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Alvarez-Covarrubias HA, Joner M, Lutz M, Xhepa E, Mayr NP, Lachmann M, Cassese S, Rheude T, Pellegrini C, Kufner S, Schunkert H, Kastrati A, Erlebach M, Lange R, Ruge H. Outcomes after transcatheter mitral valve implantation in valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification. Catheter Cardiovasc Interv 2024. [PMID: 39077791 DOI: 10.1002/ccd.31166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/05/2024] [Accepted: 07/20/2024] [Indexed: 07/31/2024]
Abstract
AIMS We aimed to evaluate transcatheter mitral valve implantation (TMVI) using predominantly balloon-expandable transcatheter heart valves (THV) in patients with a landing zone for a percutaneously delivered prosthesis. BACKGROUND Patients with a degenerated mitral valve bioprosthesis, annuloplasty ring, and mitral annulus calcification (MAC) considered at high surgical risk currently represent a treatment challenge. TMVI is an alternative treatment option. METHODS Retrospective analysis of patients with symptomatic degenerated mitral valve bioprosthesis, or annuloplasty ring, and MAC treated with TMVI between November 2011 and April 2021. Endpoints were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria and included device and procedure success at 30 days as well as mortality at 30 days and 1 year after the procedure. RESULTS A total of 77 patients underwent TMVI (valve in valve [ViV = 56], valve in ring [ViR = 11], and valve in MAC [ViMAC = 10]). There was a trend toward higher technical success (all = 93.5%, ViV = 96.4%, ViR = 90.9%, ViMAC = 80%, p = 0.06) and lower 30-day (all = 11.7%, ViV = 10.7%, ViR = 9.1%, ViMAC = 20%, p = 0.49) and 1-year mortality (all = 26%, ViV = 23.2%, ViR = 27.3%, ViMAC= 40%, p = 0.36) after ViV and ViR compared to ViMAC. CONCLUSION TMVI represents a reasonable treatment option in selected patients with MAC or who are poor candidates for redo mitral valve surgery. Technical success and survival up to 1 year were not significantly dependent on the subgroup in which TMVI was performed.
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Affiliation(s)
- Hector A Alvarez-Covarrubias
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Departamento de Cardiología, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Michael Joner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marius Lutz
- Department of Cardiac Surgery, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - N Patrick Mayr
- Institut für Anästhesiologie, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Mark Lachmann
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Costanza Pellegrini
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiac Surgery, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiac Surgery, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiac Surgery, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Guedeney P, Barthelemy O, Montalescot G. Transcatheter Mitral Valve Replacement for Valve-in-Ring: Innovative or Palliative Procedure? JACC Cardiovasc Interv 2024; 17:887-889. [PMID: 38599691 DOI: 10.1016/j.jcin.2024.03.005] [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: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance publique Hôpitaux de Paris), Paris, France.
| | - Olivier Barthelemy
- Sorbonne Université, ACTION Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance publique Hôpitaux de Paris), Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (Assistance publique Hôpitaux de Paris), Paris, France
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3
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Guerrero ME, Bapat VN, Mahoney P, Krishnaswamy A, Eleid MF, Eng MH, Yadav P, Coylewright M, Makkar R, Szerlip M, Nazif T, Kodali S, George I, Greenbaum A, Babaliaros V, Kapadia S, Rihal CS, Whisenant B, Thourani VH, McCabe JM. Contemporary 1-Year Outcomes of Mitral Valve-in-Ring With Balloon-Expandable Aortic Transcatheter Valves in the U.S. JACC Cardiovasc Interv 2024; 17:874-886. [PMID: 38599690 DOI: 10.1016/j.jcin.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Adequate valve performance after surgical mitral valve repair with an annuloplasty ring is not always sustained over time. The risk of repeat mitral valve surgery may be high in these patients. Transcatheter mitral valve-in-ring (MViR) is emerging as an alternative for high-risk patients. OBJECTIVES The authors sought to assess contemporary outcomes of MViR using third-generation balloon-expandable aortic transcatheter heart valves. METHODS Patients who underwent MViR and were enrolled in the STDS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between August 2015 and December 2022 were analyzed. RESULTS A total of 820 patients underwent MViR at 236 sites, mean age was 72.2 ± 10.4 years, 50.9% were female, mean STS score was 8.2% ± 6.9%, and most (78%) were in NYHA functional class III to IV. Mean left ventricular ejection fraction was 47.8% ± 14.2%, mean mitral gradient was 8.9 ± 7.0 mm Hg, and 75.5% had ≥ moderate mitral regurgitation. Access was transseptal in 93.9% with 88% technical success. All-cause mortality at 30 days was 8.3%, and at 1 year, 22.4%, with a reintervention rate of 9.1%. At 1-year follow-up, 75.6% were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire score increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg, and 91.7% had ≤ mild mitral regurgitation. CONCLUSIONS MViR with third-generation balloon-expandable aortic transcatheter heart valves is associated with a significant reduction in mitral regurgitation and improvement in symptoms at 1 year, but with elevated valvular gradients and a high reintervention rate. MViR is a reasonable alternative for high-risk patients unable undergo surgery who have appropriate anatomy for the procedure. (STS/ACC TVT Registry Mitral Module [TMVR]; NCT02245763).
