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Van Kampen A, Sundt Rd TM, Melnitchouk S. Blending three repair techniques in a case of complex mitral valve endocarditis. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38712707 DOI: 10.1510/mmcts.2023.089] [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] [Indexed: 05/08/2024]
Abstract
In a 39-year-old male with mitral valve endocarditis, after 6 weeks of intravenous antibiotics, echocardiography confirmed multiple vegetations on both leaflets, a flail posterior leaflet flail and contained perforation of the anterior leaflet in a windsock-like morphology. All vegetations, diseased and ruptured chords and the windsock-like contained rupture of the anterior leaflet were carefully resected via a right minithoracotomy and with femoral cannulation. Three repair techniques were blended to reconstruct the valve: (1) A large, infected portion of the prolapsing posterior leaflet was resected in a triangular fashion, and the edges were re-approximated using continuous 5-0 polypropylene sutures. (2) The anterior leaflet defect was repaired with a circular autologous pericardial patch that had been soaked in glutaraldehyde. (3) A set of artificial chords for P2 was created using CV-4 polytetrafluoroethylene sutures and adjusted under repeated saline inflation. A 38-mm Edwards Physio-I annuloplasty ring was implanted. The artificial chords were adjusted again after annuloplasty and then tied. Transoesophageal echocardiography (TEE) confirmed the absence of residual mitral regurgitation and systolic anterior motion and a mean pressure gradient of 3 mmHg. The patient was discharged after 5 days with a peripherally inserted central catheter to complete an additional 4 weeks of intravenous antibiotics and had an uneventful recovery.
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Affiliation(s)
- Antonia Van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thoralf M Sundt Rd
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Schlegel P, Crespo López P, Kreusser MM, Katus HA, Frey N, Geis NA, Raake PWJ. PASCAL-based mitral valve repair in an all-comer population: acute and mid-term clinical results. ESC Heart Fail 2021; 8:3530-3538. [PMID: 34448541 PMCID: PMC8497336 DOI: 10.1002/ehf2.13569] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS We investigated short and mid-term safety and efficacy of the PASCAL system for percutaneous mitral valve repair (PMVr) in severe mitral regurgitation (MR) in an all-comer population. METHODS AND RESULTS In the first consecutive 41 patients undergoing PMVr using the PASCAL system in our centre, procedural success and safety were assessed. Efficacy in improving MR and functional class were evaluated. Median patient age was 74 years, 58.5% were male patients, and median European System for Cardiac Operative Risk Evaluation Score II was 5.1%. All patients suffered from severe MR with 59% functional MR, 29% degenerative MR, and 12% of mixed aetiology MR. The technical success rate was 90%, limited by four cases where PASCAL implantation was aborted due to a prohibitive mitral gradient. On average, 1.16 PASCAL devices per patient were implanted. All patients successfully implanted with a PASCAL device were discharged with MR grade ≤ 2 and 79% with MR grade ≤ 1. Mean follow-up was 8.7 ± 4.9 months. Ninety-seven per cent of patients remained at MR ≤ 2 at follow-up, which translated into a significantly improved New York Heart Association functional class as well as a significant reduction of systolic pulmonary artery pressure and brain natriuretic peptide levels. The procedure-related rate for major adverse events was 3%. Neither early nor late single-leaflet detachment was found. In one patient, air embolism occurred, resulting in modification of the PASCAL instructions for use. CONCLUSIONS Percutaneous mitral valve repair using PASCAL in a real-world, all-comer population was feasible and safe, resulting in a significant mid-term reduction of MR with persistent clinical improvement.
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Affiliation(s)
- Philipp Schlegel
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Patricia Crespo López
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Nicolas A Geis
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
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Kriechbaum SD, Boeder NF, Gaede L, Arnold M, Vigelius-Rauch U, Roth P, Sander M, Böning A, Bayer M, Elsässer A, Möllmann H, Hamm CW, Nef HM. Mitral valve leaflet repair with the new PASCAL system: early real-world data from a German multicentre experience. Clin Res Cardiol 2019; 109:549-559. [PMID: 31451915 DOI: 10.1007/s00392-019-01538-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022]
Abstract
AIMS To examine the clinical experience and practical use of the PASCAL transcatheter valve repair system (Edwards Lifesciences, Irvine, CA, USA) and to report some of the first clinical results. METHODS AND RESULTS A total of 18 consecutive patients with severe, symptomatic mitral regurgitation (MR) were included in this German multicentre registry. All patients underwent clinical, echocardiographic, and laboratory assessment prior to the PASCAL procedure and before hospital discharge. MR was classified as functional in 6 patients, degenerative in 2, and combined in 10. All except one received a single PASCAL implant. The preprocedural severe MR present in all patients was reduced: grade 0 in 4 (22.2%), grade I in 11 (61.1%), grade II in 3 (16.7%). The v-wave was significantly reduced from 31.7 ± 9.5 to 18 ± 7.7 mmHg (p < 0.001). Independent leaflet capture, performed in 4 (22.2%) of the patients, wide clasps, and the 10-mm central spacer are features of the PASCAL device to optimize mitral leaflet repair. There were no periprocedural complications. CONCLUSION PASCAL is a safe and effective mitral valve repair device for the treatment of severe MR. Device-specific features allow valve repair tailored to the individual anatomy of the underlying mitral pathology in each patient.
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Affiliation(s)
- Steffen D Kriechbaum
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany.
| | - Niklas F Boeder
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Luise Gaede
- Medical Clinic 2, University Hospital of Erlangen, Giessen, Germany
| | - Martin Arnold
- Medical Clinic 2, University Hospital of Erlangen, Giessen, Germany
| | | | - Peter Roth
- Department of Adult and Paediatric Cardiovascular Surgery, University of Giessen, Giessen, Germany
| | - Michael Sander
- Department of Anaesthesiology, University of Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Adult and Paediatric Cardiovascular Surgery, University of Giessen, Giessen, Germany
| | - Matthias Bayer
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, University of Oldenburg, Oldenburg, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology and Angiology, Medical Clinic I, Universitätsklinikum Gießen and Marburg, University of Giessen, Klinikstraße 33, 35392, Giessen, Germany
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Sharma A, Goel S, Agrawal S. Percutaneous Mitral Valve Interventions and Heart Failure. Adv Exp Med Biol 2018; 1067:271-85. [PMID: 29277857 DOI: 10.1007/5584_2017_142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Mitral regurgitation (MR) is the most frequent Valvular Heart Disease (VHD) and is an important cause of heart failure. MR can be caused by primary valve abnormality (Degenerative MR/Primary MR) or it can be secondary to cardiomyopathy (Functional MR/Secondary MR). Medical management alleviates symptoms but does not alter the progression of the disease. Current guidelines recommend surgery for moderate-to-severe (Grade > 3) MR in patients with symptoms or evidence of left ventricular dysfunction. Despite current practice guidelines, the majority of patients with severe MR do not undergo surgery. The reasons include high surgical risk from advanced age or multiple comorbidities, and a lack of clear data supporting valve surgery for secondary MR with LV dysfunction. The recent emergence of percutaneous interventional approaches in treating MR has expanded therapeutic options for patients who are at high risk for conventional Mitral Valve (MV) surgery. In this chapter, we will review the novel advancements in the field of percutaneous MV interventions that could potentially become the standard of care for patients with MR and heart failure.
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