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Halboni A, Hamza M, Dayco J, Al-Abcha A, Alhalbouni A, Zghouzi M, Alhusain R, Sattar Y, Alraies MC. Outcomes of Transcatheter Mitral Valve Repair Using the MitraClip System in Patients With Atrial Fibrillation. A Meta-Analysis. Am J Cardiol 2024; 219:47-59. [PMID: 37865125 DOI: 10.1016/j.amjcard.2023.09.057] [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: 05/26/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
Transcatheter mitral valve repair (TMVR) with the MitraClip system is now approved for degenerative and functional mitral regurgitation (MR). Atrial fibrillation (AF) is commonly seen in MR. In our study, we perform a pooled analysis of the existing data to investigate the outcomes of MitraClip in patients with versus without AF. We conducted a systematic search of PubMed, Google Scholar, and SCOPUS databases through December, 2022 for studies comparing the outcomes of TMVR using the MitraClip in patients with preexisting AF versus those without AF. A meta-analysis was performed to investigate the primary outcomes of all-cause mortality and heart failure (HF) hospitalization. Secondary outcomes were cardiovascular mortality, in-hospital mortality, stroke, New York Heart Association class I or II at follow-up, length of hospital stay, and procedural time. A total of 10 studies (n = 24,111; AF = 12,789; no AF = 11,322) were included in the final analysis. Preexisting AF was associated with higher overall all-cause mortality (odds ratio 1.55, 95% confidence interval 1.32 to 1.83, p <0.0002) and higher overall HF hospitalization rate (odds ratio 1.3, 95% confidence interval 1.08 to 1.56, p <0.0154). There was no statistically significant difference in cardiovascular mortality, in-hospital mortality, stroke, length of hospital stay, procedural time, or New York Heart Association class I/II at follow-up comparing AF versus no AF. The presence of AF in patients who underwent TMVR with MitraClip is associated with higher all-cause mortality and HF hospitalization. This should be taken into consideration in the management of MR patients.
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Affiliation(s)
- Adnan Halboni
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohammad Hamza
- Department of Medicine, Albany Medical Center, Albany, New York
| | - John Dayco
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Abdallah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamed Zghouzi
- Division of Vascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rashid Alhusain
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Yasar Sattar
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
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Doldi PM, Stolz L, Kassar M, Kalbacher D, Petronio AS, Butter C, von Bardeleben RS, Iliadis C, Grayburn P, Hausleiter J. Paradox of disproportionate atrial functional mitral regurgitation and survival after transcatheter edge-to-edge repair. ESC Heart Fail 2024. [PMID: 38602287 DOI: 10.1002/ehf2.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
AIMS This study aims to assess the applicability of the mitral regurgitation (MR) proportionality concept in patients with atrial functional mitral regurgitation (aFMR) treated with transcatheter edge-to-edge repair (M-TEER). We hypothesized that patients with disproportionate MR (higher MR relative to left ventricular size) would exhibit different outcomes compared to those with proportionate MR, despite undergoing M-TEER. METHODS AND RESULTS We retrospectively analysed 98 patients with aFMR from the EuroSMR registry who underwent M-TEER between 2008 and 2019. Patients met criteria for aFMR (normal indexed left ventricular end-diastolic volume [LVEDV], preserved left ventricular ejection fraction [LVEF] ≥ 50% without regional wall motion abnormalities, and structurally normal mitral valves). We excluded patients with missing effective regurgitant orifice area (EROA) or LVEDV data. The primary endpoint was 2-year mortality, with an EROA/LVEDV ratio employed to differentiate disproportionate from proportionate MR. Procedural success and baseline characteristics were analysed, and multivariate Cox proportional hazards models were used to identify mortality predictors. The mean patient age was 79 ± 7.3 years, with 68.8% female, and 79% had a history of atrial fibrillation. The mean EROA was 0.27 ± 0.14 cm2, and LVEDV was 95.6 ± 33.7 mL. Disproportionate MR was identified with an EROA/LVEDV ratio >0.339 cm2/100 mL. While procedural success was similar in both groups, disproportionate MR was associated with a numerically higher estimate of systolic pulmonary artery pressures (sPAP) and rates of NYHA ≥III and TR ≥ 3+. Disproportionate MR had a significant association with increased 2-year mortality (P < 0.001). The EROA/LVEDV ratio and tricuspid annular plane systolic excursion (TAPSE) were independent predictors of 2-year mortality (EROA/LVEDV: HR: 1.35, P = 0.010; TAPSE: HR: 0.85, P = 0.020). CONCLUSIONS This analysis introduces the MR proportionality concept in aFMR patients and its potential prognostic value. Paradoxically, disproportionate MR in aFMR was linked to a 1.35-fold increase in 2-year mortality post-M-TEER, emphasizing the importance of accurate preprocedural FMR characterization. Our findings in patients with disproportionate MR indicate that a high degree of aFMR with high regurgitant volumes may lead to aggravated symptoms, which is a known contributor to increased mortality following M-TEER. These results underline the need for further research into the pathophysiology of aFMR to inform potential preventative and therapeutic strategies, ensuring optimal patient outcomes.
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Affiliation(s)
- Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | | | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Paul Grayburn
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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Alizadehasl A, Eslami S, Vakili K, Abdi S, Firouzi A, Azarfarin R, Abdi A. A challenging transseptal mitral valve in valve case report: Success and safety. Clin Case Rep 2024; 12:e8096. [PMID: 38292226 PMCID: PMC10825811 DOI: 10.1002/ccr3.8096] [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: 01/31/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 02/01/2024] Open
Abstract
Key Clinical Message Transcatheter mitral valve implantation (TMVI) is considered a less-invasive approach than open-heart surgery, favored in high-risk patients elected for valve replacement. Although seemingly suitable, this procedure is highly operator-dependent. Abstract Transcatheter mitral valve implantation (TMVI) is an alternative in high-risk patients. We reported a 72-year-old patient with mitral bioprosthesis degeneration successfully receiving TMVI. The procedure has lower morbidity and mortality rate than the surgical approach but can be accompanied by several complications, especially when conducted by an inexperienced operator.
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Affiliation(s)
- Azin Alizadehasl
- Cardio‐Oncology Department and Research CenterRajaie Cardiovascular Medical & Research Center, Iran University of Medical ScienceTehranIran
| | - Samira Eslami
- Department of Adult EchocardiographyRajaie Cardiovascular Medical and Research CenterTehranIran
| | - Kimia Vakili
- Student Research Committee, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehranIran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehranIran
| | - Rasoul Azarfarin
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehranIran
| | - Amir Abdi
- Student Research Committee, School of Medicine, Tehran Medical SciencesIslamic Azad UniversityTehranIran
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Marzlin N, Barrett N, Burke D, Nfor T, Tajik AJ, Muthukumar L. Challenge in mitral valve intervention: Super-elongated anterior and diminutive posterior mitral valve. J Clin Ultrasound 2024; 52:92-94. [PMID: 37997479 DOI: 10.1002/jcu.23620] [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: 06/22/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
Diminutive posterior mitral valve leaflet with an extremely elongated anterior leaflet is a rare phenomenon. We share such a case discovered in an 82-year-old patient with severe, symptomatic mitral regurgitation. LA, left atrium; LV, left ventricle; MR, mitral regurgitation.
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Affiliation(s)
- Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
| | - Nancy Barrett
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
| | - Dena Burke
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
| | - Tonga Nfor
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Lakshmi Muthukumar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
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Shechter A, Kaewkes D, Lee M, Makar M, Patel V, Koren O, Koseki K, Nagasaka T, Skaf S, Chakravarty T, Makkar RR, Siegel RJ. Correlates and prognostic implications of LVEF reduction after transcatheter edge-to-edge repair for primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2023; 25:136-147. [PMID: 37590951 DOI: 10.1093/ehjci/jead210] [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: 03/01/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023] Open
Abstract
AIMS To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure. METHODS AND RESULTS We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75-88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared with baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While post-procedural MR, transmitral mean pressure gradient, and functional status were comparable in the two study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs. 5.7%, P = 0.019), be readmitted for HF (17.1% vs. 9.0%, P = 0.033), and experience either of the two (23.8% vs. 12.7%, P = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10-0.78, P = 0.016). CONCLUSION LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Nai Muang, Thailand
| | - Mirae Lee
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Stocker TJ, Nabauer M, Massberg S, Hagl C, Hausleiter J. Successful Transcatheter Closure of Iatrogenic Mitral Regurgitation After Aortic Valve Surgery. JACC Case Rep 2023; 28:102126. [PMID: 38204537 PMCID: PMC10774818 DOI: 10.1016/j.jaccas.2023.102126] [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: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/12/2024]
Abstract
We present 2 cases of significant mitral regurgitation secondary to pericardial patch avulsion from the anterior mitral valve leaflet after aortic valve replacement with aortic annulus enlargement. Both cases were successfully managed by transcatheter repair with off-label implantation of occluder devices.
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Affiliation(s)
- Thomas J. Stocker
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Nabauer
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- Heart Surgery Clinic, LMU University Hospital, LMU Munich, Munich Germany
| | - Jörg Hausleiter
- Department of Cardiology, Department of Medicine I, LMU University Hospital, LMU Munich, Munich Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Zahr F, Chadderdon S. The State of M-TEER: Enjoy the Fruit Salad! J Am Heart Assoc 2023; 12:e032806. [PMID: 38084721 PMCID: PMC10863792 DOI: 10.1161/jaha.123.032806] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Firas Zahr
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
| | - Scott Chadderdon
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
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Shechter A, Vaturi M, Hong GJ, Kaewkes D, Patel V, Seok M, Nagasaka T, Koren O, Koseki K, Skaf S, Makar M, Chakravarty T, Makkar RR, Siegel RJ. Implications of Mitral Annular Disjunction in Patients Undergoing Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation. JACC Cardiovasc Interv 2023; 16:2835-2849. [PMID: 38092492 DOI: 10.1016/j.jcin.2023.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Little is known about mitral transcatheter edge-to-edge repair (TEER) in patients with mitral annular disjunction (MAD). OBJECTIVES The authors sought to explore TEER for degenerative mitral regurgitation (MR) according to MAD status. METHODS We retrospectively analyzed 271 consecutive patients (median age 82 [Q1-Q3: 75-88] years, 60.9% men) undergoing an isolated, first-ever TEER for whom there were viewable preprocedural echocardiograms. Stratified by MAD status at baseline, the cohort was evaluated for all-cause mortality, heart failure hospitalizations, and mitral reinterventions-the composite of which constituted the primary outcome-as well as functional capacity and residual MR, all along the first postprocedural year. RESULTS Individuals with (n = 62, 22.9%) vs without MAD had more extensive prolapse and larger valve dimensions. Although the former's procedures were longer, utilizing more devices per case, technical success rate and residual MR were comparable. MAD presence was associated with higher mortality risk (HR: 2.64; 95% CI: 1.82-5.52; P = 0.014), and increased MAD length-with lower odds of functional class ≤II (OR: 0.65; 95% CI: 0.47-0.88; P = 0.006). Among 47 MAD patients with retrievable 1-month data, MAD regressed in 91.5% and by an overall 50% (Q1-Q3: 22%-100%) compared with baseline (P < 0.001). A greater MAD shortening conferred attenuated risk for the primary outcome. CONCLUSIONS In our experience, TEER for degenerative MR accompanied by MAD was feasible and safe; however, its postprocedural course was somewhat less favorable. MAD shortening following TEER was observed in most patients and proved prognostically beneficial.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordehay Vaturi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gloria J Hong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Minji Seok
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
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Praz F, Samim D. 1-Year Outcomes With a Fourth-Generation Mitral TEER Device: Maturity Comes With Experience. JACC Cardiovasc Interv 2023; 16:2611-2614. [PMID: 37877915 DOI: 10.1016/j.jcin.2023.09.035] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Daryoush Samim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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10
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Akansel S, Kofler M, Van Praet KM, Sündermann SH, Unbehaun A, Jacobs S, Falk V, Kempfert J. Alternative minimally invasive surgical explantation techniques for failed transcatheter mitral valve repair devices. JTCVS Tech 2023; 21:65-71. [PMID: 37854815 PMCID: PMC10579955 DOI: 10.1016/j.xjtc.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 10/20/2023] Open
Abstract
Objective The use of transcatheter mitral valve repair (TMVr) devices is increasing in elderly and high-risk patients. However, the increasing number of patients with recurrent mitral regurgitation (MR) has confronted surgeons with the issue of how to explant the devices and whether the mitral valve should be repaired or replaced. The aim of the study is to summarize our clinical experience with the explantation of different TMVr devices and to provide alternative surgical techniques that can be performed in different clinical scenarios. Methods A simulator system including a dummy valve representing native valves was used to create video documentation and to develop alternative surgical methods for clip explantation. Moreover, the clip explantation techniques were shown in 2 patients undergoing minimally-invasive mitral valve repair after a failed TMVr. Results Alternative explantation techniques were described for each TMVr device; 2 techniques for MitraClip and 3 techniques for PASCAL (Precision Transcatheter Valve Repair System), which may be adjusted for each individual according to the underlying valve pathology and the degree of device encapsulation. The patients were discharged without residual MR and remained MR free at the follow-up. Conclusions Transcatheter edge-to-edge repair devices can be surgically explanted without damaging the MV leaflets. Removal of each device may require a different technique tailored to the degree of device encapsulation and valve pathology. Increasing experience may facilitate repair in patients with recurrent MR after TMVr.