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Affiliation(s)
- Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Vinayak N Bapat
- Department of Cardiothoracic Surgery, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Mahoney
- Division of Cardiology, Department of Cardiovascular Services, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marvin H Eng
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Pradeep Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Megan Coylewright
- Division of Cardiology Erlanger Health System, Chattanooga, Tennessee, USA
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Molly Szerlip
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Adam Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Brener MI, Hamandi M, Hong E, Pizano A, Harloff MT, Garner EF, El Sabbagh A, Kaple RK, Geirsson A, Deaton DW, Islam AM, Veeregandham R, Bapat V, Khalique OK, Ning Y, Kurlansky PA, Grayburn PA, Nazif TM, Kodali SK, Leon MB, Borger MA, Lee R, Kohli K, Yoganathan AP, Colli A, Guerrero ME, Davies JE, Eudailey KW, Kaneko T, Nguyen TC, Russell H, Smith RL, George I. Early outcomes following transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Thorac Cardiovasc Surg 2024; 167:1263-1275.e3. [PMID: 36153166 DOI: 10.1016/j.jtcvs.2022.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Implantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date. METHODS Patients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality. RESULTS We analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03). CONCLUSIONS Transatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Mohanad Hamandi
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Estee Hong
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Alejandro Pizano
- Division of Cardiothoracic Surgery, University of Texas Health Science Center, Houston, Tex
| | - Morgan T Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Evan F Garner
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | | | - Ryan K Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn
| | - David W Deaton
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | - Ashequl M Islam
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | | | - Vinayak Bapat
- Division of Cardiothoracic Surgery, Minneapolis Heart Institute Foundation, Minneapolis, Minn
| | - Omar K Khalique
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Yuming Ning
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Kurlansky
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Grayburn
- Division of Cardiology, Baylor Scott and White Health, Plano, Tex
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Michael A Borger
- Division of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Raymond Lee
- Division of Cardiothoracic Surgery, Keck University of Southern California, Los Angeles, Calif
| | - Keshav Kohli
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Andrea Colli
- Department of Cardio-Thoracic-Vascular Surgery, University of Pisa, Pisa, Italy
| | - Mayra E Guerrero
- Division of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minn
| | - James E Davies
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, University of California-San Francisco, San Francisco, Calif
| | - Hyde Russell
- Division of Cardiothoracic Surgery, Northshore University HealthSystem, Evanston, Ill
| | - Robert L Smith
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
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Ueyama HA, Babaliaros VC, Greenbaum AB. Left Ventricular Outflow Tract Modification for Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2024; 13:217-225. [PMID: 38432764 DOI: 10.1016/j.iccl.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Left ventricular outflow tract (LVOT) obstruction is a life-threatening complication of transcatheter mitral valve replacement. In-depth analysis of pre-procedural computed tomography enables accurate prediction of this risk. Several techniques for LVOT modification, including Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN, preemptive alcohol septal ablation, preemptive radiofrequency ablation, and Septal Scoring Along the Midline Endocardium, have been described as effective strategies to mitigate this risk. This review aims to explore the indications, procedural steps, and outcomes associated with these LVOT modification techniques.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, 550 Peachtree Street, Northeast, Atlanta, GA 30306, USA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, 550 Peachtree Street, Northeast, Atlanta, GA 30306, USA
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, 550 Peachtree Street, Northeast, Atlanta, GA 30306, USA.
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Wong N, Lim DS, Yount K, Yarboro L, Ailawadi G, Ragosta M. Preemptive alcohol septal ablation prior to transcatheter mitral valve replacement. Catheter Cardiovasc Interv 2023; 102:1341-1347. [PMID: 37855165 DOI: 10.1002/ccd.30879] [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: 06/23/2023] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Alcohol septal ablation (ASA) has been shown to increase the neo-left ventricular outflow tract (LVOT) area before transcatheter mitral valve replacement (TMVR) but there is little literature on its success and use with dedicated devices. AIMS To describe our experience with preemptive ASA to increase the predicted neo-LVOT area and its utility with both dedicated TMVR devices and balloon-expandable valves. METHODS All patients who underwent ASA for TMVR candidacy in our center between May 2018 and October 2022 and had computed tomography (CT) scans done before and after ASA were included. Each CT was assessed for the minimum predicted neo-LVOT area at end-systole, using a virtual valve of the desired TMVR device for each patient. The primary outcome was an increase in the predicted neo-LVOT area after ASA that was deemed sufficient for safe implantation of the desired TMVR device. The secondary outcome was the absence of acute LVOT obstruction after TMVR. RESULTS A total of 12 patients underwent ASA and all but 1 (n = 11, 91.6%) achieved the primary outcome of having sufficient predicted neo-LVOT area to proceed with TMVR. The mean increase in neo-LVOT area after ASA was 126 ± 64 mm2 (median 119.5, interquartile range: 65.0-163.5 mm2 ). Two patients (16.7%) required a permanent pacemaker after ASA. Nine patients went on and underwent TMVR with their respective devices and none had LVOT obstruction after the procedure. Among the remaining three patients, one had insufficient neo-LVOT clearance after ASA, one had unrelated mortality before TMVR, and one had advanced heart failure before TMVR. CONCLUSION In appropriately selected patients and at centers experienced with ASA, preemptive ASA can achieve sufficient neo-LVOT clearance for TMVR with a variety of devices in approximately 90% of patients.
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Affiliation(s)
- Ningyan Wong
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
- Department of Cardiology, National Heart Centre Singapore, Singapore City, Singapore
| | - D Scott Lim
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Kenan Yount
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Leora Yarboro
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ragosta
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
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Quentin V, Mesnier J, Delhomme C, Sayah N, Guedeney P, Barthélémy O, Suc G, Collet JP. Transcatheter Mitral Valve Replacement Using Transcatheter Aortic Valve or Dedicated Devices: Current Evidence and Future Prospects. J Clin Med 2023; 12:6712. [PMID: 37959178 PMCID: PMC10647634 DOI: 10.3390/jcm12216712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) is a novel and evolving field dedicated to addressing the therapeutic challenges posed by patients at high surgical risk with mitral valve disease. TMVR can be categorized into two distinct fields based on the type of device and its specific indications: TMVR with transcatheter aortic valves (TAV) and TMVR with dedicated devices. Similar to aortic stenosis, TMVR with TAV requires a rigid support structure to secure the valve in place. As a result, it is indicated for patients with failing bioprothesis or surgical rings or mitral valve disease associated with severe mitral annular calcification (MAC), which furnishes the necessary foundation for valve anchoring. While TMVR with TAV has shown promising outcomes in valve-in-valve procedures, its effectiveness remains more contentious in valve-in-ring or valve-in-MAC procedures. Conversely, TMVR with dedicated devices seeks to address native mitral regurgitation, whether accompanied by MAC or not, providing an alternative to Transcatheter Edge-to-Edge Repair (TEER) when TEER is not feasible or expected to yield unsatisfactory results. This emerging field is gradually surmounting technical challenges, including anchoring a valve in a non-calcified annulus and transitioning from the transapical route to the transeptal approach. Numerous devices are presently undergoing clinical trials. This review aims to furnish an overview of the supporting evidence for TMVR using TAV in each specific indication (valve-in-valve, valve-in-ring, valve-in-MAC). Subsequently, we will discuss the anticipated benefits of TMVR with dedicated devices over TEER, summarize the characteristics and clinical results of TMVR systems currently under investigation, and outline future prospects in this field.
