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Khairallah S, Rahouma M, Dabsha A, Demetres M, Gaudino MF, Mick SL. Comparison of meta-analytical estimates of outcomes after Alfieri or neochordal repair in isolated anterior mitral prolapse. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2023; 63:6984718. [PMID: 36629477 DOI: 10.1093/ejcts/ezac587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Repair of the isolated degenerative anterior mitral leaflet has been considered more challenging and associated with compromised durability compared with isolated posterior leaflet in major series. Implantation of neochordae or Alfieri edge-to-edge is the most employed repair technique for isolated anterior repair currently, but little data exist comparing their relative durability. We sought to investigate this issue with this meta-analysis. METHODS A literature search was performed (Ovid MEDLINE, Ovid Embase and The Cochrane Library). The primary outcome was the incidence rate (IR) of reoperation, the secondary outcomes were recurrent moderately severe/severe mitral regurgitation (MR), in-hospital/30-day reoperation and mortality and follow-up mortality. A random-effect model was used. Leave-one-out, subgroup analysis (Alfieri versus neochordae) and meta-regression were done. RESULTS Seventeen studies (including 1358 patients) were included. At a weighted mean follow-up of 5.56 ± 3.31 years, the IR for reoperation was 14.45 event per 1000 person-year and significantly lower in Alfieri than neochordae repair (9.40 vs 18.61, P = 0.04) on subgroup analysis. The IR of follow-up moderately severe/severe MR was 19.89 event per 1000 person-year and significantly lower in Alfieri than neochordae repair (10.68 and 28.63, P = 0.01). In a sensitivity analysis comparing homogenous studies, a significant difference in the recurrence of regurgitation in favour of the Alfieri approach remained. There were no differences in operative outcomes or survival. There were significant associations between increased incidence of late reoperation and New York Heart Association class III/IV and associated coronary artery bypass graft procedure for whole cohort. CONCLUSIONS Alfieri repair may be associated with a lower incidence of recurrent MR compared with neochordae-based repair in the setting of isolated degenerative anterior mitral pathology. This is the first such meta-analysis and further inquiry into this area is needed.
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Affiliation(s)
- Sherif Khairallah
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Anas Dabsha
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Michelle Demetres
- Scholarly Communications Librarian, Weill Cornell Medicine (WCM), Samuel J. Wood Library & C.V. Starr Biomedical Information Center, New York, NY, USA
| | - Mario Fl Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
| | - Stephanie L Mick
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York-Presbyterian Hospital (WCM), New York, NY, USA
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Lee H, Kim J, Jung JH, Yoo JS. Surgical edge-to-edge repair for tricuspid regurgitation: Impact of the concomitant annuloplasty. Int J Cardiol 2023; 372:85-90. [PMID: 36455700 DOI: 10.1016/j.ijcard.2022.11.055] [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: 07/04/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical edge-to-edge repair has been suggested for tricuspid regurgitation (TR) with complex tricuspid valve (TV) pathologies. Nevertheless, the impact of concomitant TAP has not been well established. This study aimed to compare the outcomes of tricuspid edge-to-edge repair according to the implementation of concomitant TAP. METHODS A total of 264 patients who underwent tricuspid edge-to-edge repair between January 2001 and December 2020 were enrolled in the study, and 23 patients who had undergone previous TV repair were excluded. The remaining 241 patients were categorized into two groups: TAP (n = 190) and non-TAP (n = 51). Inverse probability of treatment weighting (IPTW) was used to adjust the baseline differences between the two groups. RESULTS Early mortality and morbidity did not differ between the two groups. The mean follow-up duration was 111.5 ± 72.4 months. IPTW-adjusted survival analysis did not reveal a difference between the two groups in late significant tricuspid stenosis (trans-tricuspid pressure gradient ≥5 mmHg) and TV reoperations. However, freedom from overall mortality and late severe TR were significantly higher in the TAP group (p = 0.033 and 0.006, respectively). The sensitivity analysis, including propensity score matching, showed consistent results. CONCLUSION The long-term outcomes of surgical tricuspid edge-to-edge repair were better when performed with concomitant TAP.
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Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea.
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3
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Butany J, Schoen FJ. Cardiac valve replacement and related interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ismail I, Wert L, Hanke JS, Dogan G, Chatterjee A, Feldmann C, Cebotari S, Haverich A, Schmitto JD. Mid-term Outcome of the Edge-To-Edge Mitral Valve Repair Via Aortic Outflow Tract in High-Risk Patients. Semin Thorac Cardiovasc Surg 2021; 34:512-516. [PMID: 34089830 DOI: 10.1053/j.semtcvs.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022]
Abstract
The edge-to-edge mitral valve repair technique, invented by Alfieri and colleagues, introduced valve repair as a treatment option for patients with complex diseases where standard annuloplasty and related repair techniques are insufficient, due to annular calcification and patient frailty. We retrospectively evaluated the results of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) in high-risk patients who were undergoing aortic valve replacement. From February, 2012 to December, 2017, 43 patients underwent transaortic edge-to-edge mitral valve repair with concomitant aortic valve replacement at a single institution. Preoperative and postoperative echocardiograms were compared. Home telephone follow up was conducted and postoperative morbidity was examined, including the need for reoperation, stroke and cardiac arrhythmia. 30-day and long-term survival rates were also determined. Mitral regurgitation (MR) was graded semi-quantitatively as 0 (trace and/or none), mild (1), moderate (2) or moderate to severe (3-4). The patients were 74 ± 7.8 years old. 65% of the patients were male. Mean cardiopulmonary bypass time was 115 ± 37 minutes and mean cross-clamp time was 71 ± 23 minutes. There was a significant improvement in preoperative vs postoperative median MR grade (2 (IQR 2-3) vs 0 (IQR 0-1); P = 0.05). Follow-up transthoracic echocardiograms in 29 patients obtained at a median of 9 months' (range 3 - 19 months') and in 16 patients at a median of 34 months' postoperatively (range 21 - 53 months') showed mild (1 (IQR 1-2)) grade of mitral regurgitation. 30-day survival was 98%. Long term survival at 12 and 24 months' were 88% and 81% respectively. Mitral valve reoperation was conducted in 1 patient (2%), who was suffering of endocarditis. Stroke occurred in 2 patients (7%). Cardiac arrhythmia was observed in 15 patients (35%). 8 patients (19%) suffered from atrial fibrillation and 7 patients (16%) displayed atrioventricular blockage. 10 patients (23%) could be treated conservatively and 5 patients (12%) needed implantation of a pacemaker. Transaortic edge-to-edge mitral valve repair can be safely performed during aortic valve replacement in high-risk patients and improves even long-term MR grade. Postoperative cardiac arrhythmia occurs frequently. 66% of them could be treated successfully by conservative procedures.
