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Ruberti A, Freixa X, Sitges M, Cepas-Guillen P, Sanchis L. First in-human experience of miniaturized 4D-TOE probe supporting M-TEER. Catheter Cardiovasc Interv 2024; 103:1145-1147. [PMID: 38695178 DOI: 10.1002/ccd.31069] [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] [Revised: 04/02/2024] [Accepted: 04/20/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Andrea Ruberti
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Xavier Freixa
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Sitges
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Cepas-Guillen
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Sanchis
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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2
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Stolz L, Doldi PM, Sannino A, Hausleiter J, Grayburn PA. The Evolving Concept of Secondary Mitral Regurgitation Phenotypes: Lessons From the M-TEER Trials. JACC Cardiovasc Imaging 2024; 17:659-668. [PMID: 38551534 DOI: 10.1016/j.jcmg.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 06/07/2024]
Abstract
Conflicting results from 2 randomized clinical trials of transcatheter mitral valve edge-to-edge repair in secondary mitral regurgitation (SMR) have led to the recognition that SMR is a heterogeneous disease entity presenting with different functional and morphological phenotypes. This review summarizes the current knowledge on SMR caused primarily by atrial secondary mitral regurgitation (aSMR) and ventricular SMR pathology. Although aSMR is generally characterized by severe left atrial enlargement in the setting of preserved left ventricular anatomy and function, different patterns of mitral annular distortion cause different phenotypes of aSMR. In ventricular SMR, the relation of SMR severity to left ventricular dilation as well as the degree of pulmonary hypertension and right ventricular dysfunction are important phenotypic characteristics, which are key for a better understanding of prognosis and treatment response.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany. https://twitter.com/DoldiP
| | - Anna Sannino
- Division of Cardiology, Department of Internal Medicine, Baylor Scott and White The Heart Hospital, Plano, Texas, USA; Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy. https://twitter.com/AnnaSannino1985
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. https://twitter.com/j_hausleiter
| | - Paul A Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor Scott and White The Heart Hospital, Plano, Texas, USA.
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3
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Pręgowski J, Pracoń R, Mioduszewska A, Skowroński J, Sondergaard L, Mintz GS, Capodanno D, Kim SW, De Baker O, Waciński P, Wojakowski W, Rdzanek A, Grygier M, Chmielecki M, Franco LN, Stokłosa P, Firek B, Marczak M, Miłosz B, Chmielak Z, Demkow M, Witkowski A. Strategy to optimize PeriproCeduraL AnticOagulation in structural transseptal interventions: Design and rationale of the STOP CLOT trial. Am Heart J 2024; 271:68-75. [PMID: 38401649 DOI: 10.1016/j.ahj.2024.02.015] [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: 12/17/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Both transcatheter edge-to-edge repair (TEER) of mitral regurgitation or left atrial appendage closure (LAAC) require periprocedural anticoagulation with unfractionated heparin (UFH) that is administered either before or immediately after transseptal puncture (TSP). The optimal timing of UFH administration (before or after TSP) is unknown. The Strategy To Optimize PeriproCeduraL AnticOagulation in Structural Transseptal Interventions trial (STOP CLOT Trial) was designed to determine if early anticoagulation is effective in reducing ischemic complications without increasing the risk of periprocedural bleeding. METHODS The STOP CLOT trial is a multicenter, prospective, double-blind, placebo-controlled, randomized trial. A total of 410 patients scheduled for TEER or LAAC will be randomized 1:1 either early UFH administration (iv. bolus of 100 units/kg UFH or placebo, given after obtaining femoral vein access and at least 5 minutes prior to the start of the TSP) or late UFH administration (iv. bolus of 100 units/kg UFH or placebo given immediately after TSP). Prespecified preliminary statistical analysis will be performed after complete follow-up of the first 196 randomized subjects. To ensure blinding, a study nurse responsible for randomization and UFH/placebo preparation is not involved in the care of the patients enrolled into the study. The primary study endpoint is a composite of (1) major adverse cardiac and cerebrovascular events (death, stroke, TIA, myocardial infarction, or peripheral embolization) within 30 days post-procedure, (2) intraprocedural fresh thrombus formation in the right or left atrium as assessed with periprocedural transesophageal echocardiography, or (3) occurrence of new ischemic lesions (diameter ≥4 mm) on brain magnetic resonance imaging performed 2 to 5 days after the procedure. The safety endpoint is the occurrence of moderate or severe bleeding complications during the index hospitalization. CONCLUSIONS Protocols of periprocedural anticoagulation administration during structural interventions have never been tested in a randomized clinical trial. The Stop Clot trial may help reach consensus on the optimal timing of initiation of periprocedural anticoagulation. CLINICAL TRIALS REGISTRATION NUMBER The study protocol is registered at ClinicalTrials.gov, identifier NCT05305612.
