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Lurz P, Schmitz T, Geisler T, Hausleiter J, Eitel I, Rudolph V, Lubos E, von Bardeleben RS, Brambilla N, De Marco F, Berti S, Nef H, Linke A, Hengstenberg C, Baldus S, Spargias K, Denti P, Nickenig G, Möllmann H, Rottbauer W, Praz F, Butter C, Reinthaler M, Van Mieghem NM, Sherif M, Swaans M, Witkowski A, Buch M, Seidler T, Iñiguez A, Thiele H, Eißmann M, Schreieck J, Näbauer M, Marcoff L, Koulogiannis K, Rassaf T, Luedike P. Mitral Valve Transcatheter Edge-to-Edge Repair: 1-Year Outcomes From the MiCLASP Study. JACC Cardiovasc Interv 2024; 17:890-903. [PMID: 38599692 DOI: 10.1016/j.jcin.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Mitral transcatheter edge-to-edge repair (M-TEER) is a guideline-recommended treatment option for patients with severe symptomatic mitral regurgitation (MR). Outcomes with the PASCAL system in a post-market setting have not been established. OBJECTIVES The authors report 30-day and 1-year outcomes from the MiCLASP (Transcatheter Repair of Mitral Regurgitation with Edwards PASCAL Transcatheter Valve Repair System) European post-market clinical follow-up study. METHODS Patients with symptomatic, clinically significant MR were prospectively enrolled. The primary safety endpoint was clinical events committee-adjudicated 30-day composite major adverse event rate and the primary effectiveness endpoint was echocardiographic core laboratory-assessed MR severity at discharge compared with baseline. Clinical, echocardiographic, functional, and quality-of-life outcomes were assessed at 1 year. RESULTS A total of 544 patients were enrolled (59% functional MR, 30% degenerative MR). The 30-day composite major adverse event rate was 6.8%. MR reduction was significant from baseline to discharge and sustained at 1 year with 98% of patients achieving MR ≤2+ and 82.6% MR ≤1+ (all P < 0.001 vs baseline). One-year Kaplan-Meier estimate for survival was 87.3%, and freedom from heart failure hospitalization was 84.3%. Significant functional and quality-of-life improvements were observed at 1 year, including 71.6% in NYHA functional class I/II, 14.4-point increase in Kansas City Cardiomyopathy Questionnaire score, and 24.2-m improvement in 6-minute walk distance (all P < 0.001 vs baseline). CONCLUSIONS One-year outcomes of this large cohort from the MiCLASP study demonstrate continued safety and effectiveness of M-TEER with the PASCAL system in a post-market setting. Results demonstrate high survival and freedom from heart failure hospitalization, significant and sustained MR reduction, and improvements in symptoms, functional capacity, and quality of life.
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Affiliation(s)
- Philipp Lurz
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany.
| | - Thomas Schmitz
- Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Nordrhine Westfalia, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians University, Munich, Germany
| | - Ingo Eitel
- Universitaetsklinikum Schleswig Holstein Lübeck and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Volker Rudolph
- Herz-und Diabeteszentrum NRW-Bad Oeynhausen, Bad Oeynhausen, Germany
| | | | | | - Nedy Brambilla
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Sergio Berti
- Ospedale del Cuore, Fondazione C.N.R. Reg. Toscana-Massa Italy
| | - Holger Nef
- Universitätsklinikum Giessen UKGM, Gießen, Germany
| | - Axel Linke
- Technische Universität Dresden, Herzzentrum Universitätsklinik für Innere Medizin/Kardiologie, Dresden, Germany
| | | | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | | | | | | | | | | | | | - Christian Butter
- Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School (MHB), Bernau, Germany
| | | | | | - Mohammad Sherif
- Deutsches Herzzentrum der Charité-Campus Virchow Klinikum, Berlin, Germany
| | - Martin Swaans
- St. Antonius Nieuwegein, Nieuwegein, the Netherlands
| | | | - Mamta Buch
- Manchester University NHS FT, Manchester, United Kingdom
| | - Tim Seidler
- Universitaeres Herzzentrum Goettingen, Goettingen, Germany
| | | | - Holger Thiele
- Heart Center Leipzig at Leipzig University, Leipzig, Germany
| | - Mareike Eißmann
- Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Nordrhine Westfalia, Germany
| | - Juergen Schreieck
- Department of Cardiology and Angiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians University, Munich, Germany
| | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | - Tienush Rassaf
- West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital, Essen, Germany
| | - Peter Luedike
- West German Heart and Vascular Center, Department of Cardiology and Vascular Medicine, University Hospital, Essen, Germany