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Affiliation(s)
- Issam Ismail
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Leonhard Wert
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin Sarah Hanke
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Anamika Chatterjee
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christina Feldmann
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Dieter Schmitto
- Department of Cardiothoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Lee H, Kim J, Oh SS, Yoo JS. Long-term Clinical and Hemodynamic Outcomes of Edge-to-Edge Repair for Tricuspid Regurgitation. Ann Thorac Surg 2020; 112:803-808. [PMID: 33157062 DOI: 10.1016/j.athoracsur.2020.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/07/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The edge-to-edge technique (Alfieri stitch) has been widely adopted in mitral valve but not tricuspid valve (TV) repair. We evaluated long-term clinical and hemodynamic outcomes of tricuspid edge-to-edge repair. METHODS We retrospectively reviewed 237 patients (mean age, 58.4 ± 13.9 years) who had undergone tricuspid edge-to-edge repair from January 2001 to March 2019 in our institution. Tricuspid annuloplasty was performed in 175 patients (73.8%) using ring (91 [38.4%]) or suture (84 [35.4%]) annuloplasty. Concomitant procedures were mitral valve replacement (133 [56.1%]), mitral valve repair (52 [21.9%]), aortic valve replacement (41 [17.3%]), and maze operation (138 [58.2%]). RESULTS Postoperative echocardiography revealed mild or less tricuspid regurgitation (TR) in 220 patients (92.8%). Early mortality (<30 days) occurred in 9 patients (3.8%), reoperation for bleeding in 16 (6.8%), and low cardiac output syndrome in 15 (6.4%). Freedom from all-cause mortality was 87.2% at 5 years and 80.6% at 10 years. Freedom from moderate or severe TR was 97.1% at 5 years and 84.9% at 10 years. Transtricuspid pressure gradient was 3.8 ± 4.2 mm Hg at discharge and 3.2 ± 5.6 mm Hg at the last follow-up (P = .60). Freedom from significant tricuspid stenosis (transtricuspid pressure gradient ≥5 mm Hg) was 96.4% and 88.4% at 5 and 10 years, respectively. There was 1 early TV reoperation for severe TR on postoperative day 3 (0.4%). Freedom from TV reoperation was 99.1% at 10 years. CONCLUSIONS Tricuspid edge-to-edge repair showed acceptable long-term clinical and hemodynamic results and is an effective and safe option in TV surgery.
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Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sam Sae Oh
- Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi-do, Republic of Korea.
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Cheema FH, Loyalka P, Rajagopal K. Defining the Role of MitraClip Therapy for Mitral Valve Regurgitation. Tex Heart Inst J 2020; 47:130-133. [PMID: 32603451 DOI: 10.14503/thij-19-7082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Faisal H Cheema
- Houston Heart, HCA Houston Healthcare, Houston, Texas 77004.,HCA Research Institute, Nashville, Tennessee 37203.,University of Houston College of Medicine, Houston, Texas 77204
| | - Pranav Loyalka
- Houston Heart, HCA Houston Healthcare, Houston, Texas 77004
| | - Keshava Rajagopal
- Houston Heart, HCA Houston Healthcare, Houston, Texas 77004.,University of Houston College of Medicine, Houston, Texas 77204
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Hirji SA, Del Val FR, Yazdchi F, Lee J, Ejiofor J, Kolkailah AA, Chowdhury R, McGurk S, Kaneko T. Mitral valve repair using edge-to-edge technique in various situations: real-world experiences. Eur J Cardiothorac Surg 2019; 56:1110-1116. [DOI: 10.1093/ejcts/ezz130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 12/30/2022] Open
Abstract
AbstractOBJECTIVESEdge-to-edge (E2E) mitral valve repair (MVP) is a versatile technique used in various situations for mitral regurgitation (MR). This technique has been regaining attention, given the increasing use of the MitraClip procedure. This real-world study evaluates the durability of the E2E technique in different settings.METHODSFrom January 2002 to May 2015, a total of 303 patients with at least moderate MR who underwent E2E MVP were identified. Patients undergoing isolated MVP (n = 133) and concomitant coronary artery bypass grafting or other valvular procedures (N = 170) were included. Cox proportional hazards modelling was used to evaluate the risk factors for cumulative survival, or MV event (i.e. MV reintervention or MR recurrence) while event-free survival—defined as time to composite outcome of either death or MV event—was determined using competing risk Kaplan–Meier analysis. Median follow-up duration was 6.9 (interquartile range 5.8) years.RESULTSThe most common MR aetiology was myxomatous (34%), followed by Barlow’s disease (27.7%), and ischaemic (21.5%). E2E MVP was performed for the following indications: persistent MR (51.5%), systolic anterior motion prophylaxis (22.1%), transaortic approach (17.5%) and systolic anterior motion treatment post-MVP (8.9%). Concomitant ring annuloplasty was performed in 224 patients (73.9%). Operative mortality was 3.6% and MV event rate was 18.5%. Significant predictors of decreased survival included age, renal insufficiency, peripheral vascular disease and ischaemic MR aetiology (all P < 0.050). No ring annuloplasty (HR 2.79; P < 0.001) was the only significant predictor of MV events. Estimated event-free survival for the overall cohort was 8.5 years, and shortest for functional (non-ischaemic; 6.6 years) and ischaemic aetiology (5.5 years).CONCLUSIONSE2E repair is a versatile MVP technique, which can be used in prevention and treatment of systolic anterior motion, transaortic approach or with concomitant techniques, with reasonable outcomes. Ischaemic aetiology and absence of ring annuloplasty were associated with worse cumulative survival and MV event rates, respectively, which raises some concern in light of the expanding indication for MitraClip system.