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Affiliation(s)
| | | | | | | | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY
| | - Davide Capodanno
- Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | | | - Ole De Baker
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Piotr Waciński
- Samodzielny Publiczny Szpital Kliniczny 4 w Lublinie, Lublin, Poland
| | - Wojciech Wojakowski
- Górnośląskie Centrum Medyczne im prof. L. Gieca Śląskiego Uniwersytetu Medycznego, Katowice, Poland
| | - Adam Rdzanek
- Uniwersyteckie Centrum Medyczne Warszawskiego Uniwersytetu Medycznego, Warsaw, Poland
| | - Marek Grygier
- Uniwersytecki Szpital Kliniczny w Poznaniu, Poznań, Poland
| | - Michał Chmielecki
- Kliniczne Centrum Kardiologii, Uniwersyteckie, Centrum Kliniczne, Gdański, Poland
| | | | | | - Bohdan Firek
- National Institute of Cardiology, Warsaw, Poland
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4
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Praz F, Beyersdorf F, Haugaa K, Prendergast B. Valvular heart disease: from mechanisms to management. Lancet 2024; 403:1576-1589. [PMID: 38554728 DOI: 10.1016/s0140-6736(23)02755-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 04/02/2024]
Abstract
Valvular heart disease is common and its prevalence is rapidly increasing worldwide. Effective medical therapies are insufficient and treatment was historically limited to the surgical techniques of valve repair or replacement, resulting in systematic underprovision of care to older patients and those with substantial comorbidities, frailty, or left ventricular dysfunction. Advances in imaging and surgical techniques over the past 20 years have transformed the management of valvular heart disease. Better understanding of the mechanisms and causes of disease and an increasingly extensive and robust evidence base provide a platform for the delivery of individualised treatment by multidisciplinary heart teams working within networks of diagnostic facilities and specialist heart valve centres. In this Series paper, we aim to provide an overview of the current and future management of valvular heart disease and propose treatment approaches based on an understanding of the underlying pathophysiology and the application of multidisciplinary treatment strategies to individual patients.
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Affiliation(s)
- Fabien Praz
- University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Bernard Prendergast
- Heart Vascular and Thoracic Institute, Cleveland Clinic London, London, UK; Department of Cardiology, St Thomas' Hospital, London, UK
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5
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Zahid S, Anjali Garg J, Altibi A, Golwala H. Mitral Transcatheter Edge-to-Edge Repair: Advancing Treatment Options for Degenerative Mitral Regurgitation. Interv Cardiol Clin 2024; 13:155-165. [PMID: 38432759 DOI: 10.1016/j.iccl.2024.01.001] [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
Degenerative mitral regurgitation (DMR) has earned great interest because of modern and innovative technologies emerging in its treatment. MR affects roughly one-tenth of those older adults over the age of 75. MR if untreated leads to adverse heart remodeling, resulting in left ventricular dysfunction, pulmonary hypertension, and heart failure syndrome. Despite surgical valve repair/replacement treatment being the standard of care, a significant proportion of severe MR patients face unmet clinical needs because of high or prohibitive surgical risks. This has led to the emergence of transcatheter therapies for high- and prohibitive-risk surgical patients, most notably mitral transcatheter edge-to-edge repair devices.