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Silaschi M, Cattelaens F, Alirezaei H, Vogelhuber J, Sommer S, Sugiura A, Schulz M, Tanaka T, Sudo M, Zimmer S, Nickenig G, Weber M, Bakhtiary F, Wilde N. Transcatheter Edge-to-Edge Mitral Valve Repair versus Minimally Invasive Mitral Valve Surgery: An Observational Study. J Clin Med 2024; 13:1372. [PMID: 38592259 PMCID: PMC10932335 DOI: 10.3390/jcm13051372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Minimally invasive mitral valve surgery (MIC-MVS) has been established as preferred treatment of mitral regurgitation (MR), but mitral transcatheter edge-to-edge valve repair (M-TEER) is routinely performed in patients at high surgical risk and is increasingly performed in intermediate risk patients. Methods: From 2010 to 2021, we performed 723 M-TEER and 123 isolated MIC-MVS procedures. We applied a sensitivity analysis by matching age, left ventricular ejection fraction (LVEF), EuroSCORE II and etiology of MR. Results: Baseline characteristics showed significant differences in the overall cohort (p < 0.01): age 78.3 years vs. 61.5 years, EuroSCORE II 5.5% vs. 1.3% and LVEF 48.4% vs. 60.4% in M-TEER vs. MIC-MVS patients. Grade of MR at discharge was moderate/severe in 24.5% (171/697) in M-TEER vs. 6.5% (8/123) in MIC-MVS (p < 0.01). One-year survival was 91.5% (552/723) in M-TEER vs. 97.6% (95/123) in MIC-MVS (p = 0.04). A matching with 49 pairs (n = 98) showed comparable survival during follow-up, but a numerically higher mean mitral valve gradient of 4.1 mmHg (95% CI: 3.6-4.6) vs. 3.4 mmHg (95% CI: 3.0-3.8) in M-TEER (p = 0.04). Conclusions: Patients undergoing M-TEER had lower one-year survival than MIC-MVS, but differences disappeared after matching. Reduction in MR was less effective in M-TEER patients and postprocedural mitral valve gradients were higher.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Franca Cattelaens
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Hossien Alirezaei
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Johanna Vogelhuber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Susanne Sommer
- Department of Cardiac Surgery, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany;
| | - Atsushi Sugiura
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Max Schulz
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Mitsumasa Sudo
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Marcel Weber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Nihal Wilde
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
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Tanaka T, Sugiura A, Vogelhuber J, Öztürk C, Böhm L, Wilde N, Zimmer S, Nickenig G, Weber M. Outcomes of transcatheter edge-to-edge repair for atrial functional mitral regurgitation. EUROINTERVENTION 2024; 20:e250-e260. [PMID: 38389471 PMCID: PMC10870009 DOI: 10.4244/eij-d-23-00819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND The prognostic benefits of transcatheter edge-to-edge repair (TEER) remain unclear in patients with atrial functional mitral regurgitation (AFMR). AIMS We aimed to investigate the clinical outcomes of TEER for patients with AFMR. METHODS We retrospectively classified functional mitral regurgitation (FMR) patients undergoing TEER into those with AFMR or ventricular FMR (VFMR). A residual MR ≤1+ at discharge was considered optimal mitral regurgitation (MR) reduction, and an elevated mean mitral valve pressure gradient (MPG) was defined as an MPG ≥5 mmHg at discharge. The primary outcome was a composite of all-cause mortality and hospitalisation due to heart failure within one year. RESULTS Of 441 FMR patients, 125 patients were considered as having AFMR. Residual MR ≤1+ was associated with a lower risk of the composite outcome in both AFMR and VFMR patients, while an MPG ≥5 mmHg was associated with a higher risk of the composite outcome in patients with AFMR but not with VFMR. AFMR patients with residual MR ≤1+ and an MPG ≥5 mmHg, as well as those with residual MR >1+, had a higher incidence of the composite outcome than those with residual MR ≤1+ and an MPG <5 mmHg (50.7%, 41.8%, and 14.3%, respectively; p<0.001). This association was consistent after adjustment for clinical and echocardiographic characteristics. CONCLUSIONS An MR reduction to ≤1+ following TEER was associated with a lower risk of clinical outcomes in patients with AFMR, while an MPG ≥5 mmHg was related to a higher risk of clinical outcomes. Optimal MR reduction by TEER may have potential benefits on the prognosis of patients with AFMR, although the prognostic benefit may be attenuated by an elevated MPG.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Lukas Böhm