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Affiliation(s)
- Victor Quentin
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Jules Mesnier
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Clémence Delhomme
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Neila Sayah
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
| | - Olivier Barthélémy
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
| | - Gaspard Suc
- Department of Cardiology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris Cité Université, 75005 Paris, France
| | - Jean-Philippe Collet
- ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie (AP-HP), Sorbonne Université, 75013 Paris, France
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8
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Guerrero ME, Eleid MF, Wang DD, Pursnani A, Kodali SK, George I, Palacios I, Russell H, Makkar RR, Kar S, Satler LF, Rajagopal V, Dangas G, Tang GHL, McCabe JM, Whisenant BK, Fang K, Balan P, Smalling R, Kaptzan T, Lewis B, Douglas PS, Hahn RT, Thaden J, Oh JK, Leon M, O'Neill W, Rihal C. 5-Year Prospective Evaluation of Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Outcomes: MITRAL Trial Final Results. JACC Cardiovasc Interv 2023; 16:2211-2227. [PMID: 37758379 DOI: 10.1016/j.jcin.2023.06.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The MITRAL (Mitral Implantation of Transcatheter Valves) trial is the first prospective trial to evaluate the safety and feasibility of balloon-expandable aortic transcatheter heart valves in patients with failed surgical bioprostheses or annuloplasty rings and severe mitral annular calcification treated with mitral valve-in-valve (MViV), valve-in-ring (MViR), or valve-in-mitral annular calcification (ViMAC). OBJECTIVES The aim of this study was to evaluate 5-year outcomes among these patients. METHODS A multicenter prospective study was conducted among patients at high surgical risk at 13 U.S. sites. Patients underwent MViV (n = 30), MViR (n = 30), or ViMAC (n = 31) and were followed annually for 5 years. Kansas City Cardiomyopathy Questionnaire scores were obtained at baseline and follow-up visits. Echocardiograms were analyzed at independent core laboratories. RESULTS A total of 91 patients underwent transcatheter mitral valve replacement (February 2015 to December 2017). The mean age was 74.3 ± 8.9 years. At 5-year follow-up, the lowest all-cause mortality was observed in the MViV group (21.4%), 94.7% of patients were in NYHA functional class I or II, and the mean mitral gradient was 6.6 ± 2.5 mm Hg. The MViR and ViMAC groups had higher all-cause mortality (65.5% and 67.9%), most survivors were in NYHA functional classes I and II (50% and 55.6%), and mean mitral gradients remained stable (5.8 ± 0.1 and 6.7 ± 2.5 mm Hg). Significant improvements in Kansas City Cardiomyopathy Questionnaire scores were observed when all 3 arms were pooled. CONCLUSIONS MViV, MViR, and ViMAC procedures were associated with sustained improvement of heart failure symptoms and quality of life among survivors at 5 years. Transcatheter heart valve function remained stable in all 3 groups. Patients treated with MViV had excellent survival at 5 years, whereas survival was lower in the MViR and ViMAC groups, consistent with underlying disease severity. Patients with more residual mitral regurgitation had higher mortality.
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Affiliation(s)
- Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Amit Pursnani
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Igor Palacios
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hyde Russell
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Raj R Makkar
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Saibal Kar
- Division of Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Lowell F Satler
- Division of Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Vivek Rajagopal
- Division of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA
| | - George Dangas
- Division of Cardiology, Mount Sinai Health System, New York, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Brian K Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Kenith Fang
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Prakash Balan
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Richard Smalling
- Division of Cardiology, Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Tatiana Kaptzan
- Cardiovascular Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley Lewis
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Jeremy Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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9
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Wang Y, Mao Y, Zhai M, Ma Y, Li L, Liu Y, Yang J. Transapical Mitral Valve-in-Ring Replacement Using the Innovative System under 3-Dimensional Printing Guidance. J Cardiovasc Dev Dis 2023; 10:339. [PMID: 37623352 PMCID: PMC10455199 DOI: 10.3390/jcdd10080339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Transcatheter mitral valve-in-ring replacement (TMViR) is an emerging alternative for patients with recurrent mitral regurgitation (MR) after a prior failed annuloplasty ring. However, intraoperative common issues and complications remain to be addressed. CASE SUMMARY We describe the case of a 67-year-old male patient who underwent surgical mitral concomitant tricuspid annuloplasty repair 7 years ago who developed recurrent severe MR (New York Heart Association functional class IV). To avoid a high-risk surgical reoperation, we chose to perform a TMViR using an innovative dedicated device-the Mi-thos system-via a transapical approach. A patient-specific, 3-dimensional printed model was used to guide the procedure to avoid potential challenges. The procedure was performed successfully, and the patient exhibited symptomatic improvement. CONCLUSIONS This case report highlights the first use of the innovative Mi-thos system in a TMViR procedure. The findings demonstrate the feasibility and safety of utilizing the Mi-thos system, guided by 3-dimensional printing technology, for patients who have experienced recurrent mitral regurgitation MR following a failed annuloplasty ring.
