1
|
Chourdakis E, Koniari I, Osman N, Kounis N, Hahalis G, Werner N. Late Infective Endocarditis After Transcatheter Mitral Valve Reconstruction (MitraClip): A Case Report and a Review of the Literature. Angiology 2023; 74:205-215. [PMID: 35938650 DOI: 10.1177/00033197221116202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Percutaneous transcatheter mitral valve reconstruction in edge to edge fashion is a well-established option in inoperable or high peri-operative risk patients with severe, symptomatic mitral valve regurgitation. MitraClip in combination with medical treatment improves survival and reduces hospitalization rates compared with optimal medical therapy alone in well selected patients. Clip-associated endocarditis is a rare complication with only few reported cases in the literature. We present a case of late infective endocarditis post Mitral Clip implantation and also review the literature regarding this new rare condition.
Collapse
Affiliation(s)
| | | | - Neriman Osman
- 39643Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | | | | | - Nikos Werner
- 39643Krankenhaus der Barmherzigen Brüder, Trier, Germany
| |
Collapse
|
2
|
Sharma V, Sothwal A, Parekh J, Panaich S. Advanced Steering Maneuvers for Special Situations in Mitral Valve Transcatheter Edge-to-edge Repair. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The use of transcatheter percutaneous edge-to-edge mitral valve repair with the MitraClip (Abbott) for the treatment of mitral regurgitation has rapidly expanded since it received Food and Drug Administration approval. Currently, patients with more complex mitral valve anatomies are undergoing this procedure with progressively improving clinical outcomes. This review focuses on the advanced steering maneuvers needed for the technical success of the MitraClip procedure and discusses several scenarios where such advanced steering maneuvers may be needed. These include an anterior transseptal puncture, low or high transseptal puncture with unfavorable transseptal height to mitral valve, large gap height, patients with mitral regurgitation due to dehiscence of a prior mitral valve annuloplasty ring, placing multiple/adjacent MitraClips, or redo edge-to-edge mitral valve repair. Knowledge and mastery of such advanced steering maneuvering techniques can allow operators to complete the procedure successfully with low rate of complications even in difficult scenarios.
Collapse
Affiliation(s)
- Vikram Sharma
- Department of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Arpit Sothwal
- St. Luke's Heart Care Clinic UnityPoint Health, Cedar Rapids, IA
| | - Jai Parekh
- Department of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Sidakpal Panaich
- Department of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
3
|
Fabry N, Hendrickson MJ, Arora S, Vavalle JP. Five-year trends in cause-specific readmissions and cost burden of mitral transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2022; 99:1251-1256. [PMID: 35181978 DOI: 10.1002/ccd.30121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The study aimed to evaluate cost trends associated with mitral valve transcatheter edge-to-edge repair (TEER). BACKGROUND TEER is a treatment option for patients at prohibitive surgical risk with moderate to severe mitral valve regurgitation and NYHA class III or IV symptoms. The 30-day costs and causes of readmission following TEER have not been well studied. METHODS Patients undergoing mitral TEER in the United States from 2014 to 2018 were identified in the Nationwide Readmission Database. Patient characteristics, cause-specific readmission, and costs of the index hospitalization and readmissions were analyzed. Costs were trended over years using general linear regression. RESULTS A total of 10,196 patients underwent mitral TEER during the study period. Thirty-day readmissions were stable over time at around 16%. The mean length of stay following TEER decreased from 7 days in 2014 to 5 days in 2018. There was a significant decline in the cost of the index hospitalization of $1311 per year, and a significant decline in the total 30-day cost of $1588 per year (p < 0.001). This was strictly due to a reduction in the cost of the index hospitalization without a change in readmission costs over time (p = 0.23). Infectious causes of readmissions significantly decreased while total cardiovascular readmissions, including heart failure, remained constant. CONCLUSION The decreasing 30-day cost burden of TEER is primarily driven by the shorter index length of stay, as experience in TEER has grown and, length of stay has declined. However, cardiovascular readmissions, and consequently readmission costs, have remained steady.
Collapse
Affiliation(s)
- Nicholas Fabry
- Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - John P Vavalle
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
4
|
Kanitsoraphan C, Thangjui S, Techorueangwiwat C, Kewcharoen J, Rattanawong P, Nagamine T, Kanjanauthai S. Gender difference in outcomes of patients undergoing MitraClip therapy: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:20-25. [PMID: 34799289 DOI: 10.1016/j.carrev.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transcatheter edge-to-edge repair (TEER) of the mitral valve with MitraClip therapy is an emerging treatment in selected patients with severe mitral regurgitation. Identifying the patient with increased risk of poorer outcomes, including mortality, is crucial in these patients. Recent studies suggested conflicting data regarding the effects of gender on outcome in this patient population. We evaluate the impact of gender on the outcome of patients undergoing MitraClip therapy by systematic review and meta-analysis. METHODS The authors comprehensively searched the databases of EMBASE and MEDLINE from inception to April 2021. Included studies were published cohorts reporting univariate or multivariate analysis of the effects of gender on in-hospital and overall mortality among patients undergoing MitraClip therapy. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonioan and Laird. RESULTS A total of nine studies were included in this meta-analysis, including 9062 patients. Male gender is associated with higher in-hospital mortality with pooled OR 1.81 (95% confidence interval 1.01-3.22, p-value 0.045) and overall mortality with pooled OR 1.19 (95% CI 1.06-1.33, p-value 0.003). CONCLUSIONS According to our meta-analysis, the male gender increases the risk of in-hospital mortality up to 1.81 folds and overall mortality up to 1.19 folds.