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Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernando Ramirez Del Val
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Farhang Yazdchi
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jiyae Lee
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Julius Ejiofor
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmed A Kolkailah
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ritam Chowdhury
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Easterwood RM, Bostock IC, Nammalwar S, McCullough JN, Iribarne A. The evolution of minimally invasive cardiac surgery: from minimal access to transcatheter approaches. Future Cardiol 2017; 14:75-87. [PMID: 29199850 DOI: 10.2217/fca-2017-0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The field of minimally invasive cardiac surgery has undergone rapid transformation over recent years. In this review, we provide a summary of the most current evidence supporting the use of minimally invasive aortic and mitral valve replacement techniques, as well as transcatheter approaches for aortic and mitral valve disease. As an adjunct, the use of robotically assisted coronary bypass surgery and hybrid coronary revascularization procedures is discussed. In order to obtain optimal patient outcomes, a collaborative, heart-team approach between cardiac surgeons and interventional cardiologists is necessary.
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Affiliation(s)
- Rachel M Easterwood
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Ian C Bostock
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Shruthi Nammalwar
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Jock N McCullough
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Alexander Iribarne
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH 03766, USA
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Collis R, Watkinson O, Pantazis A, Tome-Esteban M, Elliott PM, McGregor CGA. Early and medium-term outcomes of Alfieri mitral valve repair in the management of systolic anterior motion during septal myectomy. J Card Surg 2017; 32:686-690. [DOI: 10.1111/jocs.13239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Richard Collis
- Institute of Cardiovascular Science; University College London; London United Kingdom
| | - Oliver Watkinson
- Institute of Cardiovascular Science; University College London; London United Kingdom
| | | | - Maria Tome-Esteban
- Cardiology Clinical Academic Group; St George's University Hospitals NHS Foundation Trust; Tooting London
| | - Perry M. Elliott
- Institute of Cardiovascular Science; University College London; London United Kingdom
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Mihos CG, Larrauri-Reyes M, Hung J, Santana O. Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Maiteder Larrauri-Reyes
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Orlando Santana
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
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11
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Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:425-429. [DOI: 10.1097/imi.0000000000000306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The study evaluated the feasibility of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) for moderate or greater (≥2+) functional mitral regurgitation (MR) in high-risk patients undergoing aortic valve replacement. Methods We retrospectively evaluated 40 consecutive patients who underwent aortic valve replacement combined with a transaortic edge-to-edge mitral valve repair for 2+ or greater functional MR, between February 2002 and April 2015. The MR was graded semiquantitatively as 0 (trace/none), mild moderate (2+), or moderate to severe (3–4+). Results Thirty-two patients had aortic stenosis, and eight had aortic regurgitation. The mean ± standard deviation (SD) age was 77.5 ± 5 years, 34 (85%) were male, and the mean ± SD EuroSCORE II was 14.3% ± 12.9. At a median follow-up of 1 month (interquartile range, 0.75–10), there were significant improvements in preoperative versus postoperative median MR grade (3+ vs 1+, P < 0.001), mean left ventricular ejection fraction (34% vs 41%, P = 0.018), left ventricular end-diastolic diameter (54 vs 49 mm, P = 0.005), and pulmonary artery systolic pressure (49 vs 35 mm Hg, P < 0.001). Persistent 3 to 4+ MR occurred in two patients (5%). In 12 patients with at least 6-month follow-up (mean ± SD, 18 ± 11 months), a sustained improvement in all echocardiographic parameters was observed, with persistent 3 to 4+ MR occurring in one patient (8.3%). Actuarial survival at 1, 3, and 4.5 years was 82% ± 6, 71% ± 8, and 65% ± 10, respectively. Conclusions A transaortic edge-to-edge repair for 2+ or greater functional MR can be safely performed during aortic valve replacement and is associated with improvements in MR grade, left ventricular remodeling, and pulmonary hemodynamics.
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12
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Pozzoli A, Vicentini L, De Bonis M, Di Giannuario G, La Canna G, Alfieri O. Contemporary application of the edge-to-edge repair. Ann Cardiothorac Surg 2015; 4:376-9. [PMID: 26309849 DOI: 10.3978/j.issn.2225-319x.2014.12.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/24/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Alberto Pozzoli
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Luca Vicentini
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Michele De Bonis
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Giovanni La Canna
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiothoracic Surgery, San Raffaele University Hospital, Milan, Italy
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13
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van den Heuvel AF, Alfieri O, Mariani MA. MitraClip in end-stage heart failure: a realistic alternative to surgery? Eur J Heart Fail 2014; 13:472-4. [DOI: 10.1093/eurjhf/hfr038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Ottavio Alfieri
- CardioThoracic Department; IRCCS H San Raffaele; Milan Italy
| | - Massimo A. Mariani
- Thoraxcenter; University Medical Center Groningen; Groningen The Netherlands
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14
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Biancari F, Schifano P, Pighi M, Vasques F, Juvonen T, Vinco G. Pooled estimates of immediate and late outcome of mitral valve surgery in octogenarians: a meta-analysis and meta-regression. J Cardiothorac Vasc Anesth 2013; 27:213-9. [PMID: 23507013 DOI: 10.1053/j.jvca.2012.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The authors evaluated the outcome of patients≥80 years undergoing mitral valve (MV) surgery. DESIGN Systematic review of the literature and meta-analysis. SETTING None. PARTICIPANTS None. INTERVENTIONS None. MAIN RESULTS Twenty-four studies reporting on 5,572 patients ≥80 years of age who underwent MV surgery were included in this analysis. Pooled proportion of operative mortality was 15.0% (95% confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% CI 2.6-5.2), and dialysis was 2.7% (95% CI 0.5-4.9). Early date of study (p = 0.014), increased age (p = 0.006), MV replacement (p = 0.008), procedure other than isolated MV surgery (p = 0.010), MV surgery associated with coronary artery surgery (p = 0.029), aortic cross-clamping time (p<0.001), and cardiopulmonary bypass time (p<0.001) were associated significantly with increased operative mortality. MV repair had lower operative mortality compared with MV replacement (7.3% v 14.2%, relative risk 0.573, 95% CI 0.342-0.962). Random-effects metaregression showed that prolonged aortic cross-clamping time (p = 0.005) was the only determinant of increased operative mortality, even when adjusted (p<0.001) for date of study (p = 0.004). Operative mortality was significantly higher in studies reporting a mean cross-clamp time >90 minutes (17.0% v 7.4%, p<0.001). Survival rates at 1, 3, and 5 years were 76.1%, 67.7%, and 56.5%, respectively. CONCLUSIONS MV surgery in patients ≥80 years of age is associated with operative mortality, which has decreased significantly during recent years. Prolonged aortic cross-clamp time is a major determinant of operative mortality. MV repair may achieve better results than MV replacement in the very elderly. Five-year survival of these patients is good and justifies surgical treatment of MV diseases in octogenarians.
