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Bansal A, Puri R, Yun J, Krishnaswamy A, Jilaihawi H, Makkar R, Kapadia SR. Management of complications after valvular interventions. EUROINTERVENTION 2025; 21:e390-e410. [PMID: 40259838 PMCID: PMC11995294 DOI: 10.4244/eij-d-24-00066] [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: 01/23/2024] [Accepted: 11/04/2024] [Indexed: 04/23/2025]
Abstract
Transcatheter valve interventions have transformed the outcomes of patients with valvular heart disease who are at high risk for surgery. With the increasing utilisation and expansion of transcatheter valve interventions, it is of utmost importance to be familiar with their potential complications and their subsequent management, especially given the relative infrequency of many of these issues in contemporary practice. Herein, we present a state-of-the-art review article focusing on the complications, their prevention, and treatment following transcatheter aortic valve implantation, mitral transcatheter edge-to-edge repair, and transcatheter mitral valve replacement.
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Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Yun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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2
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Baudo M, Cuko B, Ternacle J, Sicouri S, Busuttil O, Denti P, Godino C, De Vincentiis C, Ramlawi B, Leroux L, Modine T, Palloshi A, Maisano F. Transcatheter management of residual mitral regurgitation after transcatheter edge-to-edge repair: a systematic review. Cardiovasc Interv Ther 2025; 40:255-267. [PMID: 39838219 DOI: 10.1007/s12928-025-01091-z] [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: 08/06/2024] [Accepted: 01/10/2025] [Indexed: 01/23/2025]
Abstract
BACKGROUND Treatment of residual mitral regurgitation (MR) with different percutaneous devices after transcatheter edge-to-edge repair (TEER) has been reported as an alternative option to reclipping or surgery. This review aims at describing the different transcatheter strategies available and their results when managing residual MR after TEER. METHODS A literature search was undertaken across Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases, to identify article reporting patients with post-TEER residual MR managed by a transcatheter approach that did not involve only the implantation of new clips. RESULTS From 439 deduplicated studies, 24 articles ultimately met the inclusion criteria. Fifteen described an occluder device implantation, 12 with an Amplatzer and 3 with a Cardioform. The most feared complications were hemolysis and device embolization. Three cases of transcatheter annuloplasty were reported in patients with residual functional MR. An electrosurgical detachment of the TEER device from the anterior mitral leaflet (ELASTA-Clip) before mitral valve replacement was reported in 6 articles. CONCLUSIONS Transcatheter procedures addressing residual MR after TEER in carefully selected patients are feasible in experienced centers. Outcomes are promising despite some technical issues. Percutaneous strategies and related complications should be anticipated using multimodality imaging.
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Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, 100 E Lancaster Avenue, Wynnewood, PA, 19096, USA.
| | - Besart Cuko
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Julien Ternacle
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, 100 E Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Paolo Denti
- Heart Valve Center, IRCCS San Raffaele, Milan, Italy
| | - Cosmo Godino
- Heart Valve Center, IRCCS San Raffaele, Milan, Italy
| | | | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, 100 E Lancaster Avenue, Wynnewood, PA, 19096, USA
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
| | - Lionel Leroux
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University Hospital, Pessac, France
| | - Altin Palloshi
- Heart Valve Center, IRCCS San Raffaele, Milan, Italy
- Department of Interventional Cardiology, Istituto Clinico Città Studi, Milan, Italy
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3
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Arnautovic JZ, Ya'Qoub L, Wajid Z, Jacob C, Murlidhar M, Damlakhy A, Walji M. Outcomes and Complications of Mitral and Tricuspid Transcatheter Edge-to-edge Repair. Interv Cardiol 2024; 19:e20. [PMID: 39569385 PMCID: PMC11577872 DOI: 10.15420/icr.2024.08] [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: 03/21/2024] [Accepted: 08/07/2024] [Indexed: 11/22/2024] Open
Abstract
In the realm of innovative medical procedures, TEER (transcatheter edge-to-edge repair) has emerged as a promising field, showcasing significant growth and advancements. Mitral TEER has been performed for the last two decades; in contrast, tricuspid TEER is newer, with long-term outcomes pending. This article aims to provide a comprehensive review of the current literature, with a primary focus on outcomes and potential complications associated with both procedures. Both procedures carry a low risk of complications when done by experienced providers. A team approach involving specialists in cardiology, cardiothoracic surgery, cardiac imaging and heart failure ensures comprehensive care. A unified approach encompassing preprocedural workup, risk assessment, and standardised care throughout the procedure and recovery contributes to successful outcomes.
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Affiliation(s)
- Jelena Z Arnautovic
- Department of Cardiovascular Medicine and Internal Medicine Henry Ford Macomb Clinton Township, MI, US
| | - Lina Ya'Qoub
- Department of Cardiovascular Medicine, Saint Mary's Regional Medical Center Reno, NV, US
| | - Zarghoona Wajid
- Department of Internal Medicine, Henry Ford Rochester Rochester, MI, US
| | - Chris Jacob
- Department of Cardiovascular Medicine, Henry Ford Warren Warren, MI, US
| | | | - Ahmad Damlakhy
- Department of Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University Detroit, MI, US
| | - Mohammed Walji
- Department of Cardiovascular Medicine and Internal Medicine Henry Ford Macomb Clinton Township, MI, US
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4
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Shahim B, Cohen DJ, Asch FM, Bax J, George I, Rück A, Ben-Yehuda O, Kar S, Lim DS, Saxon JT, Zhou Z, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Repeat Mitral Valve Interventions After Transcatheter Edge-to-Edge Repair: The COAPT Trial. Am J Cardiol 2024; 223:7-14. [PMID: 38788821 DOI: 10.1016/j.amjcard.2024.05.025] [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: 12/27/2023] [Revised: 04/20/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
The frequency and effectiveness of repeat mitral valve interventions (RMVI) after transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation (MR) are unknown. We aimed to examine the rate of and outcomes after RMVI after TEER in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial. Only 3.9% of COAPT trial patients required a repeat mitral valve intervention during 4-year follow-up which was successful in 90% of cases but was associated with an increased rate of heart failure (HF) hospitalizations (HFH). The COAPT trial randomized HF patients with severe secondary MR to TEER with the MitraClip device plus guideline-directed medical therapy (GDMT) versus GDMT alone. We evaluated the characteristics and outcomes of patients who had an RMVI during 4-year follow-up. A MitraClip implant was attempted in 293 patients randomized to TEER+GDMT, 10 of whom underwent an RMVI procedure (9 repeat TEER and 1 surgical mitral valve replacement) after 4 years of follow-up (cumulative incidence 3.90%, 95% confidence interval [CI] 2.08 to 7.08; median 182 days after the initial procedure). Patients with RMVI had larger mitral annular diameters, fewer clips implanted, and were more likely to have ≥3+MR at discharge compared with those without RMVI. Reasons for RMVI included failed index procedure because of difficult transseptal puncture (n = 2) or tamponade (n = 1); residual or recurrent severe MR after an initially successful procedure (n = 5); partial clip detachment (n = 1); and site-assessed mitral stenosis (n = 1). RMVI was successful in 8/10 (80%) patients. Patients who underwent RMVI had higher 4-year rates of HFH but similar mortality compared with those without RMVI. The annualized incidence rates of all HFH in patients who underwent RMVI were 234 events per 100 person-years (95% CI 139 to 395) pre-RMVI and 46 per 100 person-years (95% CI 25 to 86) post-RMVI as compared with 32 events per 100 patient-years (95% CI 28 to 36) in patients without RMVI. The rate ratio of HFH was reduced after RMVI in patients who underwent RMVI (0.20, 95% CI 0.09 to 0.45). In conclusion, the cumulative incidence of RMVI after 4 years was 3.9% in patients who underwent TEER for severe secondary MR in the COAPT trial. Patients who underwent RMVI were at increased risk of HFH which was reduced after the RMVI procedure. Clinical Trial Registration: Clinical Trial Name: Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (The COAPT Trial) (COAPT) ClinicalTrial.gov Identifier: NCT01626079 URL:https://clinicaltrials.gov/ct2/show/NCT01626079.
