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Lopes V, Almeida PC, Moreira N, Ferreira LA, Teixeira R, Donato P, Gonçalves L. Computed tomography imaging in preprocedural planning of transcatheter valvular heart interventions. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03140-9. [PMID: 38780710 DOI: 10.1007/s10554-024-03140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Cardiac Computed Tomography (CCT) has become a reliable imaging modality in cardiology providing robust information on the morphology and structure of the heart with high temporal and isotropic spatial resolution. For the past decade, there has been a paradigm shift in the management of valvular heart disease since previously unfavorable candidates for surgery are now provided with less-invasive interventions. Transcatheter heart valve interventions provide a real alternative to medical and surgical management and are often the only treatment option for valvular heart disease patients. Successful transcatheter valve interventions rely on comprehensive multimodality imaging assessment. CCT is the mainstay imaging technique for preprocedural planning of these interventions. CCT is critical in guiding patient selection, choice of procedural access, device selection, procedural guidance, as well as allowing postprocedural follow-up of complications. This article aims to review the current evidence of the role of CCT in the preprocedural planning of patients undergoing transcatheter valvular interventions.
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Affiliation(s)
- Vanessa Lopes
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
| | - Pedro Carvalho Almeida
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Nádia Moreira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Luís Amaral Ferreira
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
| | - Rogério Teixeira
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Univ Coimbra, Coimbra Institute for Biomedical Imaging and Translation Research (CIBIT), Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Univ Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Univ Coimbra, Coimbra, Portugal
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Le NK, Chervu N, Mallick S, Vadlakonda A, Kim S, Curry J, Benharash P. Mortality and resource utilization in surgical versus transcatheter repeat mitral valve replacement: A national analysis. PLoS One 2024; 19:e0301939. [PMID: 38781278 PMCID: PMC11115312 DOI: 10.1371/journal.pone.0301939] [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: 10/09/2023] [Accepted: 03/25/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk patients requiring redo operations. This study aims to evaluate the association of TMVR with selected clinical and financial outcomes. METHODS Adults undergoing isolated redo mitral valve replacement were identified in the 2016-2020 Nationwide Readmissions Database and categorized into TMVR or SMVR cohorts. Various regression models were developed to assess the association between TMVR and in-hospital mortality, as well as additional secondary outcomes. Transseptal and transapical catheter-based approaches were also compared in relation to study endpoints. RESULTS Of an estimated 7,725 patients, 2,941 (38.1%) underwent TMVR. During the study period, the proportion of TMVR for redo operations increased from 17.8% to 46.7% (nptrend<0.001). Following adjustment, TMVR was associated with similar odds of in-hospital mortality (AOR 0.82, p = 0.48), but lower odds of stroke (AOR 0.44, p = 0.001), prolonged ventilation (AOR 0.43, p<0.001), acute kidney injury (AOR 0.61, p<0.001), and reoperation (AOR 0.29, p = 0.02). TMVR was additionally correlated with shorter postoperative length of stay (pLOS; β -0.98, p<0.001) and reduced costs (β -$10,100, p = 0.002). Additional analysis demonstrated that the transseptal approach had lower adjusted mortality (AOR 0.44, p = 0.02), shorter adjusted pLOS (β -0.43, p<0.001), but higher overall costs (β $5,200, p = 0.04), compared to transapical. CONCLUSIONS In this retrospective cohort study, we noted TMVR to yield similar odds of in-hospital mortality as SMVR, but fewer complications and reduced healthcare expenditures. Moreover, transseptal approaches were associated with lower adjusted mortality, shorter pLOS, but higher cost, relative to the transapical. Our findings suggest that TMVR represent a cost-effective and safe treatment modality for patients requiring redo mitral valve procedures. Nevertheless, future studies examining long-term outcomes associated with SMVR and TMVR in redo mitral valve operations, are needed.
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Affiliation(s)
- Nguyen K. Le
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, United States of America
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, United States of America
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, United States of America
| | - Joanna Curry
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, United States of America
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Napoli F, Vella C, Ferri L, Ancona MB, Bellini B, Russo F, Agricola E, Esposito A, Montorfano M. Rheumatic and Degenerative Mitral Stenosis: From an Iconic Clinical Case to the Literature Review. J Cardiovasc Dev Dis 2024; 11:153. [PMID: 38786975 PMCID: PMC11122136 DOI: 10.3390/jcdd11050153] [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: 03/29/2024] [Revised: 05/05/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Mitral stenosis (MS) poses significant challenges in diagnosis and management due to its varied etiologies, such as rheumatic mitral stenosis (RMS) and degenerative mitral stenosis (DMS). While rheumatic fever-induced RMS has declined in prevalence, DMS is rising with aging populations and comorbidities. Starting from a complex clinical case of DMS, the aim of this paper is to review the literature on mitral stenosis by analyzing the available tools and the differences in terms of diagnosis and treatment for rheumatic and degenerative stenosis. Emerging transcatheter techniques, such as transcatheter mitral valve replacement (TMVR) and lithotripsy-facilitated percutaneous mitral commissurotomy (PMC), represent promising alternatives for DMS patients deemed unfit for surgery. In particular, intravascular lithotripsy (IVL) has shown potential in facilitating percutaneous interventions by fracturing calcific deposits and enabling subsequent interventions. However, larger prospective studies are warranted to validate these findings and establish IVL's role in DMS management. To further enhance this technique, research could focus on investigating the long-term outcomes and durability of mitral lithotripsy, as well as exploring its potential in combination with PMC or TMVR.
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Affiliation(s)
- Francesca Napoli
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Luca Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Marco B. Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Esposito
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy; (F.N.); (C.V.); (M.B.A.); (B.B.); (F.R.); (M.M.)
- School of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy;
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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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5
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Eng MH, Zahr F. Orthotopic Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2024; 13:227-235. [PMID: 38432765 DOI: 10.1016/j.iccl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Mitral valve dysfunction is prevalent amongst older patients. Of those not suitable for surgical therapy, mitral transcatheter edge-to-edge repair (TEER) can treat as large proportion of patients, many are not suitable TEER candidates. As such, orthotopic transcatheter mitral valve replacement (TMVR) is an important innovation but it faces significant challenges. Orthotopic TMVR requires a prosthesis with stable anchoring, adequate sealing, minimal footprint in the left ventricle and long term durability. Multidisciplinary expertise in advanced imaging, surgery, heart failure are needed for success.
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Affiliation(s)
- Marvin H Eng
- Structural Heart Program, Division of Cardiology, University of Arizona, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA.
| | - Firas Zahr
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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6
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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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7
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Kargoli F, Al Qaraghuli AK, Fang HK, Eng MH. Postsurgical Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2024; 13:207-216. [PMID: 38432763 DOI: 10.1016/j.iccl.2023.12.002] [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
Reintervention is commonly required postsurgical mitral valve replacement (SMVR) or repair due to bioprosthetic valve and annuloplasty ring degeneration. However, redo SMVR is associated with a high risk of morbidity and mortality. Postsurgical transcatheter mitral valve replacement (TMVR) is a safe and less-invasive alternative that has repeatedly been shown to be associated with improved survival and lower rates of complications compared with redo SMVR. Comprehensive patient evaluation and thorough procedural planning are key to successful TMVR.
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Affiliation(s)
- Faraj Kargoli
- Division of Cardiology, University of Arizona, Banner University Medical Center, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Abdullah K Al Qaraghuli
- MedStar Health Research Institute, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Hao Kenith Fang
- Division of Cardiothoracic Surgery, Banner University Medical Center, 1111 East McDowell Road, Phoenix, AZ 85006, USA
| | - Marvin H Eng
- Structural Heart Program, University of Arizona, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA.
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8
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Szlapka M, Hausmann H, Timm J, Bauer A, Metz D, Pohling D, Fritzsche D, Gyoten T, Kuntze T, Dörge H, Feyrer R, Brambate A, Sodian R, Buchholz S, Sack FU, Höhn M, Fischlein T, Eichinger W, Franke U, Nagib R. Transcatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry. J Thorac Cardiovasc Surg 2024; 167:957-964. [PMID: 36088142 DOI: 10.1016/j.jtcvs.2022.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration. METHODS Data provided by 10 German heart centers underwent propensity score-matched retrospective analysis. The primary endpoint was 30-day/midterm mortality. Perioperative outcome was assessed according to the Mitral Valve Academic Research Consortium criteria. Further, the influence of moderate or greater tricuspid regurgitation (TR) on 30-day/midterm mortality was analyzed. RESULTS Between 2014 and 2019, 273 patients (79 transcatheter mitral valve-in-valve [TM-ViV] and 194 redo mitral valve replacement [Re-MVR]) underwent repeat procedure for mitral prosthesis/ring degeneration. Propensity score matching distinguished 79 patient pairs. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II-predicted risk was 15.7 ± 13.7% in the TM-ViV group and 15.0% ± 12.7% in the Re-MVR group (P = .5336). TM-ViV patients were older (74.73 vs 72.2 years; P = .0030) and had higher incidence of atrial fibrillation (54 vs 40 patients; P = .0233). Severe TR incidence was similar (17.95% in TM-ViV vs 14.10%; P = .1741). Sixty-eight TM-ViV patients previously underwent mitral valve replacement, whereas 41 Re-MVR patients underwent valve repair (P < .0001). Stenosis was the leading degeneration mechanism in 42 TM-ViV versus 22 Re-MVR patients (P < .0005). The 30-day/midterm mortality did not differ between groups. Moderate or greater TR was a predictor of total (odds ratio [OR], 4.36; P = .0011), 30-day (OR, 3.76; P = .0180), and midterm mortality (OR, 4.30; P = .0378), irrespective of group. CONCLUSIONS In both groups, observed mortality was less than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day, and midterm mortality in both groups.