Collapse
Affiliation(s)
| | - Sittinun Thangjui
- Internal Medicine Residency Program, Bassett Healthcare Network, NY, USA
| | | | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Todd Nagamine
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Somsupha Kanjanauthai
- Division of Cardiovascular Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
5
|
Elbadawi A, Mahta D, Elgendy IY, Dang AT, Mahmoud M, Iskandar M, Kaple R, Al-Azizi K, Szerlip M, Kayani W, Barker CM, Jneid H. Trends in utilization, outcomes, and readmissions after transcatheter mitral valve replacement. Catheter Cardiovasc Interv 2021; 99:906-914. [PMID: 34569695 DOI: 10.1002/ccd.29963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/24/2021] [Accepted: 09/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a paucity of real-world data regarding the temporal trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR) in the United States (US). METHODS We queried the Nationwide Readmissions Database (October 2015 to December 2018) for patients undergoing TS-TMVR procedures. We reported the temporal trends in the utilization, in-hospital outcomes and 30-day readmissions after TS-TMVR. The main study outcome was in-hospital mortality. RESULTS There was an increase in the number of TS-TMVR procedures over time (48 in 2015 vs. 978 in 2018, Ptrend < 0.001), with a notable increase in the proportion of women (Ptrend = 0.04) and the prevalence of diabetes (Ptrend = 0.03). There was an increase in the number of centers performing TS-TMVR (21 in 2015 vs. 164 in 2018, Ptrend < 0.001). The overall in-hospital mortality was 7.2% with no change over time (6.3% in 2015 vs. to 5.2% in 2018, Ptrend = 0.67). There was no change in the frequency of in-hospital complications after TS-TMVR; however, the median length of stay has decreased over time. The overall 30-day readmission rate was 17.8%, with no change during the study years. The most frequent cause for 30-day readmission after TS-TMVR was acute heart failure followed by bleeding and infection-related complications. Prior coagulopathy and small-sized hospitals were independently associated with higher in-hospital mortality and 30-day readmissions. CONCLUSION This nationwide observational analysis of real-world data showed an increase in the number of TS-TMVR procedures over time, which is now performed at a greater number of centers. There was no change in the rate of in-hospital mortality, complications or 30-day readmissions; but a significant reduction in the length of hospital stay over time was noted. As the number of TS-TMVR continue to expand, these data provide a perspective on the early experience with this procedure.
Collapse
Affiliation(s)
- Ayman Elbadawi
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Dhruv Mahta
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mona Mahmoud
- Department of Internal Medicine, Central Michigan University Health, Saginaw, Michigan, USA
| | - Mina Iskandar
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Ryan Kaple
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Karim Al-Azizi
- Cardiovascular Research Department, Baylor Scott and White the Heart Hospital, Plano, Texas, USA
| | - Molly Szerlip
- Cardiovascular Research Department, Baylor Scott and White the Heart Hospital, Plano, Texas, USA
| | - Waleed Kayani
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Colin M Barker
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hani Jneid
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| |
Collapse
|
6
|
Tonchev IR, Nam MCY, Gorelik A, Kumar S, Haqqani H, Sanders P, Kistler PM, Kalman JM. Relationship between procedural volume and complication rates for catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Europace 2021; 23:1024-1032. [PMID: 33595063 DOI: 10.1093/europace/euaa415] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/23/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS There are conflicting data as to the impact of procedural volume on outcomes with specific reference to the incidence of major complications after catheter ablation for atrial fibrillation. Questions regarding minimum volume requirements and whether these should be per centre or per operator remain unclear. Studies have reported divergent results. We performed a systematic review and meta-analysis of studies reporting the relationship between either operator or hospital atrial fibrillation (AF) ablation volumes and incidence of complications. METHODS AND RESULTS Databases were searched for studies describing the relationship between operator or hospital AF ablation volumes and incidence of complications which were published prior to 12 June 2020. Of 1593 articles identified, 14 (315 120 patients) were included in the meta-analysis. Almost two-thirds of the procedures were performed in low-volume centres. Both hospital volume of ≥50 and ≥100 procedures/year were associated with a significantly lower incidence of complications compared to <50/year (4.2% vs. 5.5%, OR = 0.58, 95% CI 0.50-0.66, P < 0.001) or <100/year (5.5% vs. 6.2%, OR = 0.62, 95% CI 0.53-0.73, P < 0.001), respectively. Hospitals performing ≥50 procedures/year demonstrated significantly lower mortality compared with those performing <50 procedures/year (0.16% vs. 0.55%, OR = 0.33, 95% CI 0.26-0.43, P < 0.001). A similar relationship existed between proceduralist volume of <50/year and incidence of complications [3.75% vs. 12.73%, P < 0.001; OR = 0.27 (0.23-0.32)]. CONCLUSION There is an inverse relationship between both hospital and proceduralist AF ablation volume and the incidence of complications. Implementation of minimum hospital and operator AF ablation volume standards should be considered in the context of a broader strategy to identify AF ablation Centers of Excellence.