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Affiliation(s)
| | | | | | | | | | - Yang Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an 710032, China; (Y.W.); (Y.M.); (M.Z.); (Y.M.); (L.L.)
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an 710032, China; (Y.W.); (Y.M.); (M.Z.); (Y.M.); (L.L.)
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10
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Park MH, Marin-Cuartas M, Sellke M, Pandya PK, Zhu Y, Wilkerson RJ, Holzhey DM, Borger MA, Woo YJ. An analytical, mathematical annuloplasty ring curvature model for planning of valve-in-ring transcatheter mitral valve replacement. JTCVS Tech 2023; 20:45-54. [PMID: 37555034 PMCID: PMC10405166 DOI: 10.1016/j.xjtc.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES An increasing number of high-risk patients with previous mitral valve annuloplasty require transcatheter mitral valve replacement due to recurrent regurgitation. Annulus dilation with a transcatheter balloon is often performed before valve-in-ring transcatheter mitral valve replacement, which is believed to reduce misalignment and paravalvular leakage, yet little evidence exists to support this practice. Our objective was to generate intuitive annuloplasty ring analyses for improved valve-in-ring transcatheter mitral valve replacement planning. METHODS We generated a mathematical model that calculates image-tracked differential ring curvature to build quantifications for improved planning for valve-in-ring procedures. Carpentier-Edwards Physio M24 and M30 (n = 2 each), Physio II M24 and M26 (n = 3 each), LivaNova AnnuloFlex M26 (n = 2), and Edwards Geoform M28 (n = 2) rings were tested with a 30-mm Toray Inoue balloon inflated to maximum rated pressures. RESULTS Curvature variance reduces with larger ring sizes, indicating that larger rings are initially more circular than smaller ones. Evaluated semi-rigid and rigid rings showed little to no difference between pre- and post-dilation states. Annuloflex rings (flexible band) showed a postdilation variance reduction of 32.83% (P < .001) followed by an increase after 10 minutes of relaxation that was still reduced by 19.62% relative to the initial state (P < .001). CONCLUSIONS We discovered that balloon dilation does not significantly deform evaluated semi-rigid or rigid rings at maximum rated balloon pressures. This may mean that dilation for these conditions before valve-in-ring transcatheter mitral valve replacement is unnecessary. Our mathematical approach creates a foundation for extended classification of this practice, providing meaningful quantification of ring geometry.
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Affiliation(s)
- Matthew H. Park
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Mateo Marin-Cuartas
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Mark Sellke
- Department of Mathematics, Stanford University, Stanford, Calif
| | - Pearly K. Pandya
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Bioengineering, Stanford University, Stanford, Calif
| | | | - David M. Holzhey
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A. Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Bioengineering, Stanford University, Stanford, Calif
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11
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Chan N, Dong T, Sabbak N, Xu B, Wang TKM. Contemporary Review of Transcatheter Mitral Valve Interventions for Mitral Regurgitation. Life (Basel) 2023; 13:1511. [PMID: 37511886 PMCID: PMC10381253 DOI: 10.3390/life13071511] [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: 06/01/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Mitral regurgitation (MR) is the most common form of valvular heart disease in the United States, and there are established guidelines for indications for requiring mitral valve surgeries. However, there is an unmet clinical need for a subset of high-risk MR patients, especially those with advanced age, heart failure and/or secondary MR. Following the successes of transcatheter aortic valve replacements, significant advances have occurred over the last decade in transcatheter mitral valve interventions in order to manage these patients in both clinical practice and trials. The three main types of these interventions include a transcatheter edge-to-edge repair, percutaneous mitral annuloplasty (both direct and indirect) and transcatheter mitral valve replacement (including when applied to a prior prosthetic valve, annuloplasty ring and mitral annuloplasty ring). This review aims to discuss the contemporary techniques, evidence, indications, multimodality imaging evaluations and outcomes of the various transcatheter mitral valve interventions.
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Affiliation(s)
- Nicholas Chan
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Tiffany Dong
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Nabil Sabbak
- Section of Invasive and Interventional Cardiology Section, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland, OH 44195, USA
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12
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Ueyama HA, Gleason PT, Babaliaros VC, Greenbaum AB. Transcatheter Mitral Valve Replacement in Failed Bioprosthetic Valve, Ring, and Mitral Annular Calcification Associated Mitral Valve Disease Using Balloon Expandable Transcatheter Heart Valve. Methodist Debakey Cardiovasc J 2023; 19:37-49. [PMID: 37213881 PMCID: PMC10198232 DOI: 10.14797/mdcvj.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/10/2023] [Indexed: 05/23/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) using the SAPIEN platform has been performed in failed bioprosthetic valves (valve-in-valve), surgical annuloplasty rings (valve-in-ring), and native valves with mitral annular calcification (MAC) (valve-in-MAC). Experience over the past decade has identified important challenges and solutions to improve clinical outcomes. In this review, we discuss the indication, trend in utilization, unique challenges, procedural planning, and clinical outcomes of valve-in-valve, valve-in-ring, and valve-in-MAC TMVR.