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Affiliation(s)
- Michal Szlapka
- Clinic for Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, Germany.
| | - Harald Hausmann
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Jürgen Timm
- Competence Center for Clinical Trials Bremen, Bremen, Germany
| | - Adrian Bauer
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Dietrich Metz
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Daniel Pohling
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Dirk Fritzsche
- Clinic for Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Takayuki Gyoten
- Clinic for Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Thomas Kuntze
- Clinic for Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Hilmar Dörge
- Clinic for Cardiac and Thoracic Surgery, Clinic Fulda, Fulda, Germany
| | - Richard Feyrer
- Clinic for Cardiovascular Surgery, Central Military Hospital, Koblenz, Germany
| | - Agrita Brambate
- Clinic for Cardiovascular Surgery, Central Military Hospital, Koblenz, Germany
| | - Ralf Sodian
- Clinic for Cardiac Surgery, MediClin Heart Center Lahr, Lahr/Schwarzwald, Germany
| | - Stefan Buchholz
- Clinic for Cardiac Surgery, MediClin Heart Center Lahr, Lahr/Schwarzwald, Germany
| | - Falk Udo Sack
- Clinic for Cardiac Surgery, Heart Center Ludwigshafen
| | - Martina Höhn
- Clinic for Cardiac Surgery, Heart Center Ludwigshafen
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Walter Eichinger
- Clinic for Cardiac Surgery, München Klinik Bogenhausen, München, Germany
| | - Ulrich Franke
- Clinic for Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ragi Nagib
- Clinic for Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
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Sankardas MA, Subban V, Kothandam S, Chopra A, Kalidoss L, Udhayakumar K, Sollimuthu R, Chidambaram K, Anandan H, Rao RS. Clinical Outcomes Following Transcatheter Mitral Valve-in-Valve Replacement Using a Meril Myval Transcatheter Heart Valve. Heart Lung Circ 2024; 33:222-229. [PMID: 38245394 DOI: 10.1016/j.hlc.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/12/2023] [Accepted: 11/12/2023] [Indexed: 01/22/2024]
Abstract
AIM Transcatheter mitral valve-in-valve (TMViV) replacement for degenerated surgically implanted bioprosthetic valves has been described by both transseptal and transapical approaches. The balloon-expandable Myval transcatheter valve (Meril Life Sciences, Vapi, India) is commonly used for transcatheter valve-in-valve procedures in India. This study aimed to report in-hospital, 30-day, and 1-year outcomes of Myval patients who underwent TMViV in a single tertiary care centre in India. METHODS Symptomatic patients with surgical bioprosthetic mitral valve failure with New York Heart Association (NYHA) class III-IV symptoms, despite optimal medical therapy and high or very high risk for redo surgery, were assigned to TMViV following heart team discussions. Data were retrospectively collected and outcomes assessed. RESULTS Twenty patients were treated, with mean age 64.4 years, 60% were female, and mean Society of Thoracic Surgeons (STS) predicted risk of operative mortality score was 8.1. The failure mechanism was combined stenosis and regurgitation in 60% of patients. Technical success was achieved in 100% of patients. The mean postprocedure and 30-day gradients were 4.6±2.7 and 6.3±2.1, respectively. None of them had significant valvular or paravalvular leaks or left ventricular outflow tract obstruction. All-cause mortality at 1 year was 10%, and all survivors were in New York Heart Association (NYHA) class I or II. CONCLUSION TMViV replacement with a Meril Myval can be safely performed with high technical success, and low 30-day and 1-year mortality.
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Affiliation(s)
| | | | | | - Aashish Chopra
- Department of Anaesthesiology, The Madras Medical Mission, Chennai, India
| | | | | | | | - Kumar Chidambaram
- Department of Anaesthesiology, The Madras Medical Mission, Chennai, India
| | - Harini Anandan
- Department of Anaesthesiology, The Madras Medical Mission, Chennai, India
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10
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de Manna ND, Martens A, Jüttner M, Berliner D, Bauersachs J, Ruhparwar A, Kempf T, Ius F. Anterior mitral leaflet laceration using the MitraCut technique for transapical transcatheter Tendyne implantation after unsuccessful Carillon indirect annuloplasty: a case report. Eur Heart J Case Rep 2024; 8:ytae035. [PMID: 38425726 PMCID: PMC10903169 DOI: 10.1093/ehjcr/ytae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/06/2024] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
Background The introduction of a transapical transcatheter beating heart replacement system has significantly expanded therapeutic options for patients with severely diseased mitral valves, particularly those ineligibles for traditional surgery or transcatheter repair. However, challenges, such as left ventricular outflow tract obstruction (LVOT-O) and the risk of dynamic systolic anterior motion (SAM) in cases with elongated anterior mitral leaflet (AML) post-prosthesis implantation, impede the widespread adoption of transcatheter mitral valve replacement (TMVR). Case summary In 2022, a 75-year-old male with severe mixed-genesis mitral regurgitation (MR) underwent Carillon Mitral Contour System annuloplasty. Recurrent heart failure admissions (New York Heart Association IV) and prohibitive risk for open-heart surgery (European System for Cardiac Operative Risk Evaluation II 8.27%) prompted evaluation for Tendyne TMVR with the MitraCut technique. This beating heart transapical approach involved scissor-mediated splitting of the elongated 27 mm AML, essential for mitigating LVOT-O risk and dynamic SAM. The screening echocardiogram revealed the poorly tethered AML near the thickened septum at the simulated neo-LVOT site. Discussion This case underscores the intricate management challenges associated with severe MR, highlighting the successful application of the MitraCut technique as a viable alternative in high-risk scenarios. The imperative for further research and clinical studies is emphasized to comprehensively elucidate outcomes and safety parameters, providing valuable insights for refining TMVR applications within this context.
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Affiliation(s)
- Nunzio Davide de Manna
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover 30625, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover 30625, Germany
| | - Marieke Jüttner
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover 30625, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, Hannover 30625, Germany
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11
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Maznyczka A, Pilgrim T. Antithrombotic Treatment After Transcatheter Valve Interventions: Current Status and Future Directions. Clin Ther 2024; 46:122-133. [PMID: 37926630 DOI: 10.1016/j.clinthera.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The optimal antithrombotic strategy after transcatheter valve interventions is a subject of ongoing debate. Although there is evidence from randomized trials in patients undergoing transcatheter aortic valve replacement (TAVR), current evidence on optimal antithrombotic management after transcatheter mitral or tricuspid valve interventions is sparse. This article appraises the current evidence on this topic. METHODS This narrative review presents key research findings and guideline recommendations, as well as highlights areas for future research. FINDINGS After TAVR, randomized trial evidence suggests that single antiplatelet therapy is reasonable for patients without pre-existing indications for oral anticoagulation (OAC). If there is a concurrent indication for OAC, the addition of antiplatelet therapy increases bleeding risk. Whether direct oral anticoagulants achieve better outcomes than vitamin K antagonists is uncertain in this setting. Although OAC has been shown to reduce subclinical leaflet thrombosis (which may progress to structural valve degeneration), bleeding events are unacceptably high. There is a lack of randomized trial data comparing antithrombotic strategies after transcatheter mitral or tricuspid valve replacement or after mitral or tricuspid transcatheter edge-to-edge repair. Single antiplatelet therapy after mitral or tricuspid transcatheter edge-to-edge repair may be appropriate, whereas at least 3 months of OAC is suggested after transcatheter mitral valve replacement or transcatheter tricuspid valve replacement. IMPLICATIONS Randomized studies are warranted to address the knowledge gaps in antithrombotic therapy after transcatheter valve interventions and to optimize outcomes.
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Affiliation(s)
- Annette Maznyczka
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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Khokhar AA, Curio J, Sticchi A, Hartley A, Demir OM, Ruparelia N. Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis. J Clin Med 2024; 13:592. [PMID: 38276098 PMCID: PMC10816283 DOI: 10.3390/jcm13020592] [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: 12/22/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis.
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Affiliation(s)
- Arif A. Khokhar
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine, University Hospital, University of Cologne, 50937 Cologne, Germany;
| | - Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
- Università di Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Adam Hartley
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Ozan M. Demir
- Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon SS16 5NL, UK
| | - Neil Ruparelia
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
- Cardiology, Royal Berkshire Hospital, Reading RG1 5AN, UK
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El Bèze N, Himbert D, Suc G, Brochet E, Ajzenberg N, Cailliau A, Kikoïne J, Delhomme C, Carrasco JL, Ou P, Iung B, Urena M. Comparison of Direct Oral Anticoagulants vs Vitamin K Antagonists After Transcatheter Mitral Valve Replacement. J Am Coll Cardiol 2024; 83:334-346. [PMID: 38199711 DOI: 10.1016/j.jacc.2023.10.031] [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: 09/08/2023] [Accepted: 10/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND There is currently no established recommendation for antithrombotic treatment following transcatheter mitral valve replacement (TMVR). However, based on the analogy with surgical mitral bioprosthesis, vitamin K antagonists (VKAs) are predominantly used. OBJECTIVES The purpose of this study was to compare bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or VKAs in a prospective cohort of TMVR patients. METHODS We enrolled consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at our center between 2011 and 2023. The primary outcome was the occurrence of bleeding. VKAs were administered to patients until October 2019, after which DOACs were prescribed. The median follow-up was 4.7 months (Q1-Q3: 2.6-6.7 months). RESULTS A total of 156 patients were included. The mean age was 65 ± 18.5 years, and 103 patients (66%) were women. The median EuroSCORE II was 7.48% (Q1-Q3: 3.80%-12.97%). Of the participants, 20.5% received DOACs and 79.5% were treated with VKAs. The primary outcome was observed in 50 (40%) patients in the VKA group and 3 (9%) patients in the DOAC group (adjusted HR: 0.21; 95% CI: 0.06-0.74; P = 0.02). Treatment with DOAC was associated with a shorter length of hospital stay. No significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death. CONCLUSIONS The use of DOACs after TMVR, compared with VKAs, appears to reduce the risk of bleeding complications and decrease the length of hospital stay for patients, without a significant increase in the risk of thrombotic events.
