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Schmitt VH, Geyer M, Born S, Bachmann K, Schnitzler K, Hell M, Tamm AR, Ruf TF, Gößler TAM, Rogmann MA, Hahad O, Hobohm L, Herzog J, Windschmitt J, Schwuchow-Thonke S, Blessing R, Schulz E, Lurz P, Münzel T, Keller K, von Bardeleben RS. Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair. IJC HEART & VASCULATURE 2025; 56:101601. [PMID: 39917728 PMCID: PMC11800078 DOI: 10.1016/j.ijcha.2025.101601] [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: 11/01/2024] [Revised: 12/26/2024] [Accepted: 01/03/2025] [Indexed: 02/09/2025]
Abstract
Aim Diabetes mellitus (DM) represents a notable risk factor within surgical and interventional procedures. Data on its influence on survival after Transcatheter Edge-to-Edge Repair (TEER) of Mitral valve Regurgitation (MR) are sparse. Methods In a retrospective monocentric assessment after successful treatment of MR using TEER from 06/2010 to 03/2018 patients were stratified for DM. Mortality was analyzed during follow-up using Cox regression analyses. Results Of 627 patients (47.0 % females, 88.2 % aged ≥ 70 years, median follow-up 486 days) consecutively included, subjects with DM (N = 174, 27.8 %) had a higher prevalence of comorbidities like obesity (27.3 % vs. 9.2 %, p < 0.001), arterial hypertension (91.4 % vs. 83.7 %, p = 0.013), renal insufficiency (63.8 % vs. 43.9 %, p < 0.001), coronary artery disease (77.0 % vs. 59.8 %, p < 0.001) and peripheral artery disease (14.4 % vs. 8.4 %, p = 0.026). Patients with DM presented with higher median logistic Euroscore I (29.4 % [20.0/43.0] vs. 25.0 % [16.7/36.6], p = 0.001) and more severely reduced systolic function (LVEF 35 % [30/50] vs. 45 % [30/55], p < 0.001). No difference in short- and long-term survival was detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6 %, p = 0.771; at 30-days 5.0 vs. 6.0 %, p = 0.842, 1-year 28.7 vs. 25.0 %, p = 0.419, 3-years 49.2 vs. 44.1 %, p = 0.554, 5-years 69.0 vs. 68.3 %, p = 0.497). The presence of DM was not attributed as an individual risk factor for elevated mortality (HR 1-year 1.17 [95 % CI 0.80-1.71], p = 0.419; HR long-term 1.13 [95 %CI 0.86-1.49], p = 0.373). Conclusion Although linked to a more vulnerable clinical profile and despite being factored in common risk factor models, DM was not associated with an elevated short- and long-term mortality after TEER of MR.
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Affiliation(s)
- Volker H. Schmitt
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katharina Schnitzler
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander R. Tamm
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias Friedrich Ruf
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Theresa Ann Maria Gößler
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marc A. Rogmann
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Johannes Herzog
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Johannes Windschmitt
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sören Schwuchow-Thonke
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Recha Blessing
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp Lurz
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
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Vinayak M, Prandi FR, Safi L, Sharma A, Tang GHL, Lerakis S, Kini AS, Sharma SK, Pinney S, Lala A, Khera S. Secondary Mitral Regurgitation: Updated Review with Focus on Percutaneous Interventional Management. J Card Fail 2024; 30:1302-1318. [PMID: 39389742 DOI: 10.1016/j.cardfail.2024.06.018] [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: 04/06/2024] [Revised: 05/26/2024] [Accepted: 06/10/2024] [Indexed: 10/12/2024]
Abstract
Secondary mitral regurgitation (SMR) is associated with increased mortality and heart failure hospitalizations. The management of heart failure patients with SMR is complex and requires a multidisciplinary Heart Team approach. Guideline-directed medical therapies remain fundamental, yet in a proportion of patients SMR persists. In the past decade, transcatheter edge-to-edge repair (TEER) has been shown to improve survival in patients with SMR who remain symptomatic despite medical therapy. Technical advancements across newer generations of devices, improved imaging, and greater operator expertise have collectively contributed to the increased safety and efficacy of this procedure over time. Various emerging transcatheter mitral valve repair and replacement devices are currently under investigation and may offer superior, complementary or synergistic treatment options in patients ineligible for TEER. This review provides a state-of-the-art overview regarding the diagnosis of SMR, and currently available transcatheter mitral valve interventions and describes a contemporary approach to the management of SMR.