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Affiliation(s)
- Salman Zahid
- Department of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, 3161 SW Pavillon Loop, Portland, OR 97239, USA
| | - Jasmine Anjali Garg
- Department of Medicine, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA
| | - Ahmed Altibi
- Department of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, 3161 SW Pavillon Loop, Portland, OR 97239, USA
| | - Harsh Golwala
- Department of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, 3161 SW Pavillon Loop, Portland, OR 97239, USA.
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Ramsay J, Tang Y, Kim JK, Frangieh AH. Transcatheter Treatment of Mitral Valve Regurgitation in the Setting of Concomitant Coronary or Multivalvular Heart Disease: A Focused Review. Interv Cardiol Clin 2024; 13:279-289. [PMID: 38432770 DOI: 10.1016/j.iccl.2023.12.005] [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
Treatment for mixed valve disease has historically been limited, often surgery being the only option. With the recent advancement of transcatheter therapies, percutaneous approaches are quickly becoming viable therapeutic considerations in inoperable or high-risk patients, also offering the option for a staged or same-session treatment. Guidelines are primarily focused on single-valve disease. However, patients often present with multiple pathologies. This review summarizes the data and literature on transcatheter treatment of patients with mitral regurgitation who concomitantly have aortic stenosis or regurgitation, tricuspid regurgitation, or ischemic cardiomyopathy. Pathophysiology, hemodynamics, available therapies as well as order and timing of interventions are discussed.
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Affiliation(s)
- Jay Ramsay
- Department of Internal Medicine, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Yicheng Tang
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Jin Kyung Kim
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA
| | - Antonio H Frangieh
- Division of Cardiology, University of California Irvine, 333 City Boulevard West, City Tower Suite 400, Orange, CA 92868, USA.
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7
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Singireddy S, Atencah SE, Dadzie SK, Opare-Addo KA, Chinnatambi C. Outcomes of Transcatheter Edge-to-Edge Repair in Patients With Chronic Kidney Disease: A Retrospective National Inpatient Sample Study. Cureus 2024; 16:e57420. [PMID: 38699130 PMCID: PMC11062799 DOI: 10.7759/cureus.57420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Background The burden of mitral regurgitation is high, and studies show it is the most common valvular pathology. The management of mitral regurgitation varies and depends on the chronicity, severity, etiology, and comorbidities of the patient. Surgical repair is recommended over replacement. Transcatheter edge-to-edge repair (TEER) has been shown to improve the prognosis of patients with mitral regurgitation and appears relatively safer than surgical repair in patients with high surgical risks. In this study, we examined the outcomes of TEER in patients with chronic kidney disease (CKD) by retrospectively evaluating data from the 2010 to 2016 Nationwide Inpatient Sample (NIS). Methodology We retrospectively evaluated data from the 2010 to 2016 NIS. TEER was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10- CM) codes of 35.97 and 02UG3JZ, respectively, from our dataset. The study sample was stratified based on renal function into two groups (CKD and no CKD). Patients with CKD were identified using ICD-9-CM codes 585.3, 585.4, 585.5, and 585.6 and ICD-10-CM codes N18.3, N18.4, N18.5, and N18.6. Results There was no significant difference in major complications and overall complications between patients with and without CKD. However, heart failure, non-ST-elevation myocardial infarction, cardiac tamponade, and cardiogenic shock were more prevalent in the CKD group. Patients with CKD were also more likely to sustain respiratory failure, post-procedure hemothorax, and require blood product transfusions. For renal complications, analysis showed that superimposed acute kidney injury and the need for hemodialysis were more common in the CKD group. Of note, there was no difference in neurologic complications, gastrointestinal bleeding, and thromboembolic complications between both groups. Patients with CKD who underwent TEER were more likely to have prolonged hospital stays without a significant increase in hospitalization charges. These patients were also more likely to be discharged to rehabilitation facilities. Conclusions CKD confers significant morbidity and mortality to patients undergoing TEER. Providers should be aware of these discrepancies in outcomes for patients with CKD in need of TEER to help better optimize their care.