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Affiliation(s)
- Nathan El Bèze
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France
| | - Gaspard Suc
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Nadine Ajzenberg
- INSERM UMRS1148, INSERM, Paris, France; Department of Hematology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Audrey Cailliau
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - John Kikoïne
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Clemence Delhomme
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Jose Luis Carrasco
- Department of Anesthesiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Phalla Ou
- Department of Radiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France
| | - Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France; INSERM UMRS1148, INSERM, Paris, France.
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Sabbak N, Kapadia S. Editorial: An atrial fixation transcatheter mitral valve replacement technology - Can we forget about the neo-LVOT? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:31-33. [PMID: 37716908 DOI: 10.1016/j.carrev.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Nabil Sabbak
- Cleveland Clinic Heart, Vascular, & Thoracic Institute, Cleveland, OH, United States of America
| | - Samir Kapadia
- Cleveland Clinic Heart, Vascular, & Thoracic Institute, Cleveland, OH, United States of America.
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Sorolla-Romero JA, Navarrete-Navarro J, Martinez-Sole J, Garcia HMG, Diez-Gil JL, Martinez-Dolz L, Sanz-Sanchez J. Pharmacological Considerations during Percutaneous Treatment of Heart Failure. Curr Pharm Des 2024; 30:565-577. [PMID: 38477207 DOI: 10.2174/0113816128284131240209113009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
Heart Failure (HF) remains a global health challenge, marked by its widespread prevalence and substantial resource utilization. Although the prognosis has improved in recent decades due to the treatments implemented, it continues to generate high morbidity and mortality in the medium to long term. Interventional cardiology has emerged as a crucial player in HF management, offering a diverse array of percutaneous treatments for both acute and chronic HF. This article aimed to provide a comprehensive review of the role of percutaneous interventions in HF patients, with a primary focus on key features, clinical effectiveness, and safety outcomes. Despite the growing utilization of these interventions, there remain critical gaps in the existing body of evidence. Consequently, the need for high-quality randomized clinical trials and extensive international registries is emphasized to shed light on the specific patient populations and clinical scenarios that stand to benefit most from these innovative devices.
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Affiliation(s)
- Jose Antonio Sorolla-Romero
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Javier Navarrete-Navarro
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Julia Martinez-Sole
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Hector M Garcia Garcia
- Department of Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, United States
| | - Jose Luis Diez-Gil
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Luis Martinez-Dolz
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
| | - Jorge Sanz-Sanchez
- Department of Cardiology, Hospital Universitari i Politècnic La Fe, Avenida Fernando Abril Martorell 116, Valencia, Spain
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16
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Fukui M, Okada A, Burns MR, Sato H, Thao KR, Wang C, Koike H, Hamid N, Enriquez-Sarano M, Lesser JR, Cavalcante JL, Sorajja P, Bapat VN. Deformation of transcatheter heart valves with mitral valve-in-valve. EUROINTERVENTION 2023; 19:e937-e947. [PMID: 37899719 PMCID: PMC10719737 DOI: 10.4244/eij-d-23-00614] [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: 07/31/2023] [Accepted: 09/24/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The use of oversizing in mitral valve-in-valve (MViV) procedures can lead to non-uniform expansion of transcatheter heart valves (THV). This may have implications for THV durability. AIMS The objective of this study was to assess the extent and predictors of THV deformation in MViV procedures. METHODS We examined 33 patients who underwent MViV with SAPIEN prostheses. The extent of THV deformation (deformation index, eccentricity, neosinus volume, asymmetric leaflet expansion and vertical deformation) and hypoattenuating leaflet thickening (HALT) were assessed using cardiac computed tomography (CT), performed prospectively at 30 days post-procedure. For descriptive purposes, the THV deformation index was calculated, with values >1.00 representing a more hourglass shape. RESULTS Non-uniform underexpansion of THV was common after MViV implantation, with a median expansion area of 74.0% (interquartile range 68.1-84.1) at the narrowest level and a THV deformation index of 1.21 (1.13-1.29), but circularity was maintained with eccentricity ranging from 0.24 to 0.28. The degree of oversizing was a key factor associated with greater underexpansion and a higher deformation index (β=-0.634; p<0.001; β=0.594; p<0.001, respectively). Overall, the incidence of HALT on the 30-day postprocedural CT was 27.3% (9 of 33). Most patients (32 of 33) were on anticoagulation therapy, but the prothrombin time and international normalised ratio (PT-INR) at the time of the CT scan was <2.5 in 23 of 32 patients. Among patients with a PT-INR of <2.5, HALT was predominantly observed with a high THV deformation index of ≥1.18. CONCLUSIONS THV deformation, i.e., underexpansion and an hourglass shape, commonly occurs after MViV implantation and is negatively affected by excessive oversizing. Optimising THV expansion during MViV could potentially prevent HALT.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Marcus R Burns
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Kiahltone R Thao
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Joao L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Dal Piaz MR, Pires LT, Herrera JCU, Labat ALB, Cividanes FR, Spina GS, Palma JH, Tarasoutchi F. Mitral re-valve-in-valve as a new perspective for high-risk patients with prosthetic valve dysfunction: case reports. Eur Heart J Case Rep 2023; 7:ytad579. [PMID: 38130861 PMCID: PMC10734623 DOI: 10.1093/ehjcr/ytad579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
Background Mitral valve diseases are a common medical condition, and surgery is the most used therapeutic approach. The need for less invasive interventions led to the development of transcatheter valve implantation in high-risk patients. However, the treatment to the dysfunctions of these prosthetic valves is still uncertain, and the yield and safety of repeated transcatheter valve implantations remain unclear. Cases summary A 69-year-old Caucasian woman with three previous mitral valve procedures performed due to rheumatic valve disease (currently with a biological prosthetic mitral valve) and a 76-year-old Latin woman with previous liver transplantation (due to metabolic-associated fatty liver disease) and biological mitral prosthesis due to mitral valve prolapse with severe regurgitation underwent mitral valve-in-valve (ViV) transcatheter implantation at the time of dysfunction of their surgical prostheses. Later, these patients developed prosthetic valve dysfunction and clinical worsening, requiring another invasive procedure. Due to maintained high-risk status and unfavourable clinical conditions for surgery, re-valve-in-valve (re-ViV) was performed. Discussion Valve-in-valve transcatheter mitral valve implantation was approved in 2017, and, since then, it has been used in several countries, mainly in high-risk patients. Nevertheless, these prosthetic valves may complicate with stenosis or regurgitation, demanding reinterventions. Although there are favourable data for mitral ViV, re-ViV still lacks robust data to support its performance, with only case reports in the literature so far. It is possible that in high-risk patients, there is a greater benefit from re-ViV when compared with the surgical strategy. However, this hypothesis must be studied in future controlled trials.
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Affiliation(s)
- Matheus Ramos Dal Piaz
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Lucas Tachotti Pires
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Jonathan Cayo Urdiales Herrera
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - André Luis Bezerra Labat
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Felipe Reale Cividanes
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Guilherme Sobreira Spina
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - José Honório Palma
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
| | - Flávio Tarasoutchi
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, 05403-000 São Paulo, SP, Brazil
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18
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El-Eshmawi A, Tang GH, Sun E, Alexis SL, Cangut B, Pandis D, Boateng P, Adams DH. Contemporary surgical techniques for mitral valve replacement in extensive mitral annular calcification. JTCVS Tech 2023; 22:1-12. [PMID: 38152201 PMCID: PMC10750984 DOI: 10.1016/j.xjtc.2023.10.009] [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: 06/06/2023] [Revised: 09/11/2023] [Accepted: 10/04/2023] [Indexed: 12/29/2023] Open
Abstract
Objectives Mitral annular calcification remains a formidable lesion in cardiac surgery with significant perioperative morbidity and mortality, particularly when en bloc annular decalcification is implemented. Respect strategies and hybrid approaches have provided safe alternatives. We report the short-term results of our institution's experience with mitral valve replacement in patients with extensive annular calcification. Methods This is a retrospective review of 72 consecutive patients with extensive annular calcification who underwent open surgical mitral valve replacement from January 1, 2013, to September 31, 2022. Degree of annular calcification was graded as partial, horseshoe, or circumferential. We excluded patients with calcification involving less than one-third of the annulus and patients with rheumatic heart disease. Results Mean patient age was 71.6 ± 10.9 years, and 50 (69.4%) were female. There were 51 patients (70.8%) with New York Heart Association class 3 or greater and 47 patients (65.3%) with pulmonary hypertension. There were 41 patients (56.9%) with partial, 12 patients (16.7%) with horseshoe, and 19 patients (26.4%) with circumferential calcification. Fifty-six patients (77.8%) underwent conventional valve replacement. Sixteen patients underwent a hybrid procedure using balloon-expandable devices. Concomitant procedures were performed in 61 patients (84.7%). In-hospital mortality and 1-year survival were 3.57% and 82.8% in the standard valve replacement cohort and 25.0% and 54.7% in the hybrid cohort, respectively. Conclusions Conventional mitral valve replacement using respect strategies is safe and associated with good outcomes in patients with extensive annular calcification. Hybrid approaches using novel devices should remain as a bailout in select patients because of higher perioperative risks and poor short-term outcomes.