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Affiliation(s)
- Bahira Shahim
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiology Unit, Karolinska University Hospital, Stockholm Sweden
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; St. Francis Hospital, Roslyn, New York
| | | | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Isaac George
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Andreas Rück
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiology Unit, Karolinska University Hospital, Stockholm Sweden
| | - Ori Ben-Yehuda
- Sulpizio Cardiovascular Institute, University of California - San Diego, San Diego, California
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California; Bakersfield Heart Hospital, Bakersfield, California
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia
| | - John T Saxon
- Division of Cardiology, University of Virginia, Charlottesville, Virginia
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Joann Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Michael J Mack
- Baylor Scott and White Heart Hospital Plano, Plano, Texas
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Dokollari A, Sicouri S, Ridwan K, Rodriguez R, Gnall E, Harish J, Shah A, Ghorpade N, Bisleri G, Kjelstrom S, Montone G, Abramson S, Hawthorne K, Goldman S, Gray W, Ramlawi B. Clinical and Echocardiographic Outcomes of Patients Undergoing Transcatheter Edge-to-Edge Repair for Functional vs Degenerative Mitral Valve Regurgitation. Curr Probl Cardiol 2024; 49:102064. [PMID: 37652113 DOI: 10.1016/j.cpcardiol.2023.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023]
Abstract
To analyze clinical and echocardiographic outcomes after transcatheter edge-to-edge repair (TEER) with mitral valve clip device (MitraClip-TM) for functional vs degenerative mitral valve regurgitation (MR). All consecutive 185 patients undergoing TEER between January 2019 and March 2023 were included in the study. A propensity-adjusted analysis investigated differences among functional vs degenerative MR mechanism groups. Preoperatively, functional vs degenerative MR included 43 vs 142 patients, respectively. Mean ejection fraction (EF) values were 37% vs 57.8%, mean STS-PROM risk score was 7% vs 4% while patients with severe MR included 29 (67.4%) vs 129 (90.9%) patients, respectively. Postoperatively, functional MR patients experienced a higher incidence of prolonged postoperative length of stay (LOS), reduced creatinine clearance, and EF<50% compared to the degenerative MR group. Mean EF was 35.9% vs 56.2% (P < 0.0001) and 1 (2.3%) vs 16 (11.3%) patients had residual severe MR (P = 0.01) in functional vs degenerative MR groups, respectively. At 30-days follow-up, all-cause death incidence was 1 (2.3%) vs 3 (2.1%) patients in functional vs degenerative MR, respectively (P = 0.9). At a mean of 1.6-years follow-up, all-cause death (P = 0.01), major adverse cardiovascular and cerebrovascular events (MACCE) (P = 0.02), cardiac death (P = 0.01) and hazard ratio for all-cause death higher in functional vs degenerative MR group. Mean EF was 39.7% vs 56% (P < 0.001) while residual severe MR was 4 (9.3%) vs 34 (24.5%) (P = 0.1) in functional vs degenerative MR groups, respectively. TEER with MitraClip device showed a higher incidence of all-cause death, cardiac death, and MACCE at follow-up for functional compared to degenerative MR after TEER.
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Affiliation(s)
- Aleksander Dokollari
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB.
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA
| | - Khalid Ridwan
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Roberto Rodriguez
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Eric Gnall
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Jarrett Harish
- Cardiac Surgery Department, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Ashish Shah
- Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB
| | - Nitin Ghorpade
- Department of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB
| | - Gianluigi Bisleri
- Cardiac Surgery Department, St. Michael's Hospital, University of Toronto, Toronto, ON
| | - Stephanie Kjelstrom
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA
| | - Georgia Montone
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA
| | - Sandra Abramson
- Division of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Katie Hawthorne
- Division of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Scott Goldman
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - William Gray
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; Division of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, PA
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6
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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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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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8
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Iwaya T, Amaki M, Kanzaki H, Izumi C. A case report of repeat clipping for recurrent severe mitral regurgitation from both sides of the clip: those who run after two hares may catch both. Eur Heart J Case Rep 2023; 7:ytad372. [PMID: 37575537 PMCID: PMC10415856 DOI: 10.1093/ehjcr/ytad372] [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: 12/07/2022] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Background Recurrent mitral regurgitation (MR) can occur even after successful transcatheter edge-to-edge mitral valve repair (TEER). While some reports show the utility of repeat clipping for recurrent MR, the results are unsatisfactory. We describe a patient who underwent repeat clipping for MR that recurred from both sides of the original clip. Case summary An 89-year-old male was admitted to our hospital with congestive heart failure. Transthoracic and transoesophageal echocardiograms (TTE/TEE) revealed severe MR due to A2 (middle segment of the anterior leaflet) prolapse. Because of his high operative risk, we performed TEER. An NTW clip was placed between A2 and P2 (middle scallop of the posterior leaflet), markedly reducing MR to mild. Six months after TEER, he complained of dyspnoea, and severe MR was evident from both sides of the clip. Although the risk of iatrogenic mitral stenosis was considered, we assessed that there might be a chance to succeed in repeat clipping if the additional two clips were placed only in the P2 beside the original clip following a careful review of TEE images. We challenged repeat clipping. After we placed NT clips on each side of the original NTW clip, MR was reduced to mild without creating iatrogenic mitral stenosis, and his symptoms subsequently improved. Discussion Anatomical features such as no valve thickening at the leaflet's grasping site and the presence of posterior leaflet indentation may increase the likelihood of a successful repeat clipping outcome. Repeat clipping should be considered after careful anatomical assessment, even in patients with challenging anatomy.
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Affiliation(s)
- Takuma Iwaya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
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Shechter A, Lee M, Kaewkes D, Koren O, Skaf S, Chakravarty T, Koseki K, Patel V, Makkar RR, Siegel RJ. Repeat Mitral Transcatheter Edge-to-Edge Repair for Recurrent Significant Mitral Regurgitation. J Am Heart Assoc 2023; 12:e028654. [PMID: 37119061 PMCID: PMC10227228 DOI: 10.1161/jaha.122.028654] [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: 10/28/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023]
Abstract
Background There are limited data on repeat mitral transcatheter edge-to-edge repair for recurrent significant mitral regurgitation (MR). Methods and Results We conducted a single-center, retrospective analysis of consecutive patients referred to a second mitral transcatheter edge-to-edge repair after a technically successful first procedure. Clinical, laboratory, and echocardiographic measures were assessed up to 1 year after the intervention. The composite of all-cause death or heart failure (HF) hospitalizations constituted the primary outcome. A total of 52 patients (median age, 81 [interquartile range, 76-87] years, 29 [55.8%] men, 26 [50.0%] with functional MR) met the inclusion criteria. MR recurrences were mostly related to progression of the underlying cardiac pathology. All procedures were technically successful. At 1 year, most patients with available records (n=24; 96.0%) experienced improvement in MR severity or New York Heart Association functional class that was statistically significant but numerically modest. Fourteen (26.9%) patients died or were hospitalized due to HF. These were higher-risk cases with predominantly functional MR who mostly underwent an urgent procedure and exhibited more severe HF indices before the intervention, as well as an attenuated 1-month clinical and echocardiographic response. Overall, 1-year course was comparable to that experienced by patients who underwent only a first transcatheter edge-to-edge repair at our institution (n=902). Tricuspid regurgitation of greater than moderate grade was the only baseline parameter to independently predict the primary outcome. Conclusions Repeat mitral transcatheter edge-to-edge repair is feasible, safe, and clinically effective, especially in non-functional MR patients without concomitant significant tricuspid regurgitation.
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Affiliation(s)
- Alon Shechter
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of CardiologyRabin Medical CenterPetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Mirae Lee
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Division of Cardiology, Department of MedicineSamsung Changwon HospitalChangwonRepublic of Korea
| | - Danon Kaewkes
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of Medicine, Faculty of MedicineKhon Kaen UniversityThailand
| | - Ofir Koren
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael
| | - Sabah Skaf
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Tarun Chakravarty
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Keita Koseki
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Vivek Patel
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Raj R. Makkar
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
| | - Robert J. Siegel
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai Medical CenterLos AngelesCAUSA
- David Geffen School of MedicineUniversity of California Los AngelesLos AngelesCAUSA
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Sauter R, Lin C, Magunia H, Schreieck J, Dürschmied D, Gawaz M, Patzelt J, Langer HF. Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR. IJC HEART & VASCULATURE 2023; 45:101190. [PMID: 36941997 PMCID: PMC10024191 DOI: 10.1016/j.ijcha.2023.101190] [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: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Background Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR). Results We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve. Results We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip. Conclusions In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
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Key Words
- CO, cardiac output
- COe, cardiac output echocardiographically determinded by combination of TTE and TEE parameters
- COi, invasively determined cardiac output
- Clips
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FMR, functional mitral regurgitation
- Heart failure
- Heart geometry
- Hemodynamics
- ICE, intracardiac echocardiography
- IVUS, intravascular ultrasound
- Interventional cardiology
- Interventional therapy
- LA, left atrium
- LV, left ventricle
- LVEDD, left ventricular end diastolic diameter
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association
- PA, pulmonary artery
- PAP, pulmonary artery pressure
- PASP, pulmonary artery systolic pressure
- PCW, pulmonary capillary wedge
- PCWP, pulmonary capillary wedge pressure
- PHT, pulmonary hypertension
- PMVR
- PMVR, percutaneous mitral valve repair
- RV, right ventricle
- SD, standard deviation
- Structural heart disease
- Surgery
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard Sauter
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Chaolan Lin
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Dürschmied
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F. Langer
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
- Corresponding author at: Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, 68167 Mannheim, Germany.