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chrissoheris MP, Kourkoveli P, Aravantinos D, Spargias K. Severe functional ischaemic mitral regurgitation: is functional a misnomer for a dysfunctional valve? A case report. Eur Heart J Case Rep 2024; 8:ytae041. [PMID: 38419752 PMCID: PMC10901261 DOI: 10.1093/ehjcr/ytae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
Background Mitral regurgitation (MR) in the context of left ventricular systolic dysfunction is often designated as functional, with emphasis on the underlying cardiomyopathy leading to malcoaptation of the 'otherwise normal valve'. Case summary A 63-year-old male with ischaemic cardiomyopathy (left ventricular ejection fraction 20%) presented with intractable heart failure in need of inotropic support and could not be stepped down from an ICU hospital setting. Functional MR, graded as moderate on transthoracic echocardiography, was initially not considered as pertinent to the clinical condition and options discussed included initiation of dialysis for volume management, chronic inotropic support, and palliative measures. However, a re-examination of the mitral valve by transoesophageal echo revealed severe regurgitation from annular dilatation and restricted mobility during systole. Transcatheter edge to edge repair utilizing the PASCAL device resulted in marked reduction of MR followed by an abrupt clinical improvement, weaning off inotropes and discharge home 4 days later. At four-year follow-up, the patient is stable on optimal heart failure therapy. Discussion For many patients with heart failure and underlying cardiomyopathy, the presence of significant functional MR, instead of a 'bystander' disease, actually becomes the dominant driver of symptoms and compounds the low cardiac output state. In these patients, the term 'functional' MR becomes a misnomer, as in fact the so called 'otherwise normal' mitral valve is actually a severely dysfunctional valve with a wide malcoaptation zone. Transcatheter edge to edge repair is an effective bailout procedure for patients with low cardiac output and disproportionate severe functional MR.
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Affiliation(s)
- Michael P Chrissoheris
- Department of Transcatheter Heart Valves, Hygeia Hospital, 9 Erythrou Stavrou Street, Marousi, TK 15123 Attiki, Greece
| | - Panagiota Kourkoveli
- Department of Transcatheter Heart Valves, Hygeia Hospital, 9 Erythrou Stavrou Street, Marousi, TK 15123 Attiki, Greece
| | - Dionysios Aravantinos
- Department of Transcatheter Heart Valves, Hygeia Hospital, 9 Erythrou Stavrou Street, Marousi, TK 15123 Attiki, Greece
| | - Konstantinos Spargias
- Department of Transcatheter Heart Valves, Hygeia Hospital, 9 Erythrou Stavrou Street, Marousi, TK 15123 Attiki, Greece
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Paukovitsch M, Felbel D, Tadic M, Keßler M, Scheffler J, Gröger M, Markovic S, Rottbauer W, Schneider LM. The effect of a smaller spacer in the PASCAL Ace on residual mitral valve orifice area. Clin Res Cardiol 2024:10.1007/s00392-023-02368-0. [PMID: 38270636 DOI: 10.1007/s00392-023-02368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Mitral transcatheter edge-to-edge repair (M-TEER) is an established treatment for functional mitral regurgitation (FMR) associated with a risk of creating iatrogenic stenosis. OBJECTIVES To investigate the impact of the P10 and its larger spacer compared to the narrower Ace and its smaller spacer on reduction of mitral valve orifice area (MVOA) during M-TEER. METHODS Consecutive patients undergoing M-TEER for treatment of severe FMR were screened retrospectively. Patients with a single PASCAL device implantation within the central segments of the MV leaflets, non-complex anatomy, and baseline MVOA ≥ 3.5cm2 were selected. Intraprocedural transesophageal echocardiography was used to compare MVOA reduction with 3D multiplanar reconstruction and direct planimetry. Device selection did not follow a prespecified MVOA threshold. RESULTS Seventy-two patients (81.0 years, IQR {74.3-85.0}) were included. In 32 patients, the P10 was implanted (44.4%). MR severity (p = 0.66), MR reduction (p = 0.73), and body surface area (p = 0.56) were comparable. Baseline MVOA tended to be smaller in P10 patients with the larger spacer (5.0 ± 1.1 vs. 5.4 ± 1.3cm2, p = 0.18), however, residual MVOA was larger in these patients (2.7 ± 0.7 vs. 2.3 ± 0.6cm2, p = 0.03). Accordingly, relative MVOA reduction was significantly less in P10 patients (- 45.9 ± 7.6 vs. - 56.3 ± 7.0%, p < 0.01). Indirect annuloplasty was more pronounced in Ace patients whereas mean transmitral gradients were similar. CONCLUSION In FMR patients with non-complex anatomy, the larger spacer of the P10 maintains greater MVOA with similar MR reduction. Hence, the use of the PASCAL Ace device in patients with small MVOAs might correlate with a risk of both clinically relevant orifice reduction and even iatrogenic stenosis.
