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Vaidyanathan A, Guruswamy J, Saluja A, Eng M, Szymanski T. Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip: Transcatheter Mitral Valve Repair. Semin Cardiothorac Vasc Anesth 2024:10892532241260535. [PMID: 38864441 DOI: 10.1177/10892532241260535] [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: 06/13/2024]
Abstract
BACKGROUND Transcatheter edge-to-edge repair (TEER) with MitraClip is a safe and effective alternative to surgical mitral valve repair/replacement in patients with high operative risk. Pleth Variability Index (PVI) is a non-invasive, dynamic index based on analysis of the respiratory variations in the plethysmographic waveform recorded transcutaneously by the pulse oximeter. OBJECTIVES The objective of the study was to evaluate if the hemodynamic effect of improved left-sided output after successful transcatheter mitral valve repair would lead to a significant change in PVI, and if it would correlate with the decrease in left atrial pressure (LAP). DESIGN Prospective, observational cohort study (ClinicalTrials.gov NCT03993938). SETTING Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021. PARTICIPANTS The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement. MEASUREMENTS AND MAIN RESULTS Of 30 patients, all components of the LAP (a wave, v wave, and mean) decreased significantly after successful MitraClip placement (P < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (P = .275). No significant correlation between change in PVI and change in LAP was observed (P = .235). CONCLUSIONS In patients with severe mitral regurgitation, successful MitraClip resulted in a significant reduction in LAP without a significant change in PVI. A larger sample size may provide more insight on the utility of using PVI as an indicator of LAP change in patients with mitral regurgitation.
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Affiliation(s)
- Ashwin Vaidyanathan
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Jayakar Guruswamy
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Abhishek Saluja
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Marvin Eng
- Structural Heart Program, Banner University Medical Center, Phoenix, AZ, USA
| | - Trevor Szymanski
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA
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Estrada Ledesma M, Bastidas Plaza D, Pozo Osinalde E, Marcos-Alberca P, Olmos Blanco C, Mahía Casado P, Luaces M, Gómez de Diego JJ, Nombela-Franco L, Jiménez-Quevedo P, Tirado G, Collado Yurrita L, Fernández-Ortiz A, Villacastín J, de Agustín JA. Superiority of 3D planimetry over pressure half-time method for the assessment of mitral valve area after percutaneous edge-to-edge mitral repair. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00180-4. [PMID: 38844072 DOI: 10.1016/j.rec.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/14/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION AND OBJECTIVES There is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient. METHODS A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient. RESULTS We analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm2 using pressure half-time (PHT), 2.87±0.83 cm2 using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively). CONCLUSIONS Our study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.
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Affiliation(s)
| | | | | | | | | | | | - María Luaces
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Gabriela Tirado
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - José Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. https://twitter.com/@DoctordeAgustin
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González-Gutiérrez JC, Benito-González T, Bosa-Ojeda F, Freixa-Rofastes X, Estevez-Loureiro R, Pascual I, Andraka-Ikazuriaga L, Díez-Gil JL, Urbano-Carrillo C, Amat-Santos IJ. Prognostic impact of vasopressor test in transcatheter edge-to-edge repair of secondary mitral regurgitation: The PETIT study. Catheter Cardiovasc Interv 2024. [PMID: 38829174 DOI: 10.1002/ccd.31115] [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: 02/04/2024] [Revised: 04/03/2024] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Vasopressor test (VPT) might be useful in patients with functional mitral regurgitation (MR) and left ventricular dysfunction (MITRA-FR-like patients) during transcatheter edge-to-edge repair (TEER). AIMS We aimed to evaluate the prognostic impact of VPT. METHODS MR treated with TEER were included in a multicenter prospective registry. VPT was used intraprocedurally in patients with left ventricular dysfunction and/or hypotension. The 1-year echocardiographic and clinical outcomes were compared according to the use of VPT. The primary endpoint was a combination of mortality + heart failure (HF) readmission at 1-year. RESULTS A total of 1115 patients were included, mean age was 72.8 ± 10.5 years and 30.4% were women. VPT was performed in 128 subjects (11.5%), more often in critically ill patients with biventricular dysfunction. Postprocedurally the VPT group had greater rate of MR ≥ 2+ (46.9% vs. 31.7%, p = 0.003) despite greater number of devices (≥2 clips, 52% vs. 40.6 p = 0.008) and device repositioning or new clip in 12.5%. At 1-year, the primary endpoint occurred more often in the VPT group (27.3% vs. 16.9%, p = 0.002) as well as all-cause mortality (21.9% vs. 8.1%, p ≤ 0.001) but no differences existed in HF readmission rate (14.8% vs. 13.2%, p = 0.610), cardiovascular mortality (4.4% vs. 3.9%, p = 0.713) or residual MR ≥ 2+ (51.1% vs 51.7%, p = 0.371). CONCLUSIONS Dynamic evaluation of MR during TEER procedure through VPT was performed in patients with worse baseline risk who also presented higher all-cause mortality at 1-year follow-up. However, 1-year residual MR, cardiovascular mortality and HF readmission rate remained comparable suggesting that VPT might help in the management of MITRA-FR-like patients.
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Affiliation(s)
| | | | - Francisco Bosa-Ojeda
- Cardiology Department, Clinic Hospital de Tenerife, Santa Cruz de Tenerife, Spain
| | | | | | - Isaac Pascual
- Cardiology Department, University Hospital Central of Asturias, Oviedo, Spain
| | | | | | | | - Ignacio J Amat-Santos
- Cardiology Department, University Clinic Hospital, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, CIBERCV, Madrid, Spain
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Xie CM, Zhu D, Wang SZ, Pan XB. Successful treatment of severe primary mitral regurgitation due to rheumatic aetiology using a novel-designed transcatheter edge-to-edge repair system. Catheter Cardiovasc Interv 2024; 103:1148-1151. [PMID: 38639161 DOI: 10.1002/ccd.31058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/07/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
The transcatheter edge-to-edge mitral valve repair (TEER) has been recommended as a reliable treatment option for selected patients with severe degenerative and functional mitral regurgitation (MR). Although MR patients with rheumatic etiology were excluded from two significant trials (EVEREST II and COAPT) that established a role for the TEER in degenerative and functional MR. However, it has been reported that the TEER procedure could be safely and effectively performed in carefully selected rheumatic MR patients. Therefore, we share a case report of successfully treating severe rheumatic MR using a novel-designed TEER system (JensClipTM).
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Affiliation(s)
- Chun-Mei Xie
- Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Da Zhu
- Department of Structure Heart Center, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
| | - Shou-Zheng Wang
- Department of Structure Heart Center, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
- Department of Structure Heart Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang-Bin Pan
- Department of Structure Heart Center, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China
- Department of Structure Heart Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Halboni A, Hamza M, Dayco J, Al-Abcha A, Alhalbouni A, Zghouzi M, Alhusain R, Sattar Y, Alraies MC. Outcomes of Transcatheter Mitral Valve Repair Using the MitraClip System in Patients With Atrial Fibrillation. A Meta-Analysis. Am J Cardiol 2024; 219:47-59. [PMID: 37865125 DOI: 10.1016/j.amjcard.2023.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
Transcatheter mitral valve repair (TMVR) with the MitraClip system is now approved for degenerative and functional mitral regurgitation (MR). Atrial fibrillation (AF) is commonly seen in MR. In our study, we perform a pooled analysis of the existing data to investigate the outcomes of MitraClip in patients with versus without AF. We conducted a systematic search of PubMed, Google Scholar, and SCOPUS databases through December, 2022 for studies comparing the outcomes of TMVR using the MitraClip in patients with preexisting AF versus those without AF. A meta-analysis was performed to investigate the primary outcomes of all-cause mortality and heart failure (HF) hospitalization. Secondary outcomes were cardiovascular mortality, in-hospital mortality, stroke, New York Heart Association class I or II at follow-up, length of hospital stay, and procedural time. A total of 10 studies (n = 24,111; AF = 12,789; no AF = 11,322) were included in the final analysis. Preexisting AF was associated with higher overall all-cause mortality (odds ratio 1.55, 95% confidence interval 1.32 to 1.83, p <0.0002) and higher overall HF hospitalization rate (odds ratio 1.3, 95% confidence interval 1.08 to 1.56, p <0.0154). There was no statistically significant difference in cardiovascular mortality, in-hospital mortality, stroke, length of hospital stay, procedural time, or New York Heart Association class I/II at follow-up comparing AF versus no AF. The presence of AF in patients who underwent TMVR with MitraClip is associated with higher all-cause mortality and HF hospitalization. This should be taken into consideration in the management of MR patients.
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Affiliation(s)
- Adnan Halboni
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohammad Hamza
- Department of Medicine, Albany Medical Center, Albany, New York
| | - John Dayco
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Abdallah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamed Zghouzi
- Division of Vascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rashid Alhusain
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Yasar Sattar
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
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Krittanawong C, Hahn J, Virk HUH, Bandyopadhyay D, Patel N, Rastogi U, Wang Z, Alam M, Jneid H, Sharma S, Stone GW. In-hospital complications after MitraClip in patients with heart failure and preserved versus reduced ejection fraction in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 62:34-39. [PMID: 38087737 DOI: 10.1016/j.carrev.2023.11.017] [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: 10/30/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 05/14/2024]
Abstract
BACKGROUND The clinical benefits of transcatheter edge to edge mitral valve repair have been well established in patients with heart failure and severe mitral regurgitation (MR) who have prohibitive surgical risk. In March of 2019, the FDA approved the MitraClip for treatment of selected patients with HF and severe secondary MR. However, the relative outcomes of patients with HFrEF and HFpEF treated with MitraClip are largely unknown. We therefore sought to investigate the incidence and characteristics of in-hospital mortality in patients with HFpEF and HFrEF following MitraClip. METHODS The study sample analyzed was originated from the National Inpatient Sample (NIS) registry which includes data from hospitalized patients in the United States (US) between January 1, 2012 and December 31, 2020. Data were extracted from the entire NIS registry using ICD-9 codes. Patients with the primary or secondary diagnosis of MitraClip were identified. Hospitalizations for HFpEF and HFrEF were identified based on ICD-9-CM and ICD-10-CM codes. Demographics, conventional risk factors, and in-hospital outcomes were evaluated. RESULTS 23,260 hospitalizations for MitraClip implantation between 2016 and 2020 were analyzed. The HFrEF group had higher absolute rates of complications as well as a higher observed in-hospital mortality (2.4 % vs 1.7 %; OR 0.75 95 % CI 0.44-1.26; p 0.28) which did not meet statistical significance. Absolute rates of acute myocardial infarction (AMI), acute kidney injury (AKI) and respiratory failure necessitating invasive mechanical ventilation were observed to be higher among HFrEF patients. Post-procedural shock was significantly more common in patients with HFrEF (9.0 % vs 2.8 %: OR 0.34 95 % CI 0.25-0.48 p < 0.001). Significantly longer hospitalizations were observed in the HFrEF cohort (5.3 ± 11.2 days vs 4.2 ± 7.3 days; p < 0.001) as well as a higher total hospitalization cost (61,723 ± 56,728 USD vs 57,278 ± 46,143). CONCLUSIONS In the present study of US patients, those with HFrEF were observed to have statistically higher risk of in-hospital post-procedural shock and longer hospitalization length of stay when compared with patients with HFpEF who underwent MitraClip implantation. Additionally, patients with HFrEF undergoing MitraClip procedure were observed to have higher absolute rates of certain post-procedural complications, however these observations did not reach statistical significance. Understanding of the aforementioned differences after MitraClip implantation may be useful in-patient selection, prognostic guidance, and hypothesis generation to propel future large clinical studies.