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11
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Leaflet tear or what? A challenging echocardiographic diagnosis after percutaneous mitral valve edge-to-edge repair. J Echocardiogr 2023; 21:61-62. [PMID: 34490552 DOI: 10.1007/s12574-021-00550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
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12
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Gerfer S, Ivanov B, Großmann C, Djordjevic I, Gaisendrees C, Eghbalzadeh K, Kuhn E, Kuhn-Régnier F, Mader N, Rahmanian P, Wahlers T. Mitral valve surgery after failed MitraClip-Operation for the inoperable? J Card Surg 2022; 37:4219-4224. [PMID: 35842819 DOI: 10.1111/jocs.16762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Percutaneous edge-to-edge mitral valve repair technique (MitraClip) is a widely used treatment for mitral regurgitation (MR) in patients assessed with high surgical risk or inoperability. Only limited experiences with this highest-risk patient population exist. Procedural failure for MitraClip or recurrent MR is a strong predictor of 1-year mortality. Open mitral valve surgery constitutes the last bailout for patients within this cohort. METHODS This retrospective single-center cohort study analyzed 17 mitral valve surgery patients after failed MitraClip. We, therefore, analyzed a high-risk patient population (EuroSCORE II = 10 ± 2.0) with persistent mitral valve regurgitation, which was mainly caused by detachment or dislocation of the MitraClip. RESULTS Symptomatic patients with failed MitraClip need a convenient operation (mean time to mitral valve surgery = 23 ± 44 days). The patient's collective showed many complex reoperations with the need for concomitant surgery. Considering the high-risk patient population, we showed an average 30-day all-cause mortality (18%, n = 3) accompanied by typical postoperative complications related to prolonged mechanical ventilation (44 ± 48 h) and ICU stay (11 ± 11 days), reflecting high-risk patients. Further, excellent valve-related outcomes were shown regarding adverse cardiac events (valve-related mortality 6%, n = 1) and postoperative echocardiographic results (moderate or severe paravalvular leak 6%, n = 1). CONCLUSION Failure of MitraClip represents a challenging situation limited by high-risk profiles of patients and limits the possibility of surgical valve repair, shown by a high rate of mitral valve replacement (94%, n = 16). Secondary surgery was associated with moderate 30-day and postdischarge outcomes. Therefore, a careful evaluation of patients undergoing MitraClip is of paramount importance.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Clara Großmann
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Christopher Gaisendrees
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ferdinand Kuhn-Régnier
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
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13
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El Shaer A, Chavez Ponce A, Mazur P, Greason K, Arghami A, Eleid MF, Guerrero M, Rihal CS, Crestanello JA, Alkhouli M. Mitral Valve Surgery for Persistent or Recurrent Mitral Regurgitation After Transcatheter Edge-to-Edge Repair Is Associated With Improved Survival. J Am Heart Assoc 2022; 11:e026236. [PMID: 36250668 PMCID: PMC9673655 DOI: 10.1161/jaha.122.026236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The management of severe mitral regurgitation (MR) after transcatheter edge‐to‐edge repair (TEER) remains a clinical conundrum. Considering the growing volume of TEER, more outcomes data for mitral surgery in this cohort are needed. Methods and Results Symptomatic patients with persistent or recurrent severe MR after TEER evaluated between May 2014 and June 2021 were included. The primary outcome was all‐cause mortality in patients who were treated with surgery versus medical therapy. The Kaplan–Meier and Cox regression methods were used to report risk‐adjusted survival analyses. Among the 142 included patients, 44 (31.0%) underwent mitral surgery. Patients who underwent surgery were younger than those treated medically (74.1±8.9 versus 78.6±10.5 years, P=0.01). Major comorbidities were similar except obesity, sleep apnea, left ventricular dimensions, and ejection fraction. Society of Thoracic Surgeons Predicted Risk of Operative Mortality was 9.0±4.7 versus 7.9±4.9 in the surgical versus medical therapy groups, respectively, P=0.22. Time from TEER to detection of severe MR was similar in both groups (median [interquartile range] 97.5 [39.5–384] versus 93.5 [40–389] days in the surgical versus medical groups, respectively [P>0.05]). In the surgical group, valve replacement was performed in all patients. Operative mortality was 4.5% (observed/expected ratio 0.55), and major complications were uncommon. After risk‐adjustment, surgery was associated with significantly lower all‐cause mortality (adjusted hazard ratio, 0.33 [95% CI, 0.12–0.92], P=0.001) compared with medial therapy. Conclusions Compared with medical therapy, mitral surgery in patients with severe persistent or recurrent MR after TEER is associated with lower mortality despite the high‐risk profile of these patients. Patients with severe MR after TEER should be considered for surgery at a referral mitral surgical center.
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Affiliation(s)
- Ahmed El Shaer
- Department of Cardiovascular Disease Mayo Clinic Rochester MN
| | | | - Piotr Mazur
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Kevin Greason
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Arman Arghami
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Mayra Guerrero
- Department of Cardiovascular Disease Mayo Clinic Rochester MN
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14
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Flores G, Mesa D, Ojeda S, de Lezo JS, Gonzalez-Manzanares R, Dueñas G, Pan M. Complications of the Percutaneous Mitral Valve Edge-To-Edge Repair: Role of Transesophageal Echocardiography. J Clin Med 2022; 11:jcm11164747. [PMID: 36012985 PMCID: PMC9410310 DOI: 10.3390/jcm11164747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The use of transcatheter edge-to-edge repair for the treatment of mitral regurgitation has markedly increased in the last few years. The rate of adverse events related to the procedure is low; however, some of the complications that may occur are potentially dangerous. Due to the growing popularity of the technique, which is no longer limited to high-volume centers, knowledge of the complications related to the procedure is fundamental. Transesophageal echocardiography has a key role in the guidance of the intervention while allowing for the avoidance of most of these adverse events, as well as enabling us to diagnose them early. In this article, we review the main complications that might present during a transcatheter mitral edge-to-edge repair procedure (tamponade, thromboembolic events, single leaflet device attachment, device embolization, vascular injury…) while highlighting key aspects of transesophageal echocardiographic monitoring in the prevention and prompt diagnosis of these complications.
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Affiliation(s)
- Guisela Flores
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Dolores Mesa
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Correspondence:
| | - Soledad Ojeda
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
| | - Javier Suárez de Lezo
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Rafael Gonzalez-Manzanares
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Guillermo Dueñas
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Manuel Pan
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
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15
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Rroku A, Barbieri F, Landmesser U, Skurk C, Kasner M, Reinthaler M. Transcatheter Caval Valve Implantation for Tricuspid Regurgitation After Single Leaflet Device Attachment. JACC Case Rep 2022; 4:481-485. [PMID: 35493801 PMCID: PMC9044288 DOI: 10.1016/j.jaccas.2022.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/17/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Andi Rroku
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Cardiology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Fabian Barbieri
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Cardiology, Berlin, Germany
- Address for correspondence: Dr Fabian Barbieri, Charité–Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany. @FabianBarbieri5
| | - Ulf Landmesser
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Cardiology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Skurk
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Cardiology, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Mario Kasner
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Cardiology, Berlin, Germany
| | - Markus Reinthaler
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Cardiology, Berlin, Germany
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Teltow, Germany
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16
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Sugiura A, Kavsur R, Spieker M, Iliadis C, Goto T, Öztürk C, Weber M, Tabata N, Zimmer S, Sinning JM, Mauri V, Horn P, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Recurrent Mitral Regurgitation After MitraClip: Predictive Factors, Morphology, and Clinical Implication. Circ Cardiovasc Interv 2022; 15:e010895. [PMID: 35193380 DOI: 10.1161/circinterventions.121.010895] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recurrent mitral regurgitation (MR) following MitraClip has not been thoroughly investigated. We aimed to examine the predictive factors, morphology, and long-term outcome of recurrent MR after MitraClip. METHODS We assessed data from the Heart Failure Network Rhineland registry from August 2010 to October 2018. Competing risk analyses were performed using the Fine and Gray model to assess the risk of recurrent MR. RESULTS Among 685 MitraClip patients with a reduction in MR to ≤2+, 61 patients developed recurrent MR within the first 12 months. Flail leaflet (hazard ratio, 3.68; P=0.002) and residual MR (MR grade 2+ versus ≤1+: hazard ratio, 2.56; P=0.03) were the predictors of recurrent MR in primary MR patients, while left atrial volume (per 10 mL increase: hazard ratio, 1.11; P<0.001) and residual MR (hazard ratio, 2.45; P=0.01) were independently associated with recurrent MR in secondary MR patients. In primary MR patients, loss of leaflet insertion or leaflet tear were the predominant morphologies with recurrent MR. In secondary MR patients, more than half of the patients with recurrent MR did not show any disorder of the clip or leaflets. Patients with recurrent MR were more likely to experience unplanned heart failure hospitalization or heart failure symptom with New York Heart Association scale III/IV (54.1% versus 37.8%; P=0.018) and undergo a repeat mitral valve intervention (9.8% versus 2.2%; P=0.005) during the follow-up. In the landmark survival analysis, patients with recurrent MR tended to have lower long-term survival (58.7% versus 83.9%; P=0.08) than patients without recurrent MR. CONCLUSIONS Flail leaflet and residual MR were the predictors of recurrent MR in primary MR patients, while a larger left atrial volume and residual MR were associated with recurrent MR in secondary MR patients, which may be associated with long-term clinical outcomes of patients after MitraClip.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan (T.G.)