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Affiliation(s)
- Michael Paukovitsch
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Dominik Felbel
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Marijana Tadic
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Mirjam Keßler
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Jinny Scheffler
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Matthias Gröger
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Sinisa Markovic
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Rottbauer
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Leonhard Moritz Schneider
- Ulm University Heart Center, Department of Cardiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Geisler T, Schreieck J, Euper M, Zdanyte M, Goldschmied A, Gawaz M, Bramlage P, Haurand JM, Kelm M, Horn P. Outcomes of patients undergoing edge-to-edge mitral valve repair with the Edwards PASCAL transcatheter valve repair system under conscious sedation. Catheter Cardiovasc Interv 2024; 103:137-146. [PMID: 37890011 DOI: 10.1002/ccd.30866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The development of the PASCAL transcatheter valve repair system for treating mitral regurgitation (MR) greatly extends therapeutic options. AIMS To assess the safety, efficacy, and time efficiency of the PASCAL system in transcatheter edge-to-edge repair (TEER) under conscious sedation (CS). METHODS This is a retrospective, two-center, German registry study consisting of 211 patients who underwent TEER using the PASCAL system under CS. The endpoints were to assess (1) technical, device, and procedural success as per Mitral Valve Academic Research Consortium (MVARC), (2) conversion rate to general anesthesia (GA), (3) hospital length of stay (LoS), (4) New York Heart Association (NYHA) class, and (5) MR compared to baseline at 30-day. RESULTS A total of 211 patients with a mean age of 78.4 ± 8.9 years, with 51.4% being female and 86.7% belonging to NYHA functional class III/IV and EuroSCORE II 6.3 ± 4.9%, were enrolled. Procedural success attained was 96.9%, and six patients (2.8%) required conversion from CS to GA. At 30 days follow-up, a significant improvement in MR was found in 96 patients (54.2%) patients with 0/1 grade MR and 45 patients (29.5%) were in NYHA functional class III + IV. Moreover, TEER under CS has a short hospital LoS (6.71 ± 5.29 days) and intensive care unit LoS (1.34 ± 3.49 days) with a 2.8% mortality rate. CONCLUSIONS Performing TEER with the PASCAL system under CS resulted in appreciable (96.9%) procedural success with low mortality and is a safe and promising alternative to GA with positive clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Jean M Haurand
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Duesseldorf, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Duesseldorf, Germany
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Wilde N, Tanaka T, Vij V, Sugiura A, Sudo M, Eicheler E, Silaschi M, Vogelhuber J, Bakhtiary F, Nickenig G, Weber M, Zimmer S. Characteristics and outcomes of patients undergoing transcatheter mitral valve replacement with the Tendyne system. Clin Res Cardiol 2024; 113:1-10. [PMID: 36645506 PMCID: PMC10808407 DOI: 10.1007/s00392-023-02155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) has emerged as alternative to transcatheter edge-to-edge repair (TEER) for treatment of mitral regurgitation (MR); however, the role of TMVR with the Tendyne system among established treatments of MR is not well defined. We assessed characteristics and outcomes of patients treated with the Tendyne system in the current clinical practice. METHODS We reviewed patients who underwent cardiac computed tomography and were judged eligible for the Tendyne system. RESULTS A total of 63 patients were eligible for TMVR with the Tendyne system. Of these, 17 patients underwent TMVR, and 46 were treated by TEER. Patients treated with the Tendyne system were more likely to have a high transmitral pressure gradient and unsuitable mitral valve morphology for TEER than those treated with TEER. TMVR with the Tendyne system reduced the severity of MR to less than 1 + in 94.1% of the patients at discharge and achieved a greater reduction in left ventricular (LV) end-diastolic volume at the 30-day follow-up compared with TEER. In contrast, patients treated with the Tendyne system had a higher 30-day mortality than those treated with TEER, while the mortality between 30 days and one year was comparable between Tendyne and TEER. CONCLUSIONS Among patients eligible for the Tendyne system, approximately a quarter of the patients underwent TMVR with the Tendyne system, which led substantial reduction of MR and LV reverse remodeling than TEER. In contrast, the 30-day mortality rate was higher after TMVR with the Tendyne compared to TEER.