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Affiliation(s)
| | - Joshua Hahn
- Division of Cardiology, Department of Internal Medicine, University of Texas Health/McGovern Medical School, Houston, TX, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Neelkumar Patel
- Division of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ujjwal Rastogi
- Cardiovascular Institute of the South, New Iberia, LA, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mahboob Alam
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Hani Jneid
- Chief of the Division of Cardiology at UTMB, Houston, TX, USA
| | - Samin Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Messori A, Fadda V, Rivano M, Trippoli S. Mitraclip Versus Medical Therapy or Surgery in Patients With Mitral Regurgitation: Long-Term Outcomes Determined by the Reconstruction of Individual Patient Data. Cureus 2024; 16:e60204. [PMID: 38746484 PMCID: PMC11093151 DOI: 10.7759/cureus.60204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/16/2024] Open
Abstract
Although MitraClip has been studied in numerous trials, its evidence in the long term is based on a few original studies. We used an original technique of evidence synthesis to review long-term comparative trials evaluating MitraClip. We searched the PubMed database to select long-term comparative trials of MitraClip. The endpoint was all-cause mortality (minimum follow-up, one year). Included trials were analyzed using the IPDfromKM (reconstruct Individual Patient Data from published Kaplan-Meier survival curves) method to reconstruct individual patient data from Kaplan-Meier curves. Standard survival statistics were used to interpret these long-term efficacy data. The survival benefit per patient was estimated from the restricted mean survival time (RMST). Six comparative studies of MitraClip were included; 973 patients were treated with MitraClip (six arms), 717 with medical therapy (five arms), and 80 with surgical repair or replacement (one arm). In our main analysis, the outcomes observed in patients treated with MitraClip were significantly better than those of medical therapy (hazard ratio for all-cause mortality, 0.5276; 95% confidence interval, 0.4412 to 0.6309; p < 0.001); the number of patients treated with surgery was too small to make reliable comparisons. Median survival was 30.4 months for medical therapy versus not reached for the other two groups. RMST was 43.931 and 33.756 months for MitraClip and controls, respectively, yielding a gain per patient of 10.17 months (95% confidence interval, 7.47 to 12.88). In our simplified cost-effectiveness evaluation, a gain of approximately 10 months per patient compared favorably with the device cost. Our analysis provided an original interpretation of the long-term evidence available on MitraClip.
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Affiliation(s)
- Andrea Messori
- Health Technology Assessment (HTA) Unit, Regione Toscana, Florence, ITA
| | - Valeria Fadda
- Pharmacology and Therapeutics, Ente di Supporto Tecnico Amministrativo Regionale (ESTAR), Florence, ITA
| | - Melania Rivano
- Clinical Oncology Pharmacy Department, Binaghi Hospital, Cagliari, ITA
| | - Sabrina Trippoli
- Health Technology Assessment (HTA) Unit, Regione Toscana, Florence, ITA
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Götte J, Zittermann A, Deutsch MA, Schramm R, Bleiziffer S, Renner A, Gummert JF. Early and Late Results after Surgical Mitral Valve Repair: A High-Volume Center Experience. Thorac Cardiovasc Surg 2024. [PMID: 38346705 DOI: 10.1055/a-2266-7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Surgical mitral valve repair is the gold standard treatment of severe primary mitral regurgitation (MR). In the light of rapidly evolving percutaneous technologies, current surgical outcome data are essential to support heart-team-based decision-making. METHODS This retrospective, high-volume, single-center study analyzed in 1779 patients with primary MR early morbidity and mortality, postoperative valve function, and long-term survival after mitral valve (MV) repair. Surgeries were performed between 2009 and 2022. Surgical approaches included full sternotomy (FS) and right-sided minithoracotomy (minimally invasive cardiac [MIC] surgery). RESULTS Of the surgeries (mean age: 59.9 [standard deviation:11.4] years; 71.5% males), 85.6% (n = 1,527) were minithoracotomies. Concomitant procedures were performed in 849 patients (47.7%), including tricuspid valve and/or atrial septal defect repair, cryoablation, and atrial appendage closure. The majority of patients did not need erythrocyte concentrates. Mediastinitis and rethoracotomy for bleeding rates were 0.1 and 4.3%, respectively. Reoperation before discharge for failed repair was necessary in 12 patients (0.7%). Freedom from more than moderate MR was > 99%. Thirty-day mortality was 0.2% and did not differ significantly between groups (p = 0.37). Median follow-up was 48.2 months with a completeness of 95.9%. Long-term survival was similar between groups (p = 0.21). In the FS and MIC groups, 1-, 5-, and 10-year survival rates were 98.8 and 98.8%, 92.9 and 94.4%, and 87.4 and 83.1%, respectively. CONCLUSION MV surgery, both minimally invasive and via sternotomy, is associated with high repair rates, excellent perioperative outcomes, and long-term survival. Data underscore the effectiveness of surgical repair in managing MR, even in the era of advancing interventional techniques.
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Affiliation(s)
- Julia Götte
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Armin Zittermann
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Marcus-Andre Deutsch
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Rene Schramm
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Sabine Bleiziffer
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Andre Renner
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Jan F Gummert
- Clinic for Cardio-Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Nordrhein-Westfalen, Germany
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Nita N, Tadic M, Mörike J, Paukovitsch M, Felbel D, Keßler M, Gröger M, Schneider LM, Rottbauer W. Long-Term Mortality after Transcatheter Edge-to-Edge Mitral Valve Repair Significantly Decreased over the Last Decade: Comparison between Initial and Current Experience from the MiTra Ulm Registry. J Clin Med 2024; 13:2172. [PMID: 38673445 PMCID: PMC11050104 DOI: 10.3390/jcm13082172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Objective: We aimed to assess whether the candidate profile, the long-term outcomes and the predictors for long-term mortality after transcatheter edge-to-edge mitral valve repair (M-TEER) have changed over the last decade; (2) Methods: Long-term follow-up data (median time of 1202 days) including mortality, MACCE and functional status were available for 677 consecutive patients enrolled in the prospective MiTra Ulm registry from January 2010 to April 2019. The initial 340 patients treated in our institution before January 2016 were compared with the following 337 patients; (3) Results: Patients treated after 2016 showed significantly less ventricular dilatation (left ventricular end-systolic diameter of 43 ± 13 mm vs. 49 ± 16 mm, p < 0.007), lower systolic pulmonary pressures (50 ± 15 mmHg vs. 57 ± 21 mmHg, p = 0.01) and a lower prevalence of severe tricuspid regurgitation (27.2% vs. 47.3%, p < 0.001) at baseline than patients treated before 2016. Compared to the cohort treated before 2016, patients treated afterwards showed a significantly lower all-cause 3-year mortality (29.4% vs. 43.8%, p < 0.001) and lower MACCE (38.6% vs. 54.1%, p < 0.001), without differences for MR etiology. While severe tricuspid regurgitation and NYHA class IV remained independently associated with an increased long-term mortality over the last decade, severe left ventricular dilatation (hazard ratio, HR 2.12, p = 0.047) and severe pulmonary hypertension (HR 2.18, p = 0.047) were predictors of long-term mortality only in patients treated before 2016. (4) Conclusions: The M-TEER candidates are currently treated earlier in the course of disease and benefit significantly in terms of a better long-term survival than patients treated at the beginning of the M-TEER era.
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Affiliation(s)
- Nicoleta Nita
- Department of Internal Medicine II, University Medical Center, 89081 Ulm, Germany; (M.T.); (J.M.); (M.P.); (D.F.); (M.K.); (M.G.); (L.-M.S.); (W.R.)
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Yokoyama H, Kokawa T, Shigekiyo S, Seno A, Izumi T, Ogura R, Mahara K, Hosokawa S. Outcomes of mitral valve transcatheter edge-to-edge repair for patients with hemodynamic instability: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00149-0. [PMID: 38584083 DOI: 10.1016/j.carrev.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) for the patients with severe mitral regurgitation (MR) in hemodynamically unstable conditions, such as cardiogenic shock, still remain unclear. We aimed to integrate previous publications regarding M-TEER indicated for life-threatening conditions and indirectly particularly compared the short-term outcomes thereof, with that of other treatments. METHODS We systematically searched the PubMed, Cochrane, and MEDLINE databases for studies from inception to June 2023, regarding M-TEER in patients with hemodynamic instability and severe MR. The primary outcomes analyzed included the in-hospital and 30-day mortality rates, and peri-procedural complications. RESULTS Of the initial 820 publications, we conducted a meta-analysis of a total of 25 studies. The relative risk of moderate-to-severe or severe MR was 0.13 (95 % confidence interval [CI]: 0.10-0.18, I2 = 45.2 %). The pooled in-hospital and 30-day mortality rates were 11.8 % (95 % CI: 8.7-15.9, I2 = 96.4 %) and 14.1 % (95 % CI: 10.9-18.3, I2 = 35.5 %), respectively. The 30-day mortality rate was statistically significantly correlated with the residual moderate-to-severe or severe MR, as per the meta-regression analysis (coefficient β = 3.48 [95 % CI: 0.99-5.97], p = 0.006). Regarding peri-procedural complications, the pooled rates of a stroke or transient ischemic attack, life-threatening or major bleeding, acute kidney injury, and peri-procedural mitral valve surgery were 2.3 % (95 % CI: 1.9-2.6), 7.6 % (95 % CI: 6.8-8.5), 32.9 % (95 % CI: 31.6-34.3), and 1.0 % (95 % CI: 0.8-1.3), respectively. CONCLUSIONS This meta-analysis demonstrates that the relatively higher rates of procedural complications were observed, nevertheless, M-TEER can potentially provide favorable short-term outcomes even in hemodynamically unstable patients. PROSPERO REGISTRATION NUMBER CRD42023468946.
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Affiliation(s)
| | | | | | - Akiho Seno
- Tokushima Red Cross Hospital, Tokushima, Japan
| | | | - Riyo Ogura
- Tokushima Red Cross Hospital, Tokushima, Japan
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Tsunamoto H, Yamamoto H, Masumoto A, Taniguchi Y, Takahashi N, Onishi T, Takaya T, Kawai H, Hirata KI, Tanaka H. Efficacy of Native T 1 Mapping for Patients With Non-Ischemic Cardiomyopathy and Ventricular Functional Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. Circ J 2024; 88:519-527. [PMID: 38325820 DOI: 10.1253/circj.cj-23-0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND We investigated the efficacy of left ventricular (LV) myocardial damage by native T1mapping obtained with cardiac magnetic resonance (CMR) for patients undergoing transcatheter edge-to-edge repair (TEER).Methods and Results: We studied 40 symptomatic non-ischemic heart failure (HF) patients and ventricular functional mitral regurgitation (VFMR) undergoing TEER. LV myocardial damage was defined as the native T1Z-score, which was converted from native T1values obtained with CMR. The primary endpoint was defined as HF rehospitalization or cardiovascular death over 12 months after TEER. Multivariable Cox proportional hazards analysis showed that the native T1Z-score was the only independent parameter associated with cardiovascular events (hazard ratio 3.40; 95% confidential interval 1.51-7.67), and that patients with native T1Z-scores <2.41 experienced significantly fewer cardiovascular events than those with native T1Z-scores ≥2.41 (P=0.001). Moreover, the combination of a native T1Z-score <2.41 and more severe VFMR (effective regurgitant orifice area [EROA] ≥0.30 cm2) was associated with fewer cardiovascular events than a native T1Z-score ≥2.41 and less severe VFMR (EROA <0.30 cm2; P=0.002). CONCLUSIONS Assessment of baseline LV myocardial damage based on native T1Z-scores obtained with CMR without gadolinium-based contrast media is a valuable additional parameter for better management of HF patients and VFMR following TEER.