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Affiliation(s)
- Manish Vinayak
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. https://twitter.com/manishvinayak
| | - Francesca R Prandi
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. https://twitter.com/prandi_fr
| | - Lucy Safi
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. https://twitter.com/LucySafi
| | - Anupam Sharma
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. https://twitter.com/GilbertTangMD
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. https://twitter.com/DoctorKini
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sean Pinney
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. https://twitter.com/spinneymd
| | - Anuradha Lala
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. https://twitter.com/dranulala
| | - Sahil Khera
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
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Yokoyama H, Ruf TF, Gößler TAM, Geyer M, Zirbs J, Schwidtal BL, Münzel T, von Bardeleben RS. Outcomes of COMBO therapy for severe mitral regurgitation compared with transcatheter edge-to-edge repair. Front Cardiovasc Med 2024; 11:1223588. [PMID: 38468721 PMCID: PMC10925764 DOI: 10.3389/fcvm.2024.1223588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Background There are different types of transcatheter mitral valve repair (TMVr) currently in clinical use, including leaflet approximation, annular cinching, and restoration of the chordal apparatus of the mitral valve (MV). While the concomitant combination (COMBO) therapy of mitral transcatheter edge-to-edge repair (M-TEER) with another TMVr concept has been proven feasible, potentially offering patient-tailored treatment for severe mitral regurgitation (MR), a comparison with M-TEER alone has not been made. Aims To evaluate the procedural and clinical outcome of COMBO therapies compared with M-TEER alone. Methods We included consecutive patients undergoing COMBO and M-TEER between March 2015 and April 2018 at our Heart Valve Center, while excluding patients presenting a case of redo or with previous MV surgery. Procedural outcomes and all-cause mortality were compared between COMBO therapy vs. M-TEER alone. Results A total of 357 patients (mean age 78.9 ± 7.0 years, 53.2% male, M-TEER n = 322, COMBO n = 35; COMBO: MitraClip and the Carillon mitral contour system n = 26, MitraClip and Cardioband n = 5, and MitraClip and NeoChord n = 4) were analyzed. Patients with COMBO therapy had larger left chamber sizes, a lower left ventricular systolic ejection fraction (LVEF; COMBO: 37.4 ± 13.8%, M-TEER: 47.9 ± 14.3%, p < 0.001), and a more severe MR grade (p < 0.001). There were no significant differences in the prevalence of residual MR ≧2+. However, the need for re-intervention, always employing M-TEER, was more common in the COMBO group. During a mean 3.6-year long-term follow-up, there was no significant difference of all-cause mortality between both groups (Log rank p = 0.921). Conclusions COMBO therapy may still be a beneficial therapy option for patients with severe MR who already have a more dilated left ventricle (LV), a more severe MR, and a more pronounced LV systolic dysfunction. The higher need for re-intervention in the COMBO group may signal more complex anatomies and possibly underlines the necessity of treating significant MR earlier. Future research is required to establish the COMBO approach as a toolbox-like treatment option, thus offering a patient-tailored approach depending on the individual anatomy and pathology.
