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Silaschi M, Cattelaens F, Alirezaei H, Vogelhuber J, Sommer S, Sugiura A, Schulz M, Tanaka T, Sudo M, Zimmer S, Nickenig G, Weber M, Bakhtiary F, Wilde N. Transcatheter Edge-to-Edge Mitral Valve Repair versus Minimally Invasive Mitral Valve Surgery: An Observational Study. J Clin Med 2024; 13:1372. [PMID: 38592259 PMCID: PMC10932335 DOI: 10.3390/jcm13051372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Minimally invasive mitral valve surgery (MIC-MVS) has been established as preferred treatment of mitral regurgitation (MR), but mitral transcatheter edge-to-edge valve repair (M-TEER) is routinely performed in patients at high surgical risk and is increasingly performed in intermediate risk patients. Methods: From 2010 to 2021, we performed 723 M-TEER and 123 isolated MIC-MVS procedures. We applied a sensitivity analysis by matching age, left ventricular ejection fraction (LVEF), EuroSCORE II and etiology of MR. Results: Baseline characteristics showed significant differences in the overall cohort (p < 0.01): age 78.3 years vs. 61.5 years, EuroSCORE II 5.5% vs. 1.3% and LVEF 48.4% vs. 60.4% in M-TEER vs. MIC-MVS patients. Grade of MR at discharge was moderate/severe in 24.5% (171/697) in M-TEER vs. 6.5% (8/123) in MIC-MVS (p < 0.01). One-year survival was 91.5% (552/723) in M-TEER vs. 97.6% (95/123) in MIC-MVS (p = 0.04). A matching with 49 pairs (n = 98) showed comparable survival during follow-up, but a numerically higher mean mitral valve gradient of 4.1 mmHg (95% CI: 3.6-4.6) vs. 3.4 mmHg (95% CI: 3.0-3.8) in M-TEER (p = 0.04). Conclusions: Patients undergoing M-TEER had lower one-year survival than MIC-MVS, but differences disappeared after matching. Reduction in MR was less effective in M-TEER patients and postprocedural mitral valve gradients were higher.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Franca Cattelaens
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Hossien Alirezaei
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Johanna Vogelhuber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Susanne Sommer
- Department of Cardiac Surgery, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany;
| | - Atsushi Sugiura
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Max Schulz
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Mitsumasa Sudo
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Marcel Weber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Nihal Wilde
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
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Du Y, Han H, Zhang T, Shen H, Han W, Jia S, Yu Y, Guo Y, Wang Z, Liu Y, Shi D, Zhou Y. Prognosis of Elevated Mitral Valve Pressure Gradient After Transcatheter Edge-to-Edge Repair: Systematic Review and Meta-Analysis. Curr Probl Cardiol 2024; 49:102095. [PMID: 37778430 DOI: 10.1016/j.cpcardiol.2023.102095] [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: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Elevation in mitral valve pressure gradient (MVPG) after mitral valve transcatheter edge-to-edge repair (M-TEER) is common, however, evidence on its prognosis is scarce and debatable. Thus, this study aims to investigate the impact of increased MVPG after M-TEER on outcomes. Studies reporting the associations between the elevated MVPG after M-TEER and outcomes were identified in a systematic search of published literatures. Associations were pooled by meta-analysis using a random-effects model. The primary outcome was the composite of all-cause mortality and heart failure (HF) hospitalization. Seven observational studies with 2,730 patients (mean age, 77.7 ± 9.3 years; male, 64.4%; functional mitral regurgitation [MR], 65.2%) were eligible for the present analysis. M-TEER was performed entirely using the MitraClip system (Abbott), followed by 29.7% of patients having increased MVPG. Elevated postprocedural MVPG was not associated with a higher risk of the primary outcome, compared to low MVPG [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.95-1.58; p = 0.12; I2 = 53.5%). However, the prognosis of elevated MVPG was observed in degenerative MR patients (HR = 1.37; 95% CI 1.03-1.84; p = 0.03; I2 = 0%), whereas not in functional MR patients. Patients with low MVPG + high residual MR had a higher risk of the primary outcome than those with high MVPG + low residual MR after M-TEER (HR = 1.50; 95% CI 1.10-2.03; p = 0.01; I2 = 13%). In conclusion, elevated MVPG seems to predict adverse outcomes mainly in patients with degenerative MR. Future studies are needed to prove these findings.
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Affiliation(s)
- Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Hongya Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Tianhao Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Wei Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Shuo Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yi Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yonghe Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yuyang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Dongmei Shi
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China.
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3
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Wilde N, Tanaka T, Vij V, Sugiura A, Sudo M, Eicheler E, Silaschi M, Vogelhuber J, Bakhtiary F, Nickenig G, Weber M, Zimmer S. Characteristics and outcomes of patients undergoing transcatheter mitral valve replacement with the Tendyne system. Clin Res Cardiol 2024; 113:1-10. [PMID: 36645506 PMCID: PMC10808407 DOI: 10.1007/s00392-023-02155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) has emerged as alternative to transcatheter edge-to-edge repair (TEER) for treatment of mitral regurgitation (MR); however, the role of TMVR with the Tendyne system among established treatments of MR is not well defined. We assessed characteristics and outcomes of patients treated with the Tendyne system in the current clinical practice. METHODS We reviewed patients who underwent cardiac computed tomography and were judged eligible for the Tendyne system. RESULTS A total of 63 patients were eligible for TMVR with the Tendyne system. Of these, 17 patients underwent TMVR, and 46 were treated by TEER. Patients treated with the Tendyne system were more likely to have a high transmitral pressure gradient and unsuitable mitral valve morphology for TEER than those treated with TEER. TMVR with the Tendyne system reduced the severity of MR to less than 1 + in 94.1% of the patients at discharge and achieved a greater reduction in left ventricular (LV) end-diastolic volume at the 30-day follow-up compared with TEER. In contrast, patients treated with the Tendyne system had a higher 30-day mortality than those treated with TEER, while the mortality between 30 days and one year was comparable between Tendyne and TEER. CONCLUSIONS Among patients eligible for the Tendyne system, approximately a quarter of the patients underwent TMVR with the Tendyne system, which led substantial reduction of MR and LV reverse remodeling than TEER. In contrast, the 30-day mortality rate was higher after TMVR with the Tendyne compared to TEER.
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Affiliation(s)
- Nihal Wilde
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Vivian Vij
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Eva Eicheler
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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von Stein P, Besler C, Riebisch M, Al‐Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Friedrichs K, Öztürk C, Baldus S, Guthoff H, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Horn P, Kelm M, Rudolph V, von Bardeleben R, Nef HM, Luedike P, Lurz P, Pfister R, Mauri V. One-Year Outcomes According to Mitral Regurgitation Etiology Following Transcatheter Edge-to-Edge Repair With the PASCAL System: Results From a Multicenter Registry. J Am Heart Assoc 2023; 12:e031881. [PMID: 38084735 PMCID: PMC10863793 DOI: 10.1161/jaha.123.031881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND We previously reported procedural and 30-day outcomes of a German early multicenter experience with the PASCAL system for severe mitral regurgitation (MR). This study reports 1-year outcomes of mitral valve transcatheter edge-to-edge repair with the PASCAL system according to MR etiology in a large all-comer cohort. METHODS AND RESULTS Clinical and echocardiographic outcomes up to 1-year were investigated according to MR etiology (degenerative [DMR], functional [FMR], or mixed [MMR]) in the first 282 patients with symptomatic MR 3+/4+ treated with the PASCAL implant at 9 centers in 2019. A total of 282 patients were included (33% DMR, 50% FMR, 17% MMR). At discharge, MR reduction to ≤1+/2+ was achieved in 58%/87% of DMR, in 75%/97% of FMR, and in 78%/98% of patients with MMR (P=0.004). MR reduction to ≤1+/2+ was sustained at 30 days (50%/83% DMR, 67%/97% FMR, 74%/100% MMR) and at 1 year (53%/78% DMR, 75%/97% FMR, 67%/91% MMR) with significant differences between etiologies. DMR patients with residual MR 3+/4+ at 1-year had at least complex valve morphology in 91.7%. Valve-related reintervention was performed in 7.4% DMR, 0.7% FMR, and 0.0% MMR (P=0.010). At 1-year, New York Heart Association Functional Class was significantly improved irrespective of MR etiology (P<0.001). CONCLUSIONS In this large all-comer cohort, mitral valve transcatheter edge-to-edge repair with the PASCAL system was associated with an acute and sustained MR reduction at 1-year in all causes. However, in patients with DMR, MR reduction was less pronounced, reflecting the high incidence of complex or very complex anatomies being referred for mitral valve transcatheter edge-to-edge repair.