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Affiliation(s)
- Hiroshi Tsunamoto
- Department of Cardiology, Hyogo Prefectural Harima-Himeji General Medical Center
- Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine
| | - Hiroyuki Yamamoto
- Department of Cardiology, Hyogo Prefectural Harima-Himeji General Medical Center
| | - Akiko Masumoto
- Department of Cardiology, Hyogo Prefectural Harima-Himeji General Medical Center
| | - Yasuyo Taniguchi
- Department of General Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center
| | - Nobuyuki Takahashi
- Department of Cardiology, Hyogo Prefectural Harima-Himeji General Medical Center
| | - Tetsuari Onishi
- Department of Cardiology, Hyogo Prefectural Harima-Himeji General Medical Center
| | - Tomofumi Takaya
- Department of Cardiology, Hyogo Prefectural Harima-Himeji General Medical Center
- Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine
| | - Hiroya Kawai
- Department of Cardiology, Hyogo Prefectural Harima-Himeji General Medical Center
- Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Mesa D, González-Manzanares R, Pan M. Primary mitral regurgitation treated with transcatheter edge-to-edge repair. Does transthoracic echocardiography provide prognostic information? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00101-4. [PMID: 38521439 DOI: 10.1016/j.rec.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain. https://twitter.com/@Cardio_HURS
| | - Rafael González-Manzanares
- Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain. https://twitter.com/@MPAOSS
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13
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Hung A, Yang J, Wallace M, Zwischenberger BA, Vemulapalli S, Mentz RJ, Thoma E, Goates S, Lewis J, Strong S, Reed SD. Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair. J Am Heart Assoc 2024; 13:e032807. [PMID: 38471830 PMCID: PMC11010000 DOI: 10.1161/jaha.123.032807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to quantify patient preferences for risk-benefit trade-offs associated with TEER and surgery. METHODS AND RESULTS A discrete choice experiment survey was administered to patients with mitral regurgitation. Attributes included procedure type; 30-day mortality risk; 5-year mortality risk and physical functioning for 5 years; number of hospitalizations in the next 5 years; and risk of additional surgery in the next 5 years. A mixed-logit regression model was fit to estimate preference weights. Two hundred one individuals completed the survey: 63% were female and mean age was 74 years. On average, respondents preferred TEER over surgery. To undergo a less invasive procedure (ie, TEER), respondents would accept up to a 13.3% (95% CI, 8.7%-18.5%) increase in reintervention risk above a baseline of 10%, 4.6 (95% CI, 3.1-6.2) more hospitalizations above a baseline of 1, a 10.7% (95% CI, 6.5%-14.5%) increase in 5-year mortality risk above a baseline of 20%, or more limited physical functioning representing nearly 1 New York Heart Association class (0.7 [95% CI, 0.4-1.1]) over 5 years. CONCLUSIONS Patients in general preferred TEER over surgery. When holding constant all other factors, a functional improvement from New York Heart Association class III to class I maintained over 5 years would be needed, on average, for patients to prefer surgery over TEER.
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Affiliation(s)
- Anna Hung
- Duke Clinical Research Institute, Duke University School of MedicineDurhamNCUSA
- Center of Innovation to Accelerate Discovery and Practice TransformationDurham Veterans Affairs Health Care SystemDurhamNCUSA
- Department of Population Health SciencesDuke University School of MedicineDurhamNCUSA
| | - Jui‐Chen Yang
- Duke Clinical Research Institute, Duke University School of MedicineDurhamNCUSA
| | - Matthew Wallace
- Duke Clinical Research Institute, Duke University School of MedicineDurhamNCUSA
| | - Brittany A. Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of SurgeryDuke University Medical CenterDurhamNCUSA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of MedicineDurhamNCUSA
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNCUSA
| | - Robert J. Mentz
- Duke Clinical Research Institute, Duke University School of MedicineDurhamNCUSA
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNCUSA
| | | | | | | | | | - Shelby D. Reed
- Duke Clinical Research Institute, Duke University School of MedicineDurhamNCUSA
- Department of Population Health SciencesDuke University School of MedicineDurhamNCUSA
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14
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Deharo P, Obadia JF, Guerin P, Cuisset T, Avierinos JF, Habib G, Torras O, Bisson A, Vigny P, Etienne CS, Semaan C, Guglieri M, Dumonteil N, Collart F, Gilard M, Modine T, Donal E, Iung B, Fauchier L. Mitral transcatheter edge-to-edge repair vs. isolated mitral surgery for severe mitral regurgitation: a French nationwide study. Eur Heart J 2024; 45:940-949. [PMID: 38243821 DOI: 10.1093/eurheartj/ehae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND AND AIMS Mitral valve surgery and, more recently, mitral transcatheter edge-to-edge repair (TEER) are the two treatments of severe mitral regurgitation in eligible patients. Clinical comparison of both therapies remains limited by the number of patients analysed. The objective of this study was to analyse the outcomes of mitral TEER vs. isolated mitral valve surgery at a nationwide level in France. METHODS Based on the French administrative hospital discharge database, the study collected information for all consecutive patients treated for mitral regurgitation with isolated TEER or isolated mitral valve surgery between 2012 and 2022. Propensity score matching was used for the analysis of outcomes. RESULTS A total of 57 030 patients were found in the database. After matching on baseline characteristics, 2160 patients were analysed in each arm. At 3-year follow-up, TEER was associated with significantly lower incidence of cardiovascular death (hazard ratio 0.685, 95% confidence interval 0.563-0.832; P = .0001), pacemaker implantation, and stroke. Non-cardiovascular death (hazard ratio 1.562, 95% confidence interval 1.238-1.971; P = .0002), recurrent pulmonary oedema, and cardiac arrest were more frequent after TEER. No significant differences between the two groups were observed regarding all-cause death (hazard ratio 0.967, 95% confidence interval 0.835-1.118; P = .65), endocarditis, major bleeding, atrial fibrillation, and myocardial infarction. CONCLUSIONS Our results suggest that TEER for severe mitral regurgitation was associated with lower cardiovascular mortality than mitral surgery at long-term follow-up. Pacemaker implantation and stroke were less frequently observed after TEER.
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Affiliation(s)
- Pierre Deharo
- Département de Cardiologie, CHU Timone, 264 rue Saint Pierre, 13005 Marseille, France
- Aix Marseille Univ, Inserm, Inra, C2VN, 264 rue Saint Pierre, 13005 Marseille, France
| | - Jean Francois Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, 28, Ave. Doyen Lépine, 69677 Bron CEDEX, France
| | - Patrice Guerin
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, 264 rue Saint Pierre, 13005 Marseille, France
- Aix Marseille Univ, Inserm, Inra, C2VN, 264 rue Saint Pierre, 13005 Marseille, France
| | | | - Gilbert Habib
- Département de Cardiologie, CHU Timone, 264 rue Saint Pierre, 13005 Marseille, France
| | - Olivier Torras
- Département de Cardiologie, CHU Timone, 264 rue Saint Pierre, 13005 Marseille, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Trousseau, Tours, France
| | - Pascal Vigny
- Service d'information médicale, Unité d'épidémiologie hospitalière régionale, Université de Tours, 60 rue du plat d' Etain, 37000, France
| | | | - Carl Semaan
- Service de Cardiologie, Centre Hospitalier Trousseau, Tours, France
| | - Mickael Guglieri
- Service de Cardiologie, Centre Hospitalier Trousseau, Tours, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Frederic Collart
- Aix Marseille Univ, Inserm, Inra, C2VN, 264 rue Saint Pierre, 13005 Marseille, France
- Département de Chirurgie Cardiaque, CHU Timone, Marseille, France
| | - Martine Gilard
- Department of Cardiology, CHRU Brest, 29200 Brest, France
| | - Thomas Modine
- Département de Cardiologie, CHU Bordeaux, Bordeaux, France
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI-UMR 1099, University of Rennes, F-35000 Rennes, France
| | - Bernard Iung
- AP-HP, Cardiology Department, Bichat Hospital, Université Paris Cité, INSERM 1148, Paris, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Trousseau, Tours, France
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15
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Hatab T, Samimi S, Bou Chaaya RG, Qamar F, Kharsa C, Wessly P, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Nagueh SF, Zaid S, Goel SS. Echocardiographic Profiling Predicts Clinical Outcomes After Mitral Transcatheter Edge-to-Edge Repair. J Am Heart Assoc 2024; 13:e032784. [PMID: 38390821 PMCID: PMC10944065 DOI: 10.1161/jaha.123.032784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER. METHODS AND RESULTS We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well-established outcomes-related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal: 0 risk factors, mixed: 1 risk factor, poor: ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all-cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two-year event-free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2-year event-rate with each worsening profile (optimal as reference; mixed profile: hazard ratio (HR), 2.87 [95% CI, 1.71-5.17], P<0.001; poor profile: HR, 3.76 [95% CI, 1.84-6.53], P<0.001). Echocardiographic profile was statistically associated with the 2-year mortality end point (optimal as reference; mixed profile: HR, 3.55 [95% CI, 1.81-5.96], P<0.001; poor profile: HR, 3.39 [95% CI, 2.56-7.33], P=0.02). CONCLUSIONS The echocardiographic profile integrating predischarge TR, MR, and TMPG presents a novel prognostic stratification tool for patients undergoing mitral TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Fatima Qamar
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Chloe Kharsa
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Marvin D Atkins
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Michael J Reardon
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Sherif F Nagueh
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Syed Zaid
- Department of Cardiology Baylor School of Medicine and the Michael E DeBakey VAMC Houston TX
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
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Mustafa A, Basman C, Cinelli MP, Goldberg Y, Wang D, Patel V, Kaur A, Singh P, Wei C, Paliwoda E, Kodra A, Pirelli L, Thampi S, Maniatis G, Rutkin B, Kalimi R, Koss E, Trost B, Supariwala AA, Jacob Scheinerman S, Kliger CA. Contemporary experience of mitral transcatheter edge-to-edge repair technology in patients with mitral annular calcification. Catheter Cardiovasc Interv 2024; 103:618-625. [PMID: 38436540 DOI: 10.1002/ccd.30988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mitral annular calcification (MAC) has been an exclusion for many of the earlier pivotal trials that were instrumental in gaining device approval and indications for mitral transcatheter edge-to-edge repair (M-TEER). AIMS To evaluate the impact of MAC on the procedural durability and success of newer generation MitraClip® systems (G3 and G4 systems). METHODS Data were collected from Northwell TEER registry. Patients that underwent M-TEER with third or fourth generation MitraClip device were included. Patients were divided into -MAC (none-mild) and +MAC (moderate-severe) groups. Procedural success was defined as ≤ grade 2 + mitral regurgitation (MR) postprocedure, and durability was defined as ≤ grade 2 + MR retention at 1 month and 1 year. Univariate analysis compared outcomes between groups. RESULTS Of 260 M-TEER patients, 160 were -MAC and 100 were +MAC. Procedural success was comparable; however, there were three patients who required conversion to cardiac surgery during the index hospitalization in the +MAC group versus none in the -MAC group (though this was not statistically significant). At 1-month follow-up, there were no significant differences in MR severity. At 1-year follow-up, +MAC had higher moderate-severe MR (22.1% vs. 7.5%; p = 0.002) and higher mean transmitral gradients (5.3 vs. 4.0 mmHg; p = 0.001) with no differences in mortality, New York Heart Association functional class or ejection fraction. CONCLUSION In selective patients with high burden of MAC, contemporary M-TEER is safe, and procedural success is similar to patients with none-mild MAC. However, a loss of procedural durability was seen in +MAC group at 1-year follow-up. Further studies with longer follow-ups are required to assess newer mTEER devices and their potential clinical implications in patients with a high burden of MAC.