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Affiliation(s)
- Nihal Wilde
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Vivian Vij
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Eva Eicheler
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Rosch S, Kösser L, Besler C, Kister T, Kresoja K, Kiefer P, Marin‐Cuartas M, Meineri M, Leontyev S, Abdel‐Wahab M, Borger MA, Thiele H, Ender J, Lurz P, Noack T. Short-Term Effects of Different Transcatheter Edge-to-Edge Devices on Mitral Valve Geometry. J Am Heart Assoc 2023; 12:e030333. [PMID: 37646220 PMCID: PMC10547342 DOI: 10.1161/jaha.123.030333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023]
Abstract
Background Short-term effects on mitral valve (MV) anatomy after transcatheter edge-to-edge repair using the PASCAL system remain unknown. Precise quantification might allow for an advanced analysis of predictors for mean transmitral gradients. Methods and Results Consecutive patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation using PASCAL or MitraClip systems were included. Quantification of short-term MV changes throughout the cardiac cycle was performed using peri-interventional 3-dimensional MV images. Predictors for mean transmitral gradients were identified in univariable and multivariable regression analysis. Long-term results were described during 1-year follow-up. A total of 100 patients undergoing transcatheter edge-to-edge repair using PASCAL (n=50) or MitraClip systems (n=50) were included. Significant reductions of anterior-posterior diameter, annular circumference, and area throughout the cardiac cycle were found in both cohorts (P<0.05 for all). Anatomic MV orifice area remained larger in the PASCAL cohort in mid (2.8±1.0 versus 2.4±0.9 cm2; P=0.049) and late diastole (2.7±1.1 versus 2.2±0.8 cm2; P=0.036) compared with the MitraClip cohort. Besides a device-specific profile of independent predictor of mean transmitral gradients, reduction of middiastolic anatomic MV orifice area was identified as an independent predictor in both the PASCAL (β=-0.410; P=0.001) and MitraClip cohorts (β=-0.318; P=0.028). At follow-up, reduction of mitral regurgitation grade to mild or less was more durable in the PASCAL cohort (90% versus 72%; P=0.035). Conclusions PASCAL and MitraClip showed comparable short-term effects on MV geometry. However, PASCAL might better preserve MV function and demonstrated more durable mitral regurgitation reduction during follow-up. Identification of independent predictors for mean transmitral gradients might potentially help to guide device selection in the future.
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Affiliation(s)
- Sebastian Rosch
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Luise Kösser
- Department of Cardiac SurgeryHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Christian Besler
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Tobias Kister
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Karl‐Patrik Kresoja
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Philipp Kiefer
- Department of Cardiac SurgeryHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Mateo Marin‐Cuartas
- Department of Cardiac SurgeryHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Massimiliano Meineri
- Department of AnaesthesiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Sergey Leontyev
- Department of Cardiac SurgeryHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Mohamed Abdel‐Wahab
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Michael A. Borger
- Department of Cardiac SurgeryHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Jörg Ender
- Department of AnaesthesiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Philipp Lurz
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Thilo Noack
- Department of Cardiac SurgeryHeart Center Leipzig at University of LeipzigLeipzigGermany
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11
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Whisenant B, Zahr F. The PASCAL Transcatheter Valve Repair System: A User's Guide. Struct Heart 2023; 7:100204. [PMID: 37745681 PMCID: PMC10512093 DOI: 10.1016/j.shj.2023.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Brian Whisenant
- Intermountain Heart Institute, Structural Heart Disease, Salt Lake City, Utah, USA
| | - Firas Zahr
- Interventional Cardiology, Oregon Health & Science University, Portland, Oregon, USA
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12
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Agricola E, Ancona F, Bartel T, Brochet E, Dweck M, Faletra F, Lancellotti P, Mahmoud-Elsayed H, Marsan NA, Maurovich-Hovart P, Monaghan M, Pontone G, Sade LE, Swaans M, Von Bardeleben RS, Wunderlich N, Zamorano JL, Popescu BA, Cosyns B, Donal E. Multimodality imaging for patient selection, procedural guidance, and follow-up of transcatheter interventions for structural heart disease: a consensus document of the EACVI Task Force on Interventional Cardiovascular Imaging: part 1: access routes, transcatheter aortic valve implantation, and transcatheter mitral valve interventions. Eur Heart J Cardiovasc Imaging 2023; 24:e209-e268. [PMID: 37283275 DOI: 10.1093/ehjci/jead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Transcatheter therapies for the treatment of structural heart diseases (SHD) have expanded dramatically over the last years, thanks to the developments and improvements of devices and imaging techniques, along with the increasing expertise of operators. Imaging, in particular echocardiography, is pivotal during patient selection, procedural monitoring, and follow-up. The imaging assessment of patients undergoing transcatheter interventions places demands on imagers that differ from those of the routine evaluation of patients with SHD, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of SHD therapies, this document intends to update the previous consensus document and address new advancements in interventional imaging for access routes and treatment of patients with aortic stenosis and regurgitation, and mitral stenosis and regurgitation.