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Affiliation(s)
- Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
| | - Karel M. Van Praet
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
| | - Simon H. Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
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11
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Chatani R, Tasaka H, Ono S, Maruo T, Kadota K. Simultaneous procedure transcatheter mitral valve repair and leadless pacemaker implantation under transesophageal echocardiography. J Arrhythm 2023; 39:816-818. [PMID: 37799796 PMCID: PMC10549847 DOI: 10.1002/joa3.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023] Open
Abstract
When we implant leadless pacemaker in patients with contrast agent allergy or poor renal function, the use of sufficient contrast agent is hesitant. Aided by imaging assessment (e.g., intracardiac echocardiography), the procedure may be feasible with a small amount of contrast medium or no contrast medium. In this case, leadless pacemaker implantation was performed at the same time as the transcatheter mitral valve repair, and leadless pacemaker implantation was successful with the use of a very small amount of contrast medium under transesophageal echocardiography guidance.
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Affiliation(s)
- Ryuki Chatani
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Hiroshi Tasaka
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Sachiyo Ono
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Takeshi Maruo
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Kazushige Kadota
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
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12
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Bansal K, Pawar S, Gupta T, Gilani F, Khera S, Kolte D. Association Between Hospital Volume and 30-Day Readmissions After Transcatheter Mitral Valve Edge-to-Edge Repair. Am J Cardiol 2023; 203:149-156. [PMID: 37499594 DOI: 10.1016/j.amjcard.2023.06.102] [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: 02/25/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
Data on the association between hospital procedural volume and 30-day readmissions after mitral valve transcatheter edge-to-edge repair (mTEER) are limited. We used the 2019 Nationwide Readmissions Database to identify hospitals that performed at least 5 mTEERs. Hospitals were categorized based on tertiles of annual mTEER volume as low-volume (5 to 13), medium-volume (14 to 28), and high-volume (29 to 171). Multivariable hierarchical logistic regression models and restricted cubic spline analyses were used to examine the association between hospital mTEER volume and 30-day readmissions. Median (interquartile range) annual hospital mTEER volume was 20 (11.5 to 34). Of 234 hospitals included in the study, 77 (32.9%), 77 (32.9%), and 80 (34.2%) were categorized as low-volume, medium-volume, and high-volume. Of 5,574 index mTEER procedures included in this study, 634 (11.4%), 1,353 (24.3%), and 3,587 (64.3%) were performed at low-volume, medium-volume, and high-volume centers, respectively. In the overall study cohort, rates of 30-day all-cause readmissions after mTEER were 13.2%. In multivariable analyses, there was no significant association between hospital mTEER volume (as a categorical variable) and 30-day all-cause or cause-specific (cardiac, non-cardiac, heart failure) readmissions. Similarly, no significant relation was observed between hospital mTEER volume as a continuous variable and 30-day all-cause or cause-specific readmissions in restricted cubic spline analysis. In conclusion, in a nationally representative sample of 234 hospitals with >5,500 mTEER procedures, we found no association between annual hospital mTEER volume and 30-day all-cause or cause-specific readmissions.
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Affiliation(s)
- Kannu Bansal
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Shubhadarshini Pawar
- Department of Medicine, Shree Vighanaharta Superspeciality Hospital, Dhule, India
| | - Tanush Gupta
- Division of Cardiology, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont
| | - Fahad Gilani
- Division of Cardiovascular Medicine, Catholic Medical Center, Manchester, New Hampshire
| | - Sahil Khera
- Division of Interventional Cardiology, Mount Sinai Hospital, New York, New York
| | - Dhaval Kolte
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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13
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Vemulapalli S, Simonato M, Ben Yehuda O, Wu C, Feldman T, Popma JJ, Sundareswaren K, Krohn C, Hardy KM, Guibone K, Christensen B, Alu MC, Ng VG, Chau KH, Chen S, Shahim B, Vincent F, MacMahon J, James S, Mack M, Leon MB, Thourani VH, Carroll J, Krucoff MW. Minimum Core Data Elements for Transcatheter Mitral Therapies: Scientific Statement by PASSION CV, HVC, and TVTR. JACC Cardiovasc Interv 2023; 16:1437-1447. [PMID: 37380225 DOI: 10.1016/j.jcin.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 06/30/2023]
Abstract
Mitral regurgitation is the most common valvular disease and is estimated to affect over 5 million Americans. Real-world data collection contributes to safety and effectiveness evidence for the U.S. Food and Drug Administration, quality evaluation for the Centers for Medicare and Medicaid Services and hospitals, and clinical best practice research. We aimed to establish a minimum core data set in mitral interventions to promote efficient, reusable real-world data collection for all of these purposes. Two expert task forces separately evaluated and reconciled a list of candidate elements derived from: 1) 2 ongoing transcatheter mitral trials; and 2) a systemic literature review of high-impact mitral trials and U.S multicenter, multidevice registries. From 703 unique data elements considered, unanimous consensus agreement was achieved on 127 "core" data elements, with the most common reasons for exclusion from the minimum core data set being burden or difficulty in accurate assessment (41.2%), duplicative information (25.0%), and low likelihood of affecting outcomes (19.6%). After a systematic review and extensive discussions, a multilateral group of academicians, industry representatives, and regulators established and implemented into the national Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapies Registry 127 interoperable, reusable core data elements to support more efficient, consistent, and informative transcatheter mitral device evidence for regulatory submissions, safety surveillance, best practice development, and hospital quality assessments.
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Affiliation(s)
- Sreekanth Vemulapalli
- Duke University Health/Duke Clinical Research Institute, Durham, North Carolina, USA.
| | | | - Ori Ben Yehuda
- University of California San Diego, San Diego, California, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | | | | | - Carole Krohn
- Society of Thoracic Surgeons, Chicago, Illinois, USA
| | | | - Kimberly Guibone
- Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | | | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - Vivian G Ng
- Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine H Chau
- Columbia University Irving Medical Center, New York, New York, USA
| | - Shmuel Chen
- Cornell Weill Medical Center/New York-Presbyterian, New York, New York, USA
| | | | | | - John MacMahon
- Mitre Medical Corporation, Morgan Hill, California, USA
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - John Carroll
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Mitchell W Krucoff
- Duke University Health/Duke Clinical Research Institute, Durham, North Carolina, USA
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14
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Tersalvi G, Gaiero L, Capriolo M, Cristoforetti Y, Salizzoni S, Senatore G, Pedrazzini G, Biasco L. Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation. Medicina (Kaunas) 2023; 59:1017. [PMID: 37374220 DOI: 10.3390/medicina59061017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US guidelines have identified common diagnostic and therapeutic pathways that do not consider patient sex in decision-making. The aim of this review is to summarize the current evidence on sex-related differences in non-rheumatic mitral regurgitation, particularly regarding incidence, imaging modalities, surgical-derived evidence, and outcomes of transcatheter edge-to-edge repair, with the goal of informing clinicians about sex-specific challenges to consider when making treatment decisions for patients with mitral regurgitation.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Lorenzo Gaiero
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Michele Capriolo
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Yvonne Cristoforetti
- Division of Cardiology, Ospedale Gradenigo, Humanitas Torino, 10153 Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Città della Salute e della Scienza, Università degli Studi di Torino, 10126 Turin, Italy
| | - Gaetano Senatore
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Luigi Biasco
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
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15
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Shechter A, Lee M, Kaewkes D, Koren O, Skaf S, Chakravarty T, Koseki K, Patel V, Makkar RR, Siegel RJ. Repeat Mitral Transcatheter Edge-to-Edge Repair for Recurrent Significant Mitral Regurgitation. J Am Heart Assoc 2023; 12:e028654. [PMID: 37119061 PMCID: PMC10227228 DOI: 10.1161/jaha.122.028654] [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: 10/28/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023]
Abstract
Background There are limited data on repeat mitral transcatheter edge-to-edge repair for recurrent significant mitral regurgitation (MR). Methods and Results We conducted a single-center, retrospective analysis of consecutive patients referred to a second mitral transcatheter edge-to-edge repair after a technically successful first procedure. Clinical, laboratory, and echocardiographic measures were assessed up to 1 year after the intervention. The composite of all-cause death or heart failure (HF) hospitalizations constituted the primary outcome. A total of 52 patients (median age, 81 [interquartile range, 76-87] years, 29 [55.8%] men, 26 [50.0%] with functional MR) met the inclusion criteria. MR recurrences were mostly related to progression of the underlying cardiac pathology. All procedures were technically successful. At 1 year, most patients with available records (n=24; 96.0%) experienced improvement in MR severity or New York Heart Association functional class that was statistically significant but numerically modest. Fourteen (26.9%) patients died or were hospitalized due to HF. These were higher-risk cases with predominantly functional MR who mostly underwent an urgent procedure and exhibited more severe HF indices before the intervention, as well as an attenuated 1-month clinical and echocardiographic response. Overall, 1-year course was comparable to that experienced by patients who underwent only a first transcatheter edge-to-edge repair at our institution (n=902). Tricuspid regurgitation of greater than moderate grade was the only baseline parameter to independently predict the primary outcome. Conclusions Repeat mitral transcatheter edge-to-edge repair is feasible, safe, and clinically effective, especially in non-functional MR patients without concomitant significant tricuspid regurgitation.
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Affiliation(s)
- Alon Shechter
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Mirae Lee
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Division of Cardiology, Department of MedicineSamsung Changwon HospitalChangwonRepublic of Korea
| | - Danon Kaewkes
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of Medicine, Faculty of MedicineKhon Kaen UniversityThailand
| | - Ofir Koren
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael
| | - Sabah Skaf
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Tarun Chakravarty
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Keita Koseki
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Vivek Patel
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Raj R. Makkar
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Robert J. Siegel
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCAUSA
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16
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Zhang J, Yang Y, Jia L, Su J, Xiao A, Lin X. Anticoagulation therapy and clinical outcomes following transcatheter mitral valve repair for patients with mitral regurgitation: A meta-analysis. Clin Cardiol 2023. [PMID: 37036075 DOI: 10.1002/clc.24017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023] Open
Abstract
Transcatheter mitral valve repair (TMVR) using MitraClip (MC) is now an established technique in the interventional treatment of mitral regurgitation. Common complications after MC procedure are bleeding and ischemic events. However, 2017 ESC/EACTS and 2020 ACC/AHA did not give a clear antithrombotic protocol, the policy has been based on clinical experience. Here, we performed a meta-analysis comparing outcomes with and without the addition of anticoagulants after TMVR. We searched the Cochrane Library, EMBASE, PubMed, and Web of Science from inception to October 6, 2022 to identify studies with or without the use of anticoagulants after TMVR. From each study, we extracted the number of people with bleeding, stroke, combined endpoints, and all-cause death. Five observational cohort studies were included, enrolling a total of 1892 patients undergoing TMVR who were assigned to either the anticoagulation group (n = 1209) or the no-anticoagulation group (n = 683). Pooled analysis showed a significantly lower stroke rate in the anticoagulated group (at least 4 weeks duration) compared with the non-anticoagulated group (RR [95% CI] = 0.14 [0.0-0.77], p = 0.02), and similar rates of bleeding, combined endpoints, and all-cause death in both groups (RR [95% CI] = 0.76 [0.48-1.22], p = 0.26), (RR [95% CI] = 0.52 [0.10-2.63], p = 0.43), and (RR [95% CI] = 0.89 [0.58-1.35], p = 0.58). We observed a reduced risk of stroke without elevated risk of bleeding, combined endpoints, or all-cause death in patients using anticoagulants (at least 4 weeks duration) after TMVR compared to no anticoagulants.