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Affiliation(s)
| | - Stanley E Atencah
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Samuel K Dadzie
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
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8
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Okuno T, Izumo M, Shiokawa N, Kuwata S, Ishibashi Y, Sato Y, Koga M, Okuyama K, Suzuki N, Kida K, Tanabe Y, Akashi YJ. Impact of the MitraClip G4 System on Routine Practice and Outcomes in Patients With Secondary Mitral Regurgitation. Circ J 2024; 88:531-538. [PMID: 38008428 DOI: 10.1253/circj.cj-23-0503] [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] [Indexed: 11/28/2023]
Abstract
BACKGROUND The MitraClip G4 system is a new iteration of the transcatheter edge-to-edge repair system. We assessed the impact of the G4 system on routine practice and outcomes in secondary mitral regurgitation (2°MR).Methods and Results: Consecutive patients with 2°MR treated with either the MitraClip G2 (n=89) or G4 (n=63) system between 2018 and 2021 were included. Baseline characteristics, procedures, and outcomes were compared. Inverse probability of treatment weighting and Cox regression were used to adjust for baseline differences. Baseline characteristics were similar, except for a lower surgical risk in the G4 group (Society of Thoracic Surgeons Predicted Risk of Mortality ≥8: 38.1% vs. 56.2%; P=0.03). In the G4 group, more patients had short (≤2 mm) coaptation length (83.7% vs. 54.0%; P<0.001) and fewer clips were used (17.5% vs. 36.0%; P=0.02). Acceptable MR reduction was observed in nearly all patients, with no difference between the G4 and G2 groups (100% vs. 97.8%, respectively; P=0.51). The G4 group had fewer patients with high transmitral gradients (>5mmHg; 3.3% vs. 13.6%; P=0.03). At 1 year, there was no significant difference between groups in the composite endpoint (death or heart failure rehospitalization) after baseline adjustment (10.5% vs. 20.2%; hazard ratio 0.39; 95% confidence interval 0.11-1.32; P=0.13). CONCLUSIONS The G4 system achieved comparable device outcomes to the early-generation G2, despite treating more challenging 2°MR with fewer clips.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, St. Marianna University Hospital
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University Hospital
| | | | - Shingo Kuwata
- Department of Cardiology, St. Marianna University Hospital
| | - Yuki Ishibashi
- Department of Cardiology, St. Marianna University Hospital
| | - Yukio Sato
- Department of Cardiology, St. Marianna University Hospital
| | - Masashi Koga
- Department of Cardiology, St. Marianna University Hospital
| | | | - Norio Suzuki
- Department of Cardiology, St. Marianna University Hospital
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine
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van-Roessel AM, Asmarats L, Li CHP, Millán X, Fernández-Peregrina E, Menduiña I, Sanchez-Ceña J, Arzamendi D. Mitral transcatheter edge-to-edge repair: patient selection, current devices, and clinical outcomes. Expert Rev Med Devices 2024; 21:187-196. [PMID: 38155555 DOI: 10.1080/17434440.2023.2298713] [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: 09/06/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Over the last two decades, mitral transcatheter edge-to-edge repair (M-TEER) has become a safe and effective therapy for severe mitral regurgitation in patients deemed at high surgical risk. AREAS COVERED This review aims to encompass the most relevant and updated evidence in the field of M-TEER from its inception, focusing on clinical and anatomical features for proper patient and device selection. EXPERT OPINION Growing operator experience and device iterations have resulted in improved clinical outcomes and an expansion of the therapy to patients with complex anatomies and clinical scenarios. Future investigations are warranted to determine the best management options and the most suitable device for every patient with MR.