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Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
- Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - Thomas Bartel
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, 26th Street, Dubai, United Arab Emirates
| | - Eric Brochet
- Cardiology Department, Hopital Bichat, 46 rue Huchard, Paris 75018, France
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Francesco Faletra
- Senior SHD Consultant Istituto Cardiocentro Via Tesserete 48, CH-6900 Lugano, Switzerland
- Senior Imaging Consultant ISMETT UPCM Hospital, Discesa dei Giudici, 4, 90133 Palermo, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh-Heart & Vascular Institute UPMC, 200 Lothrop St Ste E354.2, Pıttsburgh, PA 15213, USA
- Cardiology Department, Baskent University, Ankara, Turkey
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Nina Wunderlich
- Asklepios Klinik Langen Röntgenstrasse 20, Langen 63225, Germany
| | | | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila' -Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Bernard Cosyns
- Cardiology Department, Centrum voor Hart en Vaatziekten (CHVZ), Universitair ziekenhuis Brussel, Brussels, Belgium
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Universite´ de Rennes-1, Rennes, France
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13
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Long Y, Li W, Chen S, Li M, Hou S, Pan C, Zhou D, Pan W, Ge J. Novel arm-width-expandable transcatheter edge-to-edge repair system: Preclinical experiment and first-in-human study. Catheter Cardiovasc Interv 2023. [PMID: 37471710 DOI: 10.1002/ccd.30758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/03/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The ValveClasp system is a novel transcatheter edge-to-edge repair (TEER) device with an arm-width-expandable clip that allows treatment of patients with only one clip more frequently. OBJECTIVES This study aimed to evaluate the feasibility and safety of a novel TEER device in porcine models and patients. METHODS Fourteen young adult pigs were enrolled. A clip with an expanded arm was implanted under epicardial echocardiography and fluoroscopy guidance. Five patients with at least moderate-to-severe mitral regurgitation underwent TEER using the ValveClasp system to test the safety and effectiveness of the device. RESULTS The device success rate was 100% (14/14) in the animal experiments, and all clips were deployed at the A2P2 segments, forming a double-orifice mitral valve. Gross observations on day 180 showed a wide and continuous tissue bridge between the leaflets. The acute procedural success rate was 100% (5/5). Only one clip was required in all patients, and all achieved effective postoperative endpoints (grade ≤2+). During 30-day follow-up, no adverse events occurred. All patients' vena Contracta width (from 8.04 0.71 mm to 3.84 ± 1.18 mm, p = 0.012), mitral regurgitation area (from 12.75 ± 3.13 cm2 to 3.50 ± 1.66 cm2 , p = 0.008), and left ventricular end diastolic diameter (from 52.00 ± 2.92 mm to 46.00 ± 3.08 mm, p = 0.040) were considerably decreased, without obvious mitral stenosis. CONCLUSIONS The novel arm-width-expandable ValveClasp device is safe for TEER for treating severe mitral regurgitation.
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Affiliation(s)
- Yuliang Long
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Mingfei Li
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shiqiang Hou
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Research Unit of Cardiovascular Techniques and Devices, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
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14
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Xu R, Cai Z, Ding J, Ma G. Insight into tricuspid transcatheter edge-to-edge repair: no longer the forgotten valve. Expert Rev Cardiovasc Ther 2023; 21:877-885. [PMID: 37983042 DOI: 10.1080/14779072.2023.2286010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Tricuspid regurgitation (TR) is one of the most prevalent types of valvular heart disease linked to poor prognosis in patients with heart failure and is usually ignored. TR has received considerable attention due to the progressive advancements in transcatheter therapies in recent years. AREAS COVERED With relatively solid data and rapid technological advancements, tricuspid transcatheter edge-to-edge repair (T-TEER) is the most frequently employed in a series of tricuspid transcatheter interventional treatments for TR. However, the efficacy and technical benefits of T-TEER are limited because of the unique anatomical characteristics and pathological mechanisms of the tricuspid valve. The aim of this review is to summarize reported data on current status of T-TEER and to provide an expert opinion regarding the challenges it is now experiencing and future development direction and approach. EXPERT OPINION T-TEER is a significant treatment for TR, but its effectiveness and technical promotion are limited due to the tricuspid valve unique anatomical characteristics and pathological mechanisms. The selection criteria for suitable patients, the choice of when to intervene, device innovation, the advancement of ultrasound technology, and the volume of evidence in evidence-based medicine all indicate that the disorder of TR will eventually be better treated and understood.