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Affiliation(s)
- Jian Zhang
- Cardiology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Graduate School, Anhui Medical University, Anhui, China
| | - Yu Yang
- Cardiology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Graduate School, Anhui Medical University, Anhui, China
| | - Lin Jia
- Cardiology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Graduate School, Anhui Medical University, Anhui, China
| | - Jiannan Su
- Cardiology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Graduate School, Anhui Medical University, Anhui, China
| | - Ai Xiao
- Cardiology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Graduate School, Anhui Medical University, Anhui, China
| | - Xianhe Lin
- Cardiology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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17
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Seo M, Watanabe T, Kikuchi A, Shirakawa Y. A systematic approach for transcatheter mitral valve edge-to-edge repair of isolated commissure prolapse. Echocardiography 2023; 40:427-431. [PMID: 37021487 DOI: 10.1111/echo.15558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/23/2023] [Indexed: 04/07/2023] Open
Abstract
Although transcatheter mitral valve edge-to-edge repair (TEER) has been widely used for non-central degenerative mitral regurgitation (MR), few reports have described therapeutic strategies for commissure prolapse. Furthermore, no standard approach for TEER for commissure has established. Thus, we categorized various grasping strategies into three patterns, and proposed a promising systematic strategy to observe three possible grasping patterns for identifying appropriate grasping target. Here, we report a successful TEER case of isolated posterior commissure prolapse in which we used a systematic approach.
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Affiliation(s)
- Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yukitoshi Shirakawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
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18
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Sehgal S, Subramanyam P, Ahluwalia M, Rastogi A, Bergman G. Transcatheter mitral valve implantation: Implications of interventional technique and 3D echocardiography for complex valve-in-valve paravalvular leak. Ann Card Anaesth 2023; 26:227-231. [PMID: 37706394 PMCID: PMC10284472 DOI: 10.4103/aca.aca_166_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/07/2022] [Accepted: 07/09/2022] [Indexed: 09/15/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve-in-valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve-in-valve PVL are limited. We present a case of a symptomatic patient with severe valve-in-valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve-in-valve-in-valve implantation with a 29 mm Edwards® SAPIEN 3 valve via transseptal approach using three-dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve-in-valve PVL closures.
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Affiliation(s)
- Sankalp Sehgal
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Cardiothoracic Anesthesia, Critical Care and Pain Medicine, 330 Brookline Ave, Boston, MA, USA
| | - Pritha Subramanyam
- Weill Cornell Medical College, New York Presbyterian Hospital, Division of Cardiology, 525 E. 68th Street, New York, NY, USA
| | - Monica Ahluwalia
- Boston Medical Center, Boston University School of Medicine, Division of Cardiovascular Medicine, 72 E. Concord St, Boston, MA, USA
| | - Ashish Rastogi
- Owensboro Health Cardiology, 1301 Pleasant Valley Road, Owensboro, KY, USA
| | - Geoffrey Bergman
- Weill Cornell Medical College, New York Presbyterian Hospital, Division of Cardiology, 525 E. 68th Street, New York, NY, USA
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19
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Boekstegers P, Hausleiter J, Schmitz T, Bufe A, Comberg T, Seyfarth M, Frerker C, Beucher H, Rottländer D, Higuchi S, Ouarrak T, Schneider S. Intraprocedural Residual Mitral Regurgitation and Survival After Transcatheter Edge-to-Edge Repair: Prospective German Multicenter Registry (MITRA-PRO). JACC Cardiovasc Interv 2023; 16:574-585. [PMID: 36922044 DOI: 10.1016/j.jcin.2022.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Residual mitral regurgitation (MR) is thought to be an important predictor of long-term survival following transcatheter edge-to-edge repair (TEER). Intraprocedural MR assessment using transesophageal echocardiography could be limited by image quality, hemodynamics, and patient sedation. The MitraScore is a validated multimodal approach for intraprocedural MR assessment during TEER. OBJECTIVES This study aimed to assess the impact of residual MR using the MitraScore on 1-year mortality. METHODS Patients undergoing mitral TEER were eligible for inclusion in the prospective, multicenter MITRA-PRO registry (A Prospective Registry Study on 1-Year Mortality and the Prognostic Significance of MitraScore After MitraClip Implantation in Patients With Mitral Regurgitation). Patients with a MitraScore ≤3 were defined as patients with mild residual MR after mitral TEER, whereas a MitraScore ≥4 was considered as relevant residual MR. Mortality, rehospitalization, and major adverse events were assessed 1 year after TEER. RESULTS A MitraScore ≤3 was found in 1,059 patients (71.0%), whereas 432 patients revealed a MitraScore ≥4 (29.0%). One-year mortality was significantly lower in patients with nonrelevant residual MR (MitraScore ≤3 14.6% vs MitraScore≥4 22.1%). An almost linear relationship between intraprocedural MitraScore after TEER and mortality was observed. The combined clinical endpoint of mortality and rehospitalization within the 1-year follow-up was also significantly lower in the MitraScore ≤3 group (31.5%) than in the MitraScore ≥4 group (40.8%). A subgroup analysis confirmed the predictive value of the MitraScore in patients with primary, secondary, or mixed MR etiologies. CONCLUSIONS Residual MR assessed by intraprocedural MitraScore after TEER predicts 1-year mortality and rehospitalization. Therefore, the multimodal MitraScore improves MR assessment during mitral TEER and might improve patient survival.(A Prospective Registry Study on 1-Year Mortality and the Prognostic Significance of MitraScore After MitraClip Implantation in Patients With Mitral Regurgitation [MITRA-PRO]; DRKS00012288).
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Affiliation(s)
- Peter Boekstegers
- Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany; Department of Cardiology, Faculty of Health, School of Medicine, Witten, Witten/Herdecke University.
| | - Jörg Hausleiter
- Department of Cardiology, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Alexander Bufe
- Department of Cardiology, Faculty of Health, School of Medicine, Witten, Witten/Herdecke University; Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany
| | - Thomas Comberg
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Melchior Seyfarth
- Department of Cardiology, Faculty of Health, School of Medicine, Witten, Witten/Herdecke University; Department of Cardiology, University Hospital Helios Wuppertal, Wuppertal, Germany
| | - Christian Frerker
- Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Harald Beucher
- Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany
| | - Dennis Rottländer
- Department of Cardiology, Faculty of Health, School of Medicine, Witten, Witten/Herdecke University; Department of Cardiology, Krankenhaus Porz am Rhein, Cologne, Germany
| | - Satoshi Higuchi
- Department of Cardiology, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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20
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D'Onofrio A, Fiocco A, Nadali M, Mastro F, Aruta P, Lorenzoni G, Pittarello D, Gerosa G. Outcomes of transapical mitral valve repair with neochordae implantation. J Thorac Cardiovasc Surg 2023; 165:1036-1046.e4. [PMID: 35624055 DOI: 10.1016/j.jtcvs.2022.02.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 05/17/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Transapical off-pump beating-heart neochord implantation (NC) has shown encouraging early results in patients with degenerative mitral regurgitation. The aim of this study was to evaluate clinical and echocardiographic 5-year outcomes of patients who underwent NC. METHODS All patients who underwent NC at our institution from November 2013 to March 2016 were included. Indications were severe symptomatic degenerative mitral regurgitation due to leaflet prolapse/flail. Patients were classified as having favorable anatomy (FA) and unfavorable anatomy (UA) on the basis of the extent and severity of mitral valve disease. All patients underwent clinical and echocardiographic follow-up at 1, 3, 6, and 12 months, and annually thereafter. Data were prospectively collected and retrospectively analyzed. Outcomes were on the basis of the Mitral Valve Academic Research Consortium guidelines. RESULTS One hundred consecutive patients were included in the analysis (FA: 81%; UA: 19%). Median age was 66 years (interquartile range, 58-76) and median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 1.4% (interquartile range, 0.7-2.3). Technical and procedural success were 98% and 94%, respectively. Thirty-day mortality was 2%. Device success was 94%, 92%, and 78%, at 30 days, 1-year, and 5 years, respectively. Patient success at 1 year was 92%. Median follow-up was 5.1 years. At 5 years, overall survival was 83% with no difference between FA and UA patients. Cumulative incidence of severe mitral regurgitation recurrence at 5 years was 14% (95% CI, 6.5%-22.8%) in FA patients and 63% (95% CI, 39.7%-86.2%) in UA patients, respectively (P < .001). Patients with FA compared with UA had a lower incidence of reintervention (14.7% vs 43.4%; P < .001). CONCLUSIONS Transapical off-pump beating heart NC might represent an acceptable option in patients with degenerative mitral valve disease and FA.
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Affiliation(s)
| | | | - Matteo Nadali
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Florinda Mastro
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Patrizia Aruta
- Division of Cardiology, University of Padova, Padova, Italy
| | | | | | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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21
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Anyanwu AC, Adams DH. Benchmarking Mitral Valve Repair: Defining Standards for Surgical and Percutaneous Treatment of Severe Mitral Regurgitation. J Am Coll Cardiol 2023; 81:649-652. [PMID: 36792279 DOI: 10.1016/j.jacc.2023.01.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York, USA.
| | - David H Adams
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York, USA
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22
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Shahim B, Cohen DJ, Ben-Yehuda O, Redfors B, Kar S, Lim DS, Arnold SV, Li Y, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Impact of Peripheral Artery Disease in Patients With Heart Failure Undergoing Transcatheter Mitral Valve Repair: The COAPT Trial. J Am Heart Assoc 2023; 12:e028444. [PMID: 36752227 PMCID: PMC10111500 DOI: 10.1161/jaha.122.028444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background Peripheral artery disease (PAD) and heart failure (HF) often coexist. Whether PAD influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF and severe secondary mitral regurgitation is unknown. The objectives are to assess the impact of PAD on outcomes of TMVr plus guideline-directed medical therapy (GDMT) versus GDMT alone in patients with HF and secondary mitral regurgitation. Methods and Results The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) randomized patients with HF with ≥moderate-to-severe secondary mitral regurgitation to TMVr with MitraClip implant plus GDMT versus GDMT alone. We evaluated the relationship between PAD and 2-year outcomes in the COAPT trial and examined whether PAD modified the benefits of TMVr. Among 614 patients enrolled, 109 (17.8%) had PAD. By multivariable analysis, PAD was independently associated with 2-year mortality (adjusted hazard ratio [adjHR], 1.51 [95% CI, 1.07-2.15]) but not HF hospitalizations. Compared with GDMT alone, TMVr reduced the 2-year risk of death in patients without PAD (adjHR, 0.42 [95% CI, 0.30-0.60]) but not those with PAD (adjHR, 1.27 [95% CI, 0.72-2.27]; Pinteraction=0.001). In contrast, TMVr reduced HF hospitalizations consistently in patients with (adjHR, 0.65 [95% CI, 0.35-1.23]) and without (adjHR, 0.42 [95% CI, 0.31-0.57]) PAD (Pinteraction=0.22). Improvements in health status and exercise capacity at 2 years with TMVr compared with GDMT alone were similar in degree, irrespective of PAD status (Pinteraction=0.76 and 0.64, respectively). Conclusions In patients with HF and severe secondary mitral regurgitation, the reduced mortality with TMVr in the overall COAPT study population was not observed in the subgroup of patients with PAD. However, TMVr reduced HF hospitalizations and improved health status and exercise capacity consistently in patients with and without PAD. Registration Clinical Trial Name: Cardiovascular Outocmes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (The COAPT Trial); URL: https://www.clinicaltrials.gov/; Unique identifier: NCT01626079. https://clinicaltrials.gov/ct2/show/NCT01626079.