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Affiliation(s)
- Ahmed El-Eshmawi
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Erick Sun
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Sophia L. Alexis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Busra Cangut
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Dimosthenis Pandis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Percy Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - David H. Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
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Akodad M, Trpkov C, Cheung A, Ye J, Chatfield AG, Alosail A, Besola L, Yu M, Leipsic JA, Lounes Y, Meier D, Yang C, Nestelberger T, Tzimas G, Sathananthan J, Wood DA, Moss RR, Blanke P, Sathananthan G, Webb JG. Valve-in-Valve Transcatheter Mitral Valve Replacement: A Large First-in-Human 13-Year Experience. Can J Cardiol 2023; 39:1959-1970. [PMID: 37625668 DOI: 10.1016/j.cjca.2023.08.018] [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: 04/07/2023] [Revised: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Favourable early outcomes have been reported following valve-in-valve transcatheter mitral valve replacement (TMVR). However, reports of long-term outcomes are lacking. We aimed to evaluate early and late outcomes in a large first-in-human valve-in-valve TMVR 13-year experience. METHODS All patients undergoing valve-in-valve TMVR in our centre from 2008 to 2021 were included. Clinical and echocardiographic outcomes, defined according to the Mitral Valve Academic Research Consortium, were reported. RESULTS A total of 119 patients were analysed: mean age 76.8 ± 10.2 years, mean Society of Thoracic Surgeons score 10.7 ± 6.8%, 55.4% female, 63.9% transapical access. Thirty-day mortality was 2.5% for the total population and 0.0% after transseptal TMVR. Maximum follow-up was 13.1 years. During a median follow-up of 3.4 years (interquartile range 1.8-5.3 years), 55 patients (46.2%) died, mainly from noncardiovascular causes. Valve hemodynamics were acceptable at 5 years, with 2.5% structural dysfunction. Patients treated from 2016 on (n = 68; 57.1%), following the advent of routine use of the Sapien 3 valve, CT screening, and transseptal access, were compared with those treated before 2016 (n = 51; 42.9%). Patients from 2016 on had a higher technical success rate (100.0% vs 94.1%; P = 0.04), shorter hospitalisation (P < 0.001), trending lower 30-day mortality (1.5% vs 3.9%; P = 0.4) and better 5-year survival (74.7% vs 41.1%; P = 0.03). CONCLUSIONS Valve-in-valve TMVR can be performed with little morbidity and low mortality. Mid- to long-term survival remains limited owing to advanced age and comorbidities. Structural bioprosthetic valve dysfunction was rare and redo TMVR feasible in selected patients. Outcomes continue to improve, but the role for valve-in-valve TMVR in lower surgical risk patients remains unclear.
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Affiliation(s)
- Mariama Akodad
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Cvet Trpkov
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrew G Chatfield
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Abdulmajeed Alosail
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Laura Besola
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Maggie Yu
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Youcef Lounes
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - David Meier
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Cathevine Yang
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Nestelberger
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Georgios Tzimas
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - David A Wood
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Rob R Moss
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gnalini Sathananthan
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- Centres for Heart Valve Innovation and for Cardiovascular Innovation, St Paul's and Vancouver General Hospitals, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada; Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada.
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20
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Urena M, Lurz P, Sorajja P, Himbert D, Guerrero M. Transcatheter mitral valve implantation for native valve disease. EUROINTERVENTION 2023; 19:720-738. [PMID: 37994096 PMCID: PMC10654769 DOI: 10.4244/eij-d-22-00890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/07/2023] [Indexed: 11/24/2023]
Abstract
Mitral regurgitation is the second most frequent heart valve disease in Europe and the most frequent in the US. Although surgery is the therapy of choice when intervention is indicated, transcatheter mitral valve repair or replacement are alternatives for patients who are not eligible for surgery. However, the development of transcatheter mitral valves is slower than expected. Although several transcatheter heart valves have been developed, only one has been commercialised. Indeed, most of these devices are being evaluated in clinical studies, with promising initial results. In this review, we propose an overview on transcatheter mitral valve replacement for the treatment of native mitral valve disease, from indication to results, including patients with severe annular calcification, and we provide you with a glimpse into the future of these therapies.
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Affiliation(s)
- Marina Urena
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philipp Lurz
- Department of Cardiology, Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Dominique Himbert
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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21
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Simonato M, Whisenant BK, Unbehaun A, Kempfert J, Ribeiro HB, Kornowski R, Erlebach M, Bleiziffer S, Windecker S, Pilgrim T, Tomii D, Guerrero M, Ahmad Y, Forrest JK, Montorfano M, Ancona M, Adam M, Wienemann H, Finkelstein A, Villablanca P, Codner P, Hildick-Smith D, Ferrari E, Petronio AS, Shamekhi J, Presbitero P, Bruschi G, Rudolph T, Cerillo A, Attias D, Nejjari M, Abizaid A, Felippi de Sá Marchi M, Horlick E, Wijeysundera H, Andreas M, Thukkani A, Agrifoglio M, Iadanza A, Baer LM, Nanna MG, Dvir D. Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry. JACC Cardiovasc Interv 2023; 16:2615-2627. [PMID: 37968032 DOI: 10.1016/j.jcin.2023.08.047] [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: 05/07/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction. OBJECTIVES This study aimed to determine whether device position and asymmetry are associated with these outcomes. METHODS Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated. RESULTS A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027). CONCLUSIONS Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered.
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Affiliation(s)
- Matheus Simonato
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Axel Unbehaun
- Deutsches Herzzentrum der Charité, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Henrique B Ribeiro
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Sabine Bleiziffer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | | | | | | | | | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - John K Forrest
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Marco Ancona
- IRCCS Ospedale San Raffaele, Milan, Italy; School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Matti Adam
- Universitätsklinikum Köln, Cologne, Germany
| | | | | | | | | | | | | | | | | | | | | | - Tanja Rudolph
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | | | - David Attias
- Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Alexandre Abizaid
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Eric Horlick
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Michael G Nanna
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Danny Dvir
- Department of Cardiology, Shaare Zedek Medical Centre, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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22
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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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23
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Kikoïne J, Himbert D, Chong-Nguyen C, Suc G, Brochet E, Cailliau A, Delhomme C, Iung B, Urena M. Incidence and Predictors of Early Major Bleeding After Transseptal Transcatheter Mitral Valve Replacement Using TAV. JACC Cardiovasc Interv 2023; 16:2337-2339. [PMID: 37758391 DOI: 10.1016/j.jcin.2023.07.030] [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: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 10/03/2023]
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24
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Guerrero ME, Grayburn P, Smith RL, Sorajja P, Wang DD, Ahmad Y, Blusztein D, Cavalcante J, Tang GHL, Ailawadi G, Lim DS, Blanke P, Eleid MF, Kaneko T, Thourani VH, Bapat V, Mack MJ, Leon MB, George I. Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement. JACC Cardiovasc Interv 2023; 16:2195-2210. [PMID: 37758378 DOI: 10.1016/j.jcin.2023.06.044] [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: 01/27/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 10/02/2023]
Abstract
Mitral annular calcium (MAC) with severe mitral valvular dysfunction presents a complex problem, as valve replacement, either surgical or transcatheter, is challenging because of anatomy, technical considerations, concomitant comorbidities, and advanced age. The authors review the clinical and anatomical features of MAC that are favorable (green light), challenging (yellow light), or prohibitive (red light) for surgical or transcatheter mitral valve interventions. Under the auspices of the Heart Valve Collaboratory, an expert working group of cardiac surgeons, interventional cardiologists, and interventional imaging cardiologists was formed to develop recommendations regarding treatment options for patients with MAC as well as a proposed grading and staging system using both anatomical and clinical features.