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Affiliation(s)
- Ahmad Mustafa
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Craig Basman
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Michael P Cinelli
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Ythan Goldberg
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Denny Wang
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Vidhi Patel
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Arpanjeet Kaur
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Priyanka Singh
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Chapman Wei
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Ethan Paliwoda
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Arber Kodra
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Luigi Pirelli
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Shankar Thampi
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Gregory Maniatis
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Bruce Rutkin
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Robert Kalimi
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Elana Koss
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Biana Trost
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Azhar A Supariwala
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Samuel Jacob Scheinerman
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
| | - Chad A Kliger
- Department of Cardiovascular and Thoracic Surgery, Northwell Health, New Hyde Park, New York, New York, USA
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Faisaluddin M, Balasubramanian S, Ahmed A, Hussain K, Nso N, Gaznabi S, Erwin JP, Pursnani A, Ricciardi M. Temporal trends and procedural safety of transcatheter mitral valve repair with mitraclip in patients with hypertrophic cardiomyopathy: Insights from the national inpatient sample. Curr Probl Cardiol 2024; 49:102354. [PMID: 38135106 DOI: 10.1016/j.cpcardiol.2023.102354] [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: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
Data on utilization and safety of mitral Transcatheter Edge-to-Edge Repair (TEER) among hypertrophic cardiomyopathy (HCM) patients is limited. Our study aimed to assess the national utilization, safety, and clinical outcomes of TEER procedures among HCM patients using a nationwide real-world cohort. HCM patients undergoing TEER hospitalizations between 2015-2020 were identified using ICD-10 (International Classification of Diseases, (ICD-10-CM/PCS). HCM-TEER and HCM No-TEER formed the two comparison groups. Demographic characteristics, baseline comorbidities, procedural complications, inpatient mortality, length of stay (LOS), and cost of hospitalization were compared between the propensity-matched cohorts. Numeric values of 10 or less were not reported per NIS data use agreements. A total of 39,625 weighted cases of TEER were identified from 2015-2020. Of the included patients, 335 patients had the HCM diagnosis. The median age of the HCM-TEER group was 74 (70-79) vs. 79 (72-85) for the no-TEER cohort. The TEER procedure was more frequently performed among Caucasians (86.57%) and females (53.73%). The TEER procedure among HCM patients had similar in-hospital mortality (Adjusted odds ratio: aOR 1.50, 95% CI [0.68-3.29]; p = 0.30) and net adverse cardiac events (NACE) (aOR 1.16, 95% CI [0.73-1.85]; p = 0.51). TEER among HCM was associated with higher odds of gastrointestinal/hematological (aOR 2.33, 95% CI [1.29-4.19]; p = 0.003) complications. However, the odds of cardiac complications (aOR 0.57, 95% CI [0.33-0.96]; p = 0.03) were not higher. The median length of stay was similar in both the groups (median: 2 vs. 2, p = 0.74), although TEER among HCM was associated with higher costs of hospitalization ($44729.36 vs. $40513.82, p < 0.01). TEER is a minimally invasive procedure and could be a safe option for symptomatic HCM patients with significant MR who are poor surgical candidates. Mitral TEER among HCM has been increasingly utilized in recent years in the United States more commonly in obstructive HCM and is associated with no difference in mortality and net adverse cardiac events but higher odds for gastrointestinal/hematological complications than non-HCM patients.
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Affiliation(s)
| | - Senthil Balasubramanian
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA.
| | - Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Kifah Hussain
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Nso Nso
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Safwan Gaznabi
- University Hospital for the Albert Einstein College of Medicine at Montefiore Medical Center, Bronx, NY, USA
| | - John P Erwin
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Amit Pursnani
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
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Oh JS, Kim GY, Kim SH, Lee SH, Park YH, Kim JH, Chon MK. Novel percutaneous technique for creation of porcine model of tricuspid regurgitation via two routes. J Int Med Res 2024; 52:3000605241233524. [PMID: 38497134 PMCID: PMC10946071 DOI: 10.1177/03000605241233524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To develop an experimental porcine model of tricuspid regurgitation using two induction routes: the inferior vena cava and superior vena cava. METHODS Tricuspid regurgitation was generated using the loop wire cutting method. The tricuspid regurgitation jet direction was controlled by accessing the valve through the inferior (n = 7) or superior (n = 6) vena cava. The occurrence, direction, and progression of tricuspid regurgitation were assessed postoperatively, and echocardiography was performed at 4 to 6 weeks. Right heart dilatation was assessed using computed tomography after 6 weeks. RESULTS Moderate to severe or torrential tricuspid regurgitation occurred immediately after the procedure in 12 of 13 animals. The jet was directed toward the septum in five of seven animals in the inferior vena cava group and toward the posterolateral side in four of six animals in the superior vena cava group. The dimensions of the right heart (right atrium, ventricle, and tricuspid valve annulus) were significantly enlarged at the 4- to 6-week follow-up echocardiographic examination and confirmed to be enlarged by computed tomography, independent of the route used. CONCLUSION The loop wire cutting method successfully induced a disease model of tricuspid regurgitation while controlling the regurgitation jet direction via two procedural routes.
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Affiliation(s)
- Ji Soo Oh
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ga Yun Kim
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seok Hyun Kim
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong Hyun Park
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - June Hong Kim
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Min Ku Chon
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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van-Roessel AM, Asmarats L, Li CHP, Millán X, Fernández-Peregrina E, Menduiña I, Sanchez-Ceña J, Arzamendi D. Mitral transcatheter edge-to-edge repair: patient selection, current devices, and clinical outcomes. Expert Rev Med Devices 2024; 21:187-196. [PMID: 38155555 DOI: 10.1080/17434440.2023.2298713] [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: 09/06/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Over the last two decades, mitral transcatheter edge-to-edge repair (M-TEER) has become a safe and effective therapy for severe mitral regurgitation in patients deemed at high surgical risk. AREAS COVERED This review aims to encompass the most relevant and updated evidence in the field of M-TEER from its inception, focusing on clinical and anatomical features for proper patient and device selection. EXPERT OPINION Growing operator experience and device iterations have resulted in improved clinical outcomes and an expansion of the therapy to patients with complex anatomies and clinical scenarios. Future investigations are warranted to determine the best management options and the most suitable device for every patient with MR.
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Affiliation(s)
- Albert Massó van-Roessel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Chi Hion Pedro Li
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Xavier Millán
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | - Juan Sanchez-Ceña
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
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20
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Anaraki KT, Zahed Z, Javid RN, Shafiei S, Beiranvandi F, Kahrizsangi NG, Golafshan F, Arzhangzade A, Kojuri J, Almassian S, Hadi R, Gholizadeh P, Kazeminava F. Immune response following transcatheter aortic valve procedure. Vascul Pharmacol 2024; 154:107283. [PMID: 38340884 DOI: 10.1016/j.vph.2024.107283] [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: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
Aortic valve stenosis is the most common type of heart valve disease in the United States and Europe and calcific aortic stenosis (AS) affects 2-7% of people aged 65 years and older. Aortic valve replacement (AVR) is the only effective treatment for individuals with this condition. Transcatheter Aortic Valve Replacement (TAVR) has been widely accepted as a minimally invasive therapeutic approach for addressing symptomatic AS in patients who are considered to have a high risk for traditional surgical intervention. TAVR procedure may have a paradoxical effect on the immune system and inflammatory status. A major portion of these immune responses is regulated by activating or inhibiting inflammatory monocytes and the complement system with subsequent changes in inflammatory cytokines. TAVR has the potential to induce various concurrent exposures, including disruption of the native valve, hemodynamic changes, antigenicity of the bioprosthesis, and vascular damage, which finally lead to the development of inflammation. On the other hand, it is important to acknowledge that TAVR may also have anti-inflammatory effects by helping in the resolution of stenosis.The inflammation and immune response following TAVR are complex processes that significantly impact procedural outcomes and patient well-being. Understanding the underlying mechanisms, identifying biomarkers of inflammation, and exploring therapeutic interventions to modulate these responses are crucial for optimizing TAVR outcomes. Further research is warranted to elucidate the precise immunological dynamics and develop tailored strategies to attenuate inflammation and enhance post-TAVR healing while minimizing complications.
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Affiliation(s)
- Kasra Talebi Anaraki
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zahed
- Department of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Sasan Shafiei
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Beiranvandi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Faraz Golafshan
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Arzhangzade
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samin Almassian
- Heart Valve Disease Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Raha Hadi
- Department of Chemistry, Faculty of Basic Science, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Pourya Gholizadeh
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil, Iran; Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Fahimeh Kazeminava
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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21
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Yokoyama H, Ruf TF, Gößler TAM, Geyer M, Zirbs J, Schwidtal BL, Münzel T, von Bardeleben RS. Outcomes of COMBO therapy for severe mitral regurgitation compared with transcatheter edge-to-edge repair. Front Cardiovasc Med 2024; 11:1223588. [PMID: 38468721 PMCID: PMC10925764 DOI: 10.3389/fcvm.2024.1223588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Background There are different types of transcatheter mitral valve repair (TMVr) currently in clinical use, including leaflet approximation, annular cinching, and restoration of the chordal apparatus of the mitral valve (MV). While the concomitant combination (COMBO) therapy of mitral transcatheter edge-to-edge repair (M-TEER) with another TMVr concept has been proven feasible, potentially offering patient-tailored treatment for severe mitral regurgitation (MR), a comparison with M-TEER alone has not been made. Aims To evaluate the procedural and clinical outcome of COMBO therapies compared with M-TEER alone. Methods We included consecutive patients undergoing COMBO and M-TEER between March 2015 and April 2018 at our Heart Valve Center, while excluding patients presenting a case of redo or with previous MV surgery. Procedural outcomes and all-cause mortality were compared between COMBO therapy vs. M-TEER alone. Results A total of 357 patients (mean age 78.9 ± 7.0 years, 53.2% male, M-TEER n = 322, COMBO n = 35; COMBO: MitraClip and the Carillon mitral contour system n = 26, MitraClip and Cardioband n = 5, and MitraClip and NeoChord n = 4) were analyzed. Patients with COMBO therapy had larger left chamber sizes, a lower left ventricular systolic ejection fraction (LVEF; COMBO: 37.4 ± 13.8%, M-TEER: 47.9 ± 14.3%, p < 0.001), and a more severe MR grade (p < 0.001). There were no significant differences in the prevalence of residual MR ≧2+. However, the need for re-intervention, always employing M-TEER, was more common in the COMBO group. During a mean 3.6-year long-term follow-up, there was no significant difference of all-cause mortality between both groups (Log rank p = 0.921). Conclusions COMBO therapy may still be a beneficial therapy option for patients with severe MR who already have a more dilated left ventricle (LV), a more severe MR, and a more pronounced LV systolic dysfunction. The higher need for re-intervention in the COMBO group may signal more complex anatomies and possibly underlines the necessity of treating significant MR earlier. Future research is required to establish the COMBO approach as a toolbox-like treatment option, thus offering a patient-tailored approach depending on the individual anatomy and pathology.
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias Friedrich Ruf
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Theresa Ann Maria Gößler
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Martin Geyer
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia Zirbs
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ben Luca Schwidtal
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
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22
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Praz F, Samim D. One-year outcomes with a new mitral edge-to-edge repair device: is mitral TEER about to conquer the world? EUROINTERVENTION 2024; 20:e225-e227. [PMID: 38389475 PMCID: PMC10870007 DOI: 10.4244/eij-e-23-00071] [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: 02/24/2024]
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Daryoush Samim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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23
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Nantsios A, Ahmadvand A, Burwash IG, Chan V, Guo MH, Mesana T, Messika-Zeitoun D, Ramsay T, Rubens FD. Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitation. JTCVS Tech 2024; 23:26-43. [PMID: 38351991 PMCID: PMC10859650 DOI: 10.1016/j.xjtc.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 02/16/2024] Open
Abstract
Objective Evidence supports replacement over repair for ischemic mitral regurgitation due to improved durability; however, the latter often involves an undersized ring annuloplasty that does not include edge-to-edge approximation. The objective of this study was to evaluate the outcomes of replacement, edge-to-edge leaflet approximation with mild-undersized annuloplasty and undersized ring annuloplasty for ischemic mitral regurgitation. Methods This is a single-center retrospective study of patients undergoing mitral surgery for moderate-severe or greater ischemic mitral regurgitation, between 2004 and 2020, with mild-undersized annuloplasty, mitral valve replacement, or undersized restrictive annuloplasty (undersized ring annuloplasty). The primary outcome was all-cause mortality. Secondary outcomes included first recurrence of mitral regurgitation, heart failure hospitalization, and composite of valve-related events (bleeding, thromboembolism, endocarditis, and mitral valve reoperation). Results There were 121, 93, and 78 patients in the mitral valve replacement, mild-undersized annuloplasty, and undersized restrictive annuloplasty groups, respectively, with a median follow-up of 3.1, 5.9, and 3.8 years, respectively. Both mitral valve replacement (hazard ratio, 1.87; 95% CI, 1.029-3.415) and undersized restrictive annuloplasty (hazard ratio, 2.73; 95% CI, 1.480-5.061) were associated with worse survival compared with mild-undersized annuloplasty. At 2 years, the rate of mild-moderate mitral regurgitation was greater in the mild-undersized annuloplasty group compared with the mitral valve replacement group (P = .001) but less than in the undersized restrictive annuloplasty group (P = .001). The rate of recurrent moderate or greater mitral regurgitation at 2 years was similar between mild-undersized annuloplasty and mitral valve replacement groups but significantly higher after undersized restrictive annuloplasty (P < .0001). Mitral valve replacement and undersized restrictive annuloplasty were associated with a significant increase in the incidence of first heart failure hospitalization compared with mild-undersized annuloplasty (P < .001 and P = .001, respectively). Mitral valve replacement was associated with an increased incidence of valve-related events compared with mild-undersized annuloplasty (P = .002). Conclusions Surgical edge-to-edge approximation in addition to a mild-undersizing annuloplasty offers similar durability compared with replacement, with a lower rate of hospitalization for heart failure, and may confer a survival advantage.