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Affiliation(s)
- Bahira Shahim
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,Division of Cardiology, Department of Medicine Solna Karolinska Institutet, Karolinska University Hospital Stockholm Sweden
| | - David J Cohen
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,St. Francis Hospital Roslyn NY
| | - Ori Ben-Yehuda
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,New York-Presbyterian Hospital/Columbia University Irving Medical Center NY New York.,Division of Cardiology University of California - San Diego San Diego CA
| | - Björn Redfors
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,New York-Presbyterian Hospital/Columbia University Irving Medical Center NY New York.,Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Saibal Kar
- Los Robles Regional Medical Center Thousand Oaks CA.,Bakersfield Heart Hospital Bakersfield CA
| | - D Scott Lim
- Division of Cardiology University of Virginia Charlottesville VA
| | - Suzanne V Arnold
- University of Missouri-Kansas City School of Medicine Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Yanru Li
- Clinical Trials Center Cardiovascular Research Foundation New York NY
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section Vanderbilt Heart and Vascular Institute Nashville TN
| | - William T Abraham
- Division of Cardiovascular Medicine The Ohio State University Columbus OH
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
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23
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Stolz L, Braun D, Higuchi S, Orban M, Doldi PM, Stocker TJ, Weckbach LT, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Transcatheter edge-to-edge mitral valve repair in mitral regurgitation: current status and future prospects. Expert Rev Med Devices 2023; 20:99-108. [PMID: 35791872 DOI: 10.1080/17434440.2022.2098013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/04/2022]
Abstract
INTRODUCTION Mitral regurgitation (MR) is associated with substantial morbidity and mortality. Within the past 15 years, mitral valve edge-to-edge repair (M-TEER) has developed from an experimental approach to a guideline-recommended, safe, and effective treatment option for patients with severe primary or secondary mitral regurgitation. AREAS COVERED This review covered relevant publications of M-TEER and summarizes the development of M-TEER devices within the last 15 years. It outlines anatomical challenges which drove the evolution of M-TEER devices, provides an overview about the current state of clinical application and research, and offers an outlook into the future of transcatheter mitral valve treatment. EXPERT OPINION The development and refinement of new M-TEER device generations offer the possibility to treat a wide range of mitral valve anatomies. Choosing the best device for the individual anatomic properties of the patients and considering comorbidities is the key to maximized MR reduction, minimalized complication rates, and thus optimized postinterventional prognosis. Independent from prognostic implications, quality of life has become an important patient-centered outcome that can be improved by M-TEER in virtually all patients treated.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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24
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Trankle CR, Rodriguez Lozano PF, Mahoney PD, Haughey S, May JF, Rombaoa P, Miller L, Lim S, Gertz ZM. Impact of transcatheter mitral valve edge-to-edge repair on atrial fibrillation burden: Insights from a multicenter cohort. Pacing Clin Electrophysiol 2023; 46:195-197. [PMID: 36450156 DOI: 10.1111/pace.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/24/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Patients with significant mitralregurgitation (MR) often experience atrial fibrillation (AF). The effects of transcatheter edge-to-edge repair (TEER) for MR on AF burden is unknown. METHODS Patients who underwent TEER atthree institutions who also had a cardiac implantable electronic device with aright atrial lead were retrospectively identified. In patients with baseline AF, device data onAF burden and echocardiographic changes were recorded at baseline and 3- and 12-month follow up time points when available. Data is expressed as number (%) and median (interquartile range), withpaired values analyzed using the Wilcoxon signed-rank test. RESULTS Overall 66 patients wereidentified, of whom 54 (82%) had baseline data on AF available for review. Of these, 18 (33%) had a baseline burden ofAF (median burden 100% [54-100%]). Patients were 77 (71-83) years old, 10 (56%) male, 14 (78%) White, and 3 (17%) Black. A significant reduction in AF burdenwas observed at 3 months (11 patients, p = 0.03) which did not retainsignificance at 12 months (8 patients, p = 0.69). Indexed maximal left atrial volumes did not significantly change inthose with paired studies available (p > 0.35 for both time points). CONCLUSIONS In this multicenter cohort, one thirdof patients with severe MR undergoing TEER had an AF burden at baseline, whichwas found to be significantly lower at 3 month follow up. Further investigation is needed to confirm thefindings of this small cohort and determine its effects on downstream sequelaeof AF.
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Affiliation(s)
- Cory R Trankle
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - Sean Haughey
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA.,Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | - Lauren Miller
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Zachary M Gertz
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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25
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Sisinni A, Taramasso M, Praz F, Metra M, Agricola E, Margonato A, Fam N, Estevez-Loureiro R, Latib A, Messika-Zeitoun D, Conradi L, von Bardeleben RS, Sorajja P, Hahn RT, Caravita S, Maisano F, Adamo M, Godino C. Concomitant Transcatheter Edge-to-Edge Treatment of Secondary Tricuspid and Mitral Regurgitation: An Expert Opinion. JACC Cardiovasc Interv 2023; 16:127-139. [PMID: 36697147 DOI: 10.1016/j.jcin.2022.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023]
Abstract
Secondary (functional) tricuspid regurgitation (sTR) is common in patients with mitral regurgitation (MR). Because combined valvular heart disease affects long-term survival, in comparison with isolated MR or tricuspid regurgitation, it is essential to offer patients adequate treatment. Despite considerable experience, no conclusive data are yet available on the prognostic impact of concomitant tricuspid valve surgery at the time of mitral valve surgery. Emerging transcatheter treatments offer the opportunity to treat both conditions (MR and sTR) simultaneously or in a stepwise fashion. This review provides a clinical overview on available data regarding the rationale for treatment of sTR in patients with relevant MR undergoing mitral transcatheter edge-to-edge repair, focusing on clinical and anatomical selection criteria.
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Affiliation(s)
- Antonio Sisinni
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy. https://twitter.com/antosis_93
| | | | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marco Metra
- Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic- Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Alberto Margonato
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Sergio Caravita
- Dyspnea and Pulmonary Hypertension Center, Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Cosmo Godino
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
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26
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Wong P, Wisneski AD, Sandhu A, Wang Z, Mahadevan VS, Nguyen TC, Guccione JM. Looking towards the future: patient-specific computational modeling to optimize outcomes for transcatheter mitral valve repair. Front Cardiovasc Med 2023; 10:1140379. [PMID: 37168656 PMCID: PMC10164975 DOI: 10.3389/fcvm.2023.1140379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023] Open
Abstract
Severe mitral valve regurgitation (MR) is a heart valve disease that progresses to end-stage congestive heart failure and death if left untreated. Surgical repair or replacement of the mitral valve (MV) remains the gold standard for treatment of severe MR, with repair techniques aiming to restore the native geometry of the MV. However, patients with extensive co-morbidities may be ineligible for surgical intervention. With the emergence of transcatheter MV repair (TMVR) treatment paradigms for MR will evolve. The longer-term outcomes of TMVR and its effectiveness compared to surgical repair remain unknown given the differing patient eligibility for either treatment at this time. Advances in computational modeling will elucidate answers to these questions, employing techniques such as finite element method and fluid structure interactions. Use of clinical imaging will permit patient-specific MV models to be created with high accuracy and replicate MV pathophysiology. It is anticipated that TMVR technology will gradually expand to treat lower-risk patient groups, thus pre-procedural computational modeling will play a crucial role guiding clinicians towards the optimal intervention. Additionally, concerted efforts to create MV models will establish atlases of pathologies and biomechanics profiles which could delineate which patient populations would best benefit from specific surgical vs. TMVR options. In this review, we describe recent literature on MV computational modeling, its relevance to MV repair techniques, and future directions for translational application of computational modeling for treatment of MR.
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Affiliation(s)
- Paul Wong
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Andrew D. Wisneski
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Amitoj Sandhu
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Zhongjie Wang
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Vaikom S. Mahadevan
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Tom C. Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Julius M. Guccione
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
- Correspondence: Julius M. Guccione
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27
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Shechter A, Kaewkes D, Makar M, Patel V, Koren O, Koseki K, Solanki A, Dhillon M, Nagasaka T, Skaf S, Chakravarty T, Makkar RR, Siegel RJ. Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair. Front Cardiovasc Med 2023; 10:1111714. [PMID: 36937920 PMCID: PMC10018123 DOI: 10.3389/fcvm.2023.1111714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Background There are scarce data regarding the post-mitral transcatheter edge-to-edger repair (TEER) course in different racial groups. Objective To assess the impact of race on outcomes following TEER for mitral regurgitation (MR). Methods This is a single-center, retrospective analysis of consecutive TEER procedures performed during 2013-2020. The primary outcome was the composite of all-cause mortality or heart failure (HF) hospitalizations along the first postprocedural year. Secondary outcomes included individual components of the primary outcome, New York Heart Association (NYHA) class, MR grade, and left ventricular mass index (LVMi). Results Out of 964 cases, 751 (77.9%), 88 (9.1%), 68 (7.1%), and 57 (5.9%) were whites, blacks, Asians, and Hispanics, respectively. At baseline, non-whites and blacks were younger and more likely be female, based in lower socioeconomic areas, not fully insured, diagnosed with functional MR, and affected by biventricular dysfunction. Intra-procedurally, more devices were implanted in blacks. At 1-year, non-whites (vs. whites) and blacks (vs. non-blacks or whites) experienced higher cumulative incidence of the primary outcome (32.9% vs. 22.5%, p = 0.002 and 38.6% vs. 23.4% or 22.5%, p = 0.002 or p = 0.001, respectively), which were accounted for by hospitalizations in the functional MR sub-cohort (n = 494). NYHA class improved less among blacks with functional MR. MR severity and LVMi equally regressed in all groups. White race (HR 0.62, 95% CI 0.39-0.99, p = 0.047) and black race (HR 2.07, 95% CI 1.28-3.35, p = 0.003) were independently associated with the primary outcome in functional MR patients only. Conclusion Mitral TEER patients of different racial backgrounds exhibit major differences in baseline characteristics. Among those with functional MR, non-whites and blacks also experience a less favorable 1-year clinical outcome.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Aum Solanki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Manvir Dhillon
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Raj R. Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- *Correspondence: Raj R. Makkar,
| | - Robert J. Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Robert J. Siegel,
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28
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Lim DS, Smith RL, Gillam LD, Zahr F, Chadderdon S, Makkar R, von Bardeleben RS, Kipperman RM, Rassi AN, Szerlip M, Goldman S, Inglessis-Azuaje I, Yadav P, Lurz P, Davidson CJ, Mumtaz M, Gada H, Kar S, Kodali SK, Laham R, Hiesinger W, Fam NP, Keßler M, O'Neill WW, Whisenant B, Kliger C, Kapadia S, Rudolph V, Choo J, Hermiller J, Morse MA, Schofer N, Gafoor S, Latib A, Koulogiannis K, Marcoff L, Hausleiter J. Randomized Comparison of Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC Cardiovasc Interv 2022; 15:2523-2536. [PMID: 36121247 DOI: 10.1016/j.jcin.2022.09.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe symptomatic degenerative mitral regurgitation (DMR) has a poor prognosis in the absence of treatment, and new transcatheter options are emerging. OBJECTIVES The CLASP IID (Edwards PASCAL Transcatheter Valve Repair System Pivotal Clinical Trial) randomized trial (NCT03706833) is the first to evaluate the safety and effectiveness of the PASCAL system compared with the MitraClip system in patients with significant symptomatic DMR. This report presents the primary safety and effectiveness endpoints for the trial. METHODS Patients with 3+ or 4+ DMR at prohibitive surgical risk were assessed by a central screening committee and randomized 2:1 (PASCAL:MitraClip). Study oversight also included an echocardiography core laboratory and a clinical events committee. The primary safety endpoint was the composite major adverse event rate at 30 days. The primary effectiveness endpoint was the proportion of patients with mitral regurgitation (MR) ≤2+ at 6 months. RESULTS A prespecified interim analysis in 180 patients demonstrated noninferiority of the PASCAL system vs the MitraClip system for the primary safety and effectiveness endpoints of major adverse event rate (3.4% vs 4.8%) and MR ≤2+ (96.5% vs 96.8%), respectively. Functional and quality-of-life outcomes significantly improved in both groups (P < 0.05). The proportion of patients with MR ≤1+ was durable in the PASCAL group from discharge to 6 months (PASCAL, 87.2% and 83.7% [P = 0.317 vs discharge]; MitraClip, 88.5% and 71.2% [P = 0.003 vs discharge]). CONCLUSIONS The CLASP IID trial demonstrated safety and effectiveness of the PASCAL system and met noninferiority endpoints, expanding transcatheter treatment options for prohibitive surgical risk patients with significant symptomatic DMR.