Collapse
Affiliation(s)
- Ivaylo R Tonchev
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Royal Parade. 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia
| | - Michael Chi Yuan Nam
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Royal Parade. 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia
| | - Alexandra Gorelik
- Department of Medicine, University of Melbourne, Melbourne, VIC 3010, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, VIC 3144, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW 2145, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Haris Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Peter M Kistler
- Department of Cardiac Electrophysiology, Heart Centre, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Royal Parade. 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia
| |
Collapse
|
7
|
Guddeti RR, Pajjuru VS, Walters RW, Garcia SA, Alla VM. Impact of gender on in-hospital mortality and 90-day readmissions in patients undergoing transcatheter edge-to-edge mitral valve repair: Analysis from the National Readmission Database. Catheter Cardiovasc Interv 2021; 98:E954-E962. [PMID: 34343407 DOI: 10.1002/ccd.29887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) carry a high risk of rehospitalization due to disease, procedure, patient, hospital, and system related factors. AIMS We aimed to explore the impact of gender on in-hospital mortality and 90-day readmissions in patients undergoing TEER. METHODS We utilized the National Readmission Database from 2012 to 2018 to identify individuals who underwent TEER for mitral regurgitation. Gender-based differences in in-hospital mortality and 90-day readmissions were explored using multivariable logistic regression models. RESULTS Between 2012 and 2018, an estimated 21,415 TEER procedural hospitalizations were identified, of which 9893 (46.2%) were in women and 11,522 (53.8%) were in men. Compared with men, women were older, from a lower socioeconomic status but had a lower co-morbidity burden. In-hospital mortality rate during the index hospitalization was similar in women and men (2.1% vs. 2.1%, p = 0.908). Ninety-day all-cause and heart failure readmission rates were significantly higher in women compared to men (30.2% vs. 25.4%; p < 0.001 and 28.1% vs. 23.9%; p = 0.020 respectively). In a multivariable analysis, women had 36% greater odds of 90-day readmission compared to men (adjusted odds ratio [aOR] 1.36, 95% CI: 1.22-1.52; p < 0.001). Trend analysis revealed no significant improvement in rates of 90-day readmission during the observation period for men or women (p = 0.245, p = 0.429, respectively). CONCLUSIONS Following TEER, there has been no significant improvement in 90-day readmission rates between 2012 and 2018. Female gender is associated with higher 90-day all-cause and heart failure readmission rates.
Collapse
Affiliation(s)
- Raviteja R Guddeti
- Division of Interventional Cardiology, Minneapolis Heart Institute/Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Venkata S Pajjuru
- Division of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Ryan W Walters
- Department of Clinical Research, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Santiago A Garcia
- Division of Interventional Cardiology, Minneapolis Heart Institute/Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Venkata M Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska, USA
| |
Collapse
|
8
|
Perpetua EM, Guibone KA, Keegan PA, Palmer R, Speight MK, Jagnic K, Michaels J, Nguyen RA, Pickett ES, Ramsey D, Schnell SJ, Wong SC, Reisman M. Best Practice Recommendations for Optimizing Care in Structural Heart Programs: Planning Efficient and Resource Leveraging Systems (PEARLS). STRUCTURAL HEART 2021; 5:168-179. [PMID: 35378800 PMCID: PMC8968322 DOI: 10.1080/24748706.2021.1877858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/11/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022]
Abstract
The COVID19 pandemic brought unprecedented disruption to healthcare. Staggering morbidity, mortality, and economic losses prompted the review and refinement of care for structural heart disease (SHD). To mitigate negative impacts in the face of crisis or capacity constraints, this paper offers best practice recommendations for Planning Efficient and Resource Leveraging Systems (PEARLS) in structural heart programs. A systematic assessment is recommended for hospital capacity, Heart Team roles and functions, and patient and procedural risks associated with increased resource utilization. Strategies, tactics, and pathways are provided for the delivery of patient-centered, efficient and resource-leveraging care from referral to follow-up. Through the optimal use of capacity and resources, paired with dynamic triage, forecasting, and surveillance, Heart Teams may aspire to plan and implement an optimized system of care for SHD. Abbreviations: AS: aortic stenosis; ASD: atrioseptal defect; COVID19: Coronavirus disease 19; LAAO: left atrial appendage occlusion; MI: myocardial infarction; MR: mitral regurgitation; PFO: patent foramen ovale; PVL: paravalvular leak; SHD: structural heart disease; SAVR: surgical aortic valve replacement; SDM: shared decision-making; TAVR: transcatheter aortic valve replacement; TMVr: transcatheter mitral valve repair; TMVR: transcatheter mitral valve replacement; TEE: transesophageal echocardiography; TTE: transthoracic echocardiography.