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (N.T.)
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Jan-Malte Sinning
- Department of Cardiology, St Vinzenz-Hospital Cologne, Germany (J.-M.S.)
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
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17
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Dabiri Y, Mahadevan VS, Guccione JM, Kassab GS. A Simulation Study of the Effects of Number and Location of MitraClips on Mitral Regurgitation. JACC. ADVANCES 2022; 1:100015. [PMID: 38939090 PMCID: PMC11198285 DOI: 10.1016/j.jacadv.2022.100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 06/29/2024]
Abstract
Background MitraClip (MC) is a device that is implanted on the mitral valve (MV) percutaneously to treat severe mitral regurgitation (MR). It is common practice to place the MCs at the site of the most significant MR jets identified by echocardiography. Objectives We used computational modeling to examine changes in MR after MC placement. Methods Echocardiographic images from 29 patients with MR were analyzed to reconstruct geometries for finite element simulations and created fluid structure interaction models of the MV with deformable hyperelastic material, the left ventricle as the surrounding geometry, and blood flow. Blood flow was modelled with smoothed particle hydrodynamics. The number of blood particles on the atrial side of MV was used to estimate MR. MC placement was based on the MR jets (jet-based strategy using primary and secondary jets) and simulation models using various MCs locations. Results Computational modelling was able to quantitate reductions in MR after MC placement. Reduction in MR was related to the number of MCs used: 42% reduction with 1 MC, 62% with 2 MCs, and 88% with 3 MCs. Using 2 MCs did not always result in an MR reduction greater than with a single MC. In 31% (9 of 29) of patients, the jet-based strategy did not lead to maximum MR reduction. The majority of patients (89%) who did not have maximal MR reduction with the MC placement using the jet-based strategy, had wide jets, and/or had multiple jets. Conclusions Subject-specific simulation models may be helpful to identify optimal locations for MC placement in patients with MR.
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Mangieri A, Melillo F, Montalto C, Denti P, Praz F, Sala A, Winkel MG, Taramasso M, Tagliari AP, Fam NP, Rubbio AP, De Marco F, Bedogni F, Toggweiler S, Schofer J, Brinkmann C, Sievert H, Van Mieghem NM, Ooms JF, Paradis JM, Rodés-Cabau J, Brochet E, Himbert D, Perl L, Kornowski R, Ielasi A, Regazzoli D, Baldetti L, Masiero G, Tarantini G, Latib A, Laricchia A, Gattas A, Tchetchè D, Dumonteil N, Francesco G, Agricola E, Montorfano M, Lurz P, Crimi G, Maisano F, Colombo A. Management and Outcome of Failed Percutaneous Edge-to-Edge Mitral Valve Plasty: Insight From an International Registry. JACC Cardiovasc Interv 2022; 15:411-422. [PMID: 35210047 DOI: 10.1016/j.jcin.2021.11.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/09/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study evaluated the incidence, management, and outcome of patients who experienced MitraClip (Abbott Vascular) failure secondary to loss of leaflet insertion (LLI), single leaflet detachment (SLD), or embolization. BACKGROUND Transcatheter edge-to-edge repair with MitraClip is an established therapy for the treatment of mitral regurgitation (MR), but no data exist regarding the prevalence and outcome according to the mode of clip failure. METHODS Between January 2009 and December 2020, we retrospectively screened 4,294 procedures of MitraClip performed in 19 centers. LLI was defined as damage to the leaflet where the MitraClip was attached, SLD as demonstration of complete separation between the device and a single leaflet tissue, and clip embolization as loss of contact between MitraClip and both leaflets. RESULTS A total of 147 cases of MitraClip failure were detected (overall incidence = 3.5%), and these were secondary to LLI or SLD in 47 (31.9%) and 99 (67.3%) cases, respectively, whereas in 1 (0.8%) case clip embolization was observed. MitraClip failure occurred in 67 (45.5%) patients with functional MR, in 64 (43.5%) patients with degenerative MR, and 16 (10.8%) with mixed etiology. Although the majority of MitraClip failures were detected before discharge (47 intraprocedural and 42 in the hospital), up to 39.5% of cases were diagnosed at follow-up. In total, 80 (54.4%) subjects underwent a redo procedure, either percutaneously with MitraClip (n = 51, 34.7%) or surgically (n = 36, 24.5%) including 4 cases of surgical conversion of the index procedure and 7 cases of bailout surgery after unsuccessful redo MitraClip. After a median follow-up of 163 days (IQR: 22-720 days), 50 (43.9%) subjects presented moderate to severe MR, and 43 (29.3%) patients died. An up-front redo MitraClip strategy was associated with a trend toward a reduced rate of death at follow-up vs surgical or conservative management (P = 0.067), whereas postprocedural acute kidney injury, age, and moderate to severe tricuspid regurgitation were independent predictors of death. CONCLUSIONS MitraClip failure secondary to LLI and SLD is not a rare phenomenon and may occur during and also beyond hospitalization. Redo MitraClip strategy demonstrates a trend toward a reduced risk of death compared with bailout surgery and conservative management. A third of those patients remained with more than moderate MR and had substantial mortality at the intermediate-term follow-up.
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Affiliation(s)
- Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | | | - Claudio Montalto
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Denti
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandra Sala
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirjam G Winkel
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Ana Paula Tagliari
- Cardiac Surgery Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Joachim Schofer
- MVZ-Department Structural Heart Disease, Asklepios Clinic St Georg, Hamburg, Germany
| | - Christina Brinkmann
- MVZ-Department Structural Heart Disease, Asklepios Clinic St Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany and Anglia Ruskin University, Chelmsford, United Kingdom
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joris F Ooms
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Laval University, Québec City, Québec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Québec City, Québec, Canada
| | - Eric Brochet
- Cardiology Department University Hospital Bichat, Paris, France
| | | | - Leor Perl
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | - Luca Baldetti
- IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Angie Gattas
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Eustachio Agricola
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Montorfano
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gabriele Crimi
- Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
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Freixa X, Estévez‐Loureiro R, Pascual I, Carrasco‐Chinchilla F, Sanchis L, Nombela‐Franco L, Benito T, Li P, Flores‐Umanzor E, Amat‐Santos I, Baz JA, Jiménez‐Quevedo P, Hernández F, Fernández‐Peregrina E, Alonso‐Briales JH, Avanzas P, Fernández‐Vazquez F, Arzamendi D. Procedural and clinical outcomes after repeat edge‐to‐edge transcatheter mitral valve repair. Catheter Cardiovasc Interv 2022; 99:1619-1625. [DOI: 10.1002/ccd.30053] [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: 07/12/2021] [Revised: 10/23/2021] [Accepted: 11/27/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Xavier Freixa
- Hospital Clinic de Barcelona Institut Clínic Cardiovascular Barcelona Spain
| | | | | | | | - Laura Sanchis
- Hospital Clinic de Barcelona Institut Clínic Cardiovascular Barcelona Spain
| | | | | | - Pedro Li
- Hospital de la Santa Creu i Sant Pau Barcelona Spain
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20
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Kreusser MM, Weber A, Geis NA, Grossekettler L, Volz MJ, Hamed S, Katus HA, Pleger ST, Frey N, Raake PW. Re-do MitraClip in patients with functional mitral valve regurgitation and advanced heart failure. ESC Heart Fail 2021; 8:4617-4625. [PMID: 34498422 PMCID: PMC8712900 DOI: 10.1002/ehf2.13564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 07/08/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Aim Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for severe mitral regurgitation (MR) in advanced stages of heart failure (HF). However, progressive left ventricular dilation in these patients may lead to recurrent MR after PMVR and consequent re‐do MitraClip implantation. Here, we describe the characteristics and outcomes of this clinical scenario. Methods and results Patients with systolic HF and functional MR undergoing a re‐do MitraClip procedure were retrospectively analysed. Inclusion criteria were age ≥18 years, technical, device and procedural success at first MitraClip procedure, functional MR and systolic HF with an ejection fraction (EF) of <45%. Seventeen out of 684 patients undergoing PMVR with the MitraClip device at our institution between September 2009 and July 2019 were included. All patients displayed advanced HF with an EF of 20% (±9.9) and highly elevated N‐terminal pro‐brain natriuretic peptide. Technical success of the re‐do MitraClip procedure was 100%, whereas procedural and device success were only achieved in 11 patients (65%). Unsuccessful re‐do procedures were related to lower EF and implantation of more than one clip at initial procedure. However, despite reduction in MR grade and no occurrence of significant mitral stenosis after the procedure, the mortality during 12 months follow‐up remained high (8 of 17; 47%). Conclusions In a cohort of patients with advanced HF undergoing PMVR, re‐do MitraClip procedure was feasible, but procedural success was unsatisfactory and morbidity and mortality remained high, possibly reflecting the advanced stage of HF in these patients.