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Affiliation(s)
- D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA.
| | - Robert L Smith
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Molly Szerlip
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | - Hemal Gada
- UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | | | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | | | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | | | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
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Mauri V, Sugiura A, Spieker M, Iliadis C, Horn P, Öztürk C, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, Pfister R. Early Outcomes of 2 Mitral Valve Transcatheter Leaflet Approximation Devices: A Propensity Score-Matched Multicenter Comparison. JACC Cardiovasc Interv 2022; 15:2541-2551. [PMID: 36543448 DOI: 10.1016/j.jcin.2022.10.008] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND In addition to the edge-to-edge MitraClip repair system, the edge-to-spacer PASCAL repair system was approved for percutaneous treatment of severe mitral regurgitation (MR). Comparative data are lacking. OBJECTIVES The aim of this study was to compare procedural and short-term safety and efficacy of 2 leaflet-based transcatheter mitral valve repair systems. METHODS Procedural and 30-day outcomes were investigated in a propensity score-matched cohort of 307 PASCAL and 307 MitraClip patients at 10 sites. Matching criteria included sex, age, left ventricular ejection fraction, New York Heart Association functional class, MR etiology, left ventricular end-diastolic diameter, left atrial volume index, and vena contracta width. The primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE). RESULTS Technical success was 97.0% in the PASCAL group and 98.0% in the MitraClip group (P = 0.624). MR ≤2+ at discharge was comparable in both groups (PASCAL: 93.8% vs MitraClip: 92.4%; P = 0.527), with more patients exhibiting MR ≤1+ in the PASCAL group (70.5% vs 56.6%; P < 0.001). The postprocedural mean gradient was significantly higher in the MitraClip group (3.3 ± 1.5 mm Hg vs 3.9 ± 1.7 mm Hg; P < 0.001). At 30 days, all-cause mortality and MAE rates were similar (mortality: 1.7% vs 3.3%; P = 0.299; MAE: 3.9% vs 5.2%; P = 0.562). CONCLUSIONS In this first large propensity score-matched comparison, procedural success rates and MAE did not differ significantly between patients treated with the PASCAL or MitraClip valve repair system. Procedural results with less than moderate MR and no elevated transmitral gradient were more common in the PASCAL group, which might have an impact on long-term outcome.
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Affiliation(s)
- Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Max Spieker
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Osamah Al-Hammadi
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Muhammed Gerçek
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany; Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christoph Mues
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Niklas Boeder
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Felix Kreidel
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Kai Friedrichs
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Holger M Nef
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany.
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Wang X, Ma Y, Liu J, Wang T, Zhu L, Fan X, Cui Q, Liu C, Guan G, Wang J, Pan S, Liu Z, Zhang Y. Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting. Front Cardiovasc Med 2022; 9:953875. [PMID: 36620639 PMCID: PMC9810628 DOI: 10.3389/fcvm.2022.953875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Aims Patients with severe ischemic mitral regurgitation (IMR) may receive concurrent coronary artery bypass graft (CABG) with surgical mitral valve repair (SMVr) or percutaneous coronary stent implantation (PCI) with transcatheter edge-to-edge mitral valve repair (TMVr). However, there is no consensus on the management of severe IMR in this setting. We aimed to compare the outcomes of combined SMVr with CABG to concurrent TMVr with PCI among patients with IMR in the National Inpatient Sample (NIS) database. Methods and results The National Inpatient Sample was queried for all patients diagnosed with IMR who underwent SMVr with CABG or TMVr with PCI during the years 2016-2018. Study outcomes included all-cause in-hospital mortality, periprocedural complications, and resources used. A total of 1,360 potentially eligible patients were included in the study. After 1:5 propensity score matching, 133 patients were classified in the SMVr + CABG group and 29 patients in the TMVr + PCI group. Adjusted mortality was higher in the TMVr + PCI group compared with the SMVr + CABG group (13.8% vs. 4.5%, P = 0.034). Perioperative complications were higher among patients who underwent SMVr + CABG including blood transfusions (29.3% vs. 6.9%, P = 0.01) and post-procedural cardiogenic shock (11.3% vs. 0%, P = 0.044). The cost of care was higher (USD$783548.80 vs. USD$331846.523, P = 0.001) and the length of stay was longer (17.9 vs. 15.44 days, P < 0.001) in the TMVr + PCI group. On multivariable analysis, age (OR, 1.039 [95% CI, 1.006-1.072]; P = 0.032), renal failure (OR, 3.465 [95% CI, 1.867-6.433]; P < 0.001), and liver disease (OR, 5.012 [95% CI, 2.578-9.686]; P < 0.001) were associated with in-hospital mortality. Conclusion TMVr + PCI was associated with higher resource use and in-hospital mortality but with improved perioperative complications compared with SMVr + CABG.
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Affiliation(s)
- Xiqiang Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Yanpeng Ma
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Jing Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Ting Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Ling Zhu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiude Fan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qianwei Cui
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Chengfeng Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Shuo Pan
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China,*Correspondence: Shuo Pan,
| | - Zhongwei Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China,Zhongwei Liu,
| | - Yong Zhang
- Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China,Yong Zhang,
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Burgess S, Cader FA, Shaw E, Banerjee S, Stehli J, Krishnamorthy R, Khor L, Forotan H, Bastiany A, Rao S, Chandrasekhar J, Zaman S, Alasnag M, Chieffo A, Coylewright M. Under-representation of Women as Proceduralists and Patients in TAVR and TMVr Procedures: Data, Implications and Proposed Solutions. Eur Cardiol 2022; 17:e27. [PMID: 36845217 PMCID: PMC9947929 DOI: 10.15420/ecr.2022.33] [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: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 12/23/2022] Open
Abstract
Women are under-represented among transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr) operators. This review assesses the representation of women as patients and as proceduralists and trial authors in major structural interventions. Women are under-represented as proceduralists in structural interventions: only 2% of TAVR operators and 1% of TMVr operators are women. Only 1.5% of authors in landmark clinical TAVR and TMVr trials are interventional cardiologists who are women (4/260). Significant under-representation and under-enrolment of women in landmark TAVR trials is evident: the calculated participation-to-prevalence ratio (PPR) is 0.73, and in TMVr trials, the PPR is 0.69. Under-representation of women is also evident in registry data (PPR = 0.84 for TAVR registries and for TMVr registries). In structural interventional cardiology, women are under-represented as proceduralists, trial participants and patients. This under-representation has the potential to affect the recruitment of women to randomised trials, subsequent guideline recommendations, selection for treatment, patient outcomes and sex-specific data analysis.
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Affiliation(s)
- Sonya Burgess
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - F. Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research InstituteDhaka, Bangladesh,Department of Population Health, University of OxfordOxford, UK
| | - Elizabeth Shaw
- Department of Medicine, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Hornsby Ku-ring-gai Hospital,Sydney, New South Wales, Australia,Department of Cardiology, Sydney Adventist Hospital, WahroongaSydney, New South Wales, Australia
| | - Shrilla Banerjee
- Department of Cardiology, Surrey and Sussex Healthcare NHS TrustRedhill, UK
| | - Julia Stehli
- Department of Cardiology, University Hospital ZurichZurich, Switzerland
| | | | - Lynn Khor
- Department of Cardiology, Nepean HospitalSydney, New South Wales, Australia
| | - Homa Forotan
- Department of Cardiology, Princess Alexandra HospitalBrisbane, Queensland, Australia
| | - Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre and Northern Ontario School of MedicineThunder Bay, Ontario, Canada
| | - Sarita Rao
- Department of Cardiology, Apollo HospitalIndore, India
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern HealthMelbourne, Victoria, Australia,Eastern Health Clinical School, Monash UniversityMelbourne, Victoria, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, University of SydneySydney, New South Wales, Australia,Department of Cardiology, Westmead HospitalSydney, New South Wales, Australia
| | - Mirvat Alasnag
- Department of Cardiology, King Fahd Armed Forces HospitalJeddah, Saudi Arabia
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific InstituteMilan, Italy
| | - Megan Coylewright
- Section of Cardiovascular Medicine, Erlanger Heart and Lung InstituteChattanooga, Tennessee, US
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Kono T, Onohara D, Amedi A, Corporan D, Padala M. Effect of early versus late onset mitral regurgitation on left ventricular remodeling in ischemic cardiomyopathy in an animal model. J Thorac Cardiovasc Surg 2022; 164:e333-e347. [PMID: 34903384 PMCID: PMC9108127 DOI: 10.1016/j.jtcvs.2021.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients who survive a myocardial infarction have progressive cardiac dysfunction and ventricular remodeling. Mitral regurgitation is often diagnosed in these patients, and is a risk factor that portends poor prognosis. Whether such postinfarction mitral regurgitation magnifies adverse left ventricular remodeling is unclear, which was studied in an animal model. METHODS Forty-one adult rats were induced with myocardial infarction using left coronary artery ligation and assigned to 3 groups: group 1, myocardial infarction only; group 2, myocardial infarction with severe mitral regurgitation introduced after 4 weeks; and group 3, myocardial infarction with severe mitral regurgitation introduced after 10 weeks. Valve regurgitation was introduced by advancing a transapical ultrasound-guided needle into the mitral valve anterior leaflet. Animals were survived to 20 weeks from the index procedure, with biweekly cardiac ultrasound, and invasive hemodynamics and histology at termination. RESULTS At 20 weeks, end diastolic volume was largest in the groups with mitral regurgitation, compared with the group without the valve lesion (group 1, 760.9 ± 124.6 μL; group 2, 958.0 ± 115.1 μL; group 3, 968.3 ± 214.9 μL). Similarly, end systolic volume was larger in groups with regurgitation (group 1, 431.2 ± 152.6 μL; group 2, 533.2 ± 130.8 μL; group 3, 533.1 ± 177.5 μL). In the infarction-only group, left ventricular remodeling was maximal until 6 weeks and plateaued thereafter. In groups with mitral regurgitation, left ventricular remodeling was significantly elevated at the onset of regurgitation and persisted. CONCLUSIONS Mitral regurgitation is a potent driver of adverse cardiac remodeling after a myocardial infarction, irrespective of the timing of its onset.
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Affiliation(s)
- Takanori Kono
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga
| | - Daisuke Onohara
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga; Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga
| | - Alan Amedi
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga
| | - Daniella Corporan
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga; Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga
| | - Muralidhar Padala
- Structural Heart Research and Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, Ga; Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga.