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Affiliation(s)
- Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland.
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Northern LR, Dhawan R, Petra Bas H, Vidal-Melo MF, Mohr FW, Garbade J. CASE 1-2014 Left Ventricular Assist Device Insertion and the Mitral Valve. J Cardiothorac Vasc Anesth 2013; 28:174-180. [PMID: 23938398 DOI: 10.1053/j.jvca.2013.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Luke R Northern
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL.
| | - Heidi Petra Bas
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Marcos F Vidal-Melo
- Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Jens Garbade
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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Minimally Invasive Edge-to-Edge Mitral Repair With or Without Artificial Chordae. Ann Thorac Surg 2013; 95:1347-53. [DOI: 10.1016/j.athoracsur.2012.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
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De Bonis M, Lapenna E, Lorusso R, Buzzati N, Gelsomino S, Taramasso M, Vizzardi E, Alfieri O. Very long-term results (up to 17 years) with the double-orifice mitral valve repair combined with ring annuloplasty for degenerative mitral regurgitation. J Thorac Cardiovasc Surg 2012; 144:1019-24. [DOI: 10.1016/j.jtcvs.2012.07.034] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/08/2012] [Accepted: 07/25/2012] [Indexed: 11/15/2022]
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Early Results of Edge-to-Edge Alfieri Mitral Repair Via Right Mini-Thoracotomy in 68 Consecutive Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 4:256-60. [PMID: 22437164 DOI: 10.1097/imi.0b013e3181bba05e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : To examine early outcomes of mitral valve repair using Alfieri repair via a right mini-thoracotomy approach. METHODS : Records were examined in 68 consecutive patients undergoing Alfieri mitral repair via 6 cm right mini-thoracotomy. Most repairs were performed under cardioplegic arrest, using percutaneous femoral cannulation and direct aortic cannulation through the right first intercostal space. All patients without hypertrophic cardiomyopathy received rigid ring annuloplasty. The indications for Alfieri repair were extensive prolapse with ring size at least 30 mm. RESULTS : Mean age was 56 ± 13 (range, 20-80). Mitral disease etiology was Barlow disease in 17 of 68 (25%) patients and myxomatous disease in 47 of 68 (69%). Concurrent procedures were performed in 29 of 68 (43%) patients. Median ring size was 34 mm. Despite extensive leaflet disease, 59 of 68 (87%) patients were repaired without leaflet resection. Chord pairs were inserted on the posterior leaflet in 18 of 68 (26%) patients and anterior leaflet in four patients. There were no 30-day or late deaths. Residual intraoperative mitral regurgitation was absent in 54 of 68 (79%) patients and trace in the remainder. Local echocardiography follow-up at a mean of 99 days showed median residual regurgitation to be trace. Only two patients developed moderate regurgitation. Mean mitral gradient at follow-up was 4 ± 2 mm Hg. Local follow-up showed 28 of 39 (72%) patients to be New York Heart Association class I. CONCLUSIONS : An edge-to-edge Alfieri repair via mini-thoracotomy can provide excellent short-term results in selected patients with complex myxomatous mitral disease when minimizing the need for leaflet resection.
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Mihos CG, Santana O, Lamelas J. Transventricular edge-to-edge repair of the mitral valve during surgical ventricular restoration: review of the literature. J Card Surg 2012; 27:52-5. [PMID: 22321113 DOI: 10.1111/j.1540-8191.2011.01388.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mitral valve surgery for functional ischemic mitral regurgitation (MR) in high-risk patients, including those requiring multiple concomitant cardiac operations, carries a significant risk of morbidity and mortality. In patients undergoing surgical ventricular restoration, transventricular edge-to-edge repair provides an effective alternative to conventional mitral valve surgery. We report such a case. METHODS A 67-year-old male with ischemic cardiomyopathy and severe left ventricular dysfunction presented to our institution with a 3-month history of dyspnea on exertion, angina, and leg edema. He was found to have triple-vessel coronary artery disease, a severely dilated left ventricle with an apical aneurysm, and moderate-to-severe MR (3+). In addition to coronary artery bypass graft surgery, an edge-to-edge mitral valve repair was undertaken via a longitudinal ventriculotomy performed for concomitant surgical ventricular restoration. RESULTS Total cardiopulmonary bypass and aortic cross-clamp times were 101 minutes and 86 minutes, respectively. Postoperative transesophageal echocardiography revealed no MR, and the patient was discharged home on postoperative day 9. A follow-up transthoracic echocardiogram revealed trace MR on postoperative day 15. At 11 months postoperative, the patient remains in New York Heart Association functional class I. CONCLUSION Transventricular edge-to-edge repair of the mitral valve in patients with ischemic cardiomyopathy and functional MR undergoing SVR is a safe and effective alternative to conventional valve surgery, and should be considered in this high-risk population.