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Affiliation(s)
- Alex Nantsios
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aryan Ahmadvand
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ian G. Burwash
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ming Hao Guo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Tim Ramsay
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Fraser D. Rubens
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Imamura T, Tanaka S, Ushijima R, Fukuda N, Ueno H, Kinugawa K, Kubo S, Yamamoto M, Saji M, Asami M, Enta Y, Nakashima M, Shirai S, Izumo M, Mizuno S, Watanabe Y, Amaki M, Kodama K, Yamaguchi J, Nakajima Y, Naganuma T, Bota H, Ohno Y, Yamawaki M, Mizutani K, Otsuka T, Hayashida K. Predictive Factors of Cardiac Mortality Following TEER in Patients with Secondary Mitral Regurgitation. J Clin Med 2024; 13:851. [PMID: 38337545 PMCID: PMC10856463 DOI: 10.3390/jcm13030851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Transcatheter edge-to-edge mitral valve repair (TEER) has emerged as a viable approach to addressing substantial secondary mitral regurgitation. In the contemporary landscape where ultimate heart failure-specific therapies, such as cardiac replacement modalities, are available, prognosticating a high-risk cohort susceptible to early cardiac mortality post-TEER is pivotal for formulating an effective therapeutic regimen. Methods: Our study encompassed individuals with secondary mitral regurgitation and chronic heart failure enlisted in the multi-center (Optimized CathEter vAlvular iNtervention (OCEAN)-Mitral registry. We conducted an assessment of baseline variables associated with cardiac death within one year following TEER. Results: Amongst the 1517 patients (median age: 78 years, 899 males), 101 experienced cardiac mortality during the 1-year observation period after undergoing TEER. Notably, a history of heart failure-related admissions within the preceding year, utilization of intravenous inotropes, and elevated plasma B-type natriuretic peptide levels emerged as independent prognosticators for the primary outcome (p < 0.05 for all). Subsequently, we devised a novel risk-scoring system encompassing these variables, which significantly stratified the cumulative incidence of the 1-year primary outcome (16%, 8%, and 4%, p < 0.001). Conclusions: Our study culminated in the development of a new risk-scoring system aimed at predicting 1-year cardiac mortality post-TEER.
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Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan (H.U.)
| | - Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan (H.U.)
| | - Ryuichi Ushijima
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan (H.U.)
| | - Nobuyuki Fukuda
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan (H.U.)
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan (H.U.)
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan (H.U.)
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki 710-0052, Japan;
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi 441-8071, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya 461-0045, Japan
- Department of Cardiology, Gifu Heart Center, Gifu 500-8384, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo 143-8540, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan
| | - Yusuke Enta
- Department of Cardiology, Sendai Kosei Hospital, Sendai 980-0873, Japan (M.N.)
| | - Masaki Nakashima
- Department of Cardiology, Sendai Kosei Hospital, Sendai 980-0873, Japan (M.N.)
| | - Shinichi Shirai
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu 802-8555, Japan
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki 216-8511, Japan
| | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan;
| | - Yusuke Watanabe
- Department of Cardiology, School of Medicine, Teikyo University, Tokyo 173-8606, Japan
| | - Makoto Amaki
- Department of Cardiology, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan;
| | - Kazuhisa Kodama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto 861-4193, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Woman’s Medical University, Tokyo 162-8666, Japan
| | - Yoshifumi Nakajima
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate 028-3694, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba 270-2232, Japan
| | - Hiroki Bota
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo 065-0033, Japan
| | - Yohei Ohno
- Department of Cardiology, School of Medicine, Tokai University, Isehara 259-1193, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa 230-0012, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kinki University, Osaka 577-8502, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo 113-8602, Japan
| | - Kentaro Hayashida
- Department of Cardiology, School of Medicine, Keio University, Tokyo 160-8582, Japan
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Maznyczka A, Pilgrim T. Antithrombotic Treatment After Transcatheter Valve Interventions: Current Status and Future Directions. Clin Ther 2024; 46:122-133. [PMID: 37926630 DOI: 10.1016/j.clinthera.2023.09.028] [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: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The optimal antithrombotic strategy after transcatheter valve interventions is a subject of ongoing debate. Although there is evidence from randomized trials in patients undergoing transcatheter aortic valve replacement (TAVR), current evidence on optimal antithrombotic management after transcatheter mitral or tricuspid valve interventions is sparse. This article appraises the current evidence on this topic. METHODS This narrative review presents key research findings and guideline recommendations, as well as highlights areas for future research. FINDINGS After TAVR, randomized trial evidence suggests that single antiplatelet therapy is reasonable for patients without pre-existing indications for oral anticoagulation (OAC). If there is a concurrent indication for OAC, the addition of antiplatelet therapy increases bleeding risk. Whether direct oral anticoagulants achieve better outcomes than vitamin K antagonists is uncertain in this setting. Although OAC has been shown to reduce subclinical leaflet thrombosis (which may progress to structural valve degeneration), bleeding events are unacceptably high. There is a lack of randomized trial data comparing antithrombotic strategies after transcatheter mitral or tricuspid valve replacement or after mitral or tricuspid transcatheter edge-to-edge repair. Single antiplatelet therapy after mitral or tricuspid transcatheter edge-to-edge repair may be appropriate, whereas at least 3 months of OAC is suggested after transcatheter mitral valve replacement or transcatheter tricuspid valve replacement. IMPLICATIONS Randomized studies are warranted to address the knowledge gaps in antithrombotic therapy after transcatheter valve interventions and to optimize outcomes.
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Affiliation(s)
- Annette Maznyczka
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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Chikwe J, Chen Q, Bowdish ME, Roach A, Emerson D, Gelijns A, Egorova N. Surgery and transcatheter intervention for degenerative mitral regurgitation in the United States. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00027-8. [PMID: 38237762 DOI: 10.1016/j.jtcvs.2024.01.014] [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: 09/06/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES We evaluated practice trends and 3-year outcomes of transcatheter edge-to-edge repair (TEER) and surgical repair for degenerative mitral regurgitation in the United States. METHODS From the Centers for Medicare and Medicaid Services data (2012-2019), 53,117 mitral valve interventions (surgery or TEER) were performed for degenerative mitral regurgitation, identified by excluding rheumatic and congenital disease, endocarditis, myocardial infarction, cardiomyopathy, and concomitant or prior coronary revascularizations. Median follow-up was 2.9 years (interquartile range, 1.2-5.1 years). End points were 3-year survival, stroke, mitral reinterventions, and heart failure readmissions. RESULTS Volume of total annual mitral interventions did not significantly change (P = .18) between 2012 and 2019. However, surgical cases decreased by one-third, whereas TEER increased. Among 27,170 patients (52.5% men; mean age, 73.5 years) who underwent TEER (n = 7755) or surgical repair (n = 19,415), surgical patients were younger (71.8 vs 80.8 years; P < .001), with less comorbidity and frailty. In 4532 patient pairs matched for age, frailty, and comorbidity, 3-year survival after TEER was 65.9% (95% CI, 64.3%-67.6%) and 85.7% (95% CI, 84.5%-86.9%) after surgery (P < .001). Three years after TEER or surgery, stroke rates were 1.8% (95% CI, 1.5%-2.2%) and 2.0% (95% CI, 1.6%-2.4%) (P = .49); heart failure readmission rates were 17.8% (95% CI, 16.7%-18.9%) and 11.2% (95% CI, 10.3%-12.2%) (P < .001); and mitral reintervention rates were 6.1% (95% CI, 5.5%-6.9%) and 1.3% (95% CI, 1.0%-1.7%) (P < .001), respectively. CONCLUSIONS Among Medicare beneficiaries with degenerative mitral regurgitation, an increase in TEER utilization was associated with worse survival, increased heart failure readmissions, and more mitral reinterventions. Randomized trials are needed to better inform treatment choice.
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Affiliation(s)
- Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.
| | - Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Annetine Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Kaneko T, Newell PC, Nisivaco S, Yoo SGK, Hirji SA, Hou H, Romano M, Lim DS, Chetcuti S, Shah P, Ailawadi G, Thompson M. Incidence, characteristics, and outcomes of reintervention after mitral transcatheter edge-to-edge repair. J Thorac Cardiovasc Surg 2024; 167:143-154.e6. [PMID: 35570022 DOI: 10.1016/j.jtcvs.2022.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/20/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The use of transcatheter edge-to-edge repair (TEER) is growing substantially, and reintervention after TEER by way of repeat TEER or mitral valve surgery (MVS) is increasing as a result. In this nationally representative study we examined the incidence, characteristics, and outcomes of reintervention after index TEER. METHODS Between July 2013 and November 2017, we reviewed 11,396 patients who underwent index TEER using Medicare beneficiary data. These patients were prospectively tracked and identified as having repeat TEER or MVS. Primary outcomes included 30-day mortality, 30-day readmission, 30-day composite morbidity, and cumulative survival. RESULTS Among 11,396 patients who underwent TEER, 548 patients (4.8%) required reintervention after a median time interval of 4.5 months. Overall 30-day mortality was 8.6%, 30-day readmission was 20.9%, and 30-day composite morbidity was 48.2%. According to reintervention type, 294 (53.7%) patients underwent repeat TEER, and 254 (46.3%) underwent MVS. Patients who underwent MVS were more likely to be younger and female, but had a similar comorbidity burden compared with the repeat TEER cohort. After adjustment, there were no differences in 30-day mortality (adjusted odds ratio [AOR], 1.26 [95% CI, 0.65-2.45]) or 30-day readmission (AOR, 1.14 [95% CI, 0.72-1.81]). MVS was associated with higher 30-day morbidity (AOR, 4.76 [95% CI, 3.17-7.14]) compared with repeat TEER. Requirement for reintervention was an independent risk factor for long-term mortality in a Cox proportional hazard model (hazard ratio, 3.26 [95% CI, 2.53-4.20]). CONCLUSIONS Reintervention after index TEER is a high-risk procedure that carries a significant mortality burden. This highlights the importance of ensuring procedural success for index TEER to avoid the morbidity of reintervention altogether.
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Affiliation(s)
- Tsuyoshi Kaneko
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Paige C Newell
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sarah Nisivaco
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sang Gune K Yoo
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Sameer A Hirji
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Va
| | - Stan Chetcuti
- Department of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital, Boston, Mass
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Michael Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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Garcia S, Elmariah S, Cubeddu RJ, Zahr F, Eleid MF, Kodali SK, Seshiah P, Sharma R, Lim DS. Mitral Transcatheter Edge-to-Edge Repair With the PASCAL Precision System: Device Knobology and Review of Advanced Steering Maneuvers. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100234. [PMID: 38283574 PMCID: PMC10818146 DOI: 10.1016/j.shj.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 10/08/2023] [Indexed: 01/30/2024]
Abstract
In 2022, the Food and Drug Administration approved a second mitral transcatheter edge-to-edge repair device for the treatment of primary mitral regurgitation (PASCAL Precision Transcatheter Valve Repair System, Edwards Lifesciences, Irvine, CA). The PASCAL Precision system consists of a guide sheath, implant system, and accessories. The implant system consists of a steerable catheter, an implant catheter, and the implant (PASCAL or PASCAL Ace). The guide sheath and steerable catheter move and flex independently from each other and are not keyed, allowing for freedom of rotation in three dimensions. This manuscript provides an overview of the PASCAL Precision system and describes the basic and advanced steering maneuvers to facilitate effective and safe mitral transcatheter edge-to-edge repair.