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Affiliation(s)
- Hiroki A. Ueyama
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Patrick T. Gleason
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Vasilis C. Babaliaros
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Adam B. Greenbaum
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
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13
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Wienemann H, Mauri V, Ochs L, Körber MI, Eghbalzadeh K, Iliadis C, Halbach M, Wahlers T, Baldus S, Adam M, Kuhn E. Contemporary treatment of mitral valve disease with transcatheter mitral valve implantation. Clin Res Cardiol 2023; 112:571-584. [PMID: 36107228 PMCID: PMC10159974 DOI: 10.1007/s00392-022-02095-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transcatheter mitral valve implantation (TMVI) with self-expanding (SAV) or balloon-expandable (BAV) valves are rising as promising treatment options for high-risk patients with symptomatic mitral valve (MVD) disease unsuitable for alternative treatment options. AIMS The aim of this study was to examine the clinical, procedural and outcome parameters of patients undergoing SAV or BAV for MVD. METHODS In this observational and single-center case series, fifteen consecutive patients treated with the Tendyne Mitral Valve System (SAV) and thirty-one patients treated with SAPIEN prosthesis (BAV) were included. RESULTS The patients (aged 78 years [interquartile range (IQR): 65.5 to 83.1 years], 41% women, EuroSCORE II 10.3% [IQR: 5.5 to 17.0%] were similar regarding baseline characteristics, despite a higher rate of prior heart valve surgery and prevalence of MV stenosis in the SAV-group. At discharge, the SAV-group had a mean transvalvular gradient of 4.2 mmHg, whereas the BAV-group had a mean transvalvular gradient of 6.2 mmHg. None or trace paravalvular leakage (PVL) was assessed in 85% in SAV-group and 80% in the BAV-group. 320 day all-cause and cardiac mortality rates were comparable in both groups (SAV: 26.7% vs BAV: 20%, p = 0.60). Four deaths occurred early in the SAV-group until 32 days of follow-up. CONCLUSIONS In high-risk patients with MVD, TMVI presents a promising treatment option with encouraging mid-term outcomes and good valve durability. TMVI either with BAV or SAV may be developed to an established treatment option.
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Affiliation(s)
- Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany.
| | - Victor Mauri
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Marcel Halbach
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Thorsten Wahlers
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Elmar Kuhn
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
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14
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Katzianer D, Albert C. Structural Interventions in Heart Failure: Mending a Broken Heart. J Clin Med 2023; 12:jcm12093243. [PMID: 37176681 PMCID: PMC10179306 DOI: 10.3390/jcm12093243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Advanced heart failure is often accompanied by perturbations in cardiac chamber or valve geometries which result in worsening cardiac function and hemodynamics. Once limited to surgical procedures, recent developments in minimally invasive percutaneous techniques have demonstrated efficacy in patients with both reduced and preserved ejection fraction who are at an elevated surgical risk for perioperative events. This review highlights a subset of the interventions available in clinical practice or in development for the treatment of these valvular and structural alterations.
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Affiliation(s)
- David Katzianer
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Chonyang Albert
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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15
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Eleid MF, Nkomo VT, Pislaru SV, Gersh BJ. Valvular Heart Disease: New Concepts in Pathophysiology and Therapeutic Approaches. Annu Rev Med 2023; 74:155-170. [PMID: 36400067 DOI: 10.1146/annurev-med-042921-122533] [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: 11/21/2022]
Abstract
This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development and assessment of valvular disease, strategies for global prevention of rheumatic heart disease, understanding and management of secondary mitral regurgitation, the updated classification of bicuspid aortic valve disease, recognition of heightened cardiovascular risk associated with moderate aortic stenosis, and a growing armamentarium of transcatheter therapies.
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
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16
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Reyaldeen R, Kaur S, Krishnaswamy A, Ramchand J, Layoun H, Schoenhagen P, Miyasaka R, Unai S, Kapadia SR, Harb SC. Role of Cardiac Computed Tomography in Planning Transcatheter Mitral Valve Replacement (TMVR). Curr Cardiol Rep 2022; 24:1917-1932. [PMID: 36334213 DOI: 10.1007/s11886-022-01794-2] [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] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW Transcatheter mitral valve replacement (TMVR) is an evolving and rapidly expanding field within structural interventions, offering renewed treatment options for patients with high-risk mitral valve disease. We aim to highlight and illustrate the importance of cardiac CT in the planning of TMVR. RECENT FINDINGS As TMVR has evolved, so has the specific nuances of cardiac CT planning, we now understand the importance of accurate annular sizing and valve simulation to predict complications such as neo-LVOT obstruction and paravalvular leak (PVL). More so than any other modality, cardiac CT remains instrumental in accurately planning TVMR from feasibility, device sizing, access, and fluoroscopic angles. Cardiac CT remains the key modality in TMVR evaluation, often the first step in determining patient eligibility through comprehensive procedural planning as well as informing potential outcomes and prognosis. In this review, we discuss the critical role of cardiac computed tomography (CT) and the specific considerations involved in TMVR.
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Affiliation(s)
- Reza Reyaldeen
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Simrat Kaur
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Jay Ramchand
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Rhonda Miyasaka
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
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17
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Eleid MF, Wang DD, Pursnani A, Kodali SK, George I, Palacios I, Russell H, Makkar RR, Kar S, Satler LF, Rajagopal V, Dangas G, Tang GH, McCabe JM, Whisenant BK, Fang K, Kaptzan T, Lewis B, Douglas P, Hahn R, Thaden J, Oh JK, Leon M, O'Neill W, Rihal CS, Guerrero ME. 2-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Annular Calcification, Rings, and Bioprostheses. J Am Coll Cardiol 2022; 80:2171-2183. [DOI: 10.1016/j.jacc.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/25/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
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18
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Jain P, Mohammed AN, Fischer C, Aljure O. Current and Investigational Transcatheter Mitral Valve Replacement Systems: A Narrative Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2022; 36:4108-4128. [PMID: 35915003 DOI: 10.1053/j.jvca.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Pankaj Jain
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL.