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Affiliation(s)
- Christos G Mihos
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA
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Nardi P, Pellegrino A, Scafuri A, Olevano C, Bassano C, Zeitani J, Chiariello L. Survival and Durability of Mitral Valve Repair Surgery for Degenerative Mitral Valve Disease. J Card Surg 2011; 26:360-6. [DOI: 10.1111/j.1540-8191.2011.01275.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wong RHL, Lee APW, Ng CSH, Wan IYP, Wan S, Underwood MJ. Mitral Valve Repair: Past, Present, and Future. Asian Cardiovasc Thorac Ann 2010; 18:586-95. [DOI: 10.1177/0218492310383916] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mitral valve repair is the operation of choice for mitral valve regurgitation, with appropriate selection. Studies have shown that mitral repair is associated with a decrease in both long-term thromboembolic complications and mortality. Since its initial description, various selection criteria and techniques of mitral valve repair have been discussed in the literature. This review serves as a synopsis of the previous achievements, present status, and possible future directions of mitral valve repair, specifically from an Asian perspective. Vast experience has been amassed in understanding mitral valve pathophysiology, and excellent surgical treatments for mitral regurgitation have been developed. With the efforts of pioneers in the field of mitral valve repair, standard surgical treatment strategies have been proven to restore the life-expectancy of patients with degenerative mitral regurgitation to that of the age-adjusted population. Minimally invasive techniques of mitral valve repair further reduce access trauma, and could potentially benefit patients previously excluded from conventional surgery.
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Affiliation(s)
| | - Alex PW Lee
- Division of Cardiology Department of Medicine Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong, SAR, China
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Rahman S, Eid N, Murarka S, Heuser RR. Remodeling of the mitral valve using radiofrequency energy: review of a new treatment modality for mitral regurgitation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:249-59. [DOI: 10.1016/j.carrev.2009.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 10/16/2009] [Accepted: 10/26/2009] [Indexed: 11/30/2022]
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Sado DM, Flett AS, McGregor CGA, Pantazis AA, Elliott PM, Moon JC. Myectomy plus Alfieri technique for outflow tract obstruction in hypertrophic cardiomyopathy. Circulation 2010; 122:938-9. [PMID: 20805440 DOI: 10.1161/circulationaha.110.969451] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel M Sado
- Department of Inherited Cardiac Disease, The Heart Hospital, London, UK
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Alfieri O, De Bonis M. The Role of the Edge-to-Edge Repair in the Surgical Treatment of Mitral Regurgitation. J Card Surg 2010; 25:536-41. [DOI: 10.1111/j.1540-8191.2010.01073.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taramasso M, Cioni M, Giacomini A, Michev I, Godino C, Montorfano M, Colombo A, Alfieri O, Maisano F. Emerging approaches of transcatheter valve repair/insertion. Cardiol Res Pract 2010; 2010. [PMID: 20811476 PMCID: PMC2926577 DOI: 10.4061/2010/540749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/20/2010] [Accepted: 06/21/2010] [Indexed: 11/20/2022] Open
Abstract
Aortic stenosis (AS) and mitral regurgitation (MR) account for the majority of valvular diseases and their prevalence is increasing according to increased life expectancy. Surgical treatment is the gold standard, although operative risk may be high in some patients due to comorbidities and age. A large part of the patients at high surgical risk who could beneficiate of treatment are not referred to surgery. Therefore, there is a need of alternative and less invasive procedures.
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Affiliation(s)
- Maurizio Taramasso
- Cardiothoracic Department, San Raffaele Scientific Institute, via Olgettina 60, 20122 Milan, Italy
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Mauri L, Garg P, Massaro JM, Foster E, Glower D, Mehoudar P, Powell F, Komtebedde J, McDermott E, Feldman T. The EVEREST II Trial: design and rationale for a randomized study of the evalve mitraclip system compared with mitral valve surgery for mitral regurgitation. Am Heart J 2010; 160:23-9. [PMID: 20598968 DOI: 10.1016/j.ahj.2010.04.009] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 04/02/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mitral valve surgery is the standard of care for patients with symptomatic mitral regurgitation (MR) or asymptomatic MR with evidence of left ventricular dysfunction or dilation. Whether an endovascular approach to repair can offer comparable effectiveness with improved safety remains to be determined in randomized trials. STUDY DESIGN The EVEREST II Trial is a multicenter, randomized controlled trial to evaluate the benefits and risks of endovascular mitral valve repair using the MitraClip device compared with open mitral valve surgery (control) in patients with moderate or severe MR. Using a 2:1 randomization ratio, the trial is enrolling up to 186 MitraClip-treated subjects and 93 control subjects. Trial end points include a primary efficacy end point: the proportion of patients free from death, surgery for valve dysfunction, and with moderate-severe (3+) or severe (4+) MR at 12 months; the primary safety end point includes the proportion of patients with death, myocardial infarction, reoperation, nonelective cardiovascular surgery, stroke, renal failure, deep would infection, ventilation >48 hours, gastrointestinal complication, new permanent atrial fibrillation, septicemia, or transfusion of >or=2 U at 30 days or hospital discharge, whichever is longer. CONCLUSIONS This randomized controlled trial is designed to evaluate the performance of endovascular mitral repair in comparison to open mitral valve surgery in patients with significant MR.
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Glower DD, Desai B, Mackensen GB. Early Results of Edge-to-Edge Alfieri Mitral Repair via Right Mini-Thoracotomy in 68 Consecutive Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Donald D. Glower
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery
| | - Bhargavi Desai
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery
| | - G. Burkhard Mackensen
- Division of Cardiothoracic Anesthesia and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC USA
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Nurozler F, Kutlu T, Kucuk G. Association of edge-to-edge repair to de vega annuloplasty for tricuspid incompetence. SCAND CARDIOVASC J 2009; 41:192-6. [PMID: 17487770 DOI: 10.1080/14017430601137152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND We aimed to analyze whether association of edge to edge repair to De Vega annuloplasty would result in better results in patients with severe TR. METHODS Fifty seven patients with TR>/=3 were randomized to undergo modified De Vega alone (group D, 28 patients) or associated with edge to edge repair (group E, 29 patients). All patients had preoperative and two postoperative (early and mid-term) echocardiography. The tricuspid regurgitation, diameter of tricuspid valve annulus, pulmonary artery pressure and right ventricular EF were recorded. RESULTS Early postoperative echocardiography indicated less residual TR in group E while other parameters were comparable. The mean follow-up period was 28.2+/-5.4 months. Mid-term postoperative mean TR was 1.9+/-0.8 vs. 1.0+0.4 (p=0.0384) indicated less redevelopment of TR in group E. Additionally TVA re-dilatation was found more prominent in group D. One patient in group D underwent operation for recurred TR. CONCLUSION Our results suggested that association edge-to-edge technique to De Vega annuloplasty has resulted in reduced residual TR and less incidence of recurrence of TR and TVA dilatation.