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Affiliation(s)
| | - Sammy Elmariah
- University of California, San Francisco, California, USA
| | | | - Firas Zahr
- Oregon Health Sciences University, Portland, Oregon, USA
| | | | | | - Puvi Seshiah
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | | | - D. Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
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Challa AB, Negm AS, Mahayni AA, Wamil M, Williamson E, Guerrero M, Weishaar P, Collins JD. Transcatheter Mitral Valve Replacement: Treatment Planning With Computed Tomography. Semin Roentgenol 2024; 59:67-75. [PMID: 38388098 DOI: 10.1053/j.ro.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Apurva Bhavana Challa
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ahmed S Negm
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | | | - Malgorzata Wamil
- Department of Cardiovascular Medicine, Mayo Clinic Healthcare, London, UK
| | - Eric Williamson
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Paul Weishaar
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN
| | - Jeremy D Collins
- Department of Radiology, Division of Cardiovascular Imaging, Mayo Clinic, Rochester, MN.
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30
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Ambrožič J, Rauber M, Berlot B, Škofic N, Toplišek J, Bervar M, Cvijić M. Challenges and pitfalls in classification of disproportionate mitral regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-03043-1. [PMID: 38159132 DOI: 10.1007/s10554-023-03043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
The concept of disproportionate mitral regurgitation (dispropMR) has been introduced to identify patients with functional mitral regurgitation (MR) who benefit from percutaneous treatment. We aimed to examine echocardiographic characteristics behind this entity. We retrospectively included 172 consecutive patients with reduced left ventricular ejection fraction (LVEF), and more than mild MR referred to clinically indicated echocardiography. According to the proportionality ratio (effective regurgitant orifice area (EROA)/left ventricular end-diastolic volume (LVEDV)) patients were divided into dispropMR and proportionate MR (propMR) group. Potential factors which might affect proportionality definition were analyzed. 55 patients (32%) had dispropMR. Discrepant grading of MR severity was observed when using regurgitant volume (RegVol) by proximal isovelocity surface area (PISA) method or volumetric method, with significant discordance only in dispropMR (p < 0.001). Patients with dispropMR had more frequently left ventricular foreshortened images for LVEDV calculation than patients with propMR (p = 0.003), resulting in smaller LVEDV in dispropMR group. DispropMR group had more substantial dynamic variation of regurgitant flow compared to propMR. Accordingly, EROA was consistently overestimated by standard single-point PISA method compared to serial PISA method. This was more pronounced in dispropMR (bias:10.5 ± 28.3 mm2) compared to propMR group (bias:6.4 ± 12.8 mm2). DispropMR may be found in roughly one third of clinically indicated echocardiographic studies in patients with reduced LVEF and more than mild MR. EROA overestimation due to dynamic variation of regurgitant flow and LVEDV underestimation due to LV foreshortening were more frequently found in dispropMR. Our results indicate that methodological limitations of echocardiographic MR grading could not be neglected in classifying the proportionality of MR.
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Affiliation(s)
- Jana Ambrožič
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Martin Rauber
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Boštjan Berlot
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Nataša Škofic
- Department of Surgery, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Janez Toplišek
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Mojca Bervar
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Marta Cvijić
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, 1000, Slovenia.
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Haregu F, Wong N, McCulloch M, Lim DS. Percutaneous Mitral Valve Repair in Pediatric Patients. Pediatr Cardiol 2023:10.1007/s00246-023-03387-4. [PMID: 38150041 DOI: 10.1007/s00246-023-03387-4] [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: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
Rigorous clinical trials have demonstrated the safety and efficacy of Transcatheter Edge-to-Edge Repair to treat severe secondary mitral regurgitation (MR) in adults with primary cardiomyopathy who have failed guideline-directed medical therapy, as well as those with primary MR at high surgical risk. To date, there are only three case reports describing this procedure in the pediatric population. We report a case series of four pediatric patients, including the youngest and smallest reported, who underwent this procedure.
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Affiliation(s)
- Firezer Haregu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22908-0386, USA.
| | - Ningyan Wong
- Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Michael McCulloch
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22908-0386, USA
| | - D Scott Lim
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22908-0386, USA
- Cardiology, University of Virginia, Charlottesville, VA, USA
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Shechter A, Kaewkes D, Lee M, Makar M, Patel V, Koren O, Koseki K, Nagasaka T, Skaf S, Chakravarty T, Makkar RR, Siegel RJ. Correlates and prognostic implications of LVEF reduction after transcatheter edge-to-edge repair for primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2023; 25:136-147. [PMID: 37590951 DOI: 10.1093/ehjci/jead210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023] Open
Abstract
AIMS To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure. METHODS AND RESULTS We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75-88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared with baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While post-procedural MR, transmitral mean pressure gradient, and functional status were comparable in the two study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs. 5.7%, P = 0.019), be readmitted for HF (17.1% vs. 9.0%, P = 0.033), and experience either of the two (23.8% vs. 12.7%, P = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10-0.78, P = 0.016). CONCLUSION LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Nai Muang, Thailand
| | - Mirae Lee
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Groeneveld NTA, Swier CEL, Montero-Cabezas J, Elzo Kraemer CV, Klok FA, van den Brink FS. Mechanical Support Strategies for High-Risk Procedures in the Invasive Cardiac Catheterization Laboratory: A State-of-the-Art Review. J Clin Med 2023; 12:7755. [PMID: 38137824 PMCID: PMC10744085 DOI: 10.3390/jcm12247755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Thanks to advancements in percutaneous cardiac interventions, an expanding patient population now qualifies for treatment through percutaneous endovascular procedures. High-risk interventions far exceed coronary interventions and include transcatheter aortic valve replacement, endovascular management of acute pulmonary embolism and ventricular tachycardia ablation. Given the frequent impairment of ventricular function in these patients, frequently deteriorating during percutaneous interventions, it is hypothesized that mechanical ventricular support may improve periprocedural survival and subsequently patient outcome. In this narrative review, we aimed to provide the relevant evidence found for the clinical use of percutaneous mechanical circulatory support (pMCS). We searched the Pubmed database for articles related to pMCS and to pMCS and invasive cath lab procedures. The articles and their references were evaluated for relevance. We provide an overview of the clinically relevant evidence for intra-aortic balloon pump, Impella, TandemHeart and ECMO and their role as pMCS in high-risk percutaneous coronary intervention, transcatheter valvular procedures, ablations and high-risk pulmonary embolism. We found that the right choice of periprocedural pMCS could provide a solution for the hemodynamic challenges during these procedures. However, to enhance the understanding of the safety and effectiveness of pMCS devices in an often high-risk population, more randomized research is needed.
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Affiliation(s)
- Niels T. A. Groeneveld
- Department of Anesthesiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Carolien E. L. Swier
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.E.L.S.); (C.V.E.K.)
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Carlos V. Elzo Kraemer
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.E.L.S.); (C.V.E.K.)
| | - Frederikus A. Klok
- Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Floris S. van den Brink
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.E.L.S.); (C.V.E.K.)
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Delgado V, Ajmone Marsan N, Bonow RO, Hahn RT, Norris RA, Zühlke L, Borger MA. Degenerative mitral regurgitation. Nat Rev Dis Primers 2023; 9:70. [PMID: 38062018 DOI: 10.1038/s41572-023-00478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/18/2023]
Abstract
Degenerative mitral regurgitation is a major threat to public health and affects at least 24 million people worldwide, with an estimated 0.88 million disability-adjusted life years and 34,000 deaths in 2019. Improving access to diagnostic testing and to timely curative therapies such as surgical mitral valve repair will improve the outcomes of many individuals. Imaging such as echocardiography and cardiac magnetic resonance allow accurate diagnosis and have provided new insights for a better definition of the most appropriate timing for intervention. Advances in surgical techniques allow minimally invasive treatment with durable results that last for ≥20 years. Transcatheter therapies can provide good results in select patients who are considered high risk for surgery and have a suitable anatomy; the durability of such repairs is up to 5 years. Translational science has provided new knowledge on the pathophysiology of degenerative mitral regurgitation and may pave the road to the development of medical therapies that could be used to halt the progression of the disease.
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Affiliation(s)
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert O Bonow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Russell A Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Liesl Zühlke
- South African Medical Research Council, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics, Institute of Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Hashimoto S, Yamano M, Yamano T, Zen K, Matsubara Y, Takamatsu K, Yashige M, Nakamura T, Shiraishi H, Matoba S. Mitral valve leaflet stiffness predicts residual mitral regurgitation after transcatheter edge-to-edge mitral valve repair. Echocardiography 2023; 40:1374-1382. [PMID: 37985209 DOI: 10.1111/echo.15716] [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: 07/24/2023] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Residual regurgitation after transcatheter edge-to-edge mitral valve repair (TMVR) is a predictor of poor prognosis in patients with functional mitral regurgitation (FMR). This study sought to identify the mitral valve (MV) parameters measured by three-dimensional transesophageal echocardiography (3D-TEE) and MV leaflet features that predict residual mitral regurgitation (MR) after TMVR in patients with FMR. METHODS Consecutive patients with FMR who underwent TMVR were classified into two groups based on the degree of residual MR just after TMVR: < 2+ in the optimal MR reduction group and ≥ 2+ in the suboptimal MR reduction group. The two groups were compared with respect to 3D-TEE parameters and the MV leaflet features, including the following parameters: stiffness, defined as a leaflet that remains at a fixed angle even during diastole, and thickness, measured in both clear and rough zones. RESULTS Thirty-four of 46 patients (74%) were classified as the optimal MR reduction group. Multivariable analysis showed that anterior mitral leaflet + posterior mitral leaflet length/anteroposterior annulus diameter (p = .044) and MV leaflet stiffness (p = .007) were independent predictors of residual MR. CONCLUSION MV leaflet stiffness and the ratio of MV leaflet lengths to the annulus diameter may be good predictors of residual MR after TMVR in patients with FMR.
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Affiliation(s)
- Sho Hashimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuki Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Yashige
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Rezkalla JA, Eleid MF. Extending the success of transcatheter valvular interventions to transplanted hearts. Trends Cardiovasc Med 2023:S1050-1738(23)00098-1. [PMID: 37992884 DOI: 10.1016/j.tcm.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Joshua A Rezkalla
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
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Urena M, Lurz P, Sorajja P, Himbert D, Guerrero M. Transcatheter mitral valve implantation for native valve disease. EUROINTERVENTION 2023; 19:720-738. [PMID: 37994096 PMCID: PMC10654769 DOI: 10.4244/eij-d-22-00890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/07/2023] [Indexed: 11/24/2023]
Abstract
Mitral regurgitation is the second most frequent heart valve disease in Europe and the most frequent in the US. Although surgery is the therapy of choice when intervention is indicated, transcatheter mitral valve repair or replacement are alternatives for patients who are not eligible for surgery. However, the development of transcatheter mitral valves is slower than expected. Although several transcatheter heart valves have been developed, only one has been commercialised. Indeed, most of these devices are being evaluated in clinical studies, with promising initial results. In this review, we propose an overview on transcatheter mitral valve replacement for the treatment of native mitral valve disease, from indication to results, including patients with severe annular calcification, and we provide you with a glimpse into the future of these therapies.