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Affiliation(s)
- Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Andreas Weber
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Nicolas A Geis
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Leonie Grossekettler
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Martin J Volz
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Sonja Hamed
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
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21
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Abstract
Purpose of Review To provide a detailed overview of complications associated with MitraClip therapy and its development over time with the aim to alert physicians for early recognition of complications and to offer treatment strategies for each complication, if possible. Recent Findings The MitraClip system (MC) is the leading transcatheter technique to treat mitral regurgitation (MR) and has been established as a safe procedure with very low adverse event rates compared to mitral surgery at intermediate to high risk or in secondary MR. Lately, the fourth MC generation has been launched with novel technical features to facilitate device handling, decrease complication rates, and allow the treatment of even complex lesions. Summary Although the complication rate is low, adverse events are associated with increased morbidity and mortality. The most common complications are bleeding, acute kidney failure, procedure-induced mitral stenosis, and an iatrogenic atrial septal defect with unknown clinical impact. Supplementary Information The online version contains supplementary material available at 10.1007/s11886-021-01553-9.
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22
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Isogai T, Saad AM, Shekhar S, Gad MM, Verma BR, Ahuja KR, Miyasaka RL, Harb SC, Krishnaswamy A, Kapadia SR. Incidence and Outcomes of Early Mitral Valve Reintervention After MitraClip: A Nationwide Cohort Study. JACC Cardiovasc Interv 2021; 14:112-114. [PMID: 33413862 DOI: 10.1016/j.jcin.2020.09.039] [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: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
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23
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Kreidel F, Zaid S, Tamm AR, Ruf TF, Beiras-Fernandez A, Reinold J, Geyer M, da Rocha E Silva J, Schnitzler K, Michaela H, Münzel T, Tang GHL, von Bardeleben RS. Impact of Mitral Annular Dilation on Edge-to-Edge Therapy With MitraClip-XTR. Circ Cardiovasc Interv 2021; 14:e010447. [PMID: 34304600 DOI: 10.1161/circinterventions.120.010447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center, Valhalla, NY (S.Z.)
| | - Alexander R Tamm
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Tobias F Ruf
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Andres Beiras-Fernandez
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jenny Reinold
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jaqueline da Rocha E Silva
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Katharina Schnitzler
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Hell Michaela
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, NY (G.H.L.T.)
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
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24
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Melillo F, Baldetti L, Beneduce A, Agricola E, Margonato A, Godino C. Mitral valve surgery after a failed MitraClip procedure. Interact Cardiovasc Thorac Surg 2021; 32:380-385. [PMID: 33221925 DOI: 10.1093/icvts/ivaa270] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/03/2020] [Accepted: 09/27/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Among patients undergoing transcatheter mitral valve repair with the MitraClip device, a relevant proportion (2-6%) requires open mitral valve surgery within 1 year after unsuccessful clip implantation. The goal of this review is to pool data from different reports to provide a comprehensive overview of mitral valve surgery outcomes after the MitraClip procedure and estimate in-hospital and follow-up mortality. METHODS All published clinical studies reporting on surgical intervention for a failed MitraClip procedure were evaluated for inclusion in this meta-analysis. The primary study outcome was in-hospital mortality. Secondary outcomes were in-hospital adverse events and follow-up mortality. Pooled estimate rates and 95% confidence intervals (CIs) of study outcomes were calculated using a DerSimionian-Laird binary random-effects model. To assess heterogeneity across studies, we used the Cochrane Q statistic to compute I2 values. RESULTS Overall, 20 reports were included, comprising 172 patients. Mean age was 70.5 years (95% CI 67.2-73.7 years). The underlying mitral valve disease was functional mitral regurgitation in 50% and degenerative mitral regurgitation in 49% of cases. The indication for surgery was persistent or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas 6% of patients presented with mitral stenosis. At the time of the operation, 80% of patients presented in New York Heart Association functional class III-IV. Despite favourable intraoperative results, in-hospital mortality was 15%. The rate of periprocedural cerebrovascular accidents was 6%. At a mean follow-up of 12 months, all-cause death was 26.5%. Mitral valve replacement was most commonly required because the possibility of valve repair was jeopardized, likely due to severe valve injury after clip implantation. CONCLUSIONS Surgical intervention after failed transcatheter mitral valve intervention is burdened by high in-hospital and 1-year mortality, which reflects reflecting the high-risk baseline profile of the patients. Mitral valve replacement is usually required due to leaflet injury.
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Affiliation(s)
- Francesco Melillo
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
| | - Luca Baldetti
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
| | | | - Eustachio Agricola
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
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25
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Gupta T, Faza N, Joseph D, Little SH, Kleiman NS, Wyler von Ballmoos MC, Goel SS. QCA to guide treatment of inter-clip mitral regurgitation between two previously implanted MitraClips. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:196-199. [PMID: 34059465 DOI: 10.1016/j.carrev.2021.05.020] [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: 03/18/2021] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Treatment of recurrent MR after initially successful MitraClip procedure can pose therapeutic challenges. We report a successful case of redo MitraClip to treat recurrent inter-clip MR due to progression of underlying degenerative valvular pathology with prolapsing posterior mitral leaflet between the two prior clips. In this vignette, we describe the novel use of quantitative coronary arteriography (QCA) to select redo MitraClip as the treatment strategy.
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Affiliation(s)
- Tanush Gupta
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Nadeen Faza
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Denny Joseph
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Stephen H Little
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | | | - Sachin S Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America.
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26
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Kitamura M, Besler C, Lurz P, Noack T. Bail-out edge-to-edge mitral repair for an acute single leaflet device attachment: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab147. [PMID: 34124553 PMCID: PMC8188872 DOI: 10.1093/ehjcr/ytab147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/01/2020] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Abstract
Background An acute single leaflet device attachment (SLDA) may occur during transcatheter mitral valve edge-to-edge repair (TMVr), if an inadequate grasping of the target leaflet and/or a leaflet injury are concomitant. The bail-out TMVr often fails due to the complex pathophysiology. Case summary We report a case of an acute SLDA after TMVr with the PASCAL Repair System for severe mitral regurgitation (MR) with mixed aetiology, i.e., a thin-appeared posterior leaflet and pseudo-prolapse of the anterior mitral leaflet due to mitral annular dilatation. An acute SLDA occurred 2 min after the deployment, with device detachment of the posterior leaflet. A bail-out TMVr with the MitraClip XTR system led to an optimal MR reduction with the PASCAL stabilized. Despite an adequate leaflet insertion of the 1st device achieved, the posterior leaflet was tear due to its fragile tissue characteristics. At discharge, echocardiography confirmed an optimal MR reduction to mild grade with both devices stabilized. Discussion The pathology of the mitral valve leaflet is essential to achieve successful TMVr procedure using edge-to-edge repair device. Since the mechanical stress to the target leaflet appears to vary according to the edge-to-edge repair devices, the leaflet tissue characteristics should be respected during device selection.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
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27
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Alessandrini H, Dreher A, Harr C, Wohlmuth P, Meincke F, Hakmi S, Ubben T, Kuck KH, Hassan K, Willems S, Schmoeckel M, Geidel S. Clinical impact of intervention strategies after failed transcatheter mitral valve repair. EUROINTERVENTION 2021; 16:1447-1454. [PMID: 33074154 PMCID: PMC9724904 DOI: 10.4244/eij-d-20-01008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Failure of transcatheter mitral valve repair (fTMVR) therapy has a decisive prognostic influence, and complex retreatment is of higher risk. The aim of this analysis was to evaluate the survival outcome following percutaneous procedures and surgery after unsuccessful TMVR interventions for different aetiologies. METHODS AND RESULTS Of 824 consecutive patients who had been treated with the MitraClip device at our institution, between September 2009 and May 2019, 63 (7.6%) symptomatic patients with therapy failure and persistent or recurrent mitral regurgitation (MR) underwent reinterventions. An outcome analysis for primary (PMR) and secondary mitral regurgitation (SMR) and subsequent percutaneous versus surgical treatment was carried out. MitraClip reinterventions were performed in 36 patients (57.1%; n=26 SMR, n=10 PMR), while 27 (42.9%; n=13 SMR, n=14 PMR) underwent open heart surgery. Surgical patients with PMR showed lower mortality than patients with SMR (p<0.0001) and ReClip patients with PMR (p=0.073). Atrial fibrillation (HR 2.915, 95% CI: [1.311, 6.480]), prior open heart surgery (2.820 [1.215, 6.544]) and chronic obstructive pulmonary disease (2.506 [1.099, 5.714]) increased the risk of death. The level of post-interventional MR had no relevant impact on survival. CONCLUSIONS We conclude that, after SMR and failed TMVR, reclipping is an appropriate treatment option for symptomatic patients. For PMR patients, surgery must be favoured over a reclipping procedure. However, patients with atrial fibrillation, prior open heart surgery and chronic obstructive pulmonary disease are at risk of reduced survival after reinterventions.