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Affiliation(s)
- Philipp von Stein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Christian Besler
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Osamah Al‐Hammadi
- Medizinische Klinik I, Department of CardiologyUniversity of GiessenGermany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology IUniversity Medical Center MainzMainzGermany
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St.‐Johannes‐HospitalDortmundGermany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I der Ludwig‐Maximilians‐Universität MünchenMunichGermany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Henning Guthoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I der Ludwig‐Maximilians‐Universität MünchenMunichGermany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St.‐Johannes‐HospitalDortmundGermany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical FacultyUniversity DüsseldorfDuesseldorfGermany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical FacultyUniversity DüsseldorfDuesseldorfGermany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | | | - Holger M. Nef
- Medizinische Klinik I, Department of CardiologyUniversity of GiessenGermany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Philipp Lurz
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Victor Mauri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
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5
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Tsuda M, Egami Y, Kawanami S, Nishino M. Inverted Grasping Technique for Degenerative Mitral Regurgitation With Myxomatous Leaflet in Mitral Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2023; 16:2923-2926. [PMID: 38092497 DOI: 10.1016/j.jcin.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
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6
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Alqeeq BF, Al-Tawil M, Hamam M, Aboabdo M, Elrayes MI, Leick J, Zeinah M, Haneya A, Harky A. Transcatheter edge-to-edge repair in mitral regurgitation: A comparison of device systems and recommendations for tailored device selection. A systematic review and meta-analysis. Prog Cardiovasc Dis 2023; 81:98-104. [PMID: 37924965 DOI: 10.1016/j.pcad.2023.10.008] [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: 10/29/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair (M-TEER) is a minimally invasive method for the treatment of mitral regurgitation (MR) in patients with prohibitive surgical risks. The traditionally used device, MitraClip, showed both safety and effectiveness in M-TEER. PASCAL is a newer device that has emerged as another feasible option to be used in this procedure. METHODS We searched for observational studies that compared PASCAL to MitraClip devices in M-TEER. The electronic databases searched for relevant studies were PubMed/MEDLINE, Scopus, and Embase. The primary outcomes were technical success and the grade of MR at follow-up. Secondary outcomes included all-cause mortality, bleeding, device success and reintervention. RESULTS Technical success (PASCAL: 96.5% vs MitraClip: 97.6%, p = 0.24) and MR ≤ 2 at 30-day follow-up (PASCAL: 89.4vs MitraClip 89.9%, p = 0.51) were comparable between both groups. Both devices showed similar outcomes including all-cause mortality (RR: 0.68 [0.34, 1.38]; P = 0.28), major bleeding (RR: 1.87 [0.68, 5.10]; P = 0.22) and reintervention (RR: 1.02 [0.33, 3.16]; P = 0.97). Device success was more frequent with PASCAL device (PASCAL: 86% vs MitraClip 68.5%; P = 0.44), however, the results did not reach statistical significance. CONCLUSION Clinical outcomes of PASCAL were comparable to those of MitraClip with no significant difference in safety and effectiveness. The choice between MitraClip and PASCAL devices should be guided by various factors, including mitral valve anatomy, etiology of regurgitation, and device-specific characteristics.
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Affiliation(s)
- Basel F Alqeeq
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Mohammed Hamam
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Mohammad Aboabdo
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Mohammed I Elrayes
- Department of Pediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Juergen Leick
- Department of Cardiology, Heart Center Trier, Trier, Germany
| | - Mohamed Zeinah
- School of Medicine, Ain Shams University, Cairo, Egypt; Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Assad Haneya
- Department of Cardiac and Thoracic Surgery, Heart Center Trier, Trier, Germany
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
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7
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Izumi Y, Kagiyama N, Maekawara S, Terada M, Higuchi R, Saji M, Takamisawa I, Nanasato M, Isobe M. Transcatheter edge-to-edge mitral valve repair with extended clip arms for ventricular functional mitral regurgitation. J Cardiol 2023; 82:240-247. [PMID: 37116648 DOI: 10.1016/j.jjcc.2023.04.014] [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: 12/14/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The new sizing options of the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) with extended clip arms were recently developed. Its applicability and effectiveness for ventricular functional mitral regurgitation (VFMR) are yet to be investigated. METHODS We retrospectively reviewed consecutive patients with symptomatic VFMR who underwent transcatheter edge-to-edge repair between 2018 and 2022 at the Sakakibara Heart Institute. Pre- and post-procedural mitral valve morphologies were assessed using three-dimensional transesophageal echocardiography. RESULTS In a total of 104 VFMR patients, the posterior mitral leaflet length was 12.8 ± 2.8 mm and 92 % was indicative of the extended arm (≥9 mm). Although baseline VFMR was more severe in the patients treated with the extended arms (n = 35, XT group) than the patients treated with the standard arms (n = 69, NT group), the decrease in VFMR was greater in the XT group (delta three-dimensional vena contracta area - 43 ± 33 mm2 vs. -31 ± 22 mm2, p = 0.030) and residual VFMR was similar between the groups, with a significantly greater reduction in the mitral annulus anterior-posterior diameter (-4.9 ± 2.2 mm vs -3.1 ± 2.1 mm, p < 0.001) and mitral annulus area in the XT group. The use of extended arms was independently associated with shorter procedure time (81 ± 26 min vs 108 ± 41 min) after adjustment for device generation and the number of clips (p = 0.017). CONCLUSIONS Most VFMR patients had enough leaflet lengths for transcatheter edge-to-edge repair using the MitraClip with the extended arms, which was associated with shorter procedure time and a greater decrease in the mitral annular size.
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Affiliation(s)
- Yuki Izumi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | | | - Mai Terada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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8
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Tusa M, Popolo Rubbio A, Sisinni A, Borin A, Barletta M, Grasso C, Adamo M, Denti P, Giordano A, De Marco F, Bartorelli AL, Montorfano M, Godino C, Citro R, De Felice F, Mongiardo A, Monteforte I, Villa E, Petronio AS, Giannini C, Munafò AR, Crimi G, Tarantini G, Testa L, Tamburino C, Bedogni F. Prognostic Significance of Flail Mitral Leaflet in Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation. Am J Cardiol 2023; 200:178-187. [PMID: 37331223 DOI: 10.1016/j.amjcard.2023.05.045] [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: 02/16/2023] [Revised: 04/17/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023]
Abstract
Despite the growing experience with MitraClip in the broad spectrum of mitral regurgitation (MR), limited data are available regarding the independent prognostic role on survival of different mitral regurgitation etiology subtypes. We sought to evaluate the impact of flail leaflet etiology in a large series of patients with primary MR (PMR) who underwent MitraClip treatment. The study included 588 patients with significant PMR from the multicenter GIOTTO (Italian Society of Interventional Cardiology [GIse] registry Of Transcatheter treatment of mitral valve regurgitaTiOn), stratified into 2 groups according to MR etiology: flail+ (n = 300) and flail- (n = 288). The primary end point was a composite of cardiac death and first rehospitalization for heart failure (HF). To account for the baseline differences, patients were propensity score-matched 1:1. Flail leaflet etiology was present in about a half of the patients. Acute technical success was achieved in 98% of the overall cohort, with no significant differences between the study groups (p = 0.789). At the 2-year Kaplan-Meier analysis, the primary end point occurred in 13% of flail+ patients compared with 23% in flail- (p = 0.009). The flail+ group presented lower rates of both cardiac death and rehospitalization for HF, whereas a similar overall death rate was observed between the groups. A multivariate Cox regression analysis identified flail leaflet etiology as an independent predictor of favorable outcome in terms of the primary end point (hazard ratio 0.141, 95% confidence interval 0.049 to 0.401, p <0.001). After propensity score matching, flail+ patients had confirmed lower rates of cardiac mortality and rehospitalization for HF but similar rates of overall death. In conclusion, flail leaflet-related etiology was common in patients with PMR who underwent MitraClip treatment and was an independent predictor of midterm favorable clinical outcomes.
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Affiliation(s)
- Maurizio Tusa
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Antonio Sisinni
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Andrea Borin
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castelvolturno, Italy
| | - Federico De Marco
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Rodolfo Citro
- University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | | | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Raffaele Munafò
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Gabriele Crimi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Luca Testa
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy
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9
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Long Y, Li W, Chen S, Li M, Hou S, Pan C, Zhou D, Pan W, Ge J. Novel arm-width-expandable transcatheter edge-to-edge repair system: Preclinical experiment and first-in-human study. Catheter Cardiovasc Interv 2023. [PMID: 37471710 DOI: 10.1002/ccd.30758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/03/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The ValveClasp system is a novel transcatheter edge-to-edge repair (TEER) device with an arm-width-expandable clip that allows treatment of patients with only one clip more frequently. OBJECTIVES This study aimed to evaluate the feasibility and safety of a novel TEER device in porcine models and patients. METHODS Fourteen young adult pigs were enrolled. A clip with an expanded arm was implanted under epicardial echocardiography and fluoroscopy guidance. Five patients with at least moderate-to-severe mitral regurgitation underwent TEER using the ValveClasp system to test the safety and effectiveness of the device. RESULTS The device success rate was 100% (14/14) in the animal experiments, and all clips were deployed at the A2P2 segments, forming a double-orifice mitral valve. Gross observations on day 180 showed a wide and continuous tissue bridge between the leaflets. The acute procedural success rate was 100% (5/5). Only one clip was required in all patients, and all achieved effective postoperative endpoints (grade ≤2+). During 30-day follow-up, no adverse events occurred. All patients' vena Contracta width (from 8.04 0.71 mm to 3.84 ± 1.18 mm, p = 0.012), mitral regurgitation area (from 12.75 ± 3.13 cm2 to 3.50 ± 1.66 cm2 , p = 0.008), and left ventricular end diastolic diameter (from 52.00 ± 2.92 mm to 46.00 ± 3.08 mm, p = 0.040) were considerably decreased, without obvious mitral stenosis. CONCLUSIONS The novel arm-width-expandable ValveClasp device is safe for TEER for treating severe mitral regurgitation.