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Affiliation(s)
- Feza Nurozler
- Division of Cardiovascular Surgery, Central Hospital, Izmir, Turkey.
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Tawn Z, Himbert D, Brochet E, Messika-Zeitoun D, Iung B, Vahanian A. Percutaneous valve procedures: Present and future. ACTA ACUST UNITED AC 2009; 7:14-20. [PMID: 16019610 DOI: 10.1080/14628840510011199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Percutaneous mitral commissurotomy and aortic valvuloplasty have been being performed since the mid-1980s. Balloon commissurotomy has been used in thousands of cases worldwide and it provides good short- and long-term results in a wide range of patients. It has virtually replaced surgical commissurotomy in the treatment of mitral stenosis. In contrast, percutaneous aortic valvuloplasty is almost abandoned worldwide due to its lack of efficacy and the risks involved. The new techniques of percutaneous valve intervention: aortic valve replacement and mitral valve repair are at an early stage: the first in-man applications of these fledgling techniques started in 2002. Preliminary series show that they are feasible; however, they need to be further evaluated in comparison with contemporary treatment to assess accurately how efficient they are and the risks involved. Currently potential applications concern high-risk patients, however, in the future, after thorough evaluation, this may be extended to others. Thus, percutaneous interventions already play an important role in treatment of valvular heart disease, a role that seems set for future expansion.
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Herrmann HC, Kar S, Siegel R, Fail P, Loghin C, Lim S, Hahn R, Rogers JH, Bommer WJ, Wang A, Berke A, Lerakis S, Kramer P, Wong SC, Foster E, Glower D, Feldman T. Effect of percutaneous mitral repair with the MitraClip device on mitral valve area and gradient. EUROINTERVENTION 2009; 4:437-42. [PMID: 19284064 DOI: 10.4244/eijv4i4a76] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Percutaneous repair of mitral regurgitation (MR) by leaflet apposition using a clip deployed via transseptal catheterisation is undergoing evaluation. METHODS AND RESULTS In order to detect the potential for clinically significant left ventricular inflow obstruction after percutaneous repair, we measured mitral valve area (MVA) and mean transmitral gradient (MVG) echocardiographically in 96 patients implanted with a clip followed for up to 24 months. By planimetry, the mean MVA decreased from 6.0 +/- 1.3 cm2 to 3.6 +/- 1.2 cm2 (p < 0.05) (range 1.9 to 7.6 cm2) after clip placement, and remained unchanged after 24 months of follow-up (3.5 +/- 0.8 cm2). The mean MVG increased after clip placement from 1.7 +/- 0.9 mmHg to 4.1 +/- 2.2 mmHg (p < 0.05), and did not increase further to 24 months (3.8 +/- 1.9 mmHg). There were no differences in MVA or MVG between patients who received 1-clip (69%) and those receiving 2-clips (31%). Patients with functional MR (23%) had a slightly smaller MVA, both at baseline and after clip placement, but did not differ from degenerative MR patients at later follow-up. After 2 years of follow-up, no patient required surgery for LV inflow obstruction. CONCLUSIONS Mitral repair with the MitraClip device for MR decreases MVA without significant mitral obstruction. After 2 years of follow-up, no patient required surgery for LV inflow obstruction, and these results were not influenced by the use of more than 1 clip or the aetiology of MR.
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Affiliation(s)
- Howard C Herrmann
- Interventional Cardiology and Cardiac Catheterization Laboratories, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9038 Gates Building, Philadelphia, PA 19104, USA.
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Faillace RT, Kaddaha R, Bikkina M, Yogananthan T, Parikh R, Casthley P. The role of the out-of-operating room anesthesiologist in the care of the cardiac patient. Anesthesiol Clin 2009; 27:29-46. [PMID: 19361766 DOI: 10.1016/j.anclin.2008.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Modern invasive cardiovascular procedures require patients to be both comfortable and cooperative. In addition, these procedures demand the complete attention of the attending cardiovascular specialist, and, to a large degree, the outcomes of these procedures depend on the amount of focus and concentration the cardiovascular specialist can give to performing the procedure itself. A team approach using the specialized skills of a cardiologist and an anesthesiologist frequently is required to optimize results. This article clearly delineates the procedures cardiologists perform that might involve anesthesiologists. Mutual knowledge, understanding, and respect are fundamental requirements for integration of cardiology and anesthesia services to optimize patient outcomes.
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Affiliation(s)
- Robert T Faillace
- St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07503, USA.
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Abstract
There is significant interest in developing transcatheter therapy for valvular heart disease (VHD). Numerous devices have been developed for the percutaneous treatment of pulmonary and aortic stenosis as well as mitral regurgitation. Several of these devices have progressed to randomized clinical trials. These ongoing trials for aortic stenosis and mitral regurgitation will provide important insights into the durability of these therapies as well as the results following standard surgical repair. The field of transcatheter valve therapy is rapidly evolving, and this review aims to summarize the current status of the field.