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Affiliation(s)
- Hannes Alessandrini
- Asklepios Klinik St. Georg, Department of Cardiology, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Ansgar Dreher
- Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany
| | - Claudia Harr
- Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany
| | - Peter Wohlmuth
- Proresearch Institute, Asklepios Klinik Sankt. Georg, Hamburg, Germany
| | - Felix Meincke
- Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany
| | - Timm Ubben
- Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany
| | | | - Kambiz Hassan
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik Sankt. Georg, Hamburg, Germany
| | - Michael Schmoeckel
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Geidel
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
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Melillo F, Fisicaro A, Stella S, Ancona F, Capogrosso C, Ingallina G, Maccagni D, Romano V, Ruggeri S, Godino C, Latib A, Montorfano M, Colombo A, Agricola E. Systematic Fluoroscopic-Echocardiographic Fusion Imaging Protocol for Transcatheter Edge-to-Edge Mitral Valve Repair Intraprocedural Monitoring. J Am Soc Echocardiogr 2021; 34:604-613. [PMID: 33453367 DOI: 10.1016/j.echo.2021.01.010] [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: 03/30/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Whether fluoroscopic-echocardiographic fusion imaging (FI) might offer added value for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair is yet unknown, and few data exist regarding the safety and feasibility of this novel technology. METHODS The aim of this single-center study was to test and validate a FI protocol for intraprocedural monitoring of transcatheter edge-to-edge mitral valve repair and assess its clinical usefulness. Eighty patients underwent MitraClip implantation using FI guidance (FI+) for either degenerative (35%) or functional (65%) mitral regurgitation and were compared with the last 80 patients before FI introduction, treated using conventional echocardiography and fluoroscopic monitoring (FI-). RESULTS The number of patients treated for functional and degenerative mitral regurgitation was similar between the FI+ and FI- groups, as well as the number of devices implanted (1.51 ± 0.5 vs 1.58 ± 0.6, P = .46). The prevalence of complex mitral anatomy for percutaneous repair was high (32.5%, up to 39.2% in the hybrid arm). Fluoroscopy time was significantly lower in FI+ patients (37.3 ± 14.6 vs 48.3 ± 28.3 min, P = .003), but not kerma area product (91.5 ± 74.1 vs 108.8 ± 105.0 Gy · cm2, P = .23) or procedural time (92.2 ± 36.1 vs 103.1 ± 42.7 min, P = .086). After adjusting for confounding factors (MitraClip XT device and complex anatomy), FI reduced fluoroscopy time (coefficient = -10.4 min; 95% CI, -18.03 to -2.82; P = .007) and improved procedural success at the end of the procedure (odds ratio, 2.87; 95% CI, 1.00 to 8.24; P = .049) and discharge (odds ratio, 2.24; 95% CI, 1.04 to 4.80; P = .039). Rates of periprocedural complications were similar in both groups (8.9% vs 13.0%, P = .40). CONCLUSIONS The authors describe the systematic use of an FI protocol for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair, demonstrating a reduction in fluoroscopy time and an improvement in procedural success in a population with a high prevalence of challenging mitral anatomy for percutaneous repair.
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Affiliation(s)
- Francesco Melillo
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Fisicaro
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Capogrosso
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Maccagni
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Romano
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Ruggeri
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Laboratory, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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29
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Gyoten T, Schenk S, Grimmig O, Just S, Fritzsche D, Messroghli D. Outcome of medical therapy, repeat intervention, and mitral valve surgery after failed MitraClip therapy. Gen Thorac Cardiovasc Surg 2020; 69:803-810. [PMID: 33118111 DOI: 10.1007/s11748-020-01530-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Optimal treatment for residual mitral regurgitation (MR) after MitraClip failure is not clearly defined. We report our clinical experience and discuss treatment options. METHODS Between January 2013 and January 2018, 37 patients (75 ± 8.9 years, 46% male) were admitted for symptomatic MR (grade 3.1 ± 0.47) diagnosed after previous MitraClip therapy. Clinical outcome of these patients, who underwent medical therapy alone (n = 8, M-group), repeat MitraClip therapy (n = 8, reMC group), or mitral valve surgery (n = 21, S-group) for residual MR, were retrospectively analyzed. RESULTS Thirty-day survival was 88% (M-group), 100% (reMC-group), and 76% (S-group). The rate of discharge to home was 88% in the reMC-group, better than 38% in the M-group (p = 0.051) and 19% in the S-group (p < 0.001). Perioperative non-survivors in the S-group had high surgical risk with median logistic EuroSCORE of 64.6% (interquartile range 57.4%-87.0%); all died from low cardiac output syndrome or multiple organ failure. The main MR pathologies resulted from leaflet tear and tethering in the M-group, tethering in the reMC-group, and degenerative valve and leaflet tear in the S-group. Kaplan-Meier analysis of overall survival at 1 year showed better outcome for patients in the reMC-group (50%, 95% CI 15.2-77.5%) and S-group (47.6%, 95% CI 25.7-66.7%), as compared to those in the M-group (12.5%, 95% CI 0.70-42.3%) (log-rank test p = 0.108 and p = 0.167, respectively). CONCLUSION Medical therapy alone after failed MitraClip therapy resulted in poor 1-year prognosis. In patients without extremely high surgical risk, repeat MitraClip therapy, or surgical revision MIGHT BE CONSIDERED depending on valve pathology and cardiac comorbidities.
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Affiliation(s)
- Takayuki Gyoten
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany.
| | - Sören Schenk
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Oliver Grimmig
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Sören Just
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Dirk Fritzsche
- Department of Cardiovascular Surgery, Sana-Herzzentrum Cottbus, Leipziger Strasse 50, 03048, Cottbus, Germany
| | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Charité, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
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30
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Sugiura A, Weber M, Tabata N, Goto T, Öztürk C, Hammerstingl C, Sinning JM, Werner N, Nickenig G. Prognostic Impact of Redo Transcatheter Mitral Valve Repair for Recurrent Mitral Regurgitation. Am J Cardiol 2020; 130:123-129. [PMID: 32693917 DOI: 10.1016/j.amjcard.2020.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
There is little known about the prognostic impact of a redo transcatheter mitral valve repair (TMVR) for residual or recurrent mitral regurgitation (MR). From January 2011 to March 2019, we identified 43 consecutive patients who underwent a redo TMVR procedure with the MitraClip system. A control cohort was treated medically for MR ≥2+ after the first TMVR and was propensity score 1:1 matched using age, gender, MR severity, trans-mitral pressure gradient, and etiology of MR. To investigate the association of redo TMVR with 1-year mortality, we fitted a Cox proportional hazard model. The technical success rate of redo TMVR was 95%. A reduction in MR to ≤2+ was achieved in 79% of patients, with a significant decline of tricuspid regurgitation pressure gradient and improvement of the New York Heart Association class. After matching was performed, 43 well-matched pairs of patients were analyzed. Redo TMVR patients showed lower 1-year mortality (10.5% vs 37.6%, p = 0.01) compared with the control patients. Redo TMVR was associated with better survival (hazard ratio [HR] 0.26, 95% confidence interval [CI] 0.08 to 0.79, p = 0.02) and lower risk of the composite end point (mortality and rehospitalization due to HF: HR 0.34, 95% CI 0.15 to 0.78; p = 0.01) at 1-year follow-up. The association with the primary end point remained significant after accounting for the New York Heart Association class III/IV, TR ≥severe, the type of MR (i.e., recurrent or residual MR), or the type of previous implanted TMVR device. In conclusion, redo TMVR in selected patients with residual or recurrent MR may be associated with lower 1-year mortality than medical therapy alone.