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Affiliation(s)
| | | | | | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Yousif Ahmad
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Blusztein
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - João Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Vinayak Bapat
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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25
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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: 5] [Impact Index Per Article: 5.0] [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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26
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Martins de Carvalho M, Alves Pinto R, Proença T, Paiva M, Sousa C, Silva JC, Macedo F. Percutaneous implantation of a Sapiens 3 valve-in-valve in mitral position: A case report involving correction of prosthetic mitral valve regurgitation. Rev Port Cardiol 2023; 42:813-814. [PMID: 37019283 DOI: 10.1016/j.repc.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023] Open
Affiliation(s)
- Miguel Martins de Carvalho
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R&D Center, Faculty of Medicine of the University of Porto São João, Porto, Portugal.
| | - Ricardo Alves Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Tânia Proença
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Mariana Paiva
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Sousa
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R&D Center, Faculty of Medicine of the University of Porto São João, Porto, Portugal
| | - João Carlos Silva
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Filipe Macedo
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R&D Center, Faculty of Medicine of the University of Porto São João, Porto, Portugal
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27
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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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28
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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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Zogg CK, Hirji SA, Percy ED, Newell PC, Shah PB, Kaneko T. Comparison of Postdischarge Outcomes Between Valve-in-Valve Transcatheter Mitral Valve Replacement and Reoperative Surgical Mitral Valve Replacement. Am J Cardiol 2023; 201:200-210. [PMID: 37385175 DOI: 10.1016/j.amjcard.2023.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 07/01/2023]
Abstract
Limited data are available comparing the postdischarge perioperative outcomes of isolated valve-in-valve transcatheter mitral valve replacement (VIV-TMVR) versus surgical reoperative mitral valve replacement (re-SMVR) on a nationwide scale. The objective of this study was to perform a robust head-to-head assessment of contemporary postdischarge outcomes between isolated VIV-TMVR and re-SMVR using a large national multicenter longitudinal database. Adult patients aged ≥18 years with failed/degenerated bioprosthetic mitral valves who underwent either isolated VIV-TMVR or re-SMVR were identified in the 2015 to 2019 Nationwide Readmissions Database. The risk-adjusted differences in 30-, 90-, and 180-day outcomes were compared using propensity score weighting with overlap weights to mimic the results of a randomized controlled trial. The differences between a transeptal and transapical VIV-TMVR approach were also compared. A total of 687 patients with VIV-TMVR and 2,047 patients with re-SMVR were included. After the overlap weighting to attain balance between treatment groups, VIV-TMVR was associated with significantly lower major morbidity within 30 (odds ratio [95% confidence interval (CI)] 0.0.31 [0.22 to 0.46]), 90 (0.34 [0.23 to 0.50]), and 180 (0.35 [0.24 to 0.51]) days. The differences in major morbidity were primarily driven by less major bleeding (0.20 [0.14 to 0.30]), new onset complete heart block (0.48 [0.28 to 0.84]) and need for permanent pacemaker placement (0.26 [0.12 to 0.55]). The differences in renal failure and stroke were not significant. VIV-TMVR was also associated with shorter index hospital stays (median difference [95% CI] -7.0 [4.9 to 9.1] days) and an increased ability for patients to be discharged home (odds ratio [95% CI] 3.35 [2.37 to 4.72]). There were no significant differences in total hospital costs; in-hospital or 30-, 90-, and 180-day mortality; or readmission. The findings remained similar when stratifying the VIV-TMVR access using a transeptal versus a transapical approach. The changes in outcomes over time suggest marked improvements for patients with VIV-TMVR relative to stagnant results for patients with re-SMVR from 2015 to 2019. In this large nationally representative cohort of patients with failed/degenerated bioprosthetic mitral valves, VIV-TMVR appears to confer a short-term advantage over re-SMVR in terms of morbidity, discharge home, and length of stay. It yielded equivalent outcomes for mortality and readmission. Longer-term studies are needed to assess further follow-up beyond 180 days.
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Affiliation(s)
- Cheryl K Zogg
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Yale School of Medicine, New Haven, Connecticut
| | - Sameer A Hirji
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Edward D Percy
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Paige C Newell
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Pinak B Shah
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts; Cardiovascular Division, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri.
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Delhomme C, Urena M, Chong-Nguyen C, Brochet E, Ducrocq G, Iung B, Himbert D. Emergent transcatheter mitral valve implantation: Early and mid-term outcomes. Arch Cardiovasc Dis 2023; 116:300-308. [PMID: 37225555 DOI: 10.1016/j.acvd.2023.04.005] [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: 02/18/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Transcatheter mitral valve implantation (TMVI) may be attractive to treat high-risk patients with mitral bioprosthesis or annuloplasty ring failure or severe mitral annular calcification. AIM To report the outcomes of patients after valve-in-valve/ring/mitral annular calcification TMVI using balloon expandable transcatheter aortic valves, according to the degree of urgency of the procedure. METHODS All patients who underwent TMVI in our centre from 2010 to 2021 were classified into three groups: elective, urgent or emergent/salvage TMVI. RESULTS A total of 157 patients were included: 129 (82.2%) had elective, 21 (13.4%) urgent and 7 (4.4%) had emergent/salvage TMVI. Patients with emergent/salvage TMVI had a higher EuroSCORE II: elective, 7.3%; urgent, 9.7%; emergent/salvage, 54.5% (P<0.0001). The indication for TMVI was bioprosthesis failure in all of the emergent/salvage group, in 13 of the urgent group (61.9%) and in 62 of the elective group (48.1%). Overall, the technical success rate of TMVI was 86%, and was similar in the three groups (elective, 86.1%; urgent, 95.2%; emergent/salvage, 71.4%). The cumulative survival rate at 2-year follow-up was lower in the emergent/salvage group than in the elective or urgent group (42.9% vs 71.2% for the elective group; 76.2% for the urgent group; log-rank test, P=0.012). The excess mortality in the emergent/salvage group occurred during the first month postprocedure. Thereafter, the 30-day landmark analysis did not show any more statistical difference between the three groups (log-rank test, P=0.94). CONCLUSIONS Emergent/salvage TMVI was associated with high early mortality, but 1-month survivors had similar outcomes to patients with elective/urgent TMVI. The degree of urgency of the procedure should not prevent TMVI in high-risk patients.
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Affiliation(s)
- Clémence Delhomme
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France.
| | - Marina Urena
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France; University of Paris Cité, 75018 Paris, France
| | | | - Eric Brochet
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Grégory Ducrocq
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France; University of Paris Cité, 75018 Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France; University of Paris Cité, 75018 Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France
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Haramati A, Latib A, Lazarus MS. Post-procedural structural heart CT imaging: TAVR, TMVR, and other interventions. Clin Imaging 2023; 101:86-95. [PMID: 37311399 DOI: 10.1016/j.clinimag.2023.05.012] [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: 03/20/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
Transcatheter valve replacement has experienced substantial growth in the past decade and this technique can now be used for any of the four heart valves. Transcatheter aortic valve replacement (TAVR) has overtaken surgical aortic valve replacement. Transcatheter mitral valve replacement (TMVR) is often performed in pre-existing valves or after prior valve repair, although numerous devices are undergoing trials for replacement of native valves. Transcatheter tricuspid valve replacement (TTVR) is similarly under active development. Lastly, transcatheter pulmonic valve replacement (TPVR) is most often used for revision treatment of congenital heart disease. Given the growth of these techniques, radiologists are increasingly called upon to interpret post-procedural imaging for these patients, particularly with CT. These cases will often arise unexpectedly and require detailed knowledge of potential post-procedural appearances. We review both normal and abnormal post-procedural findings on CT. Certain complications-device migration or embolization, paravalvular leak, or leaflet thrombosis-can occur after replacement of any valve. Other complications are specific to each type of valve, including coronary artery occlusion after TAVR, coronary artery compression after TPVR, or left ventricular outflow tract obstruction after TMVR. Finally, we review access-related complications, which are of particular concern due to the requirement of large-bore catheters for these procedures.
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Affiliation(s)
- Adina Haramati
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, 525 East 68(th) Street, New York, NY 10065, United States of America
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America
| | - Matthew S Lazarus
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210(th) Street, Bronx, NY 10467, United States of America.
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Wilbring M, Petrov A, Arzt S, Eiselt JP, Taghizadeh-Waghefi A, Matschke K, Kappert U, Alexiou K. Long-Term Outcomes after Transcatheter Mitral Valve-in-Valve or Valve-in-Ring Procedures. J Pers Med 2023; 13:jpm13050803. [PMID: 37240973 DOI: 10.3390/jpm13050803] [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: 03/21/2023] [Revised: 04/26/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Redo mitral valve surgery is the standard of care for failed mitral bioprostheses or recurrence of mitral regurgitation after repair. Nonetheless, catheter-based valve-in-valve (ViV) or valve-in-ring (ViR) procedures have increasingly become viable alternatives in high-risk subpopulations. Despite reported good initial results, little is known about longer-term outcomes. Here, we report the long-term outcomes of transcatheter mitral ViV and ViR procedures. METHODS All consecutive patients (n = 54) undergoing transcatheter mitral ViV or ViR procedures for failed bioprostheses or recurring regurgitation after mitral repair in the time period between 2011 and 2021 were retrospectively enrolled. The mean age was 76.5 ± 6.5 years, and 30 (55.6%) of the patients were male. The procedures were done using a commercially available balloon-expandable transcatheter heart valve. Clinical and echocardiographic follow-up data were obtained from the hospital's database and analyzed. Follow-up reached up to 9.9 years with a total of 164.3 patient-years. RESULTS A total 25 patients received a ViV and 29 patients a ViR procedure. Both groups were at high surgical risk with an STS-PROM of 5.9 ± 3.7% in ViV and 8.7 ± 9.0% in ViR patients (p < 0.01). The procedures themselves were mainly uneventful with no intraoperative deaths and a low conversion rate (n = 2/54; 3.7%). VARC-2 procedural success was low (ViV 20.0% and ViR 10.3%; p = 0.45), which was either driven by high rates of transvalvular pressure gradients ">5 mmHg" (ViV 92.0% and ViR 27.6%; p < 0.01) or residual regurgitation ">trace" (ViV 28.0% and ViR 82.7%; p < 0.01). ICU-stay was prolonged in both groups (ViV 3.8 ± 6.8 days and ViR 4.3 ± 6.3 days; p = 0.96) with acceptable hospital stay (ViV 9.9 ± 5.9 days and ViR 13.5 ± 8.0 days; p = 0.13). Despite 30-day mortality being acceptable (ViV 4.0% and ViR 6.9%; p = 1.00), the mean posthospital survival time was disappointingly low (ViV 3.9 ± 2.6 years and ViR 2.3 ± 2.7 years; p < 0.01). Overall survival in the entire group was 33.3%. Cardiac reasons for death were frequent in both groups (ViV 38.5% and ViR 52.2%). Cox-regression analysis identified ViR procedures as a predictor of mortality (HR 2.36, CI 1.19-4.67, p = 0.01). CONCLUSIONS Despite acceptable immediate outcomes in this high-risk subpopulation, long-term results are discouraging. Transvalvular pressure gradients as well as residual regurgitations remained drawbacks in this real-world population. The indication for catheter-based mitral ViV or ViR procedures rather than conventional redo-surgery or conservative treatment must be thoughtfully considered.