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Affiliation(s)
- Yuliang Long
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Mingfei Li
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shiqiang Hou
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
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10
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Sawaya FJ, Francis J. Transcatheter Edge-to-Edge Repair: A Promising or Last Resort Technique for Carpentier Class IIIa Mitral Regurgitation? JACC Case Rep 2023; 18:101907. [PMID: 37545686 PMCID: PMC10401054 DOI: 10.1016/j.jaccas.2023.101907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Fadi J. Sawaya
- Division of Interventional and Structural Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jamil Francis
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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11
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Alkhouli M, Windecker S. Mitral TEER With Fourth-Generation Devices: A New Era of Possibilities? JACC Cardiovasc Interv 2023; 16:1486-1489. [PMID: 37380230 DOI: 10.1016/j.jcin.2023.05.021] [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: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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12
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Srinivasan A, Brown J, Ahmed H, Daniel M. PASCAL repair system for patients with mitral regurgitation: A systematic review. Int J Cardiol 2023; 376:108-114. [PMID: 36681242 DOI: 10.1016/j.ijcard.2023.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/18/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Transcatheter edge-to-edge repair (TEER) of the mitral valve has emerged as the standard treatment for patients with mitral regurgitation (MR) with high surgical risk. Even though MitraClip is widely used, the novel PASCAL device system offers distinct technical features. We aim to study the safety and efficacy of the PASCAL repair system in clinically significant MR. METHODS PubMed, Medline, Cochrane Central Register of Controlled Trials, and EMBASE were searched for articles published from August 2016 until June 2022 to identify studies that investigated the safety and efficacy of PASCAL for patients with degenerative, functional and mixed MR. Primary performance endpoints were technical, device, and procedural successes. Primary safety endpoint was composite 30 day major adverse events (MAE). Secondary endpoints were MR grade at discharge and 30 days, 30 day postprocedural NYHA functional class, left ventricular ejection fraction (LVEF), change in 6-min walk distance (6MWD), 30-day and 12-month all-cause mortality. RESULTS We included twelve retrospective and prospective observational studies and one randomized controlled study consisting of 1028 patients with severe, symptomatic MR (NYHA III-IV: 84.0%, MR ≥ 3+: 99.7%) and high surgical risk (mean logistic EuroSCORE of 16.4).Technical success was 95.7%, procedural success was 95.2%, and device success was 86.1% relative to the weighted average. MR grade was ≤2+ in 94.7% of patients at discharge and 94.0% patients at 30-day follow-up. Mean 30-day and 12-month mortality after device implantation were 4.54% and 12.2%. CONCLUSION The PASCAL repair system appears to be a safe and effective therapeutic option to treat severe, symptomatic MR in high surgical risk patients.
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Affiliation(s)
- Aswin Srinivasan
- Department of Internal Medicine, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America.
| | - Jonathan Brown
- Department of Internal Medicine, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America
| | - Haris Ahmed
- Department of Internal Medicine, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America
| | - Michael Daniel
- Department of Interventional and Structural Cardiology, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America
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13
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Russo G, Taramasso M. "Mind the Grasp": Preventing Single Leaflet Device Attachment and Clip Embolization in Transcatheter Edge-to-Edge Procedure. JACC Case Rep 2023; 9:101747. [PMID: 36909268 PMCID: PMC9998716 DOI: 10.1016/j.jaccas.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, Rome, Italy
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14
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Hungerford S, Bart N, Song N, Jansz P, Dahle G, Duncan A, Hayward C, Muller D. Thirty-day and one-year outcomes following transcatheter mitral valve edge-to-edge repair versus transapical mitral valve replacement in patients with left ventricular dysfunction. ASIAINTERVENTION 2023; 9:78-86. [PMID: 36936096 PMCID: PMC10020820 DOI: 10.4244/aij-d-22-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/25/2022] [Indexed: 03/16/2023]
Abstract
Background A comparison of 30-day and 1-year clinical outcomes in patients with pre-existing left ventricular (LV) dysfunction undergoing transcatheter mitral valve edge-to-edge repair (TEER) or transcatheter transapical mitral valve replacement (TMVR) has not previously been reported. Aims We aimed to compare 30-day and 1-year rates of all-cause and cardiovascular mortality as well as rehospitalisation for heart failure (HFH). Methods All patients with severe (≥3+) symptomatic mitral regurgitation (MR) and an LV ejection fraction ≤50% who underwent TEER or TMVR over a 5-year period were evaluated. Results Ninety-six patients (50 TEER, age 80±9 years, 70% secondary MR and 46 TMVR, age 72±9 years, 91% secondary MR) were studied. Baseline demographic and transthoracic echocardiogram characteristics were well-matched, with the exception of age (TEER 80±9 vs TMVR 72±9; p=0.01). Successful device implantation occurred in 96% of TEER patients and 97.8% of TMVR patients. Ninety-two percent of TEER patients had ≤2+MR predischarge, whilst no TMVR patient had ≥1+MR (p<0.01). No significant difference in the combined endpoint of 30-day all-cause mortality or HFH was observed (p>0.05). At 1 year, freedom from all-cause mortality and HFH was 79.2% across the entire study population but was significantly higher in patients undergoing TEER (TEER: n=45 [90%] hazard ratio 11.26, 95% confidence interval [CI]: 10.59-11.93 vs TMVR: n=39 [67.4%] 95% CI: 10.09-11.33; p=0.008). Conclusions Despite comparable rates of successful device implantation, MR reduction, and 30-day all-cause mortality/HFH, TEER patients had lower all-cause mortality and HFH rates at 1 year.
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Affiliation(s)
- Sara Hungerford
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nicole Bart
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Ning Song
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Paul Jansz
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Oslo University, Oslo, Norway
| | - Alison Duncan
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Christopher Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | - David Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School Faculty of Medicine, The University of New South Wales, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
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15
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Scotti A, Latib A. MitraClip evolution: EXPANDed options for a bespoke treatment. Eur J Heart Fail 2023; 25:422-424. [PMID: 36799514 DOI: 10.1002/ejhf.2801] [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: 01/21/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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16
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Stolz L, Braun D, Higuchi S, Orban M, Doldi PM, Stocker TJ, Weckbach LT, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Transcatheter edge-to-edge mitral valve repair in mitral regurgitation: current status and future prospects. Expert Rev Med Devices 2023; 20:99-108. [PMID: 35791872 DOI: 10.1080/17434440.2022.2098013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mitral regurgitation (MR) is associated with substantial morbidity and mortality. Within the past 15 years, mitral valve edge-to-edge repair (M-TEER) has developed from an experimental approach to a guideline-recommended, safe, and effective treatment option for patients with severe primary or secondary mitral regurgitation. AREAS COVERED This review covered relevant publications of M-TEER and summarizes the development of M-TEER devices within the last 15 years. It outlines anatomical challenges which drove the evolution of M-TEER devices, provides an overview about the current state of clinical application and research, and offers an outlook into the future of transcatheter mitral valve treatment. EXPERT OPINION The development and refinement of new M-TEER device generations offer the possibility to treat a wide range of mitral valve anatomies. Choosing the best device for the individual anatomic properties of the patients and considering comorbidities is the key to maximized MR reduction, minimalized complication rates, and thus optimized postinterventional prognosis. Independent from prognostic implications, quality of life has become an important patient-centered outcome that can be improved by M-TEER in virtually all patients treated.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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17
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Daubenspeck DK. Assessment of the MitraClip Procedure: Reassessing the Goals. J Cardiothorac Vasc Anesth 2023; 37:823-826. [PMID: 36842939 DOI: 10.1053/j.jvca.2023.01.027] [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: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Danisa K Daubenspeck
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
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18
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Hausleiter J, Stocker TJ, Adamo M, Karam N, Swaans MJ, Praz F. Mitral valve transcatheter edge-to-edge repair. EUROINTERVENTION 2023; 18:957-976. [PMID: 36688459 PMCID: PMC9869401 DOI: 10.4244/eij-d-22-00725] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/04/2022] [Indexed: 01/21/2023]
Abstract
Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER.
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Affiliation(s)
- Jörg Hausleiter
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy
| | - Nicole Karam
- Paris Cardiovascular Research Center, INSERM and Cardiology Department, European Hospital Georges Pompidou, University of Paris, Paris, France
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
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19
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Orban M, Rottbauer W, Williams M, Mahoney P, von Bardeleben RS, Price MJ, Grasso C, Lurz P, Zamorano JL, Asch FM, Maisano F, Kar S, Hausleiter J. Transcatheter edge-to-edge repair for secondary mitral regurgitation with third-generation devices in heart failure patients - results from the Global EXPAND Post-Market study. Eur J Heart Fail 2023; 25:411-421. [PMID: 36597850 DOI: 10.1002/ejhf.2770] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
AIMS Mitral valve transcatheter edge-to-edge repair is a guideline-recommended treatment option for patients with secondary mitral regurgitation (SMR). The purpose of this analysis was to report contemporary real-world outcomes in SMR patients treated with third-generation MitraClip systems. METHODS AND RESULTS EXPAND is a prospective, multicentre, international, single-arm study with 1041 patients treated for mitral regurgitation (MR) with MitraClip NTR/XTR, with 30-day and 1-year follow-up. All echocardiograms were analysed by an independent echocardiographic core lab. Study outcomes included procedural outcomes, durability of MR reduction, and major adverse events including all-cause mortality and heart failure hospitalizations (HFH). A subgroup of 413 symptomatic patients (age 74.7 ± 10.1 years, 58% male) with severe SMR were included. MR reduction to MR ≤ 1+ and MR ≤ 2+ was achieved in 93.0% and 98.5% of patients, respectively, which was sustained at 1-year follow-up. All-cause mortality was 17.7% at 1-year- follow-up, and the combined endpoint of all-cause mortality or first HFH occurred in 34% of patients. This combined endpoint was significantly less frequently observed in MR ≤ 1+ patients (Kaplan-Maier estimates: 29.7% vs. 69.6% for MR ≤ 1+ vs. MR ≥ 2 +; p < 0.0001). New York Heart Association (NYHA) functional class improved significantly from baseline (NYHA ≤ II: 17%) to 1-year follow-up (NYHA ≤ II: 78%) (p < 0.0001). While MR reduction was comparable between NTR-only vs. XTR-only treated patients, less XTR clips were required for achieving MR reduction. CONCLUSIONS Under real-world conditions, optimal sustained MR reduction to MR ≤ 1+ was achieved in a high percentage of patients with third-generation MitraClip, which translated into symptomatic improvement and low event rates. These results appear to be comparable with recent randomized clinical trials.