Collapse
|
9
|
Osman M, Khan MZ, Farjo PD, Khan MU, Khan SU, Benjamin MM, Munir MB, Balla S. In-hospital outcomes of percutaneous mitral valve repair in patients with chronic obstructive pulmonary disease: insights from the national inpatient sample database. Catheter Cardiovasc Interv 2021; 97:E104-E112. [PMID: 32374943 DOI: 10.1002/ccd.28913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/10/2020] [Accepted: 04/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to assess the in-hospital outcomes in patients with mitral regurgitation treated with percutaneous mitral valve repair (PMVR) among patients with chronic obstructive pulmonary disease (COPD). BACKGROUND There is lack of data on the outcomes of PMVR for mitral regurgitation in patients with COPD. METHODS We analyzed the national inpatient sample (NIS) database from January 2012 to December 2016. RESULTS A total of 9125 patients underwent PMVR in the period between January 2012 and December 2016, of whom 2,495 (27.3%) patients had concomitant COPD. Comparing COPD patients to non-COPD patients, COPD patients had higher proportion of females (48.3% vs. 46.6%, p = .16), were younger (75.8 ± 10.0 years vs. 76.4 ± 12.2 years; p = .04), had higher prevalence of peripheral vascular disease (17.4% vs. 13.5%; p < .01) and renal failure (39.3% vs. 37%; p < .01). After propensity matching, there was no significant difference in mortality among the COPD group versus non-COPD patients (2.6% vs. 2.9%; p = .6). Patients with COPD had higher proportion of in-hospital morbidities including St-segment elevation myocardial infarction (1.8% vs. 1.0%; p = .02), cardiogenic shock (1.4% vs. 0.4%; p < .01), vascular complications (2% vs. 0.8; p < .01), pneumothorax (1% vs. 0.4%; p < .01), and septic shock (1.2% vs. 0.4%; p < .01). Moreover, surrogates of severe disability (mechanical intubation and non-home discharges), cost of hospitalization, and length of stay were higher in the COPD group. CONCLUSIONS There was no difference in mortality between the COPD and non-COPD patients after PMVR. Moreover, we observed higher rates of in-hospital morbidities, surrogates of severe disability, and higher resources utilization by the COPD group.
Collapse
Affiliation(s)
- Mohammed Osman
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Peter D Farjo
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Mina M Benjamin
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
10
|
Parcha V, Patel N, Kalra R, Suri SS, Arora G, Arora P. Mortality Due to Mitral Regurgitation Among Adults in the United States: 1999-2018. Mayo Clin Proc 2020; 95:2633-2643. [PMID: 33276836 DOI: 10.1016/j.mayocp.2020.08.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/29/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the nationwide trends in mortality due to mitral regurgitation (MR) among American adults from 1999 to 2018. PATIENTS AND METHODS Trends in mortality due to MR were assessed using retrospective cross-sectional analyses of nationwide mortality data from death certificates of all American residents between January 1, 1999, and December 31, 2018, using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Piecewise linear regression was used to evaluate the trends in the overall population and in subgroups. RESULTS Among 45,982 deaths due to MR during the study period, higher mortality rates were seen in older White females from the western United States. In 1999, the crude and age-adjusted mortality rates were 27.4 (95% CI, 26.3 to 28.4) and 27.5 (95% CI, 26.4 to 28.5) per 1,000,000 persons, respectively. By 2018, these rates declined to 18.0 (95% CI, 17.3 to 18.7) and 17.7 (95% CI, 17.0 to 18.4) per 1,000,000 persons, respectively (P<.001 for trend for both). Crude mortality rates declined from 1999 to 2012 (annual percentage change [APC], -4.1 (95% CI, -4.6 to -3.6) but then increased after 2012 (APC, 2.6 [95% CI, 0.8 to 4.4; P<.001 for change in trend]). The age-adjusted mortality rates declined from 1999 to 2012 (APC, -3.9 [95% CI, -4.4 to -3.4]) but subsequently increased after 2012 (APC, 1.4 [95% CI, -0.4 to 3.2; P<.001 for change in trend]). The observed decrease was consistent across age, sex, race, geographic region, and urbanization subgroups (P<.05 for all). CONCLUSION Mortality due to MR in American adults declined at an annual rate of approximately 4% until 2012 and has since then increased by about 1.5% annually. These mortality trends warrant further investigation.
Collapse
Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Nirav Patel
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Rajat Kalra
- Division, University of Minnesota, Minneapolis, MN
| | - Sarabjeet S Suri
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL.