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Affiliation(s)
- Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Asen Petrov
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Sebastian Arzt
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Julia Patricia Eiselt
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Ali Taghizadeh-Waghefi
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, University Heart Center Dresden, Fetscherstrasse 76, 01307 Dresden, Germany
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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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Lamberg M, Devine A, Jewulski J, Smith A, Garster N, Sharma A, Mason PJ, Lewandowski D, Widlansky M, Mohananey D. Degenerative Mitral Stenosis: A Case-Based Review. CASE (PHILADELPHIA, PA.) 2023; 7:189-196. [PMID: 37325463 PMCID: PMC10264206 DOI: 10.1016/j.case.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Morgan Lamberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adam Devine
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jacob Jewulski
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aaron Smith
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Noelle Garster
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Abhinav Sharma
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter J Mason
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Lewandowski
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Widlansky
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Xu X, Liu H, Gu J, Li M, Shao Y. Valve-in-valve/valve-in-ring transcatheter mitral valve implantation vs. redo surgical mitral valve replacement for patients with failed bioprosthetic valves or annuloplasty rings: A systematic review and meta-analysis. Heliyon 2023; 9:e16078. [PMID: 37234656 PMCID: PMC10208839 DOI: 10.1016/j.heliyon.2023.e16078] [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: 12/24/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Background Valve-in-valve (ViV)/valve-in-ring (ViR) transcatheter mitral valve implantation (TMVI) is a less invasive alternative to redo surgical mitral valve replacement (SMVR). To further verify its feasibility, we aimed to appraise early clinical outcomes after either ViV/ViR TMVI or redo SMVR for failed bioprosthetic valves or annuloplasty rings, as a comparison of long-term follow-up results are not available for these procedures. Methods We systematically searched PubMed, Cochrane Controlled Trials Register, EMBASE, and Web of Science to identify studies that compared ViV/ViR TMVI and redo SMVR. Fixed- and random-effects meta-analyses were used to compare the early clinical results between these two groups. Results A total of 3,890 studies published from 2015 to 2022 were searched, and ten articles comprising 7,643 patients (ViV/ViR TMVI, 1,719 patients; redo SMVR, 5,924 patients) were included. In this meta-analysis, ViV/ViR TMVI significantly improved in-hospital mortality (fixed-effects model: odds ratio [OR], 0.72; 95% confidence interval [CI], 0.57-0.92; P = 0.008) and for the matched populations (fixed-effects model: OR, 0.42; 95% CI, 0.29-0.61; P < 0.00001). ViV/ViR TMVI also outperformed redo SMVR in 30-day mortality and in rates of early postoperative complications. ViV/ViR TMVI resulted in less time spent in the ICU and hospital, whereas it showed no significant difference in one-year mortality. A lack of comparison of long-term clinical outcomes and postoperative echocardiographic results are important limitations of our results. Conclusions ViV/ViR TMVI is a reliable alternative to redo SMVR for failed bioprosthetic valves or annuloplasty rings as a result of lower in-hospital mortality, higher 30-day survival, and lower early postoperative complication rates, although there is no significant difference in 1-year mortality.
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Churchill TW, Yucel E, Bernard S, Namasivayam M, Nagata Y, Lau ES, Deferm S, He W, Danik JS, Sanborn DY, Picard MH, Levine RA, Hung J, Bertrand PB. Sex Differences in Extensive Mitral Annular Calcification With Associated Mitral Valve Dysfunction. Am J Cardiol 2023; 193:83-90. [PMID: 36881941 PMCID: PMC10066827 DOI: 10.1016/j.amjcard.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 03/07/2023]
Abstract
Mitral annular calcification (MAC)-related mitral valve (MV) dysfunction is an increasingly recognized entity, which confers a high burden of morbidity and mortality. Although more common among women, there is a paucity of data regarding how the phenotype of MAC and the associated adverse clinical implications may differ between women and men. A total of 3,524 patients with extensive MAC and significant MAC-related MV dysfunction (i.e., transmitral gradient ≥3 mm Hg) were retrospectively analyzed from a large institutional database, with the goal of defining gender differences in clinical and echocardiographic characteristics and the prognostic importance of MAC-related MV dysfunction. We stratified patients into low- (3 to 5 mm Hg), moderate- (5 to 10 mm Hg), and high- (≥10 mm Hg) gradient groups and analyzed the gender differences in phenotype and outcome. The primary outcome was all-cause mortality, assessed using adjusted Cox regression models. Women represented the majority (67%) of subjects, were older (79.3 ± 10.4 vs 75.5 ± 10.9 years, p <0.001) and had a lower burden of cardiovascular co-morbidities than men. Women had higher transmitral gradients (5.7 ± 2.7 vs 5.3 ± 2.6 mm Hg, p <0.001), more concentric hypertrophy (49% vs 33%), and more mitral regurgitation. The median survival was 3.4 years (95% confidence interval 3.0 to 3.6) among women and 3.0 years (95% confidence interval 2.6 to 4.5) among men. The adjusted survival was worse among men, and the prognostic impact of the transmitral gradient did not differ overall by gender. In conclusion, we describe important gender differences among patients with MAC-related MV dysfunction and show worse adjusted survival among men; although, the adverse prognostic impact of the transmitral gradient was similar between men and women.
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Affiliation(s)
- Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Evin Yucel
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel Bernard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, New York University School of Medicine, New York University, New York, New York
| | - Mayooran Namasivayam
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Victor Chang Cardiac Research Institute, St. Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Yasufumi Nagata
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; The Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sebastien Deferm
- Department of Cardiology, Mainz University Hospital, Mainz Germany
| | - Wei He
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline S Danik
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danita Y Sanborn
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A Levine
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philippe B Bertrand
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Ziekenhuis Oost-Limburg, Genk, Belgium
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Sehgal S, Subramanyam P, Ahluwalia M, Rastogi A, Bergman G. Transcatheter mitral valve implantation: Implications of interventional technique and 3D echocardiography for complex valve-in-valve paravalvular leak. Ann Card Anaesth 2023; 26:227-231. [PMID: 37706394 PMCID: PMC10284472 DOI: 10.4103/aca.aca_166_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/07/2022] [Accepted: 07/09/2022] [Indexed: 09/15/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve-in-valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve-in-valve PVL are limited. We present a case of a symptomatic patient with severe valve-in-valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve-in-valve-in-valve implantation with a 29 mm Edwards® SAPIEN 3 valve via transseptal approach using three-dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve-in-valve PVL closures.
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Affiliation(s)
- Sankalp Sehgal
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Cardiothoracic Anesthesia, Critical Care and Pain Medicine, 330 Brookline Ave, Boston, MA, USA
| | - Pritha Subramanyam
- Weill Cornell Medical College, New York Presbyterian Hospital, Division of Cardiology, 525 E. 68th Street, New York, NY, USA
| | - Monica Ahluwalia
- Boston Medical Center, Boston University School of Medicine, Division of Cardiovascular Medicine, 72 E. Concord St, Boston, MA, USA
| | - Ashish Rastogi
- Owensboro Health Cardiology, 1301 Pleasant Valley Road, Owensboro, KY, USA
| | - Geoffrey Bergman
- Weill Cornell Medical College, New York Presbyterian Hospital, Division of Cardiology, 525 E. 68th Street, New York, NY, USA
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Moscarella E, Ielasi A, Mussayev A, Montorfano M, Mullassari A, Martin P, Testa L, Jose J, Ninios V, Toutouzas K, Giannini F, Kertesz A, Unic D, Nissen H, Ezhumalai B, Senguttuvan NB, Amat-Santos I, Seth A, Bedogni F, Tespili M. Transcatheter valve-in-valve or valve-in-ring implantation with a novel balloon-expandable device in patients with bioprosthetic left side heart valves failure: 1-year follow-up from a multicenter experience. Int J Cardiol 2023; 376:35-45. [PMID: 36657566 DOI: 10.1016/j.ijcard.2023.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transcatheter aortic and mitral valve-in-valve (ViV) or valve-in-ring (ViR) implantation into failed bioprosthetic heart valves (BHVs) or rings represents an appealing, less invasive, treatment option for patients at high surgical risk. Nowadays, few data have been reported on the use of balloon-expandable Myval (Meril Life Science, Vapi, India) transcatheter heart valve (THV) for the treatment of degenerated BHVs or rings. We aimed at evaluating the early and mid-term clinical outcomes of patients with left side heart bioprosthesis deterioration treated with transcatheter ViV/ViR implantation using Myval THV. METHODS 97 consecutive patients with symptomatic, severe aortic(n=33) and mitral(n=64) BHVs/ring dysfunction underwent transcatheter aortic ViV and mitral ViV/ViR implantation with Myval THV. RESULTS Technical success was achieved in 95 (98%) of the patients. Two cases of acute structural trans-catheter mitral ViV/ViR dysfunction requiring a second THV implantation were reported. At 30-day, a significant reduction in prosthetic trans-valvular pressure gradients and increase in valve areas were seen following both aortic and mitral ViV/ViR implantation. Overall survival at 15 months (IQR 8-21) was 92%. Patients undergoing mitral ViV/ViR had a relatively worse survival compared with those undergoing aortic ViV implantation (89% vs. 97% respectively; HR:2.7,CI:0.33-22.7;p=0.34). At longest follow-up available a significant improvement in NYHA functional class I and II was observed in patients with aortic and mitral ViV/ViR implantation(93.8% and 92.1%). CONCLUSIONS Despite high surgical risk, transcatheter ViV/ViR implantation for failed left side heart bioprosthesis can be performed safely using Myval THV with a high success rate and low early and mid-term mortality and morbidity.