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Keller K, Geyer M, Hobohm L, Tamm AR, Kreidel F, Ruf TF, Hell M, Schmitt VH, Bachmann K, Born S, Schulz E, Münzel T, von Bardeleben RS. Survival benefit of overweight patients undergoing MitraClip® procedure in comparison to normal-weight patients. Clin Cardiol 2022; 45:1236-1245. [PMID: 36070481 DOI: 10.1002/clc.23897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The number of MitraClip® implantations increased significantly in recent years. Data regarding the impact of weight class on survival are sparse. HYPOTHESIS We hypothesized that weight class influences survival of patients treated with MitraClip® implantation. METHODS We investigated in-hospital, 1-year, 3-year, and long-term survival of patients successfully treated with isolated MitraClip® implantation for mitral valve regurgitation (MR) (June 2010-March 2018). Patients were categorized by weight classes, and the impact of weight classes on survival was analyzed. RESULTS Of 617 patients (aged 79.2 years; 47.3% females) treated with MitraClip® implantation (June 2010-March 2018), 12 patients were underweight (2.2%), 220 normal weight (40.1%), 237 overweight (43.2%), and 64 obesity class I (11.7%), 12 class II (2.2%), and 4 class III (0.7%). Preprocedural Logistic EuroScore (21.1 points [IQR 14.0-37.1]; 26.0 [18.5-38.5]; 26.0 [18.4-39.9]; 24.8 [16.8-33.8]; 33.0 [25.9-49.2]; 31.6 [13.1-47.6]; p = .291) was comparable between groups. Weight class had no impact on in-hospital death (0.0%; 4.1%; 1.5%; 0.0%; 7.7%; 0.0%; p = .189), 1-year survival (75.0%; 72.0%; 76.9%; 75.0%; 75.0%; 33.3%; p = .542), and 3-year survival (40.0%; 36.8%; 38.2%; 48.6%; 20.0%; 33.3%; p = .661). Compared to normal weight, underweight (hazard ratio [HR]: 1.35 [95% confidence interval [CI]: 0.65-2.79], p = .419), obesity-class I (HR: 0.93 [95% CI: 0.65-1.34], p = .705), class II (HR: 0.39 [95% CI: 0.12-1.24], p = .112), and class III (HR: 1.28 [95% CI: 0.32-5.21], p = .726) did not affect long-term survival. In contrast, overweight was associated with better survival (HR: 1.32 [95% CI: 1.04-1.68], p = .023). CONCLUSION Overweight affected the long-term survival of patients undergoing MitraClip® implantation beneficially compared to normal weight.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Medical Clinic VII: Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias F Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Volker H Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Ralph S von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
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Xia W, Han K, Lou Y. MitraClip for the treatment of heart failure with mitral regurgitation: A cost-effectiveness analysis in a Chinese setting. Front Cardiovasc Med 2022; 9:970118. [PMID: 36440042 PMCID: PMC9691652 DOI: 10.3389/fcvm.2022.970118] [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] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/11/2022] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Heart failure (HF) with mitral regurgitation is associated with decreased survival. Guideline-directed medical therapy and transcatheter edge-to-edge repair (TEER) are the main options for HF patients with severe mitral regurgitation who are considered high-risk or prohibitive. To date, there have been no studies investigating the cost-effectiveness of MitraClip vs. optimal medical therapy (OMT) in a Chinese setting. METHODS A combined decision tree and Markov model were developed to compare the cost-effectiveness MitraClip vs. OMT with a lifetime simulation. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represented incremental costs per quality-adjusted life-year (QALY). The willingness-to-pay (WTP) threshold was set three times of per capita gross domestic product (GDP) in China in 2021, which was 242,928 CNY. MitraClip would be considered cost-effective if the ICER obtained was lower than the WTP threshold. Otherwise, it would be not considered cost-effective. One-way sensitivity and probabilistic sensitivity analyses were performed to validate the robustness of the results. RESULTS After a simulation of the lifetime, the overall cost for a patient in the MitraClip cohort was 423,817 CNY, and the lifetime cost in the OMT was 28,369 CNY. The corresponding effectiveness in both cohorts was 2.32 QALY and 1.80 QALY per person, respectively. The incremental cost and increment effectiveness were 395,448 CNY and 0.52 QALY, respectively, and the ICER was 754,410 CNY/QALY. The ICER obtained was higher than the WTP threshold. Sensitivity analysis validated our finding. CONCLUSION MitraClip provided effectiveness but with more costs compared with OMT, and the incremental cost-effectiveness ratio obtained was higher than the WTP threshold. MitraClip was considered not cost-effective in Chinese HF patients with secondary mitral regurgitation.
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Affiliation(s)
- Wengang Xia
- Department of Cardiology, Zigong Third People's Hospital, Zigong, China
| | - Kangning Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yake Lou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Adhami N, Rozor M, Percy C, Achtem L, Johnston S, Nathoo N, Pak M, Polderman J, Lauck SB. The Road to a Transcatheter Edge to Edge Repair: Patient Experiences Leading Up to the Procedure and in the Early Recovery Period. Eur J Cardiovasc Nurs 2022:6650482. [PMID: 35895525 DOI: 10.1093/eurjcn/zvac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/14/2022] [Indexed: 11/14/2022]
Abstract
AIM Mitral valve transcatheter edge-to-edge repair (TEER) is a minimally invasive treatment option for patients with severe symptomatic mitral regurgitation who are at increased risk for cardiac surgery and are receiving optimal medical therapy. Little is known about patients' perspectives of their journey of care, including their experiences leading up to treatment, and their early recovery period. The aim of this study was to explore patients' experiences of their journey to TEER and their perspectives on their early recovery. METHODS AND RESULTS We conducted a qualitative study using interpretive description. A purposive sample of 12 patients, 3 to 6 months post TEER procedure, were recruited from a tertiary hospital. The median age was 79 years and 7 were male and 5 were female. Data collection included semi-structured interviews via the telephone. Data analysis followed an iterative process and utilized thematic analysis. There were four central themes highlighting the experiences of the patients leading up to their procedure: (1) escalating challenges with everyday life; (2) plummeting losses; (3) choosing and readiness to proceed with TEER; and (4) the long and uncertain wait. The theme improved health status highlights the experiences of patients in their early recovery. CONCLUSION Patients' experiences of waiting for TEER are complex and involve multifaceted challenges related to their worsening cardiac symptoms and navigating the health care system. Care pathways must be in place to provide continuity of care and support.
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Affiliation(s)
- Nassim Adhami
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
- University of British Columbia, School of Nursing, Canada T201-2211 Wesbrook Mall Vancouver, BC, Canada, V6T 2B5
| | - Mihaela Rozor
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Celeste Percy
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Leslie Achtem
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Sylvia Johnston
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Naureen Nathoo
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Melissa Pak
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Jopie Polderman
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
| | - Sandra B Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada 5261-1081 Burrard Street Vancouver, BC, Canada, V6Z 1Y6
- University of British Columbia, School of Nursing, Canada T201-2211 Wesbrook Mall Vancouver, BC, Canada, V6T 2B5
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Xiling Z, Puehler T, Sondergaard L, Frank D, Seoudy H, Mohammad B, Müller OJ, Sellers S, Meier D, Sathananthan J, Lutter G. Transcatheter Mitral Valve Repair or Replacement: Competitive or Complementary? J Clin Med 2022; 11:jcm11123377. [PMID: 35743448 PMCID: PMC9225133 DOI: 10.3390/jcm11123377] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
Over the last two decades, transcatheter devices have been developed to repair or replace diseased mitral valves (MV). Transcatheter mitral valve repair (TMVr) devices have been proven to be efficient and safe, but many anatomical structures are not compatible with these technologies. The most significant advantage of transcatheter mitral valve replacement (TMVR) over transcatheter repair is the greater and more reliable reduction in mitral regurgitation. However, there are also potential disadvantages. This review introduces the newest TMVr and TMVR devices and presents clinical trial data to identify current challenges and directions for future research.
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Affiliation(s)
- Zhang Xiling
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
| | - Thomas Puehler
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
| | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | - Derk Frank
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Hatim Seoudy
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Baland Mohammad
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
| | - Oliver J. Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
- Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Stephanie Sellers
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada; (S.S.); (D.M.); (J.S.)
- Cardiovascular Translational Laboratory, St Paul’s Hospital & Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - David Meier
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada; (S.S.); (D.M.); (J.S.)
- Cardiovascular Translational Laboratory, St Paul’s Hospital & Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, BC V6Z 1Y6, Canada; (S.S.); (D.M.); (J.S.)
- Cardiovascular Translational Laboratory, St Paul’s Hospital & Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (Z.X.); (T.P.); (B.M.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 24105 Kiel, Germany; (D.F.); (O.J.M.)
- Correspondence: ; Tel.: +49-(0)43150022031; Fax: +49-(0)043150022048
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Alachkar MN, Müller T, Alnaimi A, Milzi A, Kneizeh K, Altiok E, Schröder J, Reith S, Marx N, Dreher M, Almalla M, Daher A. Safety and efficacy of transcatheter mitral valve repair in patients with COPD; results from real-world cohort. Catheter Cardiovasc Interv 2022; 100:145-153. [PMID: 35615874 DOI: 10.1002/ccd.30238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of transcatheter mitral valve repair (TMVR) in patients with chronic obstructive pulmonary disease (COPD). BACKGROUND Heart failure and COPD share many clinical features and commonly coexist. Data about the safety and efficacy of TMVR in patients with COPD is not conclusive. METHODS Three hundred and forty consecutive patients undergoing TMVR were retrospectively included. COPD diagnosis was based on pulmonary function tests (PFTs). Intra-hospital, 30-day- and 1-year outcomes were compared between both groups. RESULTS Eighty-two patients had COPD (24%). There was no difference in intra-hospital mortality between patients with and without COPD (both 5%, p = 0.95). Among patients who had a successful procedure and survived to discharge there was a trend toward more rehospitalization due to decompensated heart failure at 30-day follow-up in patients with COPD (12.9% vs. 6.8%, p = 0.08) with no difference in mortality. At median follow-up of 1 year, New York heart association (NYHA) category was comparable among both groups and there was no significant difference in rehospitalization (COPD: 29.9% vs. non-COPD: 34%, p = 0.5). There was a trend toward increased 1-year mortality in COPD patients (31.2% vs. 20.6%, p = 0.06). However, a composite endpoint of rehospitalization or death at 1 year did not differ between both groups (48% vs. 42.5%, p = 0.4). Regression analysis showed no correlation between COPD severity and worse TMVR outcomes. CONCLUSIONS COPD is highly prevalent among patients undergoing TMVR. However, TMVR seems to be safe and effective in COPD patients. COPD severity and PFT impairment alone should not be considered as a contraindication for TMVR.
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Affiliation(s)
- Mhd Nawar Alachkar
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Tobias Müller
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Anas Alnaimi
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Andrea Milzi
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Kinan Kneizeh
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Sebastian Reith
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany.,Clinic for Cardiology and Angiology, St. Franziskus-Hospital, Münster, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
| | - Ayham Daher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, Aachen, Germany
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Postalian A, Krajcer Z. Mitral annular calcification-A marker of risk, and a harbinger of technical challenges during intervention. Catheter Cardiovasc Interv 2022; 99:1817-1818. [PMID: 35568978 DOI: 10.1002/ccd.30216] [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: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Alexander Postalian
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
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Koell B, Ludwig S, Weimann J, Waldschmidt L, Hildebrandt A, Schofer N, Schirmer J, Westermann D, Reichenspurner H, Blankenberg S, Conradi L, Lubos E, Kalbacher D. Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair. JACC Cardiovasc Interv 2022; 15:922-934. [PMID: 35512916 DOI: 10.1016/j.jcin.2021.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 06/10/2021] [Revised: 11/18/2021] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the adverse impact of elevated postprocedural mitral valve pressure gradient (MPG) on outcome in a real-world population of patients with severe mitral regurgitation (MR) who underwent transcatheter mitral valve edge-to-edge repair (TEER). BACKGROUND TEER has become a routine treatment alternative for patients with severe MR at high surgical risk. The consequences of elevated MPG after TEER have been subject to controversial debates. METHODS All consecutive patients undergoing TEER for either severe degenerative MR (DMR) or functional MR (FMR) at a high-volume center between September 2008 and January 2020 were prospectively included and followed periodically. Postprocedural MPG by discharge transthoracic echocardiography was considered elevated at ≥5 mm Hg. The primary combined endpoint was death or heart failure rehospitalization after 5 years. RESULTS A total of 713 patients undergoing TEER (DMR, n = 265; FMR, n = 445) were included. Elevated postprocedural MPG was present in 37.0% of those with DMR (n = 98) and 22.0% of those with FMR (n = 98). In contrast to patients with FMR, 6-minute walk distance did not improve in patients with DMR with elevated MPG. Kaplan-Meier analyses did not demonstrate significant differences for the primary endpoint in patients with DMR (low vs elevated MPG, 67.3% vs 74.4%; P = 0.06) and those with FMR (78.6% vs 74.8%; P = 0.54). After adjustment, elevated MPG was an independent predictor of the primary endpoint in patients with DMR (HR: 1.59; 95% CI: 1.03-2.45; P = 0.034) but not in those with FMR (HR: 0.87; 95% CI: 0.63-1.22; P = 0.43). CONCLUSIONS Elevated postprocedural MPG is an independent predictor of adverse clinical and functional outcomes in patients with DMR but not in those with FMR.