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Affiliation(s)
- Albert Massó van-Roessel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Chi Hion Pedro Li
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Xavier Millán
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | | | | | - Juan Sanchez-Ceña
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
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10
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Alaour B, Nakase M, Pilgrim T. Combined Significant Aortic Stenosis and Mitral Regurgitation: Challenges in Timing and Type of Intervention. Can J Cardiol 2024; 40:235-249. [PMID: 37931671 DOI: 10.1016/j.cjca.2023.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
In this narrative review, we aim to summarize the literature surrounding the assessment and management of the common, yet understudied combination of aortic stenosis (AS) and mitral regurgitation (MR), the components of which are complexly inter-related and interdependent from diagnostic, prognostic, and therapeutic perspectives. The hemodynamic interdependency of AS and MR confounds the assessment of the severity of each valve disease, thus underscoring the importance of a multimodal approach integrating valvular and extravalvular indicators of severity. A large body of literature suggests that baseline MR is associated with reduced survival post aortic valve (AV) intervention and that regression of MR post-AV intervention confers a mortality benefit. Functional MR is more likely to regress after AV intervention than primary MR. The respective natural courses of the 2 valve diseases are not synchronized; therefore, significant AS and MR at or above the respective threshold for intervention might not coincide. Surgery is primarily a 1-stop-shop procedure because of a considerable perioperative risk of repeat interventions, whereas transcatheter treatment modalities allow for a more tailored timing of intervention with reassessment of concomitant MR after AV replacement and a potential staged intervention in the absence of MR regression. In summary, AS and MR, when combined, are interlaced into a complex hemodynamic, diagnostic, and prognostic synergy, with important therapeutic implications. Contemporary approaches should consider stepwise intervention by exploiting the advantage of transcatheter options. However, evidence is needed to demonstrate the efficacy of different timing and therapeutic options.
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Affiliation(s)
- Bashir Alaour
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masaaki Nakase
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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11
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Gedela M, Cangut B, Safi L, Krishnamoorthy P, Pandis D, El-Eshmawi A, Tang GHL. Mitral Valve Intervention in Elderly or High-Risk Patients: A Review of Current Surgical and Interventional Management. Can J Cardiol 2024; 40:250-262. [PMID: 38042339 DOI: 10.1016/j.cjca.2023.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023] Open
Abstract
Mitral regurgitation is a prevalent valvular disease, and its management has gained increasing importance because of the aging population. Although traditional surgery remains the gold standard, the field of transcatheter therapies, including transcatheter edge-to-edge repair and, more recently transcatheter mitral valve replacement are advancing and are being explored as viable alternatives, particularly for patients at high surgical risk. It is essential to emphasize the necessity of a multidisciplinary team approach, involving specialized valve teams, imaging experts, cardiac anaesthesiologists, and other relevant specialists, is crucial in achieving optimal outcomes. Furthermore, proper execution of procedures, postprocedural care, and diligent follow-up for these patients are essential components for successful results. It is essential to underscore that traditional mitral valve surgery continues to play a significant role. Simultaneously, it is important to acknowledge the expanding array of transcatheter interventions available for this specific patient population.
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Affiliation(s)
- Maheedhar Gedela
- Heartland Cardiology, Wesley Medical Center, Wichita, Kansas, USA
| | - Busra Cangut
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lucy Safi
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parasuram Krishnamoorthy
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dimosthenis Pandis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed El-Eshmawi
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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12
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Owais T, Bisht O, Polat E, Abdelmoteleb N, El Garhy M, Lauten P, Kuntze T, Girdauskas E. Transcatheter Aortic Valve Replacement as a bridge to minimally invasive endoscopic mitral valve surgery in Elderly Patients in the era of ERAS and Fast Track TAVI concepts. J Clin Med 2024; 13:471. [PMID: 38256605 PMCID: PMC10816775 DOI: 10.3390/jcm13020471] [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: 09/25/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
In this bicentric study, we report the outcomes of combined transcatheter aortic valve replacement combined with minimally invasive mitral valve surgery. We included a cohort of six patients (79.6 ± 3.2 years, 83% women) with high-risk profiles and deemed to be non-operable with combined mitral and aortic valvular disease. All patients had unsuitable anatomies for transcatheter mitral valve edge-to-edge repair (TEER). Moreover, most of the patients (5/6) suffered a combined aortic valve lesion, which complicates the efficiency of cardioplegia in the case of CBP through minimally invasive incisions. The first stage was implanting a TAVI valve to achieve aortic valve competency and hence facilitate the infusion of cardioplegia after clamping the aorta during endoscopic mitral valve surgery. After one week, we performed the minimally invasive mitral valve repair. Most patients (n = 5; 83%) underwent successful endoscopic mitral valve repair. Intraoperatively, the mean ischemic time was 42 min, and the total bypass time was 72 min. Postoperatively, the mean intubation time was 0 h. Postoperative complications included reoperation for bleeding in one patient (16.7%) and a new heart block requiring pacemaker implantation in one patient (16.7%). There was neither in-hospital mortality nor 1-year mortality.