| | - Asif Neil Mohammed
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Charles Fischer
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Oscar Aljure
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
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19
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Leurent G, Auffret V, Grinberg D, Le Ruz R, Saint Etienne C, Pierrard R, Champagnac D, Benard T, Lecoq G, Arnould MA, Bonnet G, Lhermusier T, Anselmi A, Corbineau H, Donal E. Transcatheter edge-to-edge repair following surgical valve repair with ring implantation: Results from the multicentre "Clip-in-Ring" registry. Arch Cardiovasc Dis 2022; 115:521-528. [PMID: 36115768 DOI: 10.1016/j.acvd.2022.05.009] [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: 10/22/2021] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Management of mitral regurgitation recurrence after failed surgical valve repair with ring implantation is controversial. AIM To describe the French experience regarding midterm safety and efficacy of transcatheter edge-to-edge mitral valve repair (TEER) in patients with failed surgical valve repair with ring implantation. METHODS The "Clip-in-Ring" registry is a multicentre registry conducted in 11 centres in France, approved by local institutional review boards, of consecutive TEER following surgical valve repair with ring implantation. Outcomes were Mitral Valve Academic Research Consortium (MVARC) technical success, modified 30-day device and procedural success (where 10mmHg is considered as a cut-off for significant mitral stenosis) and MVARC complications. RESULTS Twenty-three patients were studied: mean age, 69±10years; male sex, 74%; EuroSCORE II, 16±17; left ventricular ejection fraction, 53±12%; mitral regurgitation grade 3+/4+, 17%/78%; New York Heart Association class III/IV, 47%/22%; median surgery to TEER delay, 23 (6-94) months. Technical success was 100%. At discharge, residual mitral regurgitation grade was≤2+ in 87% and median transmitral gradient was 4 (3-5) mmHg. Thirty-day modified MVARC device and procedural success was 82%: four patients (17%) had residual mitral regurgitation grade>2+, including two patients who needed complementary surgery. No patient had a 30-day transmitral gradient>7mmHg. No patient died or had a stroke or any life-threatening complications. One patient presented a vascular access complication requiring transfusion. No other MVARC-2 adverse event was reported. CONCLUSIONS TEER in patients with failed mitral ring is feasible and safe. Further studies shoulddelineate its exact role in the therapeutic armamentarium for this medical issue.
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Affiliation(s)
- Guillaume Leurent
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes, 35000 Rennes, France.
| | - Vincent Auffret
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes, 35000 Rennes, France
| | - Daniel Grinberg
- Chirurgie Cardiothoracique et Transplantation, Hôpital Cardiovasculaire Louis-Pradel, Hospices Civils de Lyon, Claude-Bernard University, 69677 Bron, France
| | - Robin Le Ruz
- Department of Cardiology, University Hospital of Nantes, L'Institut du Thorax, Inserm, UMR 1087, CNRS-UMR 6291, 44000 Nantes, France
| | - Christophe Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Faculté de Médecine, Université François-Rabelais, 37000 Tours, France
| | - Romain Pierrard
- Service de Cardiologie, CHU Nord, 42100 Saint-Étienne, France
| | - Didier Champagnac
- Service de Cardiologie, Medipôle Lyon Villeurbanne, 69100 Villeurbanne, France
| | - Thomas Benard
- Service Médico-Chirurgical de Valvulopathies, CHU Angers, 49000 Angers, France
| | - Guillaume Lecoq
- Service de Cardiologie, Hôpital Privé Saint-Martin, 14000 Caen, France
| | - Marc Antoine Arnould
- Service de Cardiologie, Clinique Saint-Gatien, 37540 Saint-Cyr-sur-Loire, France
| | - Guillaume Bonnet
- Medico-Surgical Department of Valvulopathies, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Thibault Lhermusier
- Service de Cardiologie, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, 31400 Toulouse, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, 35000 Rennes, France
| | - Hervé Corbineau
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, 35000 Rennes, France
| | - Erwan Donal
- Department of Cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes, 35000 Rennes, France
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20
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Bhardwaj B, Golwala H, Song HK, Lantz G, Chadderdon S, Zahr F. Haemolysis resolution after transcatheter valve in valve within a prior mitral annuloplasty ring: a case report. Eur Heart J Case Rep 2022; 6:ytac326. [PMID: 36131810 PMCID: PMC9486913 DOI: 10.1093/ehjcr/ytac326] [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: 02/15/2022] [Revised: 03/22/2022] [Accepted: 07/29/2022] [Indexed: 11/12/2022]
Abstract
Background Transcatheter mitral valve in ring procedure has emerged as a minimally invasive alternative to re-do surgery among patients with failed mitral annuloplasty rings. Uncommonly, haemolysis presents as a complication after the percutaneous valvular procedures and often require aggressive measures to correct paravalvular leaks and mechanical collision. Case summary We report a case of an 82-year-old female who underwent a transcatheter valve in ring procedure (Edwards Sapien S3, Edwards Lifesciences) for symptomatic severe mitral regurgitation from a bioprosthetic annuloplasty ring failure complicated by acute haemolytic anaemia a week after the procedure manifesting as dark coloured urine, profound icterus, and acute renal injury. She was treated with a post-dilation balloon valvuloplasty leading to reduction in haemolysis, but the patient was readmitted with acute haemolysis episode again. At this time, a decision was made to perform a repeat valve in valve TMVR with a 29 mm S3 Edwards Sapien valve which led to a resolution of haemolysis. Discussion In this case, the leaflets of previously placed S3 valve sealed the blood flow through the valve frame thus diverting the blood flow away from the area of collision leading to resolution of haemolysis.
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Affiliation(s)
- Bhaskar Bhardwaj
- Knight Cardiovascular Institute, Oregon Health and Science University , Portland, OR 97223 , USA
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health and Science University , Portland, OR 97223 , USA
| | - Howard K Song
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University , Portland, OR 97223 , USA
| | - Gurion Lantz
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University , Portland, OR 97223 , USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University , Portland, OR 97223 , USA
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health and Science University , Portland, OR 97223 , USA
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21
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Transcatheter Treatment of Mitral Regurgitation. J Clin Med 2022; 11:jcm11102921. [PMID: 35629048 PMCID: PMC9146624 DOI: 10.3390/jcm11102921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
Mitral valve disease, and in particular mitral regurgitation, is a common clinical entity. Until recently, surgical repair and replacement were the only therapeutic options available, leaving many patients untreated mostly due to excessive surgical risk. Over the last number of years, huge strides have been made regarding percutaneous, catheter-based solutions for mitral valve disease. Transcatheter repair procedures have most commonly been used, and in recent years there has been exponential growth in the number of devices available for transcatheter mitral valve replacement. Furthermore, the evolution of these devices has resulted in both smaller delivery systems and a shift towards transeptal access, negating the need for surgical incisions. In line with these advancements, and clinical trials demonstrating promising outcomes in carefully selected cases, recent guidelines have strengthened their recommendations for these devices. It is appropriate, therefore, to now review the current transcatheter repair and replacement devices available and the evidence for their use.