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Affiliation(s)
- Mathias Orban
- Medizinische Klinik I, Ludwig-Maximilians Universität, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Mathew Williams
- Heart Valve Center, New York University Langone Health, New York, NY, USA
| | - Paul Mahoney
- Sentera Heart and Valve and Structural Disease Center, Norfolk, VA, USA
| | | | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA
| | - Carmelo Grasso
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | | | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC, USA
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA, USA
| | - Jörg Hausleiter
- Medizinische Klinik I, Ludwig-Maximilians Universität, Munich, Germany.,Munich Heart Alliance, Partner site German Centre for Cardiovascular Research (DZHK), Munich, Germany
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20
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Transcatheter edge to edge repair using the ease-of-use valve clamp system for functional mitral regurgitation: a primary report. Surg Today 2023; 53:90-97. [PMID: 36088621 DOI: 10.1007/s00595-022-02559-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The ValveClamp system is a novel edge-to-edge mitral valve repair system designed for the ease of operation. We report the outcomes of our initial experience of treating functional mitral regurgitation (MR) with the ValveClamp system. METHODS The subjects of this study were patients with symptomatic functional MR despite standard medical therapy, who were treated with transapical ValveClamp implantation. The patients were divided into an atrial functional mitral regurgitation (AFMR) group and a ventricular functional mitral regurgitation (VFMR) group. Clinical and echocardiographic outcomes were evaluated at baseline and then at the 3-month follow up. RESULTS Twelve patients, with a median age of 71 years (range 65-78 years), were assigned to the AFMR group (n = 5) or the VFMR group (n = 7). The device implantation rate was 100%, and 10 (83.3%) patients required implantation of only one clamp. The catheter time was less than 10 min in half of the patients, the fastest time being 5 min. There were no procedure-related complications. At the 3-month follow up, all patients were free from all-cause mortality, surgery, and rehospitalization. MR improved to ≤ 2 + in all 12 patients with MR grade 3 + or 4 + at baseline, (100%) and to ≤ 1 + in 9 of these patients (75%), with a low-pressure gradient. The left atrial diameter and the left ventricular end diastolic diameter decreased significantly in both the AFMR and VFMR groups. The left ventricular eject fraction at the 3-month follow up showed a rising trend in both the AFMR and VFMR groups, whereas PASP decreased remarkably. All 12 patients with baseline NYHA functional class III/IV (100%) showed improvement of at least 1 class, and 2 of these patients (16.7%) showed improvement of at least 2 classes. CONCLUSIONS The ValveClamp system is simple and effective for transapical transcatheter edge to edge repair in patients with functional MR.
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21
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Schneider L, Markovic S, Mueller K, Felbel D, Gerçek M, Friedrichs K, Stolz L, Rudolph V, Hausleiter J, Rottbauer W, Keßler M. Mitral Valve Transcatheter Edge-to-Edge Repair Using MitraClip or PASCAL: A Multicenter Propensity Score-Matched Comparison. JACC Cardiovasc Interv 2022; 15:2554-2567. [PMID: 36543450 DOI: 10.1016/j.jcin.2022.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Since its introduction in 2003, Abbott's MitraClip (MC) has become the most established catheter-based treatment for mitral regurgitation (MR). Recent approval of Edwards Lifescience's PASCAL device has extended the field of TEER. OBJECTIVES The aim of this retrospective multicenter study was to compare the PASCAL and MC regarding procedural results and short- and long-term outcomes after mitral valve transcatheter edge-to-edge repair (TEER). METHODS Data from 3 high-volume centers were analyzed. The primary endpoint was residual MR at discharge. Secondary endpoints were technical success, MR reduction, and 30-day mortality. After 1 year, all-cause mortality and residual MR were reported. RESULTS A total of 412 patients (216 MC, 196 PASCAL) treated between 2018 and 2020 were included. A total of 184 patients (92 in each treatment group) remained after propensity score matching. The rate of baseline MR ≥3 was 98.9% in both groups (P = 1.00). Both TEER systems achieved equally high technical success rates (97.8%; P = 1.00), resulting in residual MR ≤1 in 69.6% vs 77.1% of patients (P = 0.24) and MR reduction by ≥2 grades in 83.7% vs 92.4% of patients (P = 0.13) using the MC and PASCAL, respectively. Thirty-day mortality was 1.1% in both cohorts (P = 0.98), and 1-year follow-up showed similar MR reductions (residual MR ≤1, 78.0% with MC vs 82.3% with PASCAL; P = 0.70) and comparable all-cause mortality (14.1% with MC vs 6.5% with PASCAL; P = 0.14). In multivariate regression analysis, Society of Thoracic Surgeons score independently correlated with an optimal result (MR ≤1), while device choice did not show a significant impact. CONCLUSIONS In this retrospective multicenter study, the established MC and the novel PASCAL mitral valve TEER systems were safe and offered excellent performance with comparable short- and long-term outcomes.
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Affiliation(s)
| | - Sinisa Markovic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Katharina Mueller
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Dominik Felbel
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Muhammed Gerçek
- Herz- und Diabetes Zentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Kai Friedrichs
- Herz- und Diabetes Zentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Volker Rudolph
- Herz- und Diabetes Zentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Mirjam Keßler
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany.
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22
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Sugiura A, Kavsur R, Spieker M, Iliadis C, Mauri V, Tanaka T, Goto T, Weber M, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Impact of right ventricular-pulmonary arterial coupling on clinical outcomes of tricuspid regurgitation. EUROINTERVENTION 2022; 18:852-861. [PMID: 35550286 PMCID: PMC9724878 DOI: 10.4244/eij-d-22-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In terms of pathophysiology, tricuspid regurgitation (TR) and right ventricular (RV) function are linked to each other. AIMS This study sought to evaluate RV-pulmonary artery (PA) coupling and its impact on clinical outcomes of TR in patients undergoing mitral transcatheter edge-to-edge repair (TEER). METHODS We calculated RV-PA coupling ratios in patients undergoing mitral TEER from August 2010 to March 2019 by dividing the tricuspid annular plane systolic excursion (TAPSE) by the echocardiographic estimated PA systolic pressure (PASP). TR was graded as none/trace, mild, moderate, or severe. The primary outcome was all-cause mortality or rehospitalisation within 12 months. RESULTS Among 744 patients analysed, severe TR was documented in 22.3% of patients and the mean TAPSE/PASP was 0.43±0.25. Technical success of TEER was achieved in 97.2% of participants. Severe TR vs TR ≤moderate (adjusted HR 1.92, 95% CI: 1.39-2.66) and TAPSE/PASP (adjusted HR 0.45, 95% CI: 0.22-0.93) were associated with the outcome. Patients were divided according to the TAPSE/PASP tertile. Compared to patients with TR ≤moderate, patients with severe TR had a higher event rate (TAPSE/PASP <0.30: 32.9% vs 45.1%; 0.30≤ TAPSE/PASP <0.44: 27.8% vs 41.8%; TAPSE/PASP ≥0.44: 16.0% vs 40.4%), whereas the prognostic significance of TR was attenuated in patients with reduced TAPSE/PASP (i.e., RV-PA uncoupling; interaction term p=0.03). The trends were consistent in the multivariable regression models, spline curves, and sensitivity analysis using post-interventional parameters. CONCLUSIONS RV-PA coupling affects the outcome correlation of TR in patients undergoing mitral TEER. The prognostic impact of TR is attenuated in patients with RV-PA uncoupling.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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23
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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: 0] [Impact Index Per Article: 0] [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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24
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Tanaka T, Sugiura A, Öztürk C, Vogelhuber J, Tabata N, Wilde N, Zimmer S, Nickenig G, Weber M. Transcatheter Edge-to-Edge Repair for Atrial Secondary Mitral Regurgitation. JACC Cardiovasc Interv 2022; 15:1731-1740. [DOI: 10.1016/j.jcin.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022]
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25
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Yoon SH, Makar M, Kar S, Chakravarty T, Oakley L, Sekhon N, Koseki K, Enta Y, Nakamura M, Hamilton M, Patel JK, Singh S, Skaf S, Siegel RJ, Bax JJ, Makkar RR. Prognostic Value of Increased Mitral Valve Gradient After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation. JACC Cardiovasc Interv 2022; 15:935-945. [PMID: 35512917 DOI: 10.1016/j.jcin.2022.01.281] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study sought to evaluate the prognostic value of an increased mean mitral valve pressure gradient (MVG) in patients with primary mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER). BACKGROUND Conflicting data exist regarding impact of increased mean MVG on outcomes after TEER. METHODS This study included 419 patients with primary MR (mean age 80.6 ± 10.4 years; 40.6% female) who underwent TEER. Patients were divided into quartiles (Qs) based on discharge echocardiographic mean MVG. Primary outcome was the composite endpoint of all-cause mortality and heart failure hospitalization. Secondary outcomes included all-cause mortality and the secondary composite endpoint of all-cause mortality, heart failure hospitalization, and mitral valve reintervention. RESULTS The median number of MitraClips used was 2 per patient. MR reduction ≤moderate was achieved in 407 (97.1%) patients. Mean MVG was 1.9 ± 0.3 mm Hg, 3.0 ± 0.1 mm Hg, 4.0 ± 0.1 mm Hg, and 6.0 ± 1.2 mm Hg in Q1, Q2, Q3, and Q4, respectively. There was no significant differences across quartiles in the primary outcome (15.4%, 19.6%, 22.0%, and 21.9% in Q1-Q4, respectively; P = 0.63), all-cause mortality (15.9% vs 18.6% vs 19.4% vs 17.1%, respectively; P = 0.91), and the secondary composite endpoint at 2 years (33.3% vs 29.5% vs 22.0% vs 31.6%, respectively; P = 0.37). After multivariate adjustment for baseline clinical and procedural variables, the mean MVG in Q4 compared with Q1 to Q3 was not independently associated with the primary outcome (HR: 1.22; 95% CI: 0.82-1.83; P = 0.33), all-cause mortality, and the secondary composite endpoint. CONCLUSIONS Increased mean MVG was not independently associated with adverse events after TEER in patients with primary MR.