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Affiliation(s)
- Elisabetta Moscarella
- Division of Clinical Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Ielasi
- Cardiology Division, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy.
| | - Abdurashid Mussayev
- Catheterization Laboratory, National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Insitute, Milan, Italy
| | | | - Pedro Martin
- Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - John Jose
- Department of Cardiology, Christian Medical College & Hospital, Vellore, India
| | - Vlasis Ninios
- Department of Cardiology, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Kostantinos Toutouzas
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | | | - Attila Kertesz
- Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, University Hospital "Dubrava", Zagreb, Croatia
| | - Henrik Nissen
- Depertment of Cardiology, Odense University Hospital, Odense, Denmark
| | - Babu Ezhumalai
- Department of Cardiology, Fortis Malar Hospital, Adyar, Chennai, India
| | | | - Ignacio Amat-Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Francesco Bedogni
- Department of Cardiology, Christian Medical College & Hospital, Vellore, India
| | - Maurizio Tespili
- Cardiology Division, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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Agrawal A, Reardon MJ, Goel SS. Transcatheter Mitral Valve Replacement in Patients with Mitral Annular Calcification: A Review. Heart Int 2023; 17:19-26. [PMID: 37456353 PMCID: PMC10339466 DOI: 10.17925/hi.2023.17.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/31/2023] [Indexed: 07/18/2023] Open
Abstract
Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
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Al-Tawil M, Butt S, Reap S, Duric B, Harahwa T, Chandiramani A, Zeinah M, Harky A. Transseptal versus Transapical Transcatheter Mitral Valve-in-Valve and Valve-in-Ring Implantation: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101684. [PMID: 36921647 DOI: 10.1016/j.cpcardiol.2023.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Transcatheter mitral valve replacement has become a useful alternative for patients with failed mitral prosthesis or annuloplasty rings who are deemed high risk for re-do surgery. We aimed to compare the clinical outcomes following transseptal (TS) and transapical (TA) approaches in transcatheter mitral valve-in-valve and valve-in-ring implantation (TMViV/R) METHODS: Electronic databases PubMed, MEDLINE, and Embase were searched through November 2022. Both clinical trials and observational studies comparing patients undergoing TS and TA TMViV/R were eligible for inclusion. Primary outcomes were 30-day and one-year mortality. Post-operative stroke, left ventricle outlet tract (LVOT) obstruction, mitral valve pressure gradient (MVPG), bleeding, and length of hospital stay were also evaluated. RESULTS Seven observational studies were included comparing patients undergoing TS (n=1875) and TA (n=1120) TMViV/R. The TS group had significantly lower 30-day mortality (OR: 0.66; 95% CI [0.47, 0.94]; P=0.02, I²= 0%) and lower one-year mortality risk group (HR: 0.79; 95% CI [0.63, 0.99]; P=0.04, I²= 0%) compared to the TA group. The TS group had consistent shorter in-hospital stay (MD= -3.79; 95% CI [-5.23, -2.34] days; p<0.0001, I²= 75%). Post-operative stroke, bleeding and LVOT obstruction tended to be lower in the TS but the results did not reach statistical significance. Post-operative MVPG was similar between both groups. CONCLUSION The TS approach has lower early mortality, lower one-year death hazard, shorter in-hospital stay, and a trend toward lower complication rates when compared to TA TMViV/R. Further controlled trials may support the evidence and provide long-term outcomes.
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Affiliation(s)
| | - Sundas Butt
- Department of Thoracic Surgery, Nottingham City Hospital, Nottingham, UK
| | - Sophie Reap
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Bea Duric
- King's College London, GKT School of Medical Education, London, UK
| | - Tinotenda Harahwa
- Department of Obstetrics and Gynecology, University Hospital Lewisham, London, UK
| | | | - Mohamed Zeinah
- Faculty of Medicine, Ain Sham University, Cairo, Egypt; Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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Chen CY, Chan YH, Wu VCC, Liu KS, Cheng YT, Chu PH, Chen SW. Bioprosthetic versus mechanical mitral valve replacements in patients with rheumatic heart disease. J Thorac Cardiovasc Surg 2023; 165:1050-1060.e8. [PMID: 33840468 DOI: 10.1016/j.jtcvs.2021.03.033] [Citation(s) in RCA: 10] [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: 09/14/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains a critical problem in developed countries. Few studies have compared the long-term outcomes of bioprosthetic valves and mechanical valves in patients with RHD who have received mitral valve (MV) replacement. METHODS Patients with RHD who received MV replacement with bioprosthetic or mechanical valves were identified between 2000 and 2013 from Taiwan's National Health Insurance Research Database. The primary late outcomes of interest were all-cause mortality and redo MV surgery. Propensity score matching at a 1:1 ratio was performed. RESULTS We identified 3638 patients with RHD who underwent MV replacement. Among those patients, 1075 (29.5%) and 2563 (70.5%) chose a bioprosthetic valve and mechanical valve, respectively. After matching, 788 patients were assigned to each group. No significant difference in the risk of in-hospital mortality was observed between groups (P = .920). Higher risks of all-cause mortality (10-year actuarial estimates: 50.6% vs 45.5%; hazard ratio, 1.19; 95% confidence interval, 1.01-1.41; P = .040) and MV reoperation (10-year actuarial estimates: 8.9% vs 0.93%; subdistribution hazard ratio, 4.56; 95% confidence interval, 1.71-12.17; P <.01) were observed in the bioprosthetic valve group. Furthermore, the relative mortality benefit associated with mechanical valves was more apparent in younger patients and the beneficial effect persisted until approximately 65 years of age. CONCLUSIONS In the patients with RHD who underwent MV replacement, mechanical valves were associated with more favorable long-term outcomes in patients younger than the age of 65 years.
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Affiliation(s)
- Cheng-Yu Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan; Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Sheng Liu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Aurigemma C, Burzotta F, Trani C. Heart valve disease gender difference in the era of transcatether treatment. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Available data have demonstrated important sex-related differences in patients with valvular heart disease, regarding clinical presentation, treatment, and outcomes. Although the calcific aortic stenosis (AS) is more frequent in men compared to women, the majority of AS patients over 80 years old are women, in whom fibrotic remodeling of aortic valve is typically found. Mitral valve disease is more common in women. However females are under-referred or delayed referrals to treatment, probably due to the absence of sex-based LV dimension values guiding surgical timing. The development of transcatheter devices have revolutionized the treatment of valvular heart disease and increased the interest in this topic.
In this context, the consideration of gender differences in presentation, diagnosis, treatment success, and prognosis is of great importance.
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Meta-Analysis Comparing Valve-in-Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement in Degenerated Bioprosthetic Mitral Valve. Am J Cardiol 2023; 189:98-107. [PMID: 36521415 DOI: 10.1016/j.amjcard.2022.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022]
Abstract
Valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) and redo surgical mitral valve replacement (redo-SMVR) are 2 treatment strategies for patients with bioprosthetic mitral valve dysfunction. We conducted a systematic review and meta-analysis to compare the outcomes of ViV-TMVR versus redo-SMVR. We searched PubMed, EMBASE, Cochrane, and Google Scholar for studies comparing outcomes of ViV-TMVR versus redo-SMVR in degenerated bioprosthetic mitral valves. We used a random-effects model to calculate odd ratios (ORs) with 95% confidence intervals (CIs). Outcomes included in-hospital, 30-day, 1-year, and 2-year mortality, stroke, bleeding, acute kidney injury, arrhythmias, permanent pacemaker insertion, and hospital length of stay (LOS). A total of 6 observational studies with 707 subjects were included. The median follow-up was 2.7 years. Despite their older age and greater co-morbidity burden, patients who underwent ViV-TMVR had a similar in-hospital mortality (OR 0.52, 95% CI 0.22 to 1.23, p = 0.14), 30-day mortality (OR 0.65, 95% CI 0.36 to 1.17, p = 0.15), 1-year mortality (OR 0.97, 95% CI 0.63 to 1.49, p = 0.89), and 2-year mortality (OR 1.17, 95% CI 0.65 to 2.13, p = 0.60) compared with redo-SMVR. ViV-TMVR was associated with significantly lower periprocedural complications, including stroke, bleeding, acute kidney injury, arrhythmias, and permanent pacemaker insertion, and shorter hospital LOS than redo-SMVR. In conclusion, ViV-TMVR was associated with better outcomes than redo-SMVR in patients with degenerated bioprosthetic mitral valves, including lower complication rates and shorter hospital LOS, with no significant difference in mortality rates. Large-scale randomized trials are needed to mitigate biases and confirm our findings.