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22
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Sá MP, Ramlawi B, Gray WA, Malin JH, Van den Eynde J, Sicouri S, Torregrossa G, Klein C, Heil E, Sündermann SH, Emmerich A, Kempfert J, Kofler M, Falk V, Unbehaun A, Van Praet KM. Transcatheter mitral valve implantation in the ongoing structural heart revolution. J Card Surg 2022; 37:1691-1704. [PMID: 35340080 DOI: 10.1111/jocs.16431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Transcatheter mitral valve implantation (TMVI) has emerged as a less invasive approach potentially surmounting some of the current hurdles associated with transcatheter edge-to-edge repair and high-risk mitral valve surgery. In this review, we aimed to outline the main scenarios in the TMVI field, highlight current and upcoming devices, and describe challenges and clinical results. Finally, we briefly discuss the future perspectives for this emerging field and how TMVI might further advance the field of transcatheter treatments of mitral valve disease.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - William A Gray
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - John H Malin
- Philadelphia College of Osteopathic Medicine, Bala Cynwyd, Pennsylvania, USA
| | - Jef Van den Eynde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Christoph Klein
- Department of Internal Medicine-Cardiology, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Emanuel Heil
- Department of Internal Medicine-Cardiology, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Simon H Sündermann
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Emmerich
- Department of Anaesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Jörg Kempfert
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Markus Kofler
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Health Sciences and Technology, Institute of Translational Medicine, Swiss Federal Institute of Technology, Translational Cardiovascular Technologies, Zurich, Switzerland
| | - Axel Unbehaun
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Karel M Van Praet
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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23
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Le Ruz R, Guérin P, Leurent G, Leroux L, Lefevre T, Nejjari M, Champagnac D, Tchétché D, Lhermusier T, Senage T, Piriou PG, Caussin C, Delomez M, Bonnet G, Favereau X, Karam N, Gerbay A, Juthier F, Gilard M, Obadia JF, Iung B, Manigold T. Mitral valve-in-valve and valve-in-ring procedures: Midterm outcomes in a French nationwide registry. Catheter Cardiovasc Interv 2022; 99:1829-1838. [PMID: 35324050 DOI: 10.1002/ccd.30161] [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: 10/23/2021] [Revised: 01/31/2022] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Report contemporary outcomes in patients included in the Mitragister registry and treated with transcatheter mitral valve implantation for failed surgical annuloplasty rings or deteriorated bioprosthesis. BACKGROUND Midterm survival rates have been reported, but little is known about contemporary morbimortality endpoints. METHODS The primary safety outcome was the technical success rate. The primary efficacy composite endpoint was a composite of cardiovascular mortality and heart failure hospitalizations. RESULTS From 2016 to 2021, 102 patients (median age: 81 [74;84] years, 61% female, Euroscore II 11.0% [7.8;16.0]) undergoing valve-in-valve (ViV; n = 89) or valve-in-ring (ViR; n = 13) procedures were consecutively included. At baseline, ViR group patients had worse left ventricular ejection fraction (50% vs. 60%; p = 0.004) and more frequently severe regurgitation (46% vs. 15%; p = 0.014). The primary safety outcome was 95%: 77% and 98% in the ViR and ViV populations, respectively, (p = 0.014). At intermediate follow-up (6-12 months) clinical improvement was notable, 88% of the patients were in NYHA class ≤ II (vs. 25% at baseline; p < 0.001). At a mean follow-up of 17.1 ± 11.0 months, the primary efficacy composite reached 27%. By multivariate analysis, paravalvular leak (PVL) was the only independent predictor (hazard ratio: 2.39, 95% confidence interval: 1.08-5.29; p = 0.031) while ViR was not found statistically associated (p = 0.456). CONCLUSIONS This study confirms the safety and efficacy of the mitral ViV procedure. ViR patients appear at higher risk of procedural complications. The presence of PVL could be associated with markedly worse midterm prognosis. Whatever the intervention, procedural strategies to reduce PVL incidence remain to be assessed to prevent latter adverse outcomes.