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Affiliation(s)
- Sung-Han Yoon
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Saibal Kar
- Department of Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Tarun Chakravarty
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Luke Oakley
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Navjot Sekhon
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Keita Koseki
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yusuke Enta
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mamoo Nakamura
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michele Hamilton
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jignesh K Patel
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Siddharth Singh
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sabah Skaf
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J Siegel
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Turku University, Turku, Finland
| | - Raj R Makkar
- Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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26
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Koell B, Ludwig S, Weimann J, Waldschmidt L, Hildebrandt A, Schofer N, Schirmer J, Westermann D, Reichenspurner H, Blankenberg S, Conradi L, Lubos E, Kalbacher D. Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair. JACC Cardiovasc Interv 2022; 15:922-934. [PMID: 35512916 DOI: 10.1016/j.jcin.2021.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/18/2021] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the adverse impact of elevated postprocedural mitral valve pressure gradient (MPG) on outcome in a real-world population of patients with severe mitral regurgitation (MR) who underwent transcatheter mitral valve edge-to-edge repair (TEER). BACKGROUND TEER has become a routine treatment alternative for patients with severe MR at high surgical risk. The consequences of elevated MPG after TEER have been subject to controversial debates. METHODS All consecutive patients undergoing TEER for either severe degenerative MR (DMR) or functional MR (FMR) at a high-volume center between September 2008 and January 2020 were prospectively included and followed periodically. Postprocedural MPG by discharge transthoracic echocardiography was considered elevated at ≥5 mm Hg. The primary combined endpoint was death or heart failure rehospitalization after 5 years. RESULTS A total of 713 patients undergoing TEER (DMR, n = 265; FMR, n = 445) were included. Elevated postprocedural MPG was present in 37.0% of those with DMR (n = 98) and 22.0% of those with FMR (n = 98). In contrast to patients with FMR, 6-minute walk distance did not improve in patients with DMR with elevated MPG. Kaplan-Meier analyses did not demonstrate significant differences for the primary endpoint in patients with DMR (low vs elevated MPG, 67.3% vs 74.4%; P = 0.06) and those with FMR (78.6% vs 74.8%; P = 0.54). After adjustment, elevated MPG was an independent predictor of the primary endpoint in patients with DMR (HR: 1.59; 95% CI: 1.03-2.45; P = 0.034) but not in those with FMR (HR: 0.87; 95% CI: 0.63-1.22; P = 0.43). CONCLUSIONS Elevated postprocedural MPG is an independent predictor of adverse clinical and functional outcomes in patients with DMR but not in those with FMR.
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Affiliation(s)
- Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Annabel Hildebrandt
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Hermann Reichenspurner
- DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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27
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Pizano A, Riojas R, Ailawadi G, Smith RL, George T, Gerdisch MW, Di Eusanio M, Castillo-Sang M, Ramlawi B, Rodriguez E, Morse MA, Doolabh NS, Jessen ME, Wei L, Chu MWA, Berretta P, Cura Stura E, Salizzoni S, Rinaldi M, Kaneko T, Tang GHL, Chikwe J, Roach A, Trento A, Badhwar V, Nguyen TC. Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:42-49. [PMID: 35225065 DOI: 10.1177/15569845211070568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. Methods: International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020. Subgroups were stratified by the number of devices implanted (≤1 vs >1), as well as time interval from TEER to surgery (≤1 year vs >1 year). Results: A total of 56 patients across 13 centers were included with a mean age of 73 ± 11 years, and 50% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) score for MV replacement was 8% (Q1-Q3 = 5% to 11%) and the ratio of observed to expected mortality was 0.9. The etiology of mitral regurgitation (MR) prior to TEER was primary MR in 75% of patients and secondary MR in 25%. There were 30 patients (54%) who had >1 device implanted. The median time between TEER and surgery was 252 days (33 to 636 days). Hemodynamics, including MR severity, MV area, and mean gradient, significantly improved after minimally invasive surgery and sustained to 1-year follow-up. In-hospital and 30-day mortality was 7.1%, and 1-year actuarial survival was 85.6% ± 6%. Conclusions: Minimally invasive MV surgery after TEER may be achieved as predicted by the STS PROM. Most patients underwent MV replacement instead of repair. As TEER is applied more widely, patients should be informed about the potential need for surgical intervention over time after TEER. These discussions will allow better informed consent and post-procedure planning.
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Affiliation(s)
- Alejandro Pizano
- 12340The University of Texas Health Science Center at Houston, TX, USA
| | - Ramon Riojas
- 8785University of California San Francisco, CA, USA
| | - Gorav Ailawadi
- 12266The University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert L Smith
- 469050Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | - Timothy George
- 469050Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA
| | | | - Marco Di Eusanio
- Lancisi Cardiovascular Center-OORR, 9294Polytechnic University of Marche, Ancona, Italy
| | | | | | | | | | - Neelan S Doolabh
- 12334University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Michael E Jessen
- 12334University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Lawrence Wei
- 5631West Virginia University, Morgantown, WV, USA
| | - Michael W A Chu
- Lawson Health Sciences Centre, Western University, London, Canada
| | - Paolo Berretta
- Lancisi Cardiovascular Center-OORR, 9294Polytechnic University of Marche, Ancona, Italy
| | - Erik Cura Stura
- 18691University of Turin-Città della Salute e della Scienza, Torino, Italy
| | - Stefano Salizzoni
- 18691University of Turin-Città della Salute e della Scienza, Torino, Italy
| | - Mauro Rinaldi
- 18691University of Turin-Città della Salute e della Scienza, Torino, Italy
| | - Tsuyoshi Kaneko
- 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Joanna Chikwe
- 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Amy Roach
- 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Tom C Nguyen
- 8785University of California San Francisco, CA, USA
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wild MG, Kreidel F, Hell MM, Praz F, Mach M, Adam M, Reineke D, Ruge H, Ludwig S, Conradi L, Rudolph TK, Bleiziffer S, Kellermair J, Zierer A, Nickenig G, Weber M, Petronio AS, Giannini C, Dahle G, Rein KA, Coisne A, Vincentelli A, Dubois C, Duncan A, Quarto C, Unbehaun A, Amat‐Santos I, Cobiella J, Dumonteil N, Estevez‐Loureiro R, Fumero A, Geisler T, Lurz P, Mangieri A, Monivas V, Noack T, Nombela Franco L, Pinon MA, Stolz L, Tchétché D, Walter T, Unsöld B, Baldus S, Andreas M, Hausleiter J, Bardeleben RS. Transapical mitral valve implantation for treatment of symptomatic mitral valve disease: a real‐world multicentre experience. Eur J Heart Fail 2022; 24:899-907. [DOI: 10.1002/ejhf.2434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mirjam G. Wild
- Medizinische Klinik I LMU University Hospital Munich Germany
- Department of Cardiology Inselspital University Hospital Bern Bern Switzerland
| | - Felix Kreidel
- Department of Cardiology University Medical Center Mainz Mainz Germany
| | - Michaela M. Hell
- Department of Cardiology University Medical Center Mainz Mainz Germany
| | - Fabien Praz
- Department of Cardiology Inselspital University Hospital Bern Bern Switzerland
| | - Markus Mach
- Department of Cardiac Surgery Medical University of Vienna Vienna Vienna Austria
| | - Matti Adam
- Department of Cardiology University Hospital Cologne Cologne Germany
| | - David Reineke
- Department of Cardiac Surgery Inselspital University Hospital Bern Bern Switzerland
| | - Hendrik Ruge
- Department of Cardiovascular Surgery German Heart Center, Munich, Technical University Munich Germany
| | - Sebastian Ludwig
- Department of Cardiology University Hospital Hamburg Hamburg Germany
| | - Leonard Conradi
- Department of Cardiology University Hospital Hamburg Hamburg Germany
| | - Tanja K. Rudolph
- Department of Cardiology Heart‐ und Diabetes Center Nordrhine‐Westfalia, Bad Oeynhausen, Ruhr‐University Bochum Germany
| | - Sabine Bleiziffer
- Department of Cardiology Heart‐ und Diabetes Center Nordrhine‐Westfalia, Bad Oeynhausen, Ruhr‐University Bochum Germany
| | - Jörg Kellermair
- Department of Cardiology Kepler University Hospital Linz Austria
| | - Andreas Zierer
- Department of Cardiology Kepler University Hospital Linz Austria
| | - Georg Nickenig
- Department of Cardiac Surgery University Hospital Bonn Bonn Germany
| | - Marcel Weber
- Department of Cardiology University Hospital Bonn Bonn Germany
| | | | | | - Gry Dahle
- Department of Cardiothoracic surgery Oslo University Hospital Oslo Norway
| | - Kjell A. Rein
- Department of Cardiothoracic surgery Oslo University Hospital Oslo Norway
| | - Augustin Coisne
- Université Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐ EGID Lille France
