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Geyer M, Tamm AR, Kreidel F, Beiras-Fernandez A, Münzel T, von Bardeleben RS. Crossroads: advanced guidance through an aortic coarctation by fusion imaging in transfemoral TAVR after aorto-aortic bypass. Cardiovasc Interv Ther 2021. [PMID: 33779963 DOI: 10.1007/s12928-021-00772-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 11/10/2022]
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Geyer M, Keller K, Bachmann K, Born S, Tamm AR, Ruf TF, Kreidel F, Hahad O, Petrescu A, Hell M, Beiras-Fernandez A, Kornberger A, Schulz E, Münzel T, von Bardeleben RS. Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair. Clin Res Cardiol 2021; 110:676-688. [PMID: 33433670 PMCID: PMC8099767 DOI: 10.1007/s00392-020-01798-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
Background Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited. Methods Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed. Results Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12–2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00–2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15–9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021). Conclusion In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit. Graphic abstract ![]()
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Affiliation(s)
- Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tobias Friedrich Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Aniela Petrescu
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Andres Beiras-Fernandez
- Department for Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr 1, 55131, Mainz, Germany
| | - Angela Kornberger
- Department for Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr 1, 55131, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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Raman J, Cochrane A. Fix Tricuspid Regurgitation Before It Gets Worse! Heart Lung Circ 2020; 29:1425-1426. [PMID: 33040857 DOI: 10.1016/j.hlc.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jaishankar Raman
- Austin & St Vincent's Hospitals, Melbourne University, Melbourne, Vic, Australia; Deakin University, Geelong & Melbourne, Vic, Australia; Oregon Health and Science University, Portland, OR, USA; University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Andrew Cochrane
- Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Vic, Australia; Department of Surgery, Monash University, Melbourne, Vic, Australia
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Geyer M, Keller K, Sotiriou E, Tamm AR, Ruf TF, Kreidel F, Beiras-Fernandez A, Gori T, Schulz E, Münzel T, von Bardeleben RS. Association of transcatheter direct mitral annuloplasty with acute anatomic, haemodynamic, and clinical outcomes in severe mitral valve regurgitation. ESC Heart Fail 2020; 7:3336-3344. [PMID: 32915515 PMCID: PMC7755018 DOI: 10.1002/ehf2.12957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/07/2020] [Revised: 07/08/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Several approaches for transcatheter mitral valve repair for functional mitral valve regurgitation are established. Interventional direct annuloplasty is a novel trans-venous, trans-septal approach. While feasibility was proven recently, knowledge on its influence on cardiac dimensions, pressures, biomarkers, and clinical outcomes is sparse. METHODS AND RESULTS Patients consecutively treated with direct annuloplasty-only procedures between December 2015 and April 2018 were included in this monocentric analysis. Echocardiographic measurements, biomarker levels, clinical status [New York Heart Association (NYHA) class and 6 min walk test] were assessed at baseline, at discharge, and at a 30 day follow-up. Overall, 18 patients (in mean 77.0 ± 7.4 years, 44.4% women) with initially all high-grade mitral valve regurgitation (MR) were included in this study. Procedural success rate was high (94.4%) without severe complications. Direct annuloplasty resulted in MR-reduction (post-procedural-MR mild or no/trace: 72.2%) and the proportion of patients with severe dyspnoea (NYHA III/IV) was reduced (88.9% vs. 50%, P = 0.008). Clinical results were associated with a relevant diminution of left atrial volumes (-16.5%, P < 0.001) and cardiac pressures [left atrial pressure (-32.3%, P = 0.019) and systolic pulmonary arterial pressure (PAP, -15.8%, P = 0.025)]. Patients with lower baseline levels of PAP (P = 0.022) as well as elevated highly sensitive troponin (P = 0.034) were more likely to archive clinical benefit (improvement in NYHA class ≥1 grade) after 1 month, which could not be correlated with the grade of MR-reduction. CONCLUSIONS Transcatheter mitral valve repair by direct annuloplasty results in a relevant reduction of intracardiac pressures, left atrial volumes, dyspnoea, and MR. Lower PAP and higher troponin values at baseline could be associated to dyspnoea reduction.
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Affiliation(s)
- Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Karsten Keller
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | | | - Alexander R Tamm
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Tobias F Ruf
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Felix Kreidel
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
| | - Andres Beiras-Fernandez
- Department of Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Tommaso Gori
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | | | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany
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Martín M, Barriales V, Rozado J, Alperi A, Silva I, Lorca R, Reguero JJR, Morís C. Pregnancy in aortopathies: Foresight and anticipation. Int J Cardiol 2016; 222:792. [PMID: 27522377 DOI: 10.1016/j.ijcard.2016.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/02/2016] [Indexed: 12/11/2022]
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Yücel S, Ince H, Kische S, Sherif MA, Bushnaq H, Bärisch A, Öner A. [Interdisciplinary differential treatment of structural heart disease : When operation and when catheter-based intervention?]. Herz 2016; 41:443-58. [PMID: 27460051 DOI: 10.1007/s00059-016-4444-2] [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: 11/26/2022]
Abstract
The demographic changes in society lead to an increasing number of patients with aortic valve stenosis and mitral regurgitation. Simultaneously the higher age of patients is associated with an increase in multimorbidity with a high surgical risk so that they cannot be referred to surgery. Besides the current gold standard of surgery, minimally invasive therapeutic options are increasingly becoming established for these patients. For the differentiated indications and therapeutic success, a multidisciplinary heart team assumes an important role. The next generation of transcatheter aortic valve implantation (TAVI) systems will lead to improvement in the results, lower complication rates and mortality and as a result there is a general trend towards expanding the indications. New innovative minimally invasive mitral valve devices are still undergoing clinical trials and will define future therapy options.
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Affiliation(s)
- S Yücel
- Herzzentrum, Med. Klinik I - Kardiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
| | - H Ince
- Herzzentrum, Med. Klinik I - Kardiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland.
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland.
- Vivantes Klinikum Am Urban, Berlin, Deutschland.
| | - S Kische
- Herzzentrum, Med. Klinik I - Kardiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - M A Sherif
- Herzzentrum, Med. Klinik I - Kardiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
| | - H Bushnaq
- Universitätsklinikum Rostock Klinik und Poliklinik für Herzchirurgie, Rostock, Deutschland
| | - A Bärisch
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - A Öner
- Herzzentrum, Med. Klinik I - Kardiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
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