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Affiliation(s)
- Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Annabel Hildebrandt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Hermann Reichenspurner
- DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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Hahn RT, Hausleiter J. Transmitral Gradients Following Transcatheter Edge-to-Edge Repair: Are Mean Gradients Meaningful? JACC Cardiovasc Interv 2022; 15:946-949. [PMID: 35430172 DOI: 10.1016/j.jcin.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center, New York, New York, USA.
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK; German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
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Song C, Madhavan MV, Lindenfeld J, Abraham WT, Kar S, Lim DS, Grayburn PA, Kapadia SR, Kotinkaduwa LN, Mack MJ, Stone GW. Age-Related Outcomes After Transcatheter Mitral Valve Repair in Patients With Heart Failure: Analysis From COAPT. JACC Cardiovasc Interv 2022; 15:397-407. [PMID: 35093278 DOI: 10.1016/j.jcin.2021.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of age on outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. BACKGROUND In the COAPT trial, TEER with the MitraClip device in patients with heart failure (HF) and moderate to severe or severe secondary mitral regurgitation (SMR) reduced the risk for HF hospitalization (HFH) and all-cause mortality compared with maximally tolerated guideline-directed medical therapy (GDMT) alone. There are limited data regarding the effectiveness of MitraClip therapy in elderly patients. METHODS Patients (n = 614) were grouped by median age at randomization (74 years) and by MitraClip treatment vs GDMT alone. The primary endpoint was the 2-year rate of death or HFH assessed by multivariable Cox regression. RESULTS Death or HFH within 2 years occurred less frequently after treatment with the MitraClip vs GDMT alone in patients <74 years of age (37.3% vs 64.5%; adjusted HR: 0.41; 95% CI: 0.29-0.59) and ≥74 years of age (51.7% vs 69.6%; adjusted HR: 0.58; 95% CI: 0.42-0.81) (Pint = 0.17). Mortality was also consistently reduced with MitraClip treatment in young and elderly patients (Pint = 0.42). In contrast, elderly patients treated with the MitraClip vs GDMT alone tended to have a lesser reduction of HFH than younger patients (Pint = 0.03). Younger and older patients had similar improvements in quality of life after treatment with the MitraClip compared with GDMT alone. CONCLUSIONS In the COAPT trial, MitraClip treatment of moderate to severe and severe SMR reduced the composite risk for death or HFH and improved survival and quality of life regardless of age. As such, young and elderly patients with HF and severe SMR benefit from TEER, although elderly patients may not have as great a benefit from the MitraClip device in reducing HFH.
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Affiliation(s)
- Chris Song
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mahesh V Madhavan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, Texas, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Michael J Mack
- Baylor Scott and White Heart Hospital - Plano, Dallas, Texas, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.
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Koell B, Orban M, Weimann J, Kassar M, Karam N, Neuss M, Petrescu A, Iliadis C, Unterhuber M, Adamo M, Giannini C, Melica B, Ludwig S, Massberg S, Praz F, Pfister R, Thiele H, Stephan von Bardeleben R, Baldus S, Butter C, Lurz P, Windecker S, Metra M, Petronio AS, Hausleiter J, Lubos E, Kalbacher D; EuroSMR Investigators. Outcomes Stratified by Adapted Inclusion Criteria After Mitral Edge-to-Edge Repair. J Am Coll Cardiol 2021; 78:2408-21. [PMID: 34886961 DOI: 10.1016/j.jacc.2021.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although mitral valve transcatheter edge-to-edge repair (M-TEER) achieves symptomatic benefit for a broad spectrum of patients with relevant secondary mitral regurgitation, conflicting data exist on its prognostic impact. OBJECTIVES Adapted enrollment criteria approaching those used in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) and MITRA-FR (Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation) trials were retrospectively applied to a European real-world registry to evaluate the influence of the respective criteria on outcomes. METHODS A total of 1,022 patients included in the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry and treated with M-TEER (November 2008 to September 2019) were stratified into COAPT-eligible (n = 353 [34.5%]) and COAPT-ineligible (n = 669 [65.5%]) as well as MITRA-FR-eligible (n = 408 [48.3%]) and MITRA-FR-ineligible (n = 437 [51.7%]) groups. RESULTS Although the stratification of patients according to adapted MITRA-FR criteria led to comparable outcomes regarding all-cause mortality (P = 0.19), the application of adapted COAPT enrollment criteria demonstrated lower mortality rates in COAPT-eligible compared with COAPT-ineligible patients (P < 0.001). Multivariable Cox regression analysis identified New York Heart Association functional class IV (hazard ratio [HR]: 2.29; 95% confidence interval [CI]: 1.53-3.42; P < 0.001), logarithmic N-terminal pro-brain natriuretic peptide (HR: 1.47; 95% CI: 1.24-1.75; P < 0.001), and right ventricular-to-pulmonary arterial coupling (HR: 0.10; 95% CI: 0.02-0.57; P = 0.009) as independent predictors of outcome. Yet improvement of functional outcome was demonstrated in a subset of patients irrespective of COAPT eligibility status. CONCLUSIONS In this real-world cohort of patients with secondary mitral regurgitation undergoing M-TEER, the retrospective application of adapted COAPT enrollment criteria successfully identified a specific phenotype demonstrating lower mortality rates. On the contrary, stratification according to adapted MITRA-FR criteria resulted in comparable outcomes.
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Mandurino-Mirizzi A, Crimi G, Raineri C, Magrini G, Gazzoli F, Frassica R, Gritti V, Montalto C, Scelsi L, Turco A, Ameri P, Ghio S, Ferrario M, Oltrona-Visconti L. Haemodynamic impact of MitraClip in patients with functional mitral regurgitation and pulmonary hypertension. Eur J Clin Invest 2021; 51:e13676. [PMID: 34487548 DOI: 10.1111/eci.13676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/16/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandro Mandurino-Mirizzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Magrini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabrizio Gazzoli
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Romina Frassica
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Gritti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Ameri
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Lodhi HA, Mathews A, Bansal P, Altaii H, Morcos R, Desai A, Maini B, Khalili H. Feasibility of Transcatheter Mitral Valve Repair for Non-A2P2 Mitral Regurgitation. J Invasive Cardiol 2021; 33:E968-E969. [PMID: 34619656] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
MitraClip is approved for treatment of both degenerative and functional mitral regurgitation (MR). The landmark trials for this device included only patients with A2P2 location of MR. Initial commercial experience showed A2P2 location was associated with higher technical success as compared with non-A2P2 location. We intended to compare technical success of A2P2 vs non-A2P2 MitraClip procedures in terms of residual MR and transmitral gradient (TMG) in the contemporary setting as the operator experience has increased. A total of 159 patients with complete data were included in the study. A total of 129 patients were in the A2P2 MitraClip group and 30 patients were in the non-A2P2 MitraClip group. Post implantation, there was a significant increase in TMG in both A2P2 and non-A2P2 groups (0.73 ± 1.42 and 0.94 ± 1.85, respectively; both P<.01). However, postimplantation TMG was not different between the 2 groups (3.6 ± 1.9 A2P2 vs 3.7 ± 1.7 non-A2P2; P=.56) and there was no difference in residual MR (P=.40). At 1-month follow-up of 82 patients (64 A2P2 and 18 non-A2P2), the results were similar; TMG (3.7 ± 1.6 A2P2 vs 3.7 ± 2.1 non-A2P2; P=.96) and residual MR (P=.41). Our data showed similar technical success of MitraClip procedures in both types of MR.
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Affiliation(s)
- Hamza A Lodhi
- Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484 USA.
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Brugger N, Kassar M, Siontis GCM, Widmer S, Okuno T, Winkel MG, Corpataux N, Gräni C, Büllesfeld L, Hunziker L, Pilgrim T, Windecker S, Praz F. Integrative echocardiographic assessment of patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2021; 98:1404-1412. [PMID: 34406713 DOI: 10.1002/ccd.29916] [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: 02/07/2021] [Accepted: 07/31/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate whether the integrative echocardiographic criteria used in the cardiovascular outcomes assessment of the mitraclip percutaneous therapy (COAPT) for heart failure patients with functional mitral regurgitation study predict outcomes after edge-to-edge trancatheter mitral valve repair (TMVr) for the treatment of secondary mitral regurgitation (SMR). BACKGROUND Two randomized controlled trials comparing TMVr to medical treatment reported conflicting findings. Differences in patient selection criteria may have contributed to these diverging results. METHODS Patients undergoing TMVr were stratified following the integrative COAPT echocardiographic criteria in noneligible and eligible patients who were further classified into three tiers according to effective regurgitant orifice (EROA) (Tier 1: EROA ≥ 0.3cm2 ; Tier 2: EROA 0.2cm2 and 0.29cm2 ; Tier 3: EROA<0.2cm2 ) combined with several other severity criteria. We assessed between group differences in all-cause mortality, successful SMR reduction, and symptom relief from baseline to 2-year follow-up. RESULTS Between March 2011 and March 2018, 138 patients (mean age 75 years) satisfying the inclusion criteria underwent TMVr for treatment of symptomatic SMR. The mean EROA area was 0.35 ± 0.17 mm2 . Ten patients (7%) died within 30 days, 29 (21%) within 12 months, and 41 (30%) within 2 years. After stratification according to the COAPT echocardiographic criteria that were fulfilled in 72% of the studied population, Tier 2 patients (45%), as well as noneligible patients (38%) had a higher mortality rate compared to those in Tier 1 (19%). CONCLUSIONS SMR patients stratified into tiers according to the COAPT integrative echocardiographic criteria have diverging prognostic and symptomatic benefit after edge-to-edge TMVr.
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Affiliation(s)
- Nicolas Brugger
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Sonja Widmer
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mirjam G Winkel
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Lutz Büllesfeld
- Department of Internal Medicine and Cardiology, GFO Hospitals Bonn, Bonn, Germany
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Villablanca PA, Vemulapalli S, Stebbins A, Dai D, So CY, Eng MH, Wang DD, Frisoli TM, Lee JC, Kang G, Szerlip M, Ibrahim H, Staniloae C, Gaba P, Lemor A, Finn M, Ramakrishna H, Williams MR, Leon MB, O'Neill WW, Shah B. Sex-Based Differences in Outcomes With Percutaneous Transcatheter Repair of Mitral Regurgitation With the MitraClip System: Transcatheter Valve Therapy Registry From 2011 to 2017. Circ Cardiovasc Interv 2021; 14:e009374. [PMID: 34784236 DOI: 10.1161/circinterventions.120.009374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women have a higher rate of adverse events after mitral valve surgery. We sought to evaluate whether outcomes after transcatheter edge-to-edge repair intervention by sex have similar trends to mitral valve surgery. METHODS The primary outcome was 1-year major adverse events defined as a composite of all-cause mortality, stroke, and any bleeding in the overall study cohort. Patients who underwent transcatheter edge-to-edge repair for mitral regurgitation with the MitraClip system in the Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapy registry were evaluated. Linked administrative claims from the Centers for Medicare and Medicaid Services were used to evaluate 1-year clinical outcomes. Associations between sex and outcomes were evaluated using a multivariable logistic regression model for in-hospital outcomes and Cox model for 1-year outcomes. RESULTS From November 2013 to March 2017, 5295 patients, 47.6% (n=2523) of whom were female, underwent transcatheter edge-to-edge repair. Females were less likely to have >1 clip implanted (P<0.001) and had a lower adjusted odds ratio of device success (adjusted odds ratio, 0.78 [95% CI, 0.67-0.90]), driven by lower odds of residual mitral gradient <5 mm Hg (adjusted odds ratio, 0.54 [CI, 0.46-0.63]) when compared with males. At 1-year follow-up, the primary outcome did not differ by sex. Female sex was associated with lower adjusted 1-year risk of all-cause mortality (adjusted hazard ratio, 0.80 [CI, 0.68-0.94]), but the adjusted 1-year risk of stroke and any bleeding did not differ by sex. CONCLUSIONS No difference in composite outcome of all-cause mortality, stroke, and any bleeding was observed between females and males. Adjusted 1-year all-cause mortality was lower in females compared with males.