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Affiliation(s)
- Tamer Owais
- Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany; (T.O.); (N.A.); (E.G.)
- Department of Cardiothoracic Surgery, Cairo University, Giza P.O. Box 12613, Egypt
| | - Osama Bisht
- Department of Cardiology and Angiology, Regiomed Klinikum Coburg, 3396450 Coburg, Germany
| | - Emre Polat
- Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany; (T.O.); (N.A.); (E.G.)
| | - Noureldin Abdelmoteleb
- Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany; (T.O.); (N.A.); (E.G.)
| | - Mohammad El Garhy
- Department of Cardiology, Helios Clinic Erfurt, 99089 Erfurt, Germany;
| | - Phillip Lauten
- Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany; (P.L.); (T.K.)
| | - Thomas Kuntze
- Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany; (P.L.); (T.K.)
| | - Evaldas Girdauskas
- Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany; (T.O.); (N.A.); (E.G.)
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von Stein P, Besler C, Riebisch M, Al‐Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Friedrichs K, Öztürk C, Baldus S, Guthoff H, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Horn P, Kelm M, Rudolph V, von Bardeleben R, Nef HM, Luedike P, Lurz P, Pfister R, Mauri V. One-Year Outcomes According to Mitral Regurgitation Etiology Following Transcatheter Edge-to-Edge Repair With the PASCAL System: Results From a Multicenter Registry. J Am Heart Assoc 2023; 12:e031881. [PMID: 38084735 PMCID: PMC10863793 DOI: 10.1161/jaha.123.031881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND We previously reported procedural and 30-day outcomes of a German early multicenter experience with the PASCAL system for severe mitral regurgitation (MR). This study reports 1-year outcomes of mitral valve transcatheter edge-to-edge repair with the PASCAL system according to MR etiology in a large all-comer cohort. METHODS AND RESULTS Clinical and echocardiographic outcomes up to 1-year were investigated according to MR etiology (degenerative [DMR], functional [FMR], or mixed [MMR]) in the first 282 patients with symptomatic MR 3+/4+ treated with the PASCAL implant at 9 centers in 2019. A total of 282 patients were included (33% DMR, 50% FMR, 17% MMR). At discharge, MR reduction to ≤1+/2+ was achieved in 58%/87% of DMR, in 75%/97% of FMR, and in 78%/98% of patients with MMR (P=0.004). MR reduction to ≤1+/2+ was sustained at 30 days (50%/83% DMR, 67%/97% FMR, 74%/100% MMR) and at 1 year (53%/78% DMR, 75%/97% FMR, 67%/91% MMR) with significant differences between etiologies. DMR patients with residual MR 3+/4+ at 1-year had at least complex valve morphology in 91.7%. Valve-related reintervention was performed in 7.4% DMR, 0.7% FMR, and 0.0% MMR (P=0.010). At 1-year, New York Heart Association Functional Class was significantly improved irrespective of MR etiology (P<0.001). CONCLUSIONS In this large all-comer cohort, mitral valve transcatheter edge-to-edge repair with the PASCAL system was associated with an acute and sustained MR reduction at 1-year in all causes. However, in patients with DMR, MR reduction was less pronounced, reflecting the high incidence of complex or very complex anatomies being referred for mitral valve transcatheter edge-to-edge repair.