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Affiliation(s)
- Rongfeng Xu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, P.R.China
| | - Zhenyu Cai
- Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, P.R. China
| | - Jiandong Ding
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, P.R.China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, P.R.China
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15
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Gerçek M, Narang A, Puthumana JJ, Davidson CJ, Rudolph V. Secondary Mitral Regurgitation and Heart Failure: Current Advances in Diagnosis and Management. Heart Fail Clin 2023; 19:307-315. [PMID: 37230646 DOI: 10.1016/j.hfc.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The causes of mitral regurgitation (MR) can be broadly divided into primary and secondary causes. Although primary MR is caused by degenerative alterations of the mitral valve and the mitral valve apparatus, secondary (functional) MR is multifactorial and related to dilation of the left ventricle and/or mitral annulus commonly resulting in concomitant restriction of the leaflets. Therefore, the treatment of secondary MR (SMR) is complex and includes guideline directed heart failure therapy along with surgical and transcatheter approaches that have shown effectiveness in certain subgroups. This review aims to provide insight into current advances in diagnosis and management of SMR.
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Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany; Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Akhil Narang
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
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16
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Kherallah RY, Silva G. Cutting-Edge Trials in Structural Heart Disease at The Texas Heart Institute. Tex Heart Inst J 2023; 50:e238123. [PMID: 37339087 DOI: 10.14503/thij-23-8123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Riyad Yazan Kherallah
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Guilherme Silva
- Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, Texas
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
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Srinivasan A, Brown J, Ahmed H, Daniel M. PASCAL repair system for patients with mitral regurgitation: A systematic review. Int J Cardiol 2023; 376:108-114. [PMID: 36681242 DOI: 10.1016/j.ijcard.2023.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/18/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Transcatheter edge-to-edge repair (TEER) of the mitral valve has emerged as the standard treatment for patients with mitral regurgitation (MR) with high surgical risk. Even though MitraClip is widely used, the novel PASCAL device system offers distinct technical features. We aim to study the safety and efficacy of the PASCAL repair system in clinically significant MR. METHODS PubMed, Medline, Cochrane Central Register of Controlled Trials, and EMBASE were searched for articles published from August 2016 until June 2022 to identify studies that investigated the safety and efficacy of PASCAL for patients with degenerative, functional and mixed MR. Primary performance endpoints were technical, device, and procedural successes. Primary safety endpoint was composite 30 day major adverse events (MAE). Secondary endpoints were MR grade at discharge and 30 days, 30 day postprocedural NYHA functional class, left ventricular ejection fraction (LVEF), change in 6-min walk distance (6MWD), 30-day and 12-month all-cause mortality. RESULTS We included twelve retrospective and prospective observational studies and one randomized controlled study consisting of 1028 patients with severe, symptomatic MR (NYHA III-IV: 84.0%, MR ≥ 3+: 99.7%) and high surgical risk (mean logistic EuroSCORE of 16.4).Technical success was 95.7%, procedural success was 95.2%, and device success was 86.1% relative to the weighted average. MR grade was ≤2+ in 94.7% of patients at discharge and 94.0% patients at 30-day follow-up. Mean 30-day and 12-month mortality after device implantation were 4.54% and 12.2%. CONCLUSION The PASCAL repair system appears to be a safe and effective therapeutic option to treat severe, symptomatic MR in high surgical risk patients.