| | - André Vincentelli
- Université Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐ EGID Lille France
| | - Christophe Dubois
- Department of cardiovascular medicine acute and interventional cardiology, UZ Leuven Leuven Belgium
| | - Alison Duncan
- Department of Cardiology Royal Brompton Hospital London United Kingdom
| | - Cesare Quarto
- Department of Cardiac Surgery Royal Brompton Hospital London United Kingdom
| | - Axel Unbehaun
- Department of Cardiac Surgery German Heart Center Berlin Germany
| | - Ignacio Amat‐Santos
- Department of Cardiology CIBER‐CV, University Clinic Hospital Valladolid Valladolid Spain
| | - Javier Cobiella
- Department of Cardiology Hospital Clínico San Carlos Madrid Spain
| | | | | | - Andrea Fumero
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele‐Milan, Italy; Humanitas Research Hospital IRCCS Rozzano‐Milan Italy
| | - Tobias Geisler
- Department of Cardiology University Hospital Tuebingen Tuebingen Germany
| | - Philipp Lurz
- Department of Cardiology Heart Center Leipzig Leipzig Germany
| | - Antonio Mangieri
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele‐Milan, Italy; Humanitas Research Hospital IRCCS Rozzano‐Milan Italy
| | - Vanessa Monivas
- Department of Cardiology Puerta de Hierro Hospital Madrid Spain
| | - Thilo Noack
- University Department of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | | | - Miguel A. Pinon
- Department of Cardiology University Hospital Alvaro Cunqueiro Vigo Spain
| | - Lukas Stolz
- Medizinische Klinik I LMU University Hospital Munich Germany
| | | | - Thomas Walter
- Department of Cardiac Surgery University Hospital Frankfurt Frankfurt Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany
| | - Stephan Baldus
- Department of Cardiology University Hospital Cologne Cologne Germany
| | - Martin Andreas
- Department of Cardiac Surgery Medical University of Vienna Vienna Vienna Austria
| | - Jörg Hausleiter
- Medizinische Klinik I LMU University Hospital Munich Germany
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Koschutnik M, Dannenberg V, Donà C, Nitsche C, Kammerlander AA, Koschatko S, Zimpfer D, Hülsmann M, Aschauer S, Schneider M, Bartko PE, Goliasch G, Hengstenberg C, Mascherbauer J. Transcatheter Versus Surgical Valve Repair in Patients with Severe Mitral Regurgitation. J Pers Med 2022; 12:jpm12010090. [PMID: 35055405 PMCID: PMC8779938 DOI: 10.3390/jpm12010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background. Transcatheter edge-to-edge mitral valve repair (TMVR) is increasingly performed. However, its efficacy in comparison with surgical MV treatment (SMV) is unknown. Methods. Consecutive patients with severe mitral regurgitation (MR) undergoing TMVR (68% functional, 32% degenerative) or SMV (9% functional, 91% degenerative) were enrolled. To account for differences in baseline characteristics, propensity score matching was performed, including age, EuroSCORE-II, left ventricular ejection fraction, and NT-proBNP. A composite of heart failure (HF) hospitalization/death served as primary endpoint. Kaplan-Meier curves and Cox-regression analyses were used to investigate associations between baseline, imaging, and procedural parameters and outcome. Results. Between July 2017 and April 2020, 245 patients were enrolled, of whom 102 patients could be adequately matched (73 y/o, 61% females, EuroSCORE-II: 5.7%, p > 0.05 for all). Despite matching, TMVR patients had more co-morbidities at baseline (higher rates of prior myocardial infarction, coronary revascularization, pacemakers/defibrillators, and diabetes mellitus, p < 0.009 for all). Patients were followed for 28.3 ± 27.2 months, during which 27 events (17 deaths, 10 HF hospitalizations) occurred. Postprocedural MR reduction (MR grade <2: TMVR vs. SMV: 88% vs. 94%, p = 0.487) and freedom from HF hospitalization/death (log-rank: p = 0.811) were similar at 2 years. On multivariable Cox analysis, EuroSCORE-II (adj.HR 1.07 [95%CI: 1.00–1.13], p = 0.027) and residual MR (adj.HR 1.85 [95%CI: 1.17–2.92], p = 0.009) remained significantly associated with outcome. Conclusions. In this propensity-matched, all-comers cohort, two-year outcomes after TMVR versus SMV were similar. Given the reported favorable long-term durability of TMVR, the interventional approach emerges as a valuable alternative for a substantial number of patients with functional and degenerative MR.
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Affiliation(s)
- Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Varius Dannenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Andreas A. Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Sophia Koschatko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Stefan Aschauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
- Department of Internal Medicine, Franziskus Hospital Margareten, Nikolsdorfergasse 32, 1050 Vienna, Austria
| | - Matthias Schneider
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin (Campus Virchow-Klinikum), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philipp E. Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 St. Poelten, Austria
- Correspondence: ; Tel.: +43-1-40400-46140; Fax: +43-1-40400-42160
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Kirschfink A, Alachkar MN, Almalla M, Grebe J, Vogt F, Schröder J, Frick M, Marx N, Altiok E. Prediction of procedural success of transcatheter mitral valve repair with normal and extended clip arms. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:10.1007/s10554-021-02514-7. [PMID: 34982309 DOI: 10.1007/s10554-021-02514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
TMVR using different clip sizes is a treatment option for selected patients with mitral regurgitation (MR). This study sought to identify predictors of successful transcatheter mitral valve repair (TMVR) by 3-dimensional (3D) echocardiography and to compare different effects of the larger XTR and the smaller NT/NTR devices. 3D transesophageal echocardiography was performed on 54 patients with secondary MR undergoing TMVR with one clip (55.6% NT/NTR, 44.4% XTR). All NT/NTR and 96% of XTR patients had MR reduction ≤ 2+. Despite more severe baseline MR (3D vena contracta area (VCA): 0.67 ± 0.34 cm2 vs. 0.43 ± 0.19 cm2, p = 0.004) and greater mitral valve area (MVA) (6.8 ± 2.1 cm2 vs. 5.1 ± 1.6 cm2, p = 0.001) in the XTR group, MR severity after TMVR was not different between XTR and NT/NTR patients (3D VCA: 0.19 ± 0.14 vs. 0.17 ± 0.10, p = 0.51). Baseline 3D VCA > 0.45 cm2 in NT/NTR (AUC = 0.802, 95% CI 0.602 to 1.000) and 3D VCA > 0.54 cm2 in XTR devices (AUC = 0.868, 95% CI 0.719 to 1.000) were associated with ineffective MR reduction defined as residual VCA ≤ 0.2 cm2. Baseline MVA ≤ 4.2 cm2 in NT/NTR (AUC = 0.920, 95% CI 0.809 to 1.000) and MVA ≤ 6.0 cm2 in XTR devices (AUC = 0.865, 95% CI 0.664 to 1.000) were associated with postprocedural transmitral pressure gradient (TMPG) ≥ 5 mmHg. TMVR using the XTR device resulted in an equally effective reduction of MR despite of a greater baseline MR. Distinct cut-off values of baseline 3D VCA and MVA for prediction of successful MR reduction and postprocedural increase of TMPG were identified for the different devices.
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Affiliation(s)
- Annemarie Kirschfink
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Mhd Nawar Alachkar
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Julian Grebe
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Felix Vogt
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Michael Frick
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ertunc Altiok
- Department of Cardiology, Angiology and Intensive Care, Medical Clinic I, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
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Hahn RT. Standardised definitions of transcatheter edge-to-edge repair leaflet adverse events: identifying complications or complicating identification? EUROINTERVENTION 2021; 17:e872-e874. [PMID: 34870599 PMCID: PMC9707465 DOI: 10.4244/eijv17i11a147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rebecca T. Hahn
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
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Asch FM, Little S, Mackensen G, Grayburn P, Sorajja P, Rinaldi M, Maisano F, Kar S. Incidence and standardised definitions of mitral valve leaflet adverse events after transcatheter mitral valve repair: the EXPAND study. EUROINTERVENTION 2021; 17:e932-e941. [PMID: 34031024 PMCID: PMC9724852 DOI: 10.4244/eij-d-21-00012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND An independent panel of experts reviewed all investigator-reported cases of mitral valve leaflet adverse events (LAE) after MitraClip NTR/XTR in the EXPAND study. AIMS We aimed to report the findings of the expert panel and standardise definitions for LAE. METHODS Standard definitions for different types of LAE were formulated and events adjudicated after detailed review by the expert panel. RESULTS Enrolling centres reported LAE in 35 cases, 11 leaflet injuries (9 tears, 2 perforations) and 24 single leaflet device attachment (SLDA). The panel confirmed LAE in 20 cases (2.0% incidence), 18 patients had SLDA and 4 had leaflet injury (2 cases had both SLDA and injury). Leaflet injury occurred during device implant and resulted in surgical valve replacement or death. SLDA-alone events were identified during implant (n=2), pre-discharge (n=7) or at 30 days of follow-up (n=7) and were resolved (≤2+ residual MR) with additional clips in 75% of cases. CONCLUSIONS Mitral valve repair with MitraClip NTR/XTR is safe. The rate of LAE is lower than previously reported using older-generation devices. The proposed definitions and findings will help to differentiate leaflet injury from inadequate leaflet insertion and SLDA and provide guidance for consistent diagnosis of LAE post MitraClip implantation.