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias Friedrich Ruf
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Theresa Ann Maria Gößler
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Martin Geyer
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia Zirbs
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ben Luca Schwidtal
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Heart Valve Center, Department of Cardiology, Cardiology I, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
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4
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Chiang CY, Huang JH, Chiu KM, Chen JS. Impact of Recurrent Mitral Regurgitation on Left Ventricular Mass Regression and Cardiac Events following Mitral Valve Repair. J Clin Med 2023; 13:235. [PMID: 38202242 PMCID: PMC10779914 DOI: 10.3390/jcm13010235] [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: 11/28/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Mitral valve regurgitation results in volume overload, followed by left ventricular remodeling. Variation of reverse remodeling following mitral repair influences the clinical outcomes. We aimed to evaluate the association between recurrent mitral regurgitation and mass regression following mitral valve repair and the impact on major adverse cardiovascular events. METHODS A retrospective cohort study was conducted on 164 consecutive patients with severe mitral regurgitation who underwent elective mitral valve repair. Subgroups were classified based on the presence of recurrent mitral regurgitation exceeding moderate severity. The hemodynamic parameters were evaluated according to geometry, mass, and function with Doppler echocardiography before and after surgery. Cox regression analysis was performed to evaluate the association between hemodynamics and mass regression and clinical outcomes. RESULTS The results for MR indicated 110 cases with non-recurrent MR and 54 with recurrent MR, along with 31 major adverse cardiovascular events. The tracked echocardiographic results revealed less reduction in dimension and volume, along with less mass regression in the recurrent MR subgroup. Significant differences were revealed in the relative change of the LV end-diastolic volume index and relative mass regression between subgroups. The relative change in the LVEDVI was proportionally correlated with relative mass regression. Cox regression analysis identified correlations with major adverse cardiovascular events, including suture annuloplasty, recurrent mitral regurgitation, tracked LV mass, relative LV mass regression, and systolic dysfunction. CONCLUSION LV mass regression and relative change of the LV end-diastolic volume could be risk predictors of recurrent mitral regurgitation. The extent of LV mass regression is correlated with adverse cardiac events.
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Affiliation(s)
- Chih-Yao Chiang
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, National Defense Medical Center, Taipei 114201, Taiwan
| | - Jih-Hsin Huang
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
| | - Kuan-Ming Chiu
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
| | - Jer-Shen Chen
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan; (C.-Y.C.); (J.-H.H.)
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Zhang T, Dou Y, Luo R, Yang L, Zhang W, Ma K, Wang Y, Zhang X. A review of the development of interventional devices for mitral valve repair with the implantation of artificial chords. Front Bioeng Biotechnol 2023; 11:1173413. [PMID: 37334267 PMCID: PMC10272602 DOI: 10.3389/fbioe.2023.1173413] [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: 02/24/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Mitral regurgitation (MR) was the most common heart valve disease. Surgical repair with artificial chordal replacement had become one of the standard treatments for mitral regurgitation. Expanded polytetrafluoroethylene (ePTFE) was currently the most commonly used artificial chordae material due to its unique physicochemical and biocompatible properties. Interventional artificial chordal implantation techniques had emerged as an alternative treatment option for physicians and patients in treating mitral regurgitation. Using either a transapical or a transcatheter approach with interventional devices, a chordal replacement could be performed transcatheter in the beating heart without cardiopulmonary bypass, and the acute effect on the resolution of mitral regurgitation could be monitored in real-time by transesophageal echo imaging during the procedure. Despite the in vitro durability of the expanded polytetrafluoroethylene material, artificial chordal rupture occasionally occurred. In this article, we reviewed the development and therapeutic results of interventional devices for chordal implantation and discuss the possible clinical factors responsible for the rupture of the artificial chordal material.
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Affiliation(s)
- Tingchao Zhang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
- Hangzhou Valgen Medtech Co., Ltd., Hangzhou, China
| | - Yichen Dou
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Rifang Luo
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Li Yang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Weiwei Zhang
- Hangzhou Valgen Medtech Co., Ltd., Hangzhou, China
| | - Kangmu Ma
- Hangzhou Valgen Medtech Co., Ltd., Hangzhou, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Xingdong Zhang
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, China
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