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Abstract
PURPOSE OF REVIEW To describe the key role of the structural imager/interventional echocardiographer in transcatheter mitral valve therapies, particularly edge-to-edge repair. In addition, we review important recent advances in structural imaging and briefly describe several novel devices for transcatheter mitral valve repair. RECENT FINDINGS Structural imagers represent a new subspecialty in cardiology and anesthesiology with specific skillset and training requirements. Their role is particularly important in imaging-based transcatheter interventions such as edge-to-edge mitral valve repair. This therapy has increasingly been used to treat primary (degenerative) mitral regurgitation when surgical risk is prohibitive and has recently been extended to patients with secondary (functional) mitral regurgitation. As novel transcatheter therapies continue to emerge, so do new multimodality imaging technologies. Structural imagers have become an integral part of the heart team. Their role is particularly visible in transcatheter mitral procedures. Rapidly developing transcatheter therapies have helped shape this new subspecialty and spark innovation in imaging technologies.
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32
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Goel SS, Zuck V, Goldstein J, Goswami NJ. Redo MitraClip for Late Recurrent Severe Mitral Regurgitation: Case Report and Literature Review. CJC Open 2020; 2:179-185. [PMID: 32462133 PMCID: PMC7242512 DOI: 10.1016/j.cjco.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/19/2020] [Indexed: 11/26/2022] Open
Abstract
Transcatheter mitral valve repair using the MitraClip (Abbott Vascular, Santa Clara, CA) is a reasonable option for the treatment of patients with severe symptomatic degenerative mitral regurgitation (MR) who are at prohibitive surgical risk. The occurrence of recurrent severe MR after initial successful MitraClip repair is uncommon. Data are sparse on the management of recurrent severe MR after initial successful repair using the MitraClip. We describe a successful case of redo MitraClip repair for late recurrent severe MR secondary to progressive degenerative mitral valve disease after a successful initial MitraClip procedure and review the literature.
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Affiliation(s)
- Sachin S Goel
- Structural Heart Interventions, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas, USA
| | - Vincent Zuck
- Structural Heart Program, Prairie Heart Institute, St. John's Hospital, Springfield, Illinois, USA
| | - Jeffrey Goldstein
- Structural Heart Program, Prairie Heart Institute, St. John's Hospital, Springfield, Illinois, USA
| | - Nilesh J Goswami
- Structural Heart Program, Prairie Heart Institute, St. John's Hospital, Springfield, Illinois, USA
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33
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Management of MitraClip Single-Leaflet Detachment with an Additional Clip and an Amplatzer Vascular Plug. JACC Case Rep 2019; 1:755-760. [PMID: 34316926 PMCID: PMC8288711 DOI: 10.1016/j.jaccas.2019.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/22/2022]
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34
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Ikenaga H, Makar M, Rader F, Siegel RJ, Kar S, Makkar RR, Shiota T. Mechanisms of mitral regurgitation after percutaneous mitral valve repair with the MitraClip. Eur Heart J Cardiovasc Imaging 2019; 21:1131-1143. [DOI: 10.1093/ehjci/jez247] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 12/26/2022] Open
Abstract
Abstract
Aims
We sought to find the morphological mechanisms of recurrent mitral regurgitation (MR) after MitraClip procedure using 3D transoesophageal echocardiography (TOE).
Methods and results
Of 478 consecutive patients treated with the initial MitraClip procedure, 41 patients who underwent repeat mitral valve (MV) transcatheter or surgical intervention for recurrent MR were retrospectively reviewed. Using 3D-TOE, we investigated morphological changes of MV leading to repeat MV intervention. Aetiology of MR at the index intervention was primary in 24 (59%) and secondary in 17 (41%) patients. In the primary MR group, worsening leaflet prolapse at the clip site caused recurrent MR in 12 (50%) patients, while 7 (29%) patients had a leaflet tear at the clip site. Acute single leaflet device detachment was seen in four patients and one patient had recurrent MR between the plug and the clip. In secondary MR, left ventricular (LV)/left atrial dilation caused recurrent MR in 13 (76%) patients. Significant increase in the LV end-diastolic volume and tenting height were observed from post-index procedure to repeat intervention (LV end-diastolic volume; from 205 to 237 ml, P < 0.001, tenting height; from 0.8 to 1.3 cm, P < 0.001). New emergent leaflet prolapse/flail was seen in 3 (18%) patients, suggesting iatrogenic MR.
Conclusion
Mechanisms of recurrent MR after MitraClip procedure varied and depended on the underlying MV pathology: in primary MR, worsening mitral leaflet prolapse and in secondary MR, progressive LV dilation with worsening tenting were the main causes of recurrent MR.
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Affiliation(s)
- Hiroki Ikenaga
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Saibal Kar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
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35
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Huded C, Kapadia S. Treatment of Functional Mitral Regurgitation with Transcatheter Edge-to-Edge Repair. Interv Cardiol Clin 2019; 8:235-243. [PMID: 31078179 DOI: 10.1016/j.iccl.2019.02.004] [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] [Indexed: 11/19/2022]
Abstract
Mitral valve regurgitation is a common valvular lesion affecting approximately 1 in 10 older adults, and it can be broadly categorized as degenerative or functional in etiology. Although transcatheter mitral valve repair with the MitraClip is currently approved for commercial treatment of severe degenerative mitral regurgitation, its role in patients with functional mitral regurgitation is evolving. Two recent pivotal trials have evaluated the effectiveness of the MitraClip device in those with severe functional mitral regurgitation. We review the concepts of edge-to-edge mitral valve repair and evidence regarding transcatheter edge-to-edge repair with MitraClip in patients with functional mitral regurgitation.
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Affiliation(s)
- Chetan Huded
- Cleveland Clinic Heart and Vascular Institute, Desk J2-3, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Samir Kapadia
- Cleveland Clinic Heart and Vascular Institute, Desk J2-3, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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36
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Alfakhouri A, Heidrich FM, Sveric KM, Pfluecke C, Kvakan H, Quick S, Speiser U, Youssef A, Strasser RH, Wiedemann S. Three-dimensional transoesophageal echocardiography is crucial for valid assessment of mitral valve leaflet morphology in severe mitral regurgitation prior to interventional repair. Acta Cardiol 2018; 73:352-360. [PMID: 28978263 DOI: 10.1080/00015385.2017.1385437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Interventional mitral valve (MV) repair of severe symptomatic mitral regurgitation (MR) is a therapeutic option in high-risk surgical or inoperable patients. Assessment of the MV remains a crucial part of pre-interventional screening. Three-dimensional transoesophageal echocardiography (3D-TOE) may compensate for well-known pitfalls that occur in 2D-TOE. PURPOSE We investigated whether the functional length of the central segments of the posterior and anterior MV leaflets (PML-P2 and AML-A2) is more reliably determined by 3D-TOE full volume datasets (3D-MPR) or orthogonal biplane-imaging (Xplane) when compared to 2D-TOE. METHODS AND RESULTS Between February 2014 and August 2015, 265 consecutive patients with moderate to severe symptomatic MR were screened. Seventy patients were judged suitable for interventional MV repair by the in-house Heart-Team. Eventually, 59 patients remained for data analysis. Inter-observer variability was lowest in 3D-MPR followed by Xplane (r = 0.92 and 0.90, p < .001 for both) and highest in Mplane (r = 0.82, p < .001). Mean functional PML-P2 lengths were similar in Xplane (12.6 ± 1.7 mm) and 3D-MPR (12.1 ± 2.0 mm), however, significantly different in 2D-TOE (10.0 ± 2.1 mm, p < .001). 2D-TOE underestimated PML-P2 length with a bias of -2.5 mm compared to Xplane and -1.95 mm compared to 3D-MPR. In contrast, functional AML-A2 length was determined similar across all methods. CONCLUSIONS Our results demonstrate the superiority of 3D-TOE over 2D-TOE for accurate MV assessment in MR, especially for the determination of the functional PML length. Erroneous MV leaflet assessment may result in inadequate therapy restriction if the MV is deemed not suitable for interventional repair.