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Affiliation(s)
- Pedro A Villablanca
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | | | - Amanda Stebbins
- Duke Clinical Research Institute, Durham, NC (S.V., A.S., D.D.)
| | - Dadi Dai
- Duke Clinical Research Institute, Durham, NC (S.V., A.S., D.D.)
| | - Chak-Yu So
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Marvin H Eng
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Tiberio M Frisoli
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - James C Lee
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Guson Kang
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | | | - Homam Ibrahim
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.)
| | - Cezar Staniloae
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.)
| | - Prakriti Gaba
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (P.G., M.F., M.B.L.)
| | - Alejandro Lemor
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Matthew Finn
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (P.G., M.F., M.B.L.)
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (H.R.)
| | - Mathew R Williams
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.)
| | - Martin B Leon
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (P.G., M.F., M.B.L.).,Cardiovascular Research Foundation, New York, NY (M.B.L.)
| | - William W O'Neill
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Binita Shah
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.).,Division of Cardiology, VA New York Harbor Healthcare System (B.S.)
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47
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Czarnecki A, Han L, Abuzeid W, Cantor WJ, Chan V, Cohen EA, Cohen GN, Fam N, Garg P, Hibbert B, Mehta SR, Ong G, Osten M, Ko DT. Impact of Transcatheter Mitral Valve Repair on Preprocedural and Postprocedural Hospitalization Rates. JACC Cardiovasc Interv 2021; 14:2274-2281. [PMID: 34674865 DOI: 10.1016/j.jcin.2021.08.007] [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: 11/04/2020] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this study was to determine the effect of transcatheter mitral valve repair (TMVr) on hospitalization rates by assessing pre- and postprocedural hospitalization patterns. BACKGROUND TMVr has emerged as the treatment of choice for selected patients with mitral regurgitation, but the impact of these procedures on hospital utilization remains unclear. METHODS All patients who underwent TMVr in Ontario, Canada, between 2011 and 2017 were included in this observational study using population-based data. Hospitalization person-year rates were assessed in the years before and after TMVr and 4 predefined intervals: 1 to 30, 31 to 90, 91 to 182, and 183 to 365 days. Main outcomes of interest were all-cause and heart failure (HF) hospitalizations. Poisson regression models were used to compare incidence rates across all time periods. RESULTS The study cohort included 523 patients. In the year preceding TMVr, 66.2% of patients were hospitalized compared with 47.4% in the year following. There were stepwise increases in both all-cause and HF hospitalization rates in the periods preceding the index procedure, and all postprocedural periods had significantly lower hospitalization rates. The adjusted rate ratios for all-cause and HF-related hospitalization in the year after TMVr were 0.65 (95% CI: 0.56-0.76) and 0.38 (95% CI: 0.29-0.51), respectively. All time periods had significant reductions in all-cause and HF hospitalization in the adjusted analysis. CONCLUSIONS In this population-based study, significant reductions were observed in both all-cause and HF-related hospitalizations in all time periods after TMVr compared with the year prior. This suggests that TMVr has a sustained effect on hospitalization rates despite a high-risk population.
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Affiliation(s)
- Andrew Czarnecki
- ICES, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Lu Han
- ICES, Toronto, Ontario, Canada
| | - Wael Abuzeid
- Kingston General Hospital, Kingston, Ontario, Canada
| | - Warren J Cantor
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Eric A Cohen
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gideon N Cohen
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil Fam
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Pallav Garg
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Shamir R Mehta
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Geraldine Ong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark Osten
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Dennis T Ko
- ICES, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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48
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Brener MI, Grayburn P, Lindenfeld J, Burkhoff D, Liu M, Zhou Z, Alu MC, Medvedofsky DA, Asch FM, Weissman NJ, Bax J, Abraham W, Mack MJ, Stone GW, Hahn RT. Right Ventricular-Pulmonary Arterial Coupling in Patients With HF Secondary MR: Analysis From the COAPT Trial. JACC Cardiovasc Interv 2021; 14:2231-2242. [PMID: 34674862 DOI: 10.1016/j.jcin.2021.07.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prognostic impact of right ventricular (RV)-pulmonary arterial (PA) coupling in patients with heart failure (HF) with severe secondary mitral regurgitation (SMR) enrolled in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. BACKGROUND RV contractile function and PA pressures influence outcomes in patients with SMR, but the impact of RV-PA coupling in patients randomized to transcatheter edge-to-edge repair (TEER) vs guideline-directed medical therapy (GDMT) is unknown. METHODS RV-PA coupling was assessed by the ratio of RV free wall longitudinal strain derived from speckle-tracking echocardiography and noninvasively measured RV systolic pressure. Advanced RV-PA uncoupling was defined as RV free wall longitudinal strain/RV systolic pressure ≤0.5%/mm Hg. The primary endpoint was a composite of all-cause mortality or HF hospitalization at 24-month follow-up. RESULTS A total of 372 patients underwent speckle-tracking echocardiography, and 70.2% had advanced RV-PA uncoupling. By multivariable analysis, advanced RV-PA uncoupling was strongly associated with an increased risk for the primary 24-month endpoint of death or HF hospitalization (HR: 1.87; 95% CI: 1.31-2.66; P = 0.0005). A similar association was present for all-cause mortality alone (HR: 2.57; 95% CI: 1.54-4.29; P = 0.0003). The impact of RV-PA uncoupling was consistent in patients randomized to TEER and GDMT alone. Compared with GDMT alone, the addition of TEER improved 2-year outcomes in patients with (48.0% vs 74.8%; HR: 0.51; 95% CI: 0.37-0.71) and those without (28.8% vs 47.8%; HR: 0.51; 95% CI: 0.27-0.97) advanced RV-PA uncoupling (Pinteraction = 0.98). CONCLUSIONS In the COAPT trial, advanced RV dysfunction assessed by RV-PA uncoupling was a powerful predictor of 2-year adverse outcomes in patients with HF and SMR. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079).
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Paul Grayburn
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Mengdan Liu
- Cardiovascular Research Foundation, New York, New York, USA
| | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, New York, USA
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - Diego A Medvedofsky
- Cardiovascular Core Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Federico M Asch
- Cardiovascular Core Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Neil J Weissman
- Cardiovascular Core Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Jeroen Bax
- Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - William Abraham
- Davis Heart and Lung Research Institute, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Michael J Mack
- Baylor Scott & White Heart and Vascular Hospital, Plano, Texas, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
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Alachkar MN, Kirschfink A, Grebe J, Schälte G, Almalla M, Frick M, Schröder JW, Vogt F, Marx N, Altiok E. General Anesthesia Leads to Underestimation of Regurgitation Severity in Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Mitral Valve Repair. J Cardiothorac Vasc Anesth 2021; 36:974-982. [PMID: 34799263 DOI: 10.1053/j.jvca.2021.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/07/2021] [Revised: 09/25/2021] [Accepted: 10/16/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the effect of general anesthesia (GA) on severity of mitral regurgitation (MR) in patients undergoing transcatheter mitral valve repair (TMVR). DESIGN Retrospective cohort study. SETTING Tertiary care university hospital. PARTICIPANTS Fifty consecutive patients with symptomatic severe MR and extremely high surgical risk. INTERVENTION TMVR under GA. MEASUREMENTS AND RESULTS Transesophageal echocardiography was performed during the preprocedural workup under conscious sedation and during TMVR under GA. After the parameters of MR were assessed, color-flow jet area (CJA), vena contracta (VC), effective regurgitant orifice area (EROA), regurgitant volume (RVOL), three-dimensional (3D) vena contracta area (VCA), and severity of MR were compared between the two examinations. In patients with primary MR (n = 11), there were no significant differences in CJA, VC, EROA, RVOL, or 3D-VCA between pre- and intraprocedural transesophageal echocardiography. In patients with secondary MR (n = 39), GA led to significant decreases of CJA (10 ± 7 v 7 ± 3 cm², p < 0.001), VC (5.5 ± 1.6 v 4.7 ± 1.5 mm, p = 0.002), EROA (30 ± 11 v 24 ± 10 mm², p < 0.001), and RVOL (47 ± 17 v 34 ± 13 mL/beat, p < 0.001). Consequently, GA led to a downgrade of regurgitation severity classification in 44% of patients when assessed by two-dimensional analysis. When evaluated by 3D analysis, GA also led to a significant but less extensive decrease of MR (3D-VCA: 66 ± 27 v 60 ± 29 mm², p = 0.002), and subsequent downgrade of MR classification in 20% of patients. CONCLUSIONS GA underestimates regurgitation severity in patients with secondary, but not primary MR, undergoing TMVR. This effect must be considered when evaluating the immediate result of the procedure.
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Affiliation(s)
- Mhd Nawar Alachkar
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
| | - Annemarie Kirschfink
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Julian Grebe
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Gereon Schälte
- Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Frick
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg W Schröder
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Felix Vogt
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
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50
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Zweck E, Spieker M, Horn P, Iliadis C, Metze C, Kavsur R, Tiyerili V, Nickenig G, Baldus S, Kelm M, Becher MU, Pfister R, Westenfeld R. Machine Learning Identifies Clinical Parameters to Predict Mortality in Patients Undergoing Transcatheter Mitral Valve Repair. JACC Cardiovasc Interv 2021; 14:2027-36. [PMID: 34556277 DOI: 10.1016/j.jcin.2021.06.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to develop a machine learning (ML)-based risk stratification tool for 1-year mortality in transcatheter mitral valve repair (TMVR) patients incorporating metabolic and hemodynamic parameters. BACKGROUND The lack of appropriate, well-validated, and specific means to risk-stratify patients with mitral regurgitation complicates the evaluation of prognostic benefits of TMVR in clinical trials and practice. METHODS A total of 1,009 TMVR patients from 3 university hospitals within the Heart Failure Network Rhineland were included; 1 hospital (n = 317) served as external validation. The primary endpoint was all-cause 1-year mortality. Model performance was assessed using receiver-operating characteristic curve analysis. In the derivation cohort, different ML algorithms were tested using 5-fold cross-validation. The final model, called MITRALITY (transcatheter mitral valve repair mortality prediction system) was tested in the validation cohort with respect to existing clinical scores. RESULTS Extreme gradient boosting was selected for the MITRALITY score, using only 6 baseline clinical features for prediction (in order of predictive importance): urea, hemoglobin, N-terminal pro-brain natriuretic peptide, mean arterial pressure, body mass index, and creatinine. In the external validation cohort, the MITRALITY score's area under the curve was 0.783 (95% CI: 0.716-0.849), while existing scores yielded areas under the curve of 0.721 (95% CI: 0.63-0.811) and 0.657 (95% CI: 0.536-0.778) at best. CONCLUSIONS The MITRALITY score is a novel, internally and externally validated ML-based tool for risk stratification of patients prior to TMVR, potentially serving future clinical trials and daily clinical practice.
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