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Affiliation(s)
- Federico M. Asch
- MedStar Health Research Institute, 100 Irving Street, NW, Suite EB 5123, Washington, DC 20010, USA
| | | | - G. Mackensen
- University of Washington Medical Center, Seattle, WA, USA
| | | | - Paul Sorajja
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Michael Rinaldi
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC, USA
| | - Francesco Maisano
- University Heart Center, University Hospital Zürich, Zürich, Switzerland
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA, USA
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Transcatheter edge-to-edge mitral valve repair in atrial functional mitral regurgitation: insights from the multi-center MITRA-TUNE registry. Int J Cardiol 2021; 349:39-45. [PMID: 34826500 DOI: 10.1016/j.ijcard.2021.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND A-FMR is considered a specific sub-type of secondary MR in patients with atrial fibrillation (AF) and preserved left ventricle ejection fraction (LVEF). Aim of the study was to investigate the acute and mid-term outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) with the MitraClip in atrial functional mitral regurgitation (A-FMR). METHODS The study included patients with A-FMR and concomitant AF who underwent to the MitraClip at 7 Italian Centers. Aim of the study was to assess the safety, efficacy and mid-term cardiovascular outcomes. RESULTS After reviewing 1153 patients with FMR treated with TMVr from 2009 to 2021, 87 patients (median age 81 years, 61% female) with A-FMR were identified. Technical success was achieved in 97%, 30-day device success in 83% and 30-day procedural success in 80%. All-cause death at 30-day was 5%. Estimated two-year freedom from all-cause death and cardiac death was 60% and 77%, respectively, whereas freedom from all-cause death/heart failure hospitalization was 55%. Residual MR ≤ 2+ was encountered in 89% (n = 47/53) and improvement in NYHA class I/II in 79% (n = 48/61). Post-procedural MR ≥ 2+ (HR 5.400, CI 1.371-21.268) and inter-commissural annular diameter ≥ 35 mm (HR 4.159, CI 1.057-16.363) were independent predictors of all-cause death/heart failure hospitalization during the follow-up. Positive reverse remodeling of left atrium and mitral annular dimensions occurred after TMVr during the follow-up. CONCLUSIONS MitraClip resulted to be a safe and effective option to treat A-FMR in elderly patients.
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Resor CD. Transcatheter mitral valve interventions. Prog Cardiovasc Dis 2021; 69:84-88. [PMID: 34822806 DOI: 10.1016/j.pcad.2021.11.005] [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: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
While there are dozens of novel transcatheter mitral devices in various stages of development, they remain years away from FDA approval. The existing approved transcatheter mitral interventions-transcatheter edge to edge repair for primary and secondary mitral regurgitations and transcatheter mitral valve-in-valve and valve-in-ring procedures for failing surgical prostheses-have seen a marked increase in both use and published data over the past several years. Transcatheter edge to edge repair with MitraClip has revolutionized the management of functional mitral regurgitation in heart failure with demonstrated reductions in mortality and heart failure hospitalization and is an appropriate option for patients with primary mitral regurgitation at high or prohibitive surgical risk. In patients with failing surgical mitral prostheses transcatheter mitral valve-in-valve and valve-in-ring procedures are an appealing alternative to repeat mitral valve surgery. Existing data and relevant concerns for these procedures are discussed herein.
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Affiliation(s)
- Charles D Resor
- The CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States of America.
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37
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Villablanca PA, Vemulapalli S, Stebbins A, Dai D, So CY, Eng MH, Wang DD, Frisoli TM, Lee JC, Kang G, Szerlip M, Ibrahim H, Staniloae C, Gaba P, Lemor A, Finn M, Ramakrishna H, Williams MR, Leon MB, O'Neill WW, Shah B. Sex-Based Differences in Outcomes With Percutaneous Transcatheter Repair of Mitral Regurgitation With the MitraClip System: Transcatheter Valve Therapy Registry From 2011 to 2017. Circ Cardiovasc Interv 2021; 14:e009374. [PMID: 34784236 DOI: 10.1161/circinterventions.120.009374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women have a higher rate of adverse events after mitral valve surgery. We sought to evaluate whether outcomes after transcatheter edge-to-edge repair intervention by sex have similar trends to mitral valve surgery. METHODS The primary outcome was 1-year major adverse events defined as a composite of all-cause mortality, stroke, and any bleeding in the overall study cohort. Patients who underwent transcatheter edge-to-edge repair for mitral regurgitation with the MitraClip system in the Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapy registry were evaluated. Linked administrative claims from the Centers for Medicare and Medicaid Services were used to evaluate 1-year clinical outcomes. Associations between sex and outcomes were evaluated using a multivariable logistic regression model for in-hospital outcomes and Cox model for 1-year outcomes. RESULTS From November 2013 to March 2017, 5295 patients, 47.6% (n=2523) of whom were female, underwent transcatheter edge-to-edge repair. Females were less likely to have >1 clip implanted (P<0.001) and had a lower adjusted odds ratio of device success (adjusted odds ratio, 0.78 [95% CI, 0.67-0.90]), driven by lower odds of residual mitral gradient <5 mm Hg (adjusted odds ratio, 0.54 [CI, 0.46-0.63]) when compared with males. At 1-year follow-up, the primary outcome did not differ by sex. Female sex was associated with lower adjusted 1-year risk of all-cause mortality (adjusted hazard ratio, 0.80 [CI, 0.68-0.94]), but the adjusted 1-year risk of stroke and any bleeding did not differ by sex. CONCLUSIONS No difference in composite outcome of all-cause mortality, stroke, and any bleeding was observed between females and males. Adjusted 1-year all-cause mortality was lower in females compared with males.
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Affiliation(s)
- Pedro A Villablanca
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | | | - Amanda Stebbins
- Duke Clinical Research Institute, Durham, NC (S.V., A.S., D.D.)
| | - Dadi Dai
- Duke Clinical Research Institute, Durham, NC (S.V., A.S., D.D.)
| | - Chak-Yu So
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Marvin H Eng
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Tiberio M Frisoli
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - James C Lee
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Guson Kang
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | | | - Homam Ibrahim
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.)
| | - Cezar Staniloae
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.)
| | - Prakriti Gaba
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (P.G., M.F., M.B.L.)
| | - Alejandro Lemor
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Matthew Finn
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (P.G., M.F., M.B.L.)
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (H.R.)
| | - Mathew R Williams
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.)
| | - Martin B Leon
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY (P.G., M.F., M.B.L.).,Cardiovascular Research Foundation, New York, NY (M.B.L.)
| | - William W O'Neill
- Department of Medicine, Division of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (P.A.V., C.-y.S., M.H.E., D.D.W., T.M.F., J.C.L., G.K., A.L., W.W.O.)
| | - Binita Shah
- Division of Cardiology, NYU Grossman School of Medicine (H.I., C.S., M.R.W., B.S.).,Division of Cardiology, VA New York Harbor Healthcare System (B.S.)
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Tusa MB, Barletta M, Popolo Rubbio A, Travaglio N, Saffioti S, Granata G, Mantovani V, Stefanini E, Corciu AI, Testa L, Bedogni F. Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT R by three-dimensional echocardiography. Echocardiography 2021; 38:1913-1923. [PMID: 34755379 DOI: 10.1111/echo.15238] [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: 03/18/2021] [Revised: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mitral valve (MV) repair with MitraClip system is a safe treatment option for high-risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three-dimensional echocardiography (3D-E), changes occurring in MV after implantation of third generation MitraClip XTR device, with specific reference to the underlying MR mechanism (functional vs degenerative, FMR vs DMR). METHODS We prospectively enrolled 59 patients, who underwent intra-procedural 3D-E before and after device deployment. Three-D datasets were analyzed off-line, using a dedicated semiautomatic software, to obtain parametric quantification of mitral anatomy. RESULTS Post-procedural MR of mild or lesser degree was achieved in 40 patients (68%), with no differences between FMR and DMR (p 0.9). After MitraClip XTR implantation, the FMR group experienced an immediate annular resizing, with reduction of antero-posterior diameter (p 0.024) and sphericity index (p 0.017), next to a recovery of physiological saddle-shape, defined by lower non-planar angle (p ≤0.001) and higher annulus height to commissural width ratio (p ≤0.001). On the opposite, the DMR group revealed a significant decrease of maximum annular velocity (p 0.027), addressing a mechanic effect of the device deployment. Finally, baseline anterior mitral leaflet angle was found as an independent predictor of acute procedural result (OR 6.7, [CI 1.01-44.33], p 0.049). CONCLUSIONS MitraClip XTR implantation acts in restoring the original mitral geometry, with distinctive effects according to MR mechanism. Three-D parametric quantification of MV sheds new light on changes occurring in the valvular apparatus, and helps identifying possible new predictors of acute procedural success.
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Affiliation(s)
- Maurizio B Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marta Barletta
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nicole Travaglio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Silvia Saffioti
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppina Granata
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Mantovani
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elisa Stefanini
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anca I Corciu
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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39
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Kalbacher D, Schofer N. Reducing Rehospitalization Rates by Transcatheter Mitral Edge-to-Edge Repair: A Matter of Quality of Life. JACC Cardiovasc Interv 2021; 14:2282-2284. [PMID: 34674866 DOI: 10.1016/j.jcin.2021.08.059] [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: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany.