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Affiliation(s)
- Philipp von Stein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Christian Besler
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Osamah Al‐Hammadi
- Medizinische Klinik I, Department of CardiologyUniversity of GiessenGermany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology IUniversity Medical Center MainzMainzGermany
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St.‐Johannes‐HospitalDortmundGermany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I der Ludwig‐Maximilians‐Universität MünchenMunichGermany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Henning Guthoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I der Ludwig‐Maximilians‐Universität MünchenMunichGermany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St.‐Johannes‐HospitalDortmundGermany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical FacultyUniversity DüsseldorfDuesseldorfGermany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical FacultyUniversity DüsseldorfDuesseldorfGermany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | | | - Holger M. Nef
- Medizinische Klinik I, Department of CardiologyUniversity of GiessenGermany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Philipp Lurz
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Victor Mauri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
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14
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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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15
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Praz F, Samim D. 1-Year Outcomes With a Fourth-Generation Mitral TEER Device: Maturity Comes With Experience. JACC Cardiovasc Interv 2023; 16:2611-2614. [PMID: 37877915 DOI: 10.1016/j.jcin.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Daryoush Samim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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16
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Alqeeq BF, Al-Tawil M, Hamam M, Aboabdo M, Elrayes MI, Leick J, Zeinah M, Haneya A, Harky A. Transcatheter edge-to-edge repair in mitral regurgitation: A comparison of device systems and recommendations for tailored device selection. A systematic review and meta-analysis. Prog Cardiovasc Dis 2023; 81:98-104. [PMID: 37924965 DOI: 10.1016/j.pcad.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair (M-TEER) is a minimally invasive method for the treatment of mitral regurgitation (MR) in patients with prohibitive surgical risks. The traditionally used device, MitraClip, showed both safety and effectiveness in M-TEER. PASCAL is a newer device that has emerged as another feasible option to be used in this procedure. METHODS We searched for observational studies that compared PASCAL to MitraClip devices in M-TEER. The electronic databases searched for relevant studies were PubMed/MEDLINE, Scopus, and Embase. The primary outcomes were technical success and the grade of MR at follow-up. Secondary outcomes included all-cause mortality, bleeding, device success and reintervention. RESULTS Technical success (PASCAL: 96.5% vs MitraClip: 97.6%, p = 0.24) and MR ≤ 2 at 30-day follow-up (PASCAL: 89.4vs MitraClip 89.9%, p = 0.51) were comparable between both groups. Both devices showed similar outcomes including all-cause mortality (RR: 0.68 [0.34, 1.38]; P = 0.28), major bleeding (RR: 1.87 [0.68, 5.10]; P = 0.22) and reintervention (RR: 1.02 [0.33, 3.16]; P = 0.97). Device success was more frequent with PASCAL device (PASCAL: 86% vs MitraClip 68.5%; P = 0.44), however, the results did not reach statistical significance. CONCLUSION Clinical outcomes of PASCAL were comparable to those of MitraClip with no significant difference in safety and effectiveness. The choice between MitraClip and PASCAL devices should be guided by various factors, including mitral valve anatomy, etiology of regurgitation, and device-specific characteristics.