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Affiliation(s)
- Susheel Kodali
- Columbia University Medical Center, New York, New York 10032
| | - Allan Schwartz
- Columbia University Medical Center, New York, New York 10032
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Sugiyama H, Hoshiai M, Naitoh A, Kadono T, Suzuki S, Sugita K. Outcome of Non-Transplant Surgical Strategy for End-Stage Dilated Cardiomyopathy in Young Children. Circ J 2009; 73:1045-8. [DOI: 10.1253/circj.cj-08-0928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hisashi Sugiyama
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Minako Hoshiai
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Atsushi Naitoh
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Toshie Kadono
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
| | - Syoji Suzuki
- Second Division of Surgery, Faculty of Medicine, University of Yamanashi
| | - Kanji Sugita
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi
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Affiliation(s)
- Paul W.M. Fedak
- From Libin Cardiovascular Institute of Alberta (P.W.M.F.), Division of Cardiac Surgery, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; and Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery (P.M.M.) and Division of Cardiology (R.O.B.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Patrick M. McCarthy
- From Libin Cardiovascular Institute of Alberta (P.W.M.F.), Division of Cardiac Surgery, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; and Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery (P.M.M.) and Division of Cardiology (R.O.B.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert O. Bonow
- From Libin Cardiovascular Institute of Alberta (P.W.M.F.), Division of Cardiac Surgery, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; and Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery (P.M.M.) and Division of Cardiology (R.O.B.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Feldman T, Glower D. Patient selection for percutaneous mitral valve repair: insight from early clinical trial applications. ACTA ACUST UNITED AC 2008; 5:84-90. [DOI: 10.1038/ncpcardio1068] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 09/26/2007] [Indexed: 11/09/2022]
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Affiliation(s)
- Ted Feldman
- Evanston Hospital, Cardiology Division, Walgreen Bldg 3rd Floor, 2650 Ridge Ave, Evanston, IL 60201, USA.
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Alfirevic A, Insler S. Deep Hypothermic Circulatory Arrest in a Patient With Osteogenesis Imperfecta. J Cardiothorac Vasc Anesth 2007; 21:245-9. [PMID: 17418740 DOI: 10.1053/j.jvca.2006.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Andrej Alfirevic
- Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Himbert D, Brochet E, Messika-Zeitoun D, Vahanian A. Current status of percutaneous valvular procedures. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2006; 8:435-42. [PMID: 20848347 DOI: 10.1007/s11936-006-0031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT During the past few decades, percutaneous valvular procedures have been used in mitral and aortic stenosis. Percutaneous mitral commissurotomy, which has virtually replaced surgical commissurotomy in the treatment of mitral stenosis, has been performed since the mid-1980s and has provided good results in thousands of patients worldwide. Percutaneous balloon aortic valvuloplasty has largely been abandoned due to its limited efficacy and the risks involved. New percutaneous procedures are currently being developed in mitral regurgitation and aortic stenosis, which represent the two most frequent valve diseases in industrialized countries. They are in the early stages of development but have opened a very exciting field of investigation. Two percutaneous mitral valve treatment techniques have been used: the edge-to-edge technique and the prosthetic ring annuloplasty. Preliminary series show that they are feasible; however, they need to be further evaluated in comparison with contemporary treatment to accurately assess their effectiveness and the risks involved. Since 2003, percutaneous aortic valve replacement has been performed in approximately 100 compassionate cases with end-stage aortic stenosis, formally declined for surgery. It results in hemodynamic and clinical improvement, with an acceptable risk in this highly selected population. The evaluation of these new percutaneous procedures requires a close collaboration between interventionalists, echocardiographers, engineers, and surgeons. It is probable that they will play an important role in the treatment of valve disease in the future.
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Affiliation(s)
- Dominique Himbert
- Department of Cardiology, CHU Bichat Claude Bernard, AP-HP, 46 rue Henri Huchard, 75015, Paris, France,
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Kuduvalli M, Ghotkar SV, Grayson AD, Fabri BM. Edge-to-Edge Technique for Mitral Valve Repair: Medium-Term Results With Echocardiographic Follow-Up. Ann Thorac Surg 2006; 82:1356-61. [PMID: 16996933 DOI: 10.1016/j.athoracsur.2006.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 05/01/2006] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The follow-up data for the Alfieri edge-to-edge technique of mitral valve repair is still a matter of interest. We describe the medium-term results of a single surgeon's practice with clinical and echocardiographic follow-up. METHODS Between October 1998 and July 2003, 41 patients underwent the Alfieri repair. Mean age of the patients was 68 years, 34.2% were female, 26 (63.41%) had New York Heart Association (NHYA) class III symptoms, and 19 (46.3%) had concomitant coronary disease. Preoperatively, 26 patients had grade 4+, 12 patients had grade 3+, and 3 patients had grade 2+ mitral regurgitation. The pathologies included myxomatous degeneration (73.2%), ischemic cardiomyopathy (12.2%), rheumatic (4.9%), dilated cardiomyopathy (2.4%), previous infection (2.4%), and indeterminate pathology (4.9%). Thirty-three patients (80.4%) had a ring annuloplasty, and 17 (41.4%) had concomitant coronary surgery. Median duration of echocardiographic follow-up was 22.1 months (range, 0.2 to 60.1). RESULTS Hospital mortality was 4.8% (2 of 41). Four patients underwent reintervention on the mitral valve. At follow-up, 26 patients (66.6%) were in NYHA class I. The actuarial freedom from death or reoperation at 5 years was 80.4%. Transthoracic echocardiography was performed in 94.3% of the 35 hospital survivors who did not undergo reoperation. Twenty-nine patients (87.8%) had grade 0-1+ mitral regurgitation, and the remainder had grade 2+ mitral regurgitation. All patients discharged from hospital were alive in December 2005. CONCLUSIONS The Alfieri edge-to-edge repair for mitral regurgitation is a safe and useful technique and should be included in the armamentarium of the mitral valve surgeon.
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Affiliation(s)
- Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Cardiothoracic Centre Liverpool, Liverpool, United Kingdom.
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New developments in catheter interventional treatment of heart valve disease: percutaneous valve replacement and percutaneous valve repair. Eur Surg 2006. [DOI: 10.1007/s10353-006-0277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Surgical mitral valve repair is the procedure of choice to treat mitral regurgitation of all etiologies. Whereas annuloplasty is the cornerstone of mitral valve repair, a variety of other surgical techniques are utilized to correct dysfunction of the leaflets and subvalvular apparatus; in most cases, surgical repair entails application of multiple repair techniques in each patient. Preclinical studies and early human experience have demonstrated that some of these surgical repair techniques can be performed using percutaneous approaches. Specifically, there has been great progress in the development of novel technology to facilitate percutaneous annuloplasty and percutaneous edge-to-edge repair. The objectives of this report were to (1) discuss the surgical foundations for these percutaneous approaches; (2) review device design and experimental and clinical results of percutaneous valve repair; and (3) address future directions, including the key challenges of patient selection and clinical trial design.