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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40
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 277] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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41
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Sticchi A, Bartkowiak J, Brugger N, Weiss S, Windecker S, Praz F. Retrograde Retrieval of a Novel Large Mitral Clip After Embolization Into the Left Ventricle. JACC Case Rep 2021; 3:1561-1568. [PMID: 34729501 PMCID: PMC8543158 DOI: 10.1016/j.jaccas.2021.08.024] [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: 06/15/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 11/05/2022]
Abstract
We describe the successful retrieval of a novel large mitral clip, which embolized in a patient with severe secondary mitral regurgitation and left ventricular dysfunction, dilated left ventricle, and severely tethered mitral valve leaflets in the setting of a challenging anatomy for transcatheter edge-to-edge repair. The description highlights planning, technical issues, and possible adverse events of this bailout procedure. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Alessandro Sticchi
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro per la Lotta Contro L'Infarto Foundation, Rome, Italy.,Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Joanna Bartkowiak
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salome Weiss
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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42
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Kassar M, Praz F, Hunziker L, Pilgrim T, Windecker S, Seiler C, Brugger N. Anatomical and Technical Predictors of Three-Dimensional Mitral Valve Area Reduction After Transcatheter Edge-To-Edge Repair. J Am Soc Echocardiogr 2021; 35:96-104. [PMID: 34506920 DOI: 10.1016/j.echo.2021.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Among current transcatheter therapies for the treatment of mitral regurgitation, the MitraClip (MC; Abbott Vascular, Abbott Park, IL) system is the most commonly used. MitraClip implantation is usually contraindicated in patients with a mitral valve area (MVA) < 4.0 cm2. However, little is known about the real impact of MC implantation on MVA. Our goal was to investigate the factors influencing MVA reduction and derive the minimal MVA required to prevent the development of a clinically significant mitral stenosis (MVA < 1.5 cm2) in different clinical scenarios. METHODS Using three-dimensional data sets, the annulus and leaflet anatomy and MVA before clip implantation (MVABC) were assessed. After each MC implant (NTR or XTR), the relative MVA reduction and the absolute residual MVA were measured and their predictors evaluated. RESULTS The present analysis included 116 patients. An MC XTR was the first device implanted in 50% of the subjects, and 53% were treated with a single implant. The MVA reduction following one XTR was 57% ± 7% versus 52% ± 8% after one NTR (P = .001). A lower MVA reduction was observed when the MC was placed commissural/central versus paracentral (50% ± 8% vs 57% ± 7%, P < .0001). After a second device, the additional MVA reduction was higher when creating a triple-compared with a double-orifice morphology (34% ± 11% vs 25% ± 9%, P = .001). The MVA after one MC correlated with MVABC as well as with the clip type and position (r = 0.91, P < .0001). The MVABC, orifice morphology, and first device position predicted MVA after two implants (r = 0.82, P < .0001). Based on the mathematical relationship between these parameters, the minimal MVABC needed in eight different clinical scenarios was summarized in a decision algorithm: the values ranged from 3.5 to 4.7 cm2 for one and 4.5 to 6.3 cm2 for two MC strategies. CONCLUSIONS The minimal native MVA preventing clinically relevant MS after transcatheter edge-to-edge repair is predicted by the number and location of clip(s), orifice morphology, and device type. Based on these parameters, an algorithm has been derived to optimize patient selection and preprocedural planning.
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Affiliation(s)
- Mohammad Kassar
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
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43
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 1886] [Impact Index Per Article: 628.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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44
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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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45
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Mauri V, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Horn P, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Öztürk C, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, Pfister R. German Multicenter Experience With a New Leaflet-Based Transcatheter Mitral Valve Repair System for Mitral Regurgitation. JACC Cardiovasc Interv 2021; 13:2769-2778. [PMID: 33303115 DOI: 10.1016/j.jcin.2020.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the procedural and short-term safety and efficacy of a new leaflet-based transcatheter mitral valve repair system. BACKGROUND The PASCAL repair system has been recently approved for percutaneous treatment of mitral regurgitation (MR). Novel characteristics are broad paddles positioned around a central spacer and the ability for independent leaflet capture. METHODS Procedural and 30-day outcomes were investigated in the first 309 patients with symptomatic MR 3+/4+ treated with the PASCAL repair system at 10 sites. Primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE). RESULTS Among the 309 patients (mean age 77 ± 10 years, 42% women, mean European System for Cardiac Operative Risk Evaluation II score 5.8 ± 4.5%) included in this study, MR etiology was degenerative in 33%, functional in 52%, and mixed in 16%. Eighty-six percent of patients were in New York Heart Association functional class III or IV. The technical success rate was 96%. Of 308 patients discharged alive, MR was ≤2+ in 93.5%. At 30 days, the MAE rate was 4.1%, with an estimated all-cause mortality rate of 2.0%, and 72% of patients were in New York Heart Association functional class ≤II (p < 0.001). Rates of device success and CLASP (Edwards PASCAL Transcatheter Mitral Valve Repair System Study) trial-defined clinical success were 81.9% and 86.9%, respectively. Single-leaflet device attachment occurred in 7 patients (2.3%). CONCLUSIONS Mitral valve repair with the PASCAL system in the early post-approval phase was effective and safe, with high procedural success rates and low rates of MAE. MR was significantly reduced, accompanied by significant improvement in functional status.
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Affiliation(s)
- Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Medical Faculty, Essen, Germany
| | - Osamah Al-Hammadi
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Muhammed Gerçek
- General and Interventional Cardiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany; Ruhr University Bochum, Bochum, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christoph Mues
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Niklas Boeder
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Felix Kreidel
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Kai Friedrichs
- General and Interventional Cardiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany; Ruhr University Bochum, Bochum, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Medical Faculty, Essen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany; Ruhr University Bochum, Bochum, Germany
| | | | - Holger M Nef
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Medical Faculty, Essen, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany.
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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: 2.7] [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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Perez-Camargo D, Chen M, Taramasso M. Devices for transcatheter mitral valve repair: current technology and a glimpse into the future. Expert Rev Med Devices 2021; 18:609-628. [PMID: 34092173 DOI: 10.1080/17434440.2021.1940141] [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] [Indexed: 10/21/2022]
Abstract
Introduction: Due to a large unmet need for the treatment of mitral regurgitation, transcatheter mitral valve repair devices have emerged in the last decade as an alternative therapeutic option. Given the complexity of this disease, several device systems for transcatheter mitral valve repair have been developed and are categorized according to its mechanism of action; each device has advantages and disadvantages for certain clinical and pathophysiologic characteristics, and in order to improve outcomes, proper patient selection among other key points are fundamental.Areas covered: The purpose of this article is to review the current state-of-the-art technologies available for transcatheter mitral valve repair, patient suitability, outcomes, and future perspectives.Expert opinion: Transcatheter therapy for mitral regurgitation improves outcomes and pushes the boundaries of biomedical technology while maintaining scientific rigor for device development. Surgical and percutaneous procedures should be viewed as complements to treat a wider spectrum of patients affected by this entity. Future directions from multidisciplinary innovation and cooperation will consolidate this therapeutic option.
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Affiliation(s)
- Daniel Perez-Camargo
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,Fundación Interhospitalaria Para la Investigación Cardiovascular, Madrid, Spain
| | - Mi Chen
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maurizio Taramasso
- Cardiac Surgery Department, University Hospital of Zurich, Zurich, Switzerland.,HerzZentrum Hirlsanden Zurich, Zurich, Switzerland
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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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Flint N, Price MJ, Little SH, Mackensen GB, Wunderlich NC, Makar M, Siegel RJ. State of the Art: Transcatheter Edge-to-Edge Repair for Complex Mitral Regurgitation. J Am Soc Echocardiogr 2021; 34:1025-1037. [PMID: 33872701 DOI: 10.1016/j.echo.2021.03.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
Transcatheter edge-to-edge mitral valve repair has revolutionized the treatment of primary and secondary mitral regurgitation. The landmark EVEREST (Endovascular Valve Edge-to-Edge Repair Study) and COAPT (Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk Patients) trials included only clinically stable patients with favorable mitral valve anatomy for edge-to-edge repair. However, since its initial commercial approval in the United States, growing operator experience, device iterations, and improvements in intraprocedural imaging have led to an expansion in the use of transcatheter edge-to-edge repair to more complex mitral valve pathologies and clinical scenarios, many of which were previously considered contraindications for the procedure. Because patients with prohibitive surgical risk are often older and present with complex mitral valve disease, knowledge of the potential effectiveness, versatility, and technical approach to a broad range of anatomy is clinically relevant. In this review the authors examine the current experience with mitral valve transcatheter edge-to-edge repair in various pathologies and scenarios that go well beyond the EVEREST II trial inclusion criteria.
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Affiliation(s)
- Nir Flint
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Weill Cornell Medicine, Houston, Texas
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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50
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Corpataux N, Brugger N, Hunziker L, Reineke D, Windecker S, Vahanian A, Praz F. The role of transcatheter mitral valve leaflet approximation for the treatment of secondary mitral regurgitation: current status and future prospects. Expert Rev Med Devices 2021; 18:261-272. [PMID: 33682563 DOI: 10.1080/17434440.2021.1899804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Secondary mitral regurgitation (SMR) is one of the most common valvulopathies and is associated with poor prognosis. Over the past years, medical management and mitral valve repair options have rapidly evolved offering new opportunities for a wide range of patients.Areas covered: We provide an up-to-date review of the value of medical and transcatheter mitral valve leaflet approximation for SMR integrating the results of most recent trials and putting their findings into clinical perspective.Expert opinion: Treatment of SMR requires a multidisciplinary approach with a long-term perspective. After optimization of medical treatment, transcatheter mitral valve repair should be considered in patients with persisting symptomatic severe SMR to improve symptoms and prognosis.
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Affiliation(s)
- Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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