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Affiliation(s)
- Basel F Alqeeq
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | | | - Mohammed Hamam
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Mohammad Aboabdo
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Mohammed I Elrayes
- Department of Pediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Juergen Leick
- Department of Cardiology, Heart Center Trier, Trier, Germany
| | - Mohamed Zeinah
- School of Medicine, Ain Shams University, Cairo, Egypt; Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Assad Haneya
- Department of Cardiac and Thoracic Surgery, Heart Center Trier, Trier, Germany
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
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17
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Zhang X, Jin Q, Pan W, Li W, Guo Y, Ma G, Pan C, Chen S, Zhang Y, Zhang L, Li M, Hou S, Lam YY, Modine T, Lee APW, Qian J, Zhou D, Ge J. First-in-human study of the K-Clip™ transcatheter annular repair system for severe functional tricuspid regurgitation. Int J Cardiol 2023; 390:131174. [PMID: 37442353 DOI: 10.1016/j.ijcard.2023.131174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Severe TR is associated with impaired prognosis while limited interventional options available. The purpose of this observational first-in-human experience with the K-Clip™ transcatheter tricuspid annular reconstruction system is to investigate its feasibility, safety as well as short-term clinical impact on patients with severe functional tricuspid regurgitation (TR). METHODS In this compassionate-use, prospective, multi-center, single-arm study, 15 patients with severe symptomatic functional TR were treated with the K-Clip™ system and followed up at 30 days after discharge. Feasibility endpoints consisted of safety (major clinical cardiovascular events (MACEs), echocardiographic, clinical and functional endpoints. RESULTS All the 15 patients (9 males, 72.67 ± 9.42 years of age) successfully received implants and no MACEs were reported throughout the study at 30 days. Between baseline and 30 days, echocardiography showed remarkable reduction of tricuspid annular circumference and area by 14.30% and 25.96%. Improvement of ≥ + 2 grade and ≥ +3 grade TR was presented in 9/15(60.00%) and 4/15(26.67%) respectively while 10/15(66.67%) of patients had ≤ moderate TR. Clinical evaluation indicated that 86.67% of patients were finally in NYHA functional class I or II (p<0.001) and overall Kansas City Cardiomyopathy Questionnaire score improved from 62.28 ± 18.97 to 77.90 ± 11.70 (p = 0.016). CONCLUSION Our first-in-human results of the transcatheter tricuspid annular reconstruction using the K-Clip™ system demonstrated initial favorable procedural success, acceptable safety and remarkable TR reduction in consistent with significant clinical improvement. Larger-scaled prospective trials with longer follow-up duration are warranted to further determine whether these promising findings could be promoted to a broader population in the long term.
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Affiliation(s)
- Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qinchun Jin
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Li
- Shanghai Institution of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Genshan Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Cuizhen Pan
- Shanghai Institution of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Mingfei Li
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shiqiang Hou
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yat-Yin Lam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Thomas Modine
- Interventional and Cardiovascular Surgery, Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille), 2 Avenue Oscar Lambret, Lille 59037, France
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Disease, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
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18
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Dowling C, Haeffele C, Yeung AC, Sharma RP. Emergency Transcatheter Repair for Anterior Leaflet Tear Following Percutaneous Balloon Mitral Valvuloplasty. JACC Case Rep 2023; 23:101980. [PMID: 37954949 PMCID: PMC10635879 DOI: 10.1016/j.jaccas.2023.101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 11/14/2023]
Abstract
We present the case of a 66-year-old woman who developed severe mitral regurgitation from rupture of the anterior mitral valve leaflet following percutaneous balloon mitral valvuloplasty. Emergency transcatheter mitral valve repair was used to reduce the severity of mitral regurgitation and facilitate definitive surgical treatment. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Cameron Dowling
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Christiane Haeffele
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rahul P. Sharma
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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19
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Meier D, Akodad M, Tzimas G, Muller O, Cheung A, Wood DA, Blanke P, Sathananthan J, Praz F, Boone RH, Webb JG. Update on Transcatheter Treatment of Mitral and Tricuspid Valve Regurgitation. Curr Cardiol Rep 2023; 25:1361-1371. [PMID: 37698820 DOI: 10.1007/s11886-023-01954-y] [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] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Mitral and tricuspid regurgitation represents a clinical challenge. They are associated with a poor prognosis, and many patients are not eligible for conventional surgery. Transcatheter therapies have been the focus of numerous studies and devices over the past decade. Here, we provide a summary of current options for transcatheter treatment of these 2 entities. RECENT FINDINGS Recent studies have demonstrated the benefits of edge-to-edge repair for increasing numbers of patients. Encouraging early results with transcatheter valve replacement are also becoming available. To date, transcatheter edge-to-edge repair is currently the first-line transcatheter treatment for both mitral and tricuspid regurgitation for many patients who are not candidates for surgery. A number of transcatheter replacement devices are under development and clinical investigation but, for the most part, their current use is limited to compassionate cases or clinical trials.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anson Cheung
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Philipp Blanke
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, Canada
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert H Boone
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada.
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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