combined Transcatheter Treatment of Ventricular Septal Rupture and Mitral Regurgitation After an Acute Myocardial Infarction. JACC Cardiovasc Interv 2017; 10:2577-2579. [PMID: 29198460 DOI: 10.1016/j.jcin.2017.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | | | - Javier Gualis
- Department of Cardiovascular Surgery, Hospital of León, León, Spain
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Benito-González T, Estévez-Loureiro R, Iglesias-Gárriz I, Gualis J, Pérez de Prado A, Garrote C, Swaans MJ, S Van der Heyden JA, Feldman T, Giannini C, Alonso D, Rodriguez-Santamarta M, Castaño M, Fernández-Vázquez F. Survival Advantage of MitraClip® Over Medical Treatment in Patients with Mitral Regurgitation: A Meta-Analysis. J Heart Valve Dis 2017; 26:651-658. [PMID: 30207115] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The MitraClip® system is a percutaneous treatment for mitral regurgitation (MR) that has shown promising results in patients who are inoperable or at high risk for mitral surgery. Data on the efficacy of the system over optimal medical therapy, above all in patients with functional MR, are scarce. The study aim was to assess the effect of MitraClip on the survival of patients with moderate/severe or severe MR compared to medical therapy, using meta-analytical techniques. METHODS Independently, reviewers searched electronically for relevant articles based on predefined criteria and end-points. Only articles with a comparison between MitraClip and conservative therapy were included. Standard meta-analysis techniques were used. The primary outcomes were 30-day and one-year mortalities. RESULTS Five observational reports were included that enrolled a total of 1,271 patients: 720 patients underwent percutaneous mitral valve repair (PMVR) with the MitraClip device, and 551 were managed conservatively. A total of 49 all-cause mortality events was reported at 30 days: 3.05% (22/720) in the PMVR arm, and 4.90% (27/510) in the conservative group, with no significant differences in all-cause mortality (OR 0.64; 95% CI 0.36-1.14). A total of 269 all-cause mortality events at one year was reported: 15.14% (109/720) in the PMVR arm, and 29.04% (160/551) in the conservative group. A significant difference favoring PMVR with the MitraClip system over medical therapy alone was observed (OR 0.44; 95% CI 0.30-0.64, p <0.0001). Neither significance between study heterogeneity (p = 0.18) nor publication bias was detected (p = 0.3). CONCLUSIONS PMVR with the MitraClip system may be associated with an improvement in one-year survival compared to stand-alone medical management.
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Affiliation(s)
| | | | | | - Javier Gualis
- Department of Cardiac Surgery, University Hospital of León, León, Spain
| | | | - Carmen Garrote
- Department of Cardiology, University Hospital of León, León, Spain
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Ted Feldman
- Cardiology Division, Evanston Hospital, NorthShore University Health System, Evanston, Illinois, USA
| | - Cristina Giannini
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - David Alonso
- Department of Cardiology, University Hospital of León, León, Spain
| | | | - Mario Castaño
- Department of Cardiac Surgery, University Hospital of León, León, Spain
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Rodríguez-Santamarta M, Estévez-Loureiro R, Benito-González T, Gualis J, Garrote C, Pérez de Prado A, Fernández-Vázquez F. Trileaflet Mitral Valve Treated with the MitraClip® System. J Heart Valve Dis 2017; 26:589-591. [PMID: 29762929] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 79-year-old woman with a history of ischemic dilated cardiomyopathy, severely depressed left ventricular ejection fraction and significant mitral regurgitation (MR) was admitted to the authors´ institution for percutaneous mitral valve repair. Transesophageal echocardiography (TEE) revealed the presence of a posterior mitral cleft at the P2 level, causing a trileaflet mitral valve that contributed significantly to the regurgitant jet. The procedure was performed under general anesthesia and guided by real-time three-dimensional TEE. Three MitraClip® devices (Abbott Vascular, Santa Clara, CA, USA) were implanted, which reduced the MR to grade 1+.
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Affiliation(s)
- Miguel Rodríguez-Santamarta
- Departamento de Cardiología, Complejo Asistencial Universitario de León, León, Spain. Electronic correspondence:
| | | | - Tomás Benito-González
- Departamento de Cardiología, Complejo Asistencial Universitario de León, León, Spain
| | - Javier Gualis
- Departamento de Cardiología, Complejo Asistencial Universitario de León, León, Spain
| | - Carmen Garrote
- Departamento de Cardiología, Complejo Asistencial Universitario de León, León, Spain
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Benito-González T, Estévez-Loureiro R, Cardona JG, Prado APD, Ruiz MC, Fernández-Vázquez F. Percutaneous Treatment of Mitral and Tricuspid Regurgitation in Heart Failure. Interv Cardiol 2017. [DOI: 10.5772/intechopen.68493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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48
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Benito-González T, Pinedo-Gago M, Gualis J, Estévez-Loureiro R, Castaño M, Fernández-Vázquez F. Giant aortic pseudoaneurysm following prosthetic aortic root substitution. J Saudi Heart Assoc 2017; 29:230-231. [PMID: 28652680 DOI: 10.1016/j.jsha.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/21/2017] [Accepted: 01/26/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Marta Pinedo-Gago
- Department of Cardiology, University Hospital of León, León, SpainaSpain
| | - Javier Gualis
- Department of Cardiac Surgery, University Hospital of León, León, SpainbSpain
| | | | - Mario Castaño
- Department of Cardiac Surgery, University Hospital of León, León, SpainbSpain
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Estévez-Loureiro R, Benito-González T, Cuellas C, Pérez de Prado A, Gualis J, Castaño M, Fernández-Vázquez F. Late Left Coronary Artery Compromise After Corevalve Implantation: Insights From Instant Free Ratio Analysis. Ann Thorac Surg 2017; 103:e371. [PMID: 28359502 DOI: 10.1016/j.athoracsur.2016.10.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/27/2016] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Carlos Cuellas
- Department of Cardiology, University Hospital of León, León, Spain
| | | | - Javier Gualis
- Department of Cardiovascular Surgery, University Hospital of León, León, Spain
| | - Mario Castaño
- Department of Cardiovascular Surgery, University Hospital of León, León, Spain
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50
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Estévez-Loureiro R, Benito-González T, Gualis J, Pérez de Prado A, Cuellas C, Fernandez-Vazquez F. Percutaneous paravalvular leak closure after CoreValve transcatheter aortic valve implantation using an arterio-arterial loop. J Thorac Dis 2017; 9:E103-E108. [PMID: 28275491 DOI: 10.21037/jtd.2017.02.41] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Significant periprosthetic aortic regurgitation after transcatheter aortic valve implantation has become a major concern of this technique given its association with impaired survival. We report the successful closure of such defect using a vascular occlusion device with the creation of an arterio-arterial loop to gain enough support to advance the delivery sheath into de the left ventricle.
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Affiliation(s)
| | | | - Javier Gualis
- Interventional Cardiology Unit, University Hospital of Leon, Leon, Spain
| | | | - Carlos Cuellas
- Interventional Cardiology Unit, University Hospital of Leon, Leon, Spain
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