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Affiliation(s)
- Marina Urena
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philipp Lurz
- Department of Cardiology, Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Dominique Himbert
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Kaddoura R, Bhattarai S, Abushanab D, Al-Hijji M. Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 207:159-169. [PMID: 37741106 DOI: 10.1016/j.amjcard.2023.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/25/2023]
Abstract
This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior with PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Sanket Bhattarai
- Department of hematology and oncology, Bhaktapur Cancer Hospital, Dudhpati, Bhaktapur, Nepal
| | - Dina Abushanab
- Drug Information Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Hijji
- Interventional Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Praz F, Samim D. 1-Year Outcomes With a Fourth-Generation Mitral TEER Device: Maturity Comes With Experience. JACC Cardiovasc Interv 2023; 16:2611-2614. [PMID: 37877915 DOI: 10.1016/j.jcin.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Daryoush Samim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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Liu H, Simonian NT, Pouch AM, Iaizzo PA, Gorman JH, Gorman RC, Sacks MS. A Computational Pipeline for Patient-Specific Prediction of the Postoperative Mitral Valve Functional State. J Biomech Eng 2023; 145:111002. [PMID: 37382900 PMCID: PMC10405284 DOI: 10.1115/1.4062849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
While mitral valve (MV) repair remains the preferred clinical option for mitral regurgitation (MR) treatment, long-term outcomes remain suboptimal and difficult to predict. Furthermore, pre-operative optimization is complicated by the heterogeneity of MR presentations and the multiplicity of potential repair configurations. In the present work, we established a patient-specific MV computational pipeline based strictly on standard-of-care pre-operative imaging data to quantitatively predict the post-repair MV functional state. First, we established human mitral valve chordae tendinae (MVCT) geometric characteristics obtained from five CT-imaged excised human hearts. From these data, we developed a finite-element model of the full patient-specific MV apparatus that included MVCT papillary muscle origins obtained from both the in vitro study and the pre-operative three-dimensional echocardiography images. To functionally tune the patient-specific MV mechanical behavior, we simulated pre-operative MV closure and iteratively updated the leaflet and MVCT prestrains to minimize the mismatch between the simulated and target end-systolic geometries. Using the resultant fully calibrated MV model, we simulated undersized ring annuloplasty (URA) by defining the annular geometry directly from the ring geometry. In three human cases, the postoperative geometries were predicted to 1 mm of the target, and the MV leaflet strain fields demonstrated close agreement with noninvasive strain estimation technique targets. Interestingly, our model predicted increased posterior leaflet tethering after URA in two recurrent patients, which is the likely driver of long-term MV repair failure. In summary, the present pipeline was able to predict postoperative outcomes from pre-operative clinical data alone. This approach can thus lay the foundation for optimal tailored surgical planning for more durable repair, as well as development of mitral valve digital twins.
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Affiliation(s)
- Hao Liu
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712-1229
| | - Natalie T. Simonian
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712-1229
| | - Alison M. Pouch
- Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia, PA 19104
| | - Paul A. Iaizzo
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN 55455
| | - Joseph H. Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Robert C. Gorman
- Gorman Cardiovascular Research Group, Department of Surgery, Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Michael S. Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712-1229
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Quentin V, Mesnier J, Delhomme C, Sayah N, Guedeney P, Barthélémy O, Suc G, Collet JP. Transcatheter Mitral Valve Replacement Using Transcatheter Aortic Valve or Dedicated Devices: Current Evidence and Future Prospects. J Clin Med 2023; 12:6712. [PMID: 37959178 PMCID: PMC10647634 DOI: 10.3390/jcm12216712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) is a novel and evolving field dedicated to addressing the therapeutic challenges posed by patients at high surgical risk with mitral valve disease. TMVR can be categorized into two distinct fields based on the type of device and its specific indications: TMVR with transcatheter aortic valves (TAV) and TMVR with dedicated devices. Similar to aortic stenosis, TMVR with TAV requires a rigid support structure to secure the valve in place. As a result, it is indicated for patients with failing bioprothesis or surgical rings or mitral valve disease associated with severe mitral annular calcification (MAC), which furnishes the necessary foundation for valve anchoring. While TMVR with TAV has shown promising outcomes in valve-in-valve procedures, its effectiveness remains more contentious in valve-in-ring or valve-in-MAC procedures. Conversely, TMVR with dedicated devices seeks to address native mitral regurgitation, whether accompanied by MAC or not, providing an alternative to Transcatheter Edge-to-Edge Repair (TEER) when TEER is not feasible or expected to yield unsatisfactory results. This emerging field is gradually surmounting technical challenges, including anchoring a valve in a non-calcified annulus and transitioning from the transapical route to the transeptal approach. Numerous devices are presently undergoing clinical trials. This review aims to furnish an overview of the supporting evidence for TMVR using TAV in each specific indication (valve-in-valve, valve-in-ring, valve-in-MAC). Subsequently, we will discuss the anticipated benefits of TMVR with dedicated devices over TEER, summarize the characteristics and clinical results of TMVR systems currently under investigation, and outline future prospects in this field.
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Affiliation(s)
- Victor Quentin
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Jules Mesnier
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Clémence Delhomme
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Neila Sayah
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
| | - Olivier Barthélémy
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
| | - Gaspard Suc
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Jean-Philippe Collet
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
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Koschutnik M, Donà C, Nitsche C, Kammerlander AA, Dannenberg V, Brunner C, Koschatko S, Mascherbauer K, Heitzinger G, Halavina K, Spinka G, Winter MP, Hülsmann M, Bartko PE, Hengstenberg C, Mascherbauer J, Goliasch G. Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair. Clin Res Cardiol 2023:10.1007/s00392-023-02318-w. [PMID: 37870628 DOI: 10.1007/s00392-023-02318-w] [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: 05/18/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Right ventricular-to-pulmonary artery (RV-PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce. METHODS Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization and death. RESULTS Between April 2018 and January 2021, 156 patients (median 78 y/o, 55% female, EuroSCORE II: 6.9%) underwent M-TEER. On presentation, 64% showed impaired RV-PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio < 0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82%, p < 0.001), both in patients with primary (64 vs. 91%, p = 0.009) and secondary MR (54 vs. 76%, p = 0.026). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio < 0.36 was independently associated with outcome (adj.HR 2.74, 95% CI 1.17-6.43, p = 0.021). At 1-year follow-up, RV-PA coupling improved (TAPSE: ∆ + 3 mm, PASP: ∆ - 10 mmHg, p for both < 0.001), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥ II: 77-54%, p < 0.001). CONCLUSIONS TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV-PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.
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Affiliation(s)
- Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andreas A Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Varius Dannenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christina Brunner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sophia Koschatko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor Heitzinger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kseniya Halavina
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Spinka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Zhou C, Tan K, Liu W, Li S, Xia Z, Song Y, Lian Z. Temporal Trends and Early Outcomes of Transcatheter versus Surgical Mitral Valve Repair in Atrial Fibrillation Patients. J Interv Cardiol 2023; 2023:4332684. [PMID: 37868768 PMCID: PMC10586899 DOI: 10.1155/2023/4332684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 08/21/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To study trends of utilization, in-hospital outcomes, and short outcomes in patients undergoing transcatheter mitral valve repair (TMVR) vs. surgical mitral valve repair (SMVR) in atrial fibrillation (AF). Background TMVR is a treatment option in inoperable or high-risk patients with mitral regurgitation (MR). AF is a common comorbidity of MR. Data comparing between TMVR and SMVR in MR patients with AF is lacking. Methods The National Readmission Database from 2016 to 2019 was utilized to identify hospitalizations undergoing TMVR or SMVR with AF. Outcomes of interest included mortality, postoperative complications, length of stay, and 30-day readmission rate. Results A total of 9,195 patients underwent TMVR and 16,972 patients underwent SMVR with AF; the number of AF undergoing TMVR was increasing from 1,342 in 2016 to 4,215 in 2019 and SMVR. The incidence of in-hospital mortality decreased from 2.6% in 2016 to 1.8% in 2019. We identified length of stay>5 days, dyslipidemia, cerebrovascular disease, heart failure with reduced ejection fraction, and urgent/emergent admissions as independent risk factors for in-hospital mortality. After matching, we included 4,680 patients in each group; the in-hospital death, transfusion, acute kidney injury, sepsis, stroke, and mechanical ventilation were lower in TMVR compared with SMVR. TMVR was associated with a similar rate of all-cause readmission at 30 days compared with SMVR. Conclusion Patients with AF receiving TMVR have been increasing along with progressive improvement in in-hospital death and length of stay. Compared to SMVR, AF patients receiving TMVR had a lower rate of in-hospital death and postoperative complications.
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Affiliation(s)
- Chi Zhou
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Tan
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weili Liu
- Interventional Operation Room, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shaohua Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zongyi Xia
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanxu Song
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Akansel S, Kofler M, Van Praet KM, Sündermann SH, Unbehaun A, Jacobs S, Falk V, Kempfert J. Alternative minimally invasive surgical explantation techniques for failed transcatheter mitral valve repair devices. JTCVS Tech 2023; 21:65-71. [PMID: 37854815 PMCID: PMC10579955 DOI: 10.1016/j.xjtc.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 10/20/2023] Open
Abstract
Objective The use of transcatheter mitral valve repair (TMVr) devices is increasing in elderly and high-risk patients. However, the increasing number of patients with recurrent mitral regurgitation (MR) has confronted surgeons with the issue of how to explant the devices and whether the mitral valve should be repaired or replaced. The aim of the study is to summarize our clinical experience with the explantation of different TMVr devices and to provide alternative surgical techniques that can be performed in different clinical scenarios. Methods A simulator system including a dummy valve representing native valves was used to create video documentation and to develop alternative surgical methods for clip explantation. Moreover, the clip explantation techniques were shown in 2 patients undergoing minimally-invasive mitral valve repair after a failed TMVr. Results Alternative explantation techniques were described for each TMVr device; 2 techniques for MitraClip and 3 techniques for PASCAL (Precision Transcatheter Valve Repair System), which may be adjusted for each individual according to the underlying valve pathology and the degree of device encapsulation. The patients were discharged without residual MR and remained MR free at the follow-up. Conclusions Transcatheter edge-to-edge repair devices can be surgically explanted without damaging the MV leaflets. Removal of each device may require a different technique tailored to the degree of device encapsulation and valve pathology. Increasing experience may facilitate repair in patients with recurrent MR after TMVr.
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Affiliation(s)
- Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
| | - Karel M. Van Praet
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
| | - Simon H. Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site, Berlin, Germany
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Simonian NT, Liu H, Vakamudi S, Pirwitz MJ, Pouch AM, Gorman JH, Gorman RC, Sacks MS. Patient-Specific Quantitative In-Vivo Assessment of Human Mitral Valve Leaflet Strain Before and After MitraClip Repair. Cardiovasc Eng Technol 2023; 14:677-693. [PMID: 37670097 DOI: 10.1007/s13239-023-00680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Mitral regurgitation (MR) is a highly prevalent and deadly cardiac disease characterized by improper mitral valve (MV) leaflet coaptation. Among the plethora of available treatment strategies, the MitraClip is an especially safe option, but optimizing its long-term efficacy remains an urgent challenge. METHODS We applied our noninvasive image-based strain computation pipeline [1] to intraoperative transesophageal echocardiography datasets taken from ten patients undergoing MitraClip repair, spanning a range of MR etiologies and MitraClip configurations. We then analyzed MV leaflet strains before and after MitraClip implementation to develop a better understanding of (1) the pre-operative state of human regurgitant MV, and (2) the MitraClip's impact on the MV leaflet deformations. RESULTS The MV pre-operative strain fields were highly variable, underscoring both the heterogeneity of the MR in the patient population and the need for patient-specific treatment approaches. Similarly, there were no consistent overall post-operative strain patterns, although the average A2 segment radial strain difference between pre- and post-operative states was consistently positive. In contrast, the post-operative strain fields were better correlated to their respective pre-operative strain fields than to the inter-patient post-operative strain fields. This quantitative result implies that the patient specific pre-operative state of the MV guides its post-operative deformation, which suggests that the post-operative state can be predicted using pre-operative data-derived modelling alone. CONCLUSIONS The pre-operative MV leaflet strain patterns varied considerably across the range of MR disease states and after MitraClip repair. Despite large inter-patient heterogeneity, the post-operative deformation appears principally dictated by the pre-operative deformation state. This novel finding suggests that though the variation in MR functional state and MitraClip-induced deformation were substantial, the post-operative state can be predicted from the pre-operative data alone. This study suggests that, with use of larger patient cohort and corresponding long-term outcomes, quantitative predictive factors of MitraClip durability can be identified.