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Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA.
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Davidson MJ, White JK, Baim DS. Percutaneous therapies for valvular heart disease. Cardiovasc Pathol 2006; 15:123-9. [PMID: 16697924 DOI: 10.1016/j.carpath.2006.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 02/27/2006] [Indexed: 11/30/2022] Open
Abstract
Balloon valvuloplasty has been in clinical use for over 20 years, but the prospect of repairing and replacing cardiac valves via catheter-based techniques represents a truly recent development. This review introduces evolving technologies and their relevance to cardiovascular pathologists.
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Affiliation(s)
- Michael J Davidson
- Center for the Integration of Medicine and Innovative Technology, Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, , Boston, MA 02120, USA
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Oc M, Doukas G, Alexiou C, Oc B, Hadjinikolaou L, Sosnowski AW, Spyt TJ. Edge-to-Edge Repair With Mitral Annuloplasty for Barlow’s Disease. Ann Thorac Surg 2005; 80:1315-8. [PMID: 16181861 DOI: 10.1016/j.athoracsur.2005.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2004] [Revised: 02/25/2005] [Accepted: 03/04/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose of this study was to define the early and midterm results obtained after the use of edge-to-edge repair with mitral annuloplasty in the setting of Barlow's disease. METHODS Between 1998 and 2004, 41 patients having Barlow's disease had an edge-to-edge repair creating a double-lumen mitral valve orifice in our unit. In 38 patients (93%), an annuloplasty band was also inserted. RESULTS Preoperatively, all patients had severe mitral regurgitation (MR), 12 were in New York Heart Association (NYHA) class I, 15 in class II, and 14 in class III. One patient died in hospital (2.4%) and 5 experienced complications (12.5%). There were no late deaths. At follow-up, 2 patients had severe MR and underwent valve replacement, 1 exhibited moderate MR, and 5 had mild MR. Kaplan-Meier 5-year survival, freedom from reoperation and recurrent moderate-severe MR was 97.6% +/- 2.4%, 94% +/- 4.4%, and 90.6% +/- 5.1%, respectively. At latest echocardiographic evaluation (mean 35 +/- 12 months) the mean left ventricular end-systolic and end-diastolic diameters, and the mitral valve area decreased (p = 0.0001) compared with baseline. The mean mitral valve gradient increased (p = 0.001) without clinical evidence of mitral stenosis whereas ejection fraction did not change. Currently, 35 patients are in NYHA class I and 5 are in class II. CONCLUSIONS In the setting of Barlow's disease, use of edge-to-edge repair with mitral annuloplasty is safe and provides lasting restoration of mitral valve competence with measurable hemodynamic and clinical benefits. In our unit, it is the procedure of choice for correction of MR in patients having Barlow's disease.
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Affiliation(s)
- Mehmet Oc
- Department of Cardiac Surgery, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
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Abstract
PURPOSE OF REVIEW Since its introduction 27 years ago by Andreas Gruntzig, interventional cardiology has expanded its scope from coronary disease to peripheral, congenital, and also valve diseases.Percutaneous mitral commissurotomy and aortic valvuloplasty have been performed since the mid 1980s. Balloon commissurotomy has been used in tens of thousands of patients worldwide and provides good short- and long-term results in a wide range of patients. It has virtually replaced surgical commissurotomy in the management of mitral stenosis. On the other hand, percutaneous aortic valvuloplasty is almost abandoned worldwide due to its lack of efficacy and the risks involved. RECENT FINDINGS The new techniques of percutaneous valve intervention are aortic valve replacement, and mitral valve repair. Both are at an early stage since the first in-man applications only started in 2002. Preliminary series show that these techniques are feasible; however, they must be further evaluated in comparison with contemporary treatment to accurately assess efficacy and risks. Today potential applications concern high-risk patients, however, after thorough evaluation this may be extended to others in the future. SUMMARY Therefore, percutaneous interventions already play an important role in management of valvular heart disease, which is likely to grow in the future.
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Affiliation(s)
- Alec Vahanian
- Bichat Hospital, Paris, France, Pitie-Salepetriere Hospital, Paris, France.
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Fann JI, St Goar FG, Komtebedde J, Oz MC, Block PC, Foster E, Butany J, Feldman T, Burdon TA. Beating Heart Catheter-Based Edge-to-Edge Mitral Valve Procedure in a Porcine Model. Circulation 2004; 110:988-93. [PMID: 15302782 DOI: 10.1161/01.cir.0000139855.12616.15] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Surgical edge-to-edge repair has been used in the treatment of mitral regurgitation. We evaluated the ability of a catheter-delivered clip (Evalve, Inc) to achieve edge-to-edge mitral valve approximation without cardiopulmonary bypass and the healing response of this technique.
Methods and Results—
Twenty-one pigs underwent general anesthesia and left thoracotomy. A 10F flexible delivery catheter with a clip was placed into the left atrium. With echocardiographic and fluoroscopic guidance, the clip grasped and approximated the mid portion of the anterior and posterior leaflets. After a double orifice had been confirmed, the clip was detached and the catheter withdrawn. All animals survived and had successful clip placement. Three animals were euthanized at 4 weeks, 9 at 12 weeks, 1 at 17 weeks, 7 at 24 weeks, and 1 at 52 weeks. The clip was well positioned, with leaflet approximation in all animals except 1, in which the clip separated from the posterior leaflet at 4 weeks without affecting valve function. The clip was modified and implanted in 4 pigs; all were intact at 12 to 24 weeks. Scanning electron microscopy showed clip encapsulation with complete endothelialization. Mitral stenosis and thromboembolism did not develop. Two animals developed endocarditis (1 at 12 weeks and 1 at 17 weeks). Progressive healing occurred in all other animals.
Conclusions—
Edge-to-edge mitral valve approximation can be successfully and reliably achieved with a catheter-delivered clip without cardiopulmonary bypass, resulting in durable healing. The success of this device supports the development of a percutaneous catheter-based system for mitral valve repair.
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