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Affiliation(s)
- Robin Le Ruz
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Patrice Guérin
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Guillaume Leurent
- Department of Cardiology, University Hospital of Rennes, Rennes, France
| | - Lionel Leroux
- CHU de Bordeaux, Service Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Chirurgie Cardiaque Adulte, Cardiologie Interventionnelle Structurelle Adulte, Bordeaux, France
| | - Thierry Lefevre
- Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Thomas Senage
- Department of Thoracic and Cardiovascular Surgery, PHU 2 Institut du Thorax et du Sytème Nerveux, CHU Nantes, Nantes, France
| | - Pierre-Guillaume Piriou
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | | | | | - Guillaume Bonnet
- Service de Cardiologie Interventionnelle, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Xavier Favereau
- Private Hospital of Parly II, Le Chesnay-Rocquencourt, France
| | - Nicole Karam
- Cardiology Department, Université de Paris, PARCC, INSERM, European Hospital Georges Pompidou, Paris, France
| | - Antoine Gerbay
- Division of Cardiology, Jean Monnet University (ADC, CD, JBG, AG, RP, CRB, and KI), Saint-Etienne, France
| | | | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Brest, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Bernard Iung
- Department of Cardiology, University Hospital Department Fire and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France
| | - Thibaut Manigold
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
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24
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Simard T, Lloyd J, Crestanello J, Thaden JJ, Alkhouli M, Guerrero M, Rihal CS, Eleid MF. Five-year outcomes of transcatheter mitral valve implantation and redo surgery for mitral prosthesis degeneration. Catheter Cardiovasc Interv 2022; 99:1659-1665. [PMID: 35019211 DOI: 10.1002/ccd.30059] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to redo surgical mitral valve replacement (SMVR) in patients with degenerated mitral prostheses, with limited comparative data. METHODS We compared mid-term outcomes in patients with degenerated mitral valve prostheses treated with TMVR or redo SMVR. The primary endpoint was survival at 5 years of follow-up. RESULTS From 2014 to 2020, 215 patients presented with degenerated mitral valve prostheses. Of whom 86 (40%) were treated with TMVR (75[87%] valve-in-valve and 11[13%] valve-in-ring), while 129 patients (60%) underwent SMVR. The TMVR cohort was older (p < 0.0001), more symptomatic (p = 0.0003) and had more chronic lung disease (p = 0.02), worse renal function (p = 0.02) and higher right ventricular systolic pressures (p < 0.0001). Thirty-day mortality was lower with TMVR versus SMVR (2.4% vs. 10.2%, OR4.69 [95% CI 1.25-30.5], p = 0.04) with probability of mortality at 1, 2, and 5 years being 14.7% versus 17.5%, 24.5% versus 20.7%, and 49.9% versus 34.0%, respectively. Mode of prosthesis degeneration, baseline hemodynamics, and valve selection did not appreciably impact outcomes. CONCLUSIONS TMVR for degenerated mitral prostheses is associated with better early survival compared to SMVR despite a greater burden of comorbidities. In contrast, 5 year survival rates appear more favorable with SMVR, which may reflect the lower baseline risk of this population. Clinical, hemodynamic, and echocardiographic follow-up support the mid-term durability of TMVR for degenerated mitral prostheses. Further dedicated studies, however, are required to optimize outcomes in this challenging patient cohort and to navigate the choice of approach for each individual patient.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - James Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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25
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Simonato M, Forrest JK, Dvir D. The Dos and Don'ts of Mitral Valve-in-Valve and Valve-in-Ring. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:402-408. [PMID: 34839722 DOI: 10.1177/15569845211048940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Danny Dvir
- Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
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26
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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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27
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The Art of SAPIEN 3 Transcatheter Mitral Valve Replacement in Valve-in-Ring and Valve-in-Mitral-Annular-Calcification Procedures. JACC Cardiovasc Interv 2021; 14:2195-2214. [PMID: 34674861 DOI: 10.1016/j.jcin.2021.08.044] [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: 04/29/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
The SAPIEN 3 is the only transcatheter heart valve commercially available for compassionate transcatheter mitral valve replacement in patients with previous mitral surgical rings and mitral annular calcification (valve in ring [VIR] and valve in mitral annular calcification [VIM]). Reported outcomes have been inconsistent or poor. The review provides an overview of the authors' approach to achieve largely consistent results despite the intrinsic limitations of SAPIEN 3 VIM and VIR. The approach includes bedside modifications of the valve implant, the delivery system, and of the cardiac substrate itself. Until purpose-built devices are readily available, VIR and VIM procedures will require aggressive multidisciplinary cooperation, meticulous planning and execution, and postprocedure management by experienced, high-volume operators.
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28
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Ben-Dor I, Weissman G, Case BC, Satler LF, Waksman R, Rogers T. Valve-in-Valve for Failing Mitral Bioprosthesis With Tip-to-Base LAMPOON to Prevent Left Ventricular Outflow Tract Obstruction. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:409-413. [PMID: 34636690 DOI: 10.1177/15569845211048899] [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: 11/17/2022]
Abstract
Transcatheter mitral valve replacement (TMVR) is a new approach for treating failed bioprosthetic valves, annuloplasty repairs, and mitral annular calcification. Computed tomography is the key in procedure planning and guiding to identify patients at high risk of anatomic complications, in particular, for left ventricular outflow tract (LVOT) obstruction. There are several methods to reduce the risk of LVOT obstruction. A simple option is preemptive alcohol septal ablation, but this needs to be done prior to the TMVR procedure. Intentional laceration of the anterior mitral leaflet to prevent LVOT obstruction (LAMPOON), a transcatheter electrosurgical technique to split the anterior mitral valve leaflet immediately prior to TMVR, can be done anterograde or retrograde but requires leaflet traversal, which is technically challenging. In this article, we describe a case of valve-in-valve TMVR in a patient with high risk for LVOT obstruction and a novel simple technique-tip-to-base LAMPOON.
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Affiliation(s)
- Itsik Ben-Dor
- Section of Interventional Cardiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Gaby Weissman
- Division of Cardiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian C Case
- Section of Interventional Cardiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, 8405MedStar Washington Hospital Center, Washington, DC, USA.,Cardiovascular Branch, Division of Intramural Research, 536681National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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29
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Safety and Efficacy of Transcatheter Mitral Valve Replacement Guided by Intracardiac Echocardiography. JACC Cardiovasc Interv 2021; 14:1620-1622. [PMID: 34294404 DOI: 10.1016/j.jcin.2021.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022]
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30
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Chuang MYA, Akodad M, Chatfield AG, Wood D, Sathananthan J, Leipsic JA, Blanke P, Cheung A, Webb JG, Ye J. Stent Frame Fracture and Late Atrial Migration of a Mitral SAPIEN 3 Transcatheter Valve. JACC Cardiovasc Interv 2021; 14:1610-1612. [PMID: 34217626 DOI: 10.1016/j.jcin.2021.05.031] [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: 04/29/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ming-Yu Anthony Chuang
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. https://twitter.com/Anthonychh1
| | - Mariama Akodad
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew G Chatfield
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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31
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Sticchi A, Reineke D, Praz F, Windecker S. Transcatheter Mitral Valve Replacement for Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Using Balloon-Expandable Transcatheter Heart Valves. JACC Cardiovasc Interv 2021; 14:873-878. [PMID: 33888232 DOI: 10.1016/j.jcin.2021.02.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Alessandro Sticchi
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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