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Affiliation(s)
- Natalie T Simonian
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin , 201 East 24th St., Stop C0200, Austin, TX, 78712-1229, USA
| | - Hao Liu
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin , 201 East 24th St., Stop C0200, Austin, TX, 78712-1229, USA
| | - Sneha Vakamudi
- Ascension Texas Cardiovascular & Division of Cardiology, Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Mark J Pirwitz
- Ascension Texas Cardiovascular & Division of Cardiology, Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Alison M Pouch
- Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Smilow Center for Translational Research, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael S Sacks
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences and the Department of Biomedical Engineering, The University of Texas at Austin , 201 East 24th St., Stop C0200, Austin, TX, 78712-1229, USA.
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Biasco L, Klersy C, Benfari G, Biaggi P, Corti R, Curti M, Gaemperli O, Jeger R, Maisano F, Mueller O, Naegeli B, Noble S, Praz F, Tersalvi G, Toggweiler S, Valgimigli M, Enriquez-Sarano M, Pedrazzini G. Restoration of Life Expectancy After Transcatheter Edge-to-Edge Mitral Valve Repair. JACC Cardiovasc Interv 2023; 16:2231-2241. [PMID: 37632476 DOI: 10.1016/j.jcin.2023.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Survival data after mitral transcatheter edge-to-edge repair (TEER) are scarce, and its impact on predicted life expectancy is unknown. OBJECTIVES The aim of this study was to estimate the impact of TEER on postprocedural life expectancy among patients enrolled in the MitraSwiss registry through a relative survival (RS) analysis. METHODS Consecutive TEER patients 60 to 89 years of age enrolled between 2011 and 2018 (N = 1140) were evaluated. RS was defined as the ratio between post-TEER survival and expected survival in an age-, sex- and calendar period-matched group derived from the Swiss national 2011 to 2019 mortality tables. The primary aim was to assess 5-year survival and RS after TEER. The secondary aim was to assess RS according to the etiology of mitral regurgitation, age class and sustained procedural success over time. RESULTS Overall, 5-year survival after TEER was 59.3% (95% CI: 54.9%-63.4%), whereas RS reached 80.5% (95% CI: 74.6%-86.0%). RS was 91.1% (95% CI: 82.5%-98.6%) in primary mitral regurgitation (PMR) and 71.5% (95% CI: 63.0%-79.3%) in secondary mitral regurgitation (SMR). Patients 80 to 89 years of age (n = 579) showed high 5-year RS (93.0%; 95% CI: 83.3%-101.9%). In this group, restoration of predicted life expectancy was achieved in PMR with a 5-year RS of 100% (95% CI: 87.9%-110.7%), whereas sustained procedural success increased the RS rate to 90.6% (95% CI: 71.3%-107.3%) in SMR. CONCLUSIONS Mitral TEER in patients 80 to 89 years of age is able to restore predicted life expectancy in PMR, whereas in SMR with sustained procedural success, high RS estimates were observed. Our analysis suggests that successful, sustained mitral regurgitation reduction is key to survival improvement, particularly in patients 80 to 89 years of age.
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Affiliation(s)
- Luigi Biasco
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Azienda Sanitaria Locale Torino 4, Ciriè, Turin, Italy.
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biostatistics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Giovanni Benfari
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Patric Biaggi
- Heart Clinic Zurich, Hirslanden, Zurich, Switzerland
| | - Roberto Corti
- Heart Clinic Zurich, Hirslanden, Zurich, Switzerland
| | - Moreno Curti
- Service of Clinical Epidemiology and Biostatistics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | | | - Raban Jeger
- Division of Cardiology, Triemli Hospital Zürich, Zurich, Switzerland; Division of Cardiology, University of Basel, Basel, Switzerland
| | - Francesco Maisano
- Division of Cardiovascular Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Olivier Mueller
- Division of Cardiology, University Hospital Lausanne, Switzerland
| | | | - Stephane Noble
- Division of Cardiology, University Hospital Geneve, Geneve, Switzerland
| | - Fabien Praz
- Division of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Gregorio Tersalvi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Marco Valgimigli
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Shah AM, Almomani AA, Sako EY, Hui DS. Surgical and Transcatheter Mitral Valve Therapy: Medicare Utilization and Reimbursement. Ann Thorac Surg 2023:S0003-4975(23)00965-7. [PMID: 37741565 DOI: 10.1016/j.athoracsur.2023.09.014] [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: 01/21/2023] [Revised: 08/02/2023] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND We aimed to examine trends in the utilization and reimbursement of surgical and transcatheter mitral valve therapies and their changing relationship. METHODS A query of administrative data on US Medicare beneficiaries undergoing mitral valve therapy was conducted from 2015 to 2020 using the Centers for Medicare and Medicaid Services Part B National Summary Data File. Inflation adjustment was to the 2020 Consumer Price Index. Trend analysis was quantified with growth rate and simple linear regression calculations. RESULTS The annual number of all mitral valve procedures remained constant. Transcatheter mitral valve therapies increased by 313% with an increase of 1552 cases per year (P < .001), whereas surgical mitral valve therapies decreased by 31.4% with a decline of 1446 procedures per year (P = .004). As a proportion of all mitral valve therapies, surgical therapies decreased from 91.8% to 65.0%. Annual Medicare reimbursements for transcatheter and surgical mitral valve therapies mirrored the annual procedural trends. For transcatheter mitral valve therapies, per-case reimbursement decreased by 14.1% ($1283.18 to $1102.88), and for surgical mitral valve therapies, per-case reimbursement decreased by 3.8% ($1480.65 to $1424.57). CONCLUSIONS Medicare utilization of mitral valve therapies has been stable in recent years, with growth of transcatheter volumes offset by a decrease in surgical volumes. This suggests that transcatheter therapy availability has not expanded the pool of patients with access to therapy. Nonetheless, case reimbursements decreased for both modalities.
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Affiliation(s)
- Aakash M Shah
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ahmed A Almomani
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Edward Y Sako
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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48
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Alasnag M, Bokhari F, Almoghairi A, Marri K, Alenezi A, AlHarbi W, Alanazi N, Amin H, Noor H, Al-Shaikh S, Bardowli F, Lawati HA, AlFaraidy K, AlShehri M, Tash A, AlHabeeb W, Balghith M, Thabane M, Thabane L, Al-Shaibi K. One-year real-world outcomes for patients undergoing transcatheter mitral valve repair: the Gulf MTEER registry (GULF Mitral Transcatheter Edge to Edge Repair). BMJ Open 2023; 13:e073549. [PMID: 37730395 PMCID: PMC10514668 DOI: 10.1136/bmjopen-2023-073549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Severe mitral regurgitation (MR) with left ventricular dysfunction portends worse outcomes. Over the course of the last two decades, transcatheter repair of the mitral valve offered an alternative therapeutic modality for those deemed inoperable or high risk. Landmark studies such as the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation and Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation trials have shown conflicting results with respect to all-cause death and heart failure rehospitalisations. The Gulf Mitral Transcatheter Edge to Edge Repair registry (Gulf MTEER registry) is a regional registry that captured outcomes in those undergoing transcatheter repair of the mitral valve. The objectives of this study were to describe the baseline characteristics of patients undergoing transcatheter mitral valve repair in the Gulf region and estimate the cardiovascular effects of the mitral transcatheter therapies in routine practice. METHODS The Gulf MTEER registry is an observational, multicentre, retrospective registry that enrolled all patients undergoing transcatheter repair of the mitral valve from four of the Gulf countries (Saudi Arabia, Kuwait, Bahrain, Oman) between 1 January 2017 and 31 December 2019. Baseline characteristics, echocardiographic parameters and immediate procedural success were reported. The primary outcome was a composite of death and rehospitalisations at 1 year. The secondary outcomes were the individual components of the composite endpoint; that is, death and rehospitalisations at 1 year as well as residual or recurrent MR or worsening New York Heart Association class and a need for repeat repair. RESULTS A total of 176 patients were enrolled. Men constituted 56.3% of the total. At 1 year the primary outcome occurred in 21.1% (95% CI 15.6, 27.9). The secondary outcomes of death occurred in 5.4% (CI 2.9, 10.0) and rehospitalisations occurred in 16.9% (CI 11.9, 23.3). Univariate analysis revealed that the odds of having death or re-hospitalisation was two times higher if the effective regurgitant orifice (ERO) >40 mm2 irrespective of the therapy. CONCLUSIONS The Gulf MTEER registry is the first registry in the Gulf region defining the patient population receiving MTEER therapies and evaluating 1-year outcomes. This is a low risk cohort with a high rate of immediate procedural success and low rate of all-cause death and rehospitalisations at 1 year. The odds of an event was two times higher if the ERO ≥40 mm2 with only a signal to higher odds for low left ventricular ejection fraction and larger end systolic dimension.
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Affiliation(s)
- Mirvat Alasnag
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Fayez Bokhari
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Khaled Marri
- Adult Cardiology Department, Chest Diseases Hospital, Kuwait, Kuwait
| | - Abdullah Alenezi
- Adult Cardiology Department, Chest Diseases Hospital, Kuwait, Kuwait
| | - Waleed AlHarbi
- Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alanazi
- Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Haitham Amin
- Adult Cardiology Department, Mohammed bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Hussam Noor
- Adult Cardiology Department, Mohammed bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Shereen Al-Shaikh
- Adult Cardiology Department, Mohammed bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Fawaz Bardowli
- Adult Cardiology Department, Mohammed bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Hatim Al Lawati
- Adult Cardiology Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalid AlFaraidy
- Adult Cardiology Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Mohammed AlShehri
- Adult Cardiology Department, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia
| | - Adel Tash
- Adult Cardiology Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Waleed AlHabeeb
- Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Balghith
- Adult Cardiology Department, National Guard Hospital, Riyadh, Saudi Arabia
| | - Michael Thabane
- Thabane Professional Health Services Inc, Ancaster, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Khaled Al-Shaibi
- Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
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Shechter A, Kaewkes D, Patel V, Vaturi M, Wangmang F, Koseki K, Koren O, Nagasaka T, Makar M, Chakravarty T, Skaf S, Makkar RR, Siegel RJ. Outcome Prediction score for mitral transcatheter edge-to-edge repair in patients with concomitant significant tricuspid regurgitation. Hellenic J Cardiol 2023:S1109-9666(23)00155-0. [PMID: 37696418 DOI: 10.1016/j.hjc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Tricuspid regurgitation (TR) adversely affects prognosis following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a risk stratification tool for patients undergoing TEER for mitral regurgitation while exhibiting significant TR. METHODS This is a single-center, retrospective analysis of 217 consecutive individuals referred to an isolated mitral TEER who had moderate-to-severe or greater TR at baseline. The primary outcome was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75%-to-25% ratio, creating train (n = 163) and test (n = 54) datasets. Model development, discrimination, and calibration were based on the train dataset. Internal validation was applied to the test dataset. RESULTS Overall, 81 (37.3%) patients experienced the primary outcome. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-to-3 scale, in which each point represented one of three baseline variables independently associated with this combined endpoint: serum B-natriuretic peptide (BNP) level >1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and cardiac implantable electronic device (CIED). C-statistic of the model was 0.66 (95% CI, 0.57-0.75, p = 0.002) and 0.75 (95% CI, 0.61-0.89, p = 0.004) in the train and test datasets, respectively-representing comparable performance to current, more complex tools. Neither this BNP-RV-CIED (BRC) score nor other models were prognostically meaningful in 32 patients excluded from the main analysis who underwent a combined mitral-tricuspid TEER. CONCLUSION The BRC score is a simple clinical prediction tool that may aid in the triage of isolated mitral TEER candidates with significant pre-existing TR.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mordehay Vaturi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Felix Wangmang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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50
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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