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| |
Collapse
|
11
|
Wahl S. Cardiac Surgery: Beyond Conventional Sternotomy With Cardiopulmonary Bypass. Crit Care Nurse 2020; 40:66-73. [PMID: 32006037 DOI: 10.4037/ccn2020258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Minimally invasive cardiac surgery options, which originated with off-pump coronary artery bypass grafting and aortic valve procedures, continue to evolve in order to address complex conditions, including those requiring mitral and tricuspid valve repair. Although these procedures are primarily indicated for high-risk patient populations, favorable patient outcomes have resulted in recommendations being expanded to include intermediate-risk groups. This article increases nursing-related knowledge of minimally invasive cardiac procedures, providing an overview of current minimally invasive cardiac surgeries and their associated risks and benefits.
Collapse
Affiliation(s)
- Sharon Wahl
- Sharon Wahl is a clinical nurse specialist at Abbott Northwestern Hospital, Minneapolis, Minnesota
| |
Collapse
|
12
|
Sawalha K, Al-Akchar M, Ibrahim A, Buhnerkempe M, Koester C, Salih M, Bhattarai M, Tandan N, Bhatt DL, Hafiz AM. Impact of chronic kidney disease on in-hospital outcomes and readmission rate after edge-to-edge transcatheter mitral valve repair. Catheter Cardiovasc Interv 2020; 97:E569-E579. [PMID: 32969155 DOI: 10.1002/ccd.29188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) is a treatment option for patients with 3+ or greater mitral regurgitation who cannot undergo mitral valve surgery. Outcomes in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) are unclear. We sought to evaluate the TMVR in-hospital outcomes, readmission rates and its impact on kidney function. METHODS Data from 2016 National Readmission Database was used to obtain all patients who underwent TMVR. Patients were classified by their CKD status: no CKD, CKD, or ESRD. The primary outcomes were: in-hospital mortality, 30- and 90-day readmission rate, and change in CKD status on readmission. Multivariable logistic regression analysis was used to assess in-hospital, readmission outcomes and kidney function stage. RESULTS A total of 4,645 patients were assessed (mean age 78.5 ± 10.3 years). In-hospital mortality was higher in patients with CKD (4.0%, odds ratio [OR]:2.01 [95% CI, confidence interval: 1.27-3.18]) and ESRD (6.6%, OR: 6.38 [95% CI: 1.49-27.36]) compared with non-CKD (2.4%). 30-day readmission rate was higher in ESRD versus non-CKD patients (17.8% vs. 10.4%, OR: 2.24 [95% CI: 1.30-3.87]) as was 90-day readmission (41.2% vs. 21% OR: 2.51 [95% CI:1.70-3.72]). Kidney function improved in 25% of patients with CKD stage 3 and in 50% with CKD stage 4-5 at 30-and 90-day readmission. Incidence of AKI, major bleeding, and respiratory failure were higher in CKD group. CONCLUSIONS Patients with CKD and ESRD have worse outcomes and higher readmission rate after TMVR. In patients who were readmitted after TMVR, renal function improved in some patients, suggesting that TMVR could potentially improve CKD stage.
Collapse
Affiliation(s)
- Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School- Baystate Medical Center, Springfield, Massachusetts
| | - Mohammad Al-Akchar
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Abdisamad Ibrahim
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Michael Buhnerkempe
- Department of Internal Medicine, Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Cameron Koester
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mohsin Salih
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mukul Bhattarai
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Nitin Tandan
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Abdul Moiz Hafiz
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| |
Collapse
|
13
|
Case BC, Yerasi C, Forrestal BJ, Wang Y, Musallam A, Hahm J, Torguson R, Ben-Dor I, Satler LF, Rogers T, Waksman R. MitraClip 30-Day Readmissions and Impact of Early Discharge: An Analysis from the Nationwide Readmissions Database 2016. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:954-958. [DOI: 10.1016/j.carrev.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
|
14
|
Ben-Shoshan J, Overtchook P, Buithieu J, Mousavi N, Martucci G, Spaziano M, de Varennes B, Lachapelle K, Brophy J, Modine T, Baumbach A, Maisano F, Prendergast B, Tamburino C, Windecker S, Piazza N. Predictors of Outcomes Following Transcatheter Edge-to-Edge Mitral Valve Repair. JACC Cardiovasc Interv 2020; 13:1733-1748. [DOI: 10.1016/j.jcin.2020.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/20/2023]
|
15
|
Raheja H, Ahuja KR, Nazir S, Saad AM, Gad MM, Chatterjee S, Abdelfattah OM, Hassanein M, Harb S, Kapadia SR. Association of baseline kidney disease with outcomes of transcatheter mitral valve repair by MitraClip. Catheter Cardiovasc Interv 2020; 97:E857-E867. [DOI: 10.1002/ccd.29129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Hitesh Raheja
- Department of Cardiovascular Medicine Maimonides Medical Center Brooklyn New York
| | - Keerat Rai Ahuja
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio
| | - Salik Nazir
- Department of Cardiovascular Medicine University of Toledo Medical Center Toledo Ohio
| | - Anas M. Saad
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio
| | - Mohamed M. Gad