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Xu B, Saijo Y, Reyaldeen RM, Vega Brizneda M, Chan N, Gillinov AM, Pettersson GB, Unai S, Flamm SD, Schoenhagen P, Grimm RA, Obuchowski N, Griffin BP. Novel Multi-Parametric Mitral Annular Calcification Score Predicts Outcomes in Mitral Valve Dysfunction. Curr Probl Cardiol 2023; 48:101456. [PMID: 36265589 DOI: 10.1016/j.cpcardiol.2022.101456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
The objective of the study was to construct a multi-parametric mitral annular calcification (MAC) score using computed tomography (CT) features for prediction of outcomes in patients undergoing mitral valve surgery. We constructed a multi-parametric MAC score, which ranges between 2 and 12, and consists of Agatston calcium score (1 point: <1000 Agatston units (AU); 2 points: 1000-<3000 AU; 3 points: 3000-5000 AU; 4 points: >5000 AU), quantitative MAC circumferential angle (1 point: <90°; 2 points: 90-<180°; 3 points: 180-<270°; 4 points: 270-360°), involvement of trigones (1 point: 1 trigone; 2 points: both trigones), and 1 point each for myocardial infiltration and left ventricular outflow tract extension/involvement of aorto-mitral curtain. The association between MAC score and clinical outcomes was evaluated. The study cohort consisted of 334 patients undergoing mitral valve surgery (128 mitral valve repairs, 206 mitral valve replacements) between January 2011 and September 2019, who had both non-contrast gated CT scan and evidence of MAC. The mean age was 72 ± 11 years, with 58% of subjects being female. MAC score was a statistically significant predictor of total operation time (P<0.001), cross-clamp time (P = 0.001) and in-hospital complications (P = 0.003). Additionally, MAC score was a significant predictor of time to all-cause death (P = 0.046). A novel multi-parametric score based on CT features allowed systematic assessment of MAC, and predicted clinical outcomes in patients with mitral valve dysfunction undergoing mitral valve surgery.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195.
| | - Yoshihito Saijo
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Reza M Reyaldeen
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Maria Vega Brizneda
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Paul Schoenhagen
- Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Nancy Obuchowski
- the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA, 44195
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH, USA, 44195, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA, 44195
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Zhou J, Li Y, Chen Z, Zhang H. Transcatheter mitral valve replacement versus redo surgery for mitral prosthesis failure: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1058576. [PMID: 36741847 PMCID: PMC9889358 DOI: 10.3389/fcvm.2022.1058576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Background Transcatheter mitral valve replacement (TMVR) has emerged as an alternative to redo surgery. TMVR compared with redo surgical mitral valve replacement (SMVR) in patients with mitral prosthesis failure remains limited. In this study, we performed a meta-analysis to assess the outcomes of TMVR (including valve-in-valve and valve-in-ring) versus redo surgery for mitral prosthesis failure. Methods We comprehensively searched the PubMed, Embase, and Cochrane library databases according to predetermined inclusion and exclusion criteria, and then we extracted data. We compared the outcomes of TMVR and redo SMVR for mitral prosthesis failure in terms of the in-hospital mortality, stroke, renal dysfunction, vascular complication, pacemaker implantation, exploration for bleeding, paravalvular leak, mean mitral valve gradient, 30-day mortality, and 1-year mortality. Results Nine retrospective cohort studies and a total of 3,038 patients were included in this analysis. Compared with redo SMVR for mitral prosthesis failure, TMVR was associated with lower in-hospital mortality [odds ratios (OR): 0.44; 95% confidence interval (CI): 0.30-0.64; P < 0.001], stroke (OR: 0.44; 95% CI: 0.29-0.67; P = 0.0001), renal dysfunction (OR: 0.52; 95% CI: 0.37-0.75; P = 0.0003), vascular complication (OR: 0.58; 95% CI: 0.43-0.78; P = 0.004), pacemaker implantation (OR: 0.23; 95% CI: 0.15-0.36; P < 0.00001), and exploration for bleeding (OR: 0.24; 95% CI: 0.06-0.96; P = 0.04). Conversely, redo SMVR had lower paravalvular leak (OR: 22.12; 95% CI: 2.81-174.16; P = 0.003). There was no difference in mean mitral valve gradient (MD: 0.04; 95% CI: -0.47 to 0.55; P = 0.87), 30-day mortality (OR: 0.65; 95% CI: 0.36-1.17; P = 0.15), and 1-year mortality (OR: 0.96; 95% CI: 0.63-1.45; P = 0.84). Conclusion In patients with mitral prosthesis failure, TMVR is associated with lower in-hospital mortality and lower occurrence of postoperative complications, except for paravalvular leak. TMVR offers a viable alternative to the conventional redo surgery in selected patients.
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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] [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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Hill SJ, Young A, Prendergast B, Redwood S, Rajani R, De Vecchi A. Patient-specific fluid simulation of transcatheter mitral valve replacement in mitral annulus calcification. Front Cardiovasc Med 2022; 9:934305. [PMID: 36588546 PMCID: PMC9797989 DOI: 10.3389/fcvm.2022.934305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Transcatheter mitral valve replacement is a promising alternative to open-heart surgery in elderly patients. Patients with severe mitral annulus calcification (MAC) are a particularly high-risk population, where postprocedural complications can have catastrophic effects. Amongst these, obstruction of the left ventricular outflow tract can lead to ventricular hypertrophic remodeling and subsequent heart failure, while subclinical valve thrombosis can result in early bioprosthetic valve failure. Methods To elucidate the mechanisms of left ventricular outflow tract obstruction and valve thrombosis following valve-in-MAC procedures, we used image processing and Computational Fluid Dynamics (CFD) software to generate patient- and device-specific models based on preprocedural CT data. Personalized computer simulations were performed to predict the left ventricular haemodynamics after implantation in three patients with severe MAC. Results The simulations have successfully captured the increased pressure gradient in the left ventricular outflow tract as a result of the partial obstruction due to the implanted valve. Regions of wall shear stress above the threshold value for platelet activation were also observed on the bioprosthetic frame as a result of the reduced outflow tract area, which led to increases in flow resistance and blood residence time inside the ventricle. Consistent with these findings, areas of slow recirculating flow and blood stasis formed near the valve frame, creating potential pro-thrombotic conditions. Discussion This study provides insight into the relationship between size and shape of the outflow tract post-implantation, pressure gradients and pro-thrombotic flow metrics such as wall shear stress and blood residence time. Results show the potential of CFD modeling to bring key functional metrics into preprocedural assessment for a comprehensive evaluation of post-procedural risks beyond anatomical factors. Following further validation and extension to the atrial chamber, this approach can provide an in-depth analysis of the likelihood of valvular thrombosis.
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Affiliation(s)
- Samuel Joseph Hill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom,*Correspondence: Samuel Joseph Hill,
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascular Directorate, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Redwood
- Cardiovascular Directorate, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Adelaide De Vecchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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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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Cotton J, Groves DW, Vargas D, Morrison J, Desai A, Rove JY. Impact of advanced imaging techniques on preoperative planning in cardiac surgery. J Card Surg 2022; 37:4112-4118. [PMID: 36054405 DOI: 10.1111/jocs.16864] [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: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Review how advanced imaging techniques and a multidisciplinary heart team approach are used to evaluate complex cardiac structural pathology. METHODS Single-center retrospective case series. RESULTS AND CONCLUSIONS Cardiac computed tomography angiography in addition to transthoracic and transesophageal echocardiography impacts pre-procedural planning and procedural success.
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Affiliation(s)
- Jake Cotton
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel W Groves
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Section of Cardiothoracic Imaging, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel Vargas
- Section of Cardiothoracic Imaging, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Justin Morrison
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Aken Desai
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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Zahid S, Ullah W, Hashem AM, Khan MZ, Gowda S, Vishnevsky A, Fischman DL. Transcatheter valve-in-valve implantation versus redo surgical mitral valve replacement in patients with failed mitral bioprostheses. EUROINTERVENTION 2022; 18:824-835. [PMID: 36106346 PMCID: PMC9724889 DOI: 10.4244/eij-d-22-00437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Data on the safety of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) compared with redo surgical mitral valve replacement (SMVR) in patients with a history of bioprosthetic mitral valve (MV) remain limited. AIMS We aimed to evaluate the in-hospital, 30-day and 6-month readmission outcomes of ViV-TMVR compared with redo-SMVR in a real-world cohort. METHODS The Nationwide Readmission Database was utilised, analysing data from 2015 to 2019. To determine the adjusted odds ratio (aOR), we used the propensity-matched analysis for major outcomes at index hospitalisation, 30 days, and 6 months during the episode of readmission. RESULTS A total of 3,691 patients were included, of these, 24.2% underwent ViV-TMVR and 75.8% underwent redo-SMVR. Patients undergoing ViV-TMVR were older with higher rates of comorbidities. The mean length of stay (15 days vs 4 days) and cost of hospitalisation ($76,558 vs $46,743) were significantly higher for redo-SMVR. The rate of in-hospital all-cause mortality was also significantly lower in ViV-TMVR (2.6% vs 7.3%). By contrast, 30-day all-cause mortality during the episode of readmission (aOR 1.01, 95% confidence interval [CI]: 0.40-2.55) and all-cause readmission rates (aOR 0.82, 95% CI: 0.66-1.02) were similar between both groups. The incidence of all-cause readmissions at 6 months (aOR 0.83, 95% CI: 0.65-1.05) and all-cause mortality during the episode of readmission at 6 months (aOR 1.84, 95% CI: 0.54-6.36) were also comparable. The utilisation of the ViV-TMVR procedure increased significantly during our study duration, from 5.2% to 36.8%, (ptrend<0.01). CONCLUSIONS ViV-TMVR is associated with lower odds of in-hospital mortality, complications, and resource utilisation. The all-cause readmissions and 30-day and 6-month mortality during the episode of readmissions were comparable between both groups.
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Affiliation(s)
- Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Anas M Hashem
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Smitha Gowda
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Alec Vishnevsky
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - David L Fischman
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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