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Affiliation(s)
- Amr Alfakhouri
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | | | | | - Christian Pfluecke
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Heda Kvakan
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Silvio Quick
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Uwe Speiser
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Akram Youssef
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Ruth H. Strasser
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
| | - Stephan Wiedemann
- Technische Universität Dresden, Heart Center Dresden University Hospital, Dresden, Germany
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37
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Incidence, Timing, Causes and Predictors of Early and Late Re-Hospitalization in Patients Who Underwent Percutaneous Mitral Valve Repair With the MitraClip System. Am J Cardiol 2018; 121:1253-1259. [PMID: 29650238 DOI: 10.1016/j.amjcard.2018.01.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/14/2018] [Accepted: 01/22/2018] [Indexed: 11/20/2022]
Abstract
The pattern and reasons for re-hospitalization (RH) after MitraClip implantation are not well characterized. A total of 322 consecutive MitraClip patients were included, with data stratified by RH status. Multivariate analyses were conducted to identify predictors of early (30-day) and late (30-day to 12-month) RH. Eighty-nine patients (27.6%) were readmitted to hospital during the study period and early RH occurred in 27%. The median time from MitraClip to RH was 99 days. RH was mostly related to cardiovascular causes (66.3%). Anemia and gastrointestinal bleeding were the most frequent noncardiovascular causes. Independent predictors of early RH were length of stay ≥3 days during the index procedure (odds ratio [OR] 4.13, 95% confidence interval [CI] 1.32 to 12.91), reduction of left ventricular ejection fraction ≥5% after MitraClip implantation (OR 4.88, 95% CI 1.36 to 18.91), and severe systolic pulmonary artery pressure ≥60 mm Hg at discharge (OR 3.72, 95% CI 1.23 to 11.26). Conversely, the independent predictors of late RH were device failure (OR 4.02, 95% CI 1.22 to 13.25) and systolic pulmonary artery pressure ≥60 mm Hg at discharge (OR 2.34, 95% CI 1.01 to 5.44). In patients with early RHs, survival was significantly worse at 12 months compared with patients with late RH and no-RH (69.3% vs 82.6% vs 86%, p <0.001). In conclusion, RH is not uncommon after MitraClip implantation and cardiovascular causes represent its most frequent etiology. Clinical and echocardiographic predictors of early and late RH can be identified at discharge. Early RH carries a worse prognosis than late RH.
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38
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Grasso C, Buccheri S, Popolo Rubbio A, Di Salvo ME, Scandura S, Mangiafico S, Immè S, Castania G, Barbanti M, Capranzano P, Capodanno D, Tamburino C. Feasibility and Outcomes of Repeat Percutaneous Edge-to-Edge Mitral Valve Repair Procedures in Patients at High Risk for Surgery. JACC Cardiovasc Interv 2018; 11:818-820. [PMID: 29673518 DOI: 10.1016/j.jcin.2017.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 11/16/2022]
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Kliger C. Editorial: Just clip it, then ReClip it again: Expanding populations for transcatheter mitral repair and options for recurrent mitral regurgitation. J Interv Cardiol 2018; 31:91-93. [PMID: 29430784 DOI: 10.1111/joic.12471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Chad Kliger
- Lenox Hill Hospital, Northwell Health, Director, Valve and Structural Heart Center, Department of Cardiothoracic Surgery, New York, New York
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40
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Kreidel F, Alessandrini H, Wohlmuth P, Schmoeckel M, Geidel S. Is Surgical or Catheter-based Interventions an Option After an Unsuccessful Mitral Clip? Semin Thorac Cardiovasc Surg 2018; 30:152-157. [DOI: 10.1053/j.semtcvs.2018.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/11/2022]
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41
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Hachinohe D, Latib A, Agricola E, Colombo A. Repeat MitraClip for early recurrent mitral regurgitation. Catheter Cardiovasc Interv 2017; 92:611-616. [PMID: 29280535 DOI: 10.1002/ccd.27460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/19/2017] [Accepted: 11/26/2017] [Indexed: 11/06/2022]
Abstract
Treatment for recurrent mitral regurgitation (MR) after MitraClip therapy remains a challenging issue. This study reports the efficacy of repeat MitraClip therapy for recurrent MR during the early phase after the index MitraClip procedure. We present a case series of four consecutive patients who underwent repeat MitraClip procedures for severe recurrent MR during the early phase. Partial clip detachment (PCD) was the suspected cause of recurrent MR in these cases. All patients received additional clip(s). PCD could be stabilized and MR grade improved in all cases compared with that before the second procedure. Repeat MitraClip procedures for recurrent MR due to PCD are feasible during the early phase. However, patients having PCD with paracommissural MR may not be good candidates for repeat MitraClip.
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Affiliation(s)
- Daisuke Hachinohe
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Eustachio Agricola
- Non-invasive Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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42
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Initial Slovenian experience with MitraClip therapy. Wien Klin Wochenschr 2017; 130:211-219. [DOI: 10.1007/s00508-017-1295-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
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43
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Curio J, Reinthaler M, Kasner M, Al-Hindwan HSA, Baeckemo-Johansson J, Neumann T, Jacobs S, Lauten A, Landmesser U. Repeated MitraClip procedure in patients with recurrent MR after a successful first procedure: Limitations and outcome. J Interv Cardiol 2017; 31:83-90. [DOI: 10.1111/joic.12457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jonathan Curio
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | - Markus Reinthaler
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
- Helmholtz Institution Geesthacht; Campus Teltow; Berlin Germany
| | - Mario Kasner
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | | | | | - Tim Neumann
- Department of Anaesthetics; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | - Stephan Jacobs
- Department of Cardiothoracic Surgery; German Heart Center Berlin; Berlin Germany
| | - Alexander Lauten
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
| | - Ulf Landmesser
- Department of Cardiology; Campus Benjamin Franklin; Charité Berlin; Berlin Germany
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Grasso C, Buccheri S, Capodanno D, Popolo Rubbio A, Di Salvo ME, Scandura S, Mangiafico S, Salerno T, Cannata S, Dezio V, Castania G, Barbanti M, Capranzano P, Tamburino C. Strategies and Outcomes of Repeat Mitral Valve Interventions after Failed MitraClip Therapy. Cardiology 2017; 137:114-120. [PMID: 28324874 DOI: 10.1159/000460240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Abstract
Percutaneous mitral valve repair (PMVR) with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) is a valid therapeutic option for patients with severe mitral regurgitation (MR) deemed to be at high or prohibitive surgical risk. Despite the reassuring data on efficacy and long-term durability of the procedure, the proportion of patients with residual or relapsing severe MR after MitraClip therapy is not negligible. In light of the detrimental prognostic impact of severe MR, repeat interventions are increasingly performed in clinical practice using different techniques. In high-risk settings, percutaneous procedures have proven to be effective and safe at reducing MR. Building on this, we sought to summarize the current landscape and clinical experience of reinterventions after failed MitraClip therapy, so as to assist physicians facing the clinical hurdle of proper treatment management after failed PMVR.
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Affiliation(s)
- Carmelo Grasso
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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Patzelt J, Zhang Y, Magunia H, Jorbenadze R, Droppa M, Ulrich M, Cai S, Lausberg H, Walker T, Wengenmayer T, Rosenberger P, Schreieck J, Seizer P, Gawaz M, Langer HF. Immediate increase of cardiac output after percutaneous mitral valve repair (PMVR) determined by echocardiographic and invasive parameters: Patzelt: Increase of cardiac output after PMVR. Int J Cardiol 2017; 236:356-362. [PMID: 28185701 DOI: 10.1016/j.ijcard.2016.12.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. METHODS 101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe). RESULTS All patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p<0.001). Furthermore, pulmonary artery systolic pressure (PASP) showed a significant decrease after PMVR (47.6±16.1 before, 44.7±15.5mmHg after, p=0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p=0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots. CONCLUSIONS CO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.
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Affiliation(s)
- Johannes Patzelt
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Yingying Zhang
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Rezo Jorbenadze
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Michal Droppa
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Miriam Ulrich
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Shanglang Cai
- University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China
| | - Henning Lausberg
- University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Walker
- University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology, Heart Center Freiburg University, 79106 Freiburg im Breisgau, Germany
| | - Peter Rosenberger
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
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Carrasco-Chinchilla F, Rodríguez-Bailón I, Briales JA, Domínguez-Franco A, Muñoz-García A, deTeresa-Galván E, Hernández-García JM. Mitral annuloplasty ring and two MitraClip® devices: Quintuple diastolic filling orifice. Int J Cardiol 2016; 203:182-3. [PMID: 26512834 DOI: 10.1016/j.ijcard.2015.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
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Rogers JH, Smith T. Repeat MitraClip Procedures. JACC Cardiovasc Interv 2015; 8:1490-1492. [DOI: 10.1016/j.jcin.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
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