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio
| | - Saurav Chatterjee
- Department of Cardiovascular Medicine Long Island Jewish Medical Center Queens New York
| | | | - Mohamed Hassanein
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio
| | - Serge Harb
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio
| | - Samir R. Kapadia
- Heart and Vascular Institute Cleveland Clinic Foundation Cleveland Ohio
| |
Collapse
|
16
|
Elbadawi A, Elgendy IY, Mohamed AH, Almahmoud MF, Omer M, Abuzaid A, Mahmoud K, Ogunbayo GO, Denktas A, Paniagua D, Banerjee S, Jneid H. Temporal Trends and Outcomes of Transcatheter Mitral Valve Repair and Surgical Mitral Valve Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1560-1566. [PMID: 32620401 DOI: 10.1016/j.carrev.2020.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a paucity of data regarding the contemporary changes in the uptake and outcomes of transcatheter mitral valve repair (TMVR) and surgical mitral valve repair/replacement (SMVR). METHODS We queried the NIS database (2012-2016) to identify hospitalizations for TMVR and SMVR. We reported the temporal trends for uptake of TMVR and SMVR and their in-hospital outcomes. RESULTS The analysis included 77,645 hospitalizations: 8760 (11.3%) for TMVR and 68,885 (88.7%) for SMVR. Those undergoing TMVR were older and had a higher prevalence of comorbidities, but shorter length of stay (5.5 ± 8.8 vs. 14.3 ± 13.8, p < 0.001) compared with SMVR. There was a marked increase in the number of TMVRs over time (from 420 in 2012 to 3850 in 2016; +917%; Ptrend = 0.008) but a modest increase in the number of SMVRs (+117%; Ptrend = 0.02). Overall, TMVR was associated with low in-hospital mortality (2%) and favorable safety profile. After adjusting for clinical and hospital variables, there were non-significant trends towards lower adjusted mortality among TMVR and SMVR (Ptrend = 0.16 and Ptrend = 0.13, respectively). Notably, among TMVR patients, female sex was associated with lower in-hospital mortality while CKD was associated with increased in-hospital mortality. There was a significant downtrend in the incidences of cardiac arrest, hemodialysis and length of stay in TMVR patients. CONCLUSION Real world data showed a steady increase in the number of TMVR and SMVR procedures. Overall, TMVR was associated with low in-hospital mortality and complications rates. Despite older age and increased comorbidities, TMVR patients had lower in-hospital mortality and shorter length than their SMVR counterparts.
Collapse
Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
| | - Mohamed F Almahmoud
- Division of Cardiovascular Medicine, University of South Carolina, Charleston, SC, United States of America
| | - Mohmed Omer
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - A Abuzaid
- Division of Cardiovascular Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robins, GA, United States of America
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Ali Denktas
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America
| | - David Paniagua
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America
| | - Subhash Banerjee
- Division of Cardiovascular Medicine, University of Texas South Western, Dallas, TX, United States of America
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, TX, United States of America.
| |
Collapse
|
17
|
Trends in MitraClip, mitral valve repair, and mitral valve replacement from 2000 to 2016. J Thorac Cardiovasc Surg 2020; 162:551-562.e4. [PMID: 32089343 DOI: 10.1016/j.jtcvs.2019.12.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The dissemination of mitral valve repair as the first-line treatment and the introduction of MitraClip for patients who have a prohibitive risk for surgery have changed the landscape of mitral valve intervention. The aim of this study is to provide current and generalizable data regarding the trend of mitral valve interventions and outcomes from 2000 to 2016. METHODS Patients ≥18 years of age who underwent mitral-valve interventions were identified using the National Inpatient Sample database. National estimates were generated by means of discharge weights; comorbid conditions were identified using Elixhauser methods. All trends were analyzed with JoinPoint software. RESULTS A total of 656,030 mitral valve interventions (298,102 mitral valve replacement, 349,053 mitral valve repair, and 8875 MitraClip) were assessed. No changes in rate of procedures (per 100,000 people in the United States) were observed over this period (annual percent change, -0.4; 95% confidence limit, -1.1 to 0.3; P = .3). From 2000 to 2010, the number of replacements decreased by 5.6% per year (P < .001), whereas repair increased by 8.4% per year from 2000 to 2006 (P < .001). MitraClip procedures increased by 84.4% annually from 2013 to 2016 (P < .001). The burden of comorbidities increased throughout the study for all groups, with the greatest score for MitraClip recipients. Overall, length of stay has decreased for all interventions, most significantly for MitraClip. In-hospital mortality decreased from 8.5% to 3.7% for all interventions, with MitraClip having the most substantial decrease from 3.6% to 1.5%. CONCLUSIONS Over a 17-year period, mitral-valve interventions were associated with improved outcomes despite being applied to an increasingly sicker population.
Collapse
|
18
|
Lima FV, Kolte D, Rofeberg V, Molino J, Zhang Z, Elmariah S, Aronow HD, Abbott JD, Ben Assa E, Khera S, Gordon PC, Inglessis I, Palacios IF. Thirty-day readmissions after transcatheter versus surgical mitral valve repair in high-risk patients with mitral regurgitation: Analysis of the 2014-2015 Nationwide readmissions databases. Catheter Cardiovasc Interv 2019; 96:664-674. [PMID: 31868999 DOI: 10.1002/ccd.28647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/25/2019] [Accepted: 12/07/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Determine the rates, reasons, predictors, and costs of 30-day readmissions following transcatheter mitral valve repair (TMVR) versus surgical mitral valve repair (SMVR) in the United States. BACKGROUND Data on 30-day readmissions after TMVR are limited. METHODS High-risk patients with mitral regurgitation (MR) undergoing TMVR or SMVR were identified from the 2014-2015 Nationwide Readmissions Databases. Multivariable stepwise regression models were used to identify independent predictors of 30-day readmission. Risk of 30-day readmission was compared between the two groups using univariate and propensity score adjusted regression models. RESULTS Among 8,912 patients undergoing mitral valve repair during 2014-2015 (national estimate 17,809), we identified 7,510 (84.7%) that underwent SMVR and 1,402 (15.3%) that underwent TMVR. Thirty-day readmission rates after SMVR and TMVR were 10.7% and 11.7%, respectively (unadjusted OR 1.11, 95% CI 0.89-1.39, p = .35). After propensity score adjustment, TMVR was associated with a lower risk of 30-day readmissions compared with SMVR (adjusted OR 0.70, 95% CI 0.51-0.95, p = .02). Heart failure and arrhythmias were the leading cardiac reasons for readmission. Anemia and fluid and electrolyte disorder were independent predictors of 30-day readmission after TMVR. Demographics, comorbidities, and length of stay were independent predictors of 30-day readmission after SMVR. CONCLUSIONS One in 10 patients are readmitted within 30 days following TMVR or SMVR. Approximately half of the readmissions are for cardiac reasons. The predictors of 30-day readmission are different among patients undergoing TMVR and SMVR, but can be easily screened for to identify patients at highest risk for readmission.
Collapse
Affiliation(s)
- Fabio V Lima
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Valerie Rofeberg
- Center for Evidence Synthesis in Health, School of Public Health of Brown University, Providence, Rhode Island
| | - Janine Molino
- Lifespan Biostatistics Core, Rhode Island Hospital, Providence, Rhode Island
| | - Zheng Zhang
- Department of Biostatistics, School of Public Health of Brown University, Providence, Rhode Island
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - J Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eyal Ben Assa
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil Khera
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C Gordon
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ignacio Inglessis
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Igor F Palacios
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
19
|
Fabris E, De Luca A, Vitrella G, Stolfo D, Masè M, Korcova R, Merlo M, Rakar S, Van't Hof AWJ, Kedhi E, Perkan A, Sinagra G. Treatment of Functional Mitral Regurgitation in Heart Failure. Curr Cardiol Rep 2019; 21:139. [PMID: 31734930 DOI: 10.1007/s11886-019-1221-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To analyze the current state of the art of functional mitral regurgitation (FMR) treatment. RECENT FINDINGS The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a "proof of concept" that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.
Collapse
Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy.
| | - Antonio De Luca
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Giancarlo Vitrella
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Marco Masè
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Renata Korcova
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Serena Rakar
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Arnoud W J Van't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Andrea Perkan
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| |
Collapse
|
20
|
Giannini F, Baldetti L, Gallone G, Tzanis G, Latib A, Colombo A. Transcatheter Valve Replacement in Asia Pacific: Current Practice and Perspectives. J Am Coll Cardiol 2019; 72:3189-3199. [PMID: 30545457 DOI: 10.1016/j.jacc.2018.09.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
Although the field of transcatheter therapies for valvular heart disease (VHD) is continuously expanding in western countries, uptake of this treatment in Asia has been slow, mainly due to the high cost of devices, need for specific training programs, and lack of specialized heart teams and dedicated structures. Moreover, anatomic considerations of the Asian population, such as smaller aorta and peripheral vessel size, high prevalence of bicuspid aortic valves, high calcium burden of stenotic aortic valve leaflets, low coronary ostia, and high prevalence of rheumatic etiology, might raise concerns about feasibility, risk of procedural complications, prosthesis durability, and long-term outcomes after transcatheter treatment of VHD. Asia Pacific and China's medical communities and manufacturer companies are setting up to address this unmet clinical need. The aim of this review is to summarize the landscape of currently available devices for transcatheter valve interventions and the clinical experience to date in China and Asian Pacific countries, with a specific focus on new, locally designed, and/or manufactured devices.
Collapse
Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Luca Baldetti
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guglielmo Gallone
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Georgios Tzanis
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, New York. https://twitter.com/azeemlatib
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
| |
Collapse
|
21
|
Relation of Hospital Volume With In-Hospital and 90-Day Outcomes After Transcatheter Mitral Valve Repair Using MitraClip. Am J Cardiol 2019; 124:63-69. [PMID: 31030971 DOI: 10.1016/j.amjcard.2019.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/23/2019] [Accepted: 04/01/2019] [Indexed: 11/23/2022]
Abstract
MitraClip therapy has shown increasing use since it was commercially adopted among US hospitals in October 2013. However, the relation of institutional MitraClip volume with outcomes is unclear. This study sought to examine the association between hospital volume and outcomes after transcatheter mitral valve repair using the MitraClip device. Using the Nationwide Readmissions Database, we identified all patients who underwent a MitraClip procedure and categorized hospitals into tertiles based on their annual procedure volume: low (≤3 procedures/year), medium (4 to 13/year), and high (≥14/year) volume centers. Multivariable logistic and Cox regression analyses were performed to examine the impact of institutional MitraClip volume on in-hospital and 90-day outcomes, respectively. From 2014 to 2015, a total of 3,420 procedures were performed at 266 hospitals with a median annual procedural volume of 5 per hospital. Low (n = 81), medium (n = 86), and high (n = 99) volume hospitals performed 147 (4.3%), 403 (11.8%), and 2,870 (83.9%) MitraClip procedures, respectively. The low versus high hospital volume was independently associated with increased in-hospital mortality (7.8% vs 3.0%; adjusted odds ratio [aOR] 2.64; p = 0.04), acute myocardial infarction (10.2% vs 2.2%; aOR 2.93; p = 0.02), and acute respiratory failure (19.3% vs 7.7%; aOR 2.24; p = 0.02) during index admission as well as 90-day all-cause readmissions (37.8% vs 26.6%; adjusted hazard ratio 1.54; p = 0.03), and 90-day infective endocarditis (2.4% vs 0.3%; adjusted hazard ratio 10.06; p = 0.003). In conclusion, low hospital MitraClip volume is an independent determinant of worse outcomes including in-hospital mortality and 90-day readmissions.
Collapse
|
22
|
Lloyd JW, Reeder GS, Rihal CS, Eleid MF. Effect of saline administration on left atrial pressure during transcatheter mitral valve repair. Catheter Cardiovasc Interv 2018; 92:1427-1432. [PMID: 30079571 DOI: 10.1002/ccd.27710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To measure the intraprocedural change in left atrial pressure (LAP) with saline administration during transcatheter mitral valve repair (TMVR). BACKGROUND TMVR with MitraClip offers an alternative to surgery in select patients. During this procedure, large volumes of fluid are routinely administered with anesthesia and to facilitate transcatheter valve repair. LAP, a measure used to guide repair, may thereby change as a result of volume expansion, suggesting a need for continuous intracardiac pressure monitoring. METHODS Consecutive patients with severe mitral regurgitation underwent TMVR with MitraClip and continuous LAP monitoring through a dedicated sampling catheter. Specific LAP values were acquired immediately after transseptal access; before first clip deployment; and after deployment of the last clip. RESULTS 151 patients (age 80 ± 8 years, 64% male) underwent TMVR with MitraClip and continuous LAP monitoring. Mean LAP and v-wave pressure increased significantly from baseline to pre-MitraClip deployment (P < 0.0001) and decreased significantly from deployment to procedure end (P < 0.0001). Linear regression of v-wave pressure change (from procedure start to clip deployment) relative to volume administration yielded a significantly nonzero slope (0.28 mmHg/min, P < 0.0001, r = 0.30). CONCLUSION Fluid administration during TMVR leads to time-dependent increases in LAP. Such intraprocedural change underscores the need for targeted, if not continuous, LAP measurement during TMVR to optimize MitraClip placement and mitral regurgitation reduction.
Collapse
Affiliation(s)
- James W Lloyd
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
23
|
Hermanns H, Wiegerinck EMA, Lagrand WK, Baan J, Cocchieri R, Kaya A. Two Cases of Endocarditis After MitraClip Procedure Necessitating Surgical Mitral Valve Replacement. Ann Thorac Surg 2018; 107:e101-e103. [PMID: 30031842 DOI: 10.1016/j.athoracsur.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 11/25/2022]
Abstract
In the present report, we describe 2 cases of endocarditis after MitraClip (Abbott Vascular, Santa Clara, CA) procedures. In both patients, successful bailout surgical treatment was performed despite a high-risk constellation due to significant comorbidities. These cases highlight that surgical treatment may still be an option in patients initially declined for surgical therapy and that endocarditis after MitraClip procedure might be an underrecognized complication.
Collapse
Affiliation(s)
- Henning Hermanns
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Esther M A Wiegerinck
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim K Lagrand
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Riccardo Cocchieri
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
24
|
|