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Affiliation(s)
- Aswin Srinivasan
- Department of Internal Medicine, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America.
| | - Jonathan Brown
- Department of Internal Medicine, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America
| | - Haris Ahmed
- Department of Internal Medicine, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America
| | - Michael Daniel
- Department of Interventional and Structural Cardiology, HCA Kingwood/University of Houston College of Medicine, Kingwood, TX, United States of America
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Hausleiter J, Lim DS, Gillam LD, Zahr F, Chadderdon S, Rassi AN, Makkar R, Goldman S, Rudolph V, Hermiller J, Kipperman RM, Dhoble A, Smalling R, Latib A, Kodali SK, Lazkani M, Choo J, Lurz P, O'Neill WW, Laham R, Rodés-Cabau J, Kar S, Schofer N, Whisenant B, Inglessis-Azuaje I, Baldus S, Kapadia S, Koulogiannis K, Marcoff L, Smith RL. Transcatheter Edge-to-Edge Repair in Patients With Anatomically Complex Degenerative Mitral Regurgitation. J Am Coll Cardiol 2023; 81:431-442. [PMID: 36725171 DOI: 10.1016/j.jacc.2022.11.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair is safe and effective in treating degenerative mitral regurgitation (DMR) patients at prohibitive surgical risk, but outcomes in complex mitral valve anatomy patients vary. OBJECTIVES The PASCAL IID registry assessed safety, echocardiographic, and clinical outcomes with the PASCAL system in prohibitive risk patients with significant symptomatic DMR and complex mitral valve anatomy. METHODS Patients in the prospective, multicenter, single-arm registry had 3+ or 4+ DMR, were at prohibitive surgical risk, presented with complex anatomic features based on the MitraClip instructions for use, and were deemed suitable for the PASCAL system by a central screening committee. Enrolled patients were treated with the PASCAL system. Safety, effectiveness, and functional and quality-of-life outcomes were assessed. Study oversight also included an echocardiographic core laboratory and clinical events committee. RESULTS The study enrolled 98 patients (37.2% ≥2 independent significant jets, 15.0% severe bileaflet/multi scallop prolapse, 13.3% mitral valve orifice area <4.0 cm2, and 10.6% large flail gap and/or large flail width). The implant success rate was 92.9%. The 30-day composite major adverse event rate was 11.2%. At 6 months, 92.4% patients achieved MR ≤2+ and 56.1% achieved MR ≤1+ (P < 0.001 vs baseline). The Kaplan-Meier estimates for survival, freedom from major adverse events, and heart failure hospitalization at 6 months were 93.7%, 85.6%, and 92.6%, respectively. Patients experienced significant symptomatic improvement compared with baseline (P < 0.001). CONCLUSIONS The outcomes of the PASCAL IID registry establish the PASCAL system as a useful therapy for prohibitive surgical risk DMR patients with complex mitral valve anatomy. (PASCAL IID Registry within the Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID] NCT03706833).
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Affiliation(s)
| | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Abhijeet Dhoble
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Richard Smalling
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Mohamad Lazkani
- UC Health Medical Center of the Rockies, Loveland, Colorado, USA
| | | | | | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | | | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert L Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
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Inanc IH, Cilingiroglu M, Iliescu C, NInios V, Matar F, Ates I, Toutouzas K, Hermiller J, Marmagkiolis K. Comparison of American and European Guidelines for the Management of Patients With Valvular Heart Disease. Cardiovasc Revasc Med 2023; 47:76-85. [PMID: 36270966 DOI: 10.1016/j.carrev.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 01/25/2023]
Abstract
This review compares the recommendations of the recent 2020 American College of Cardiology (ACC)/American Heart Association (AHA) and 2021 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines on the management of patients with valvular heart disease (VHD). ACC/AHA and ESC/EACTS guidelines are both the updated versions of previous 2017 documents. Both guidelines fundamentally agree on the extended indications of percutaneous valve interventions, the optimal use of imaging modalities other than 2D echocardiography, the importance of a multidisciplinary Heart Team as well as active patient participation in clinical decision making, more widespread use of NOACs and earlier intervention with lower left ventricular dilatation thresholds to decrease long-term mortality. The differences between the guidelines are mainly related to the classification of the severity of valve pathologies and frequency of follow-up, level of recommendations of valve intervention indications in special patient groups such as frail patients and the left ventricular diameter and ejection fraction thresholds for intervention.
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Affiliation(s)
- Ibrahim Halil Inanc
- Kırıkkale Yuksek Ihtisas Hospital, Department of Cardiology, Kırıkkale, Turkey.
| | - Mehmet Cilingiroglu
- University of Texas in Houston, MD Anderson Cancer Center, Houston, TX, United States of America
| | - Cezar Iliescu
- University of Texas in Houston, MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Vlasis NInios
- Department of Cardiology, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Fadi Matar
- Department of Cardiology, University of South Florida, Tampa, FL, United States of America.
| | - Ismail Ates
- Department of Cardiology, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Konstantinos Toutouzas
- Hippocrateion Athens General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - James Hermiller
- Department of Cardiology, St Vincent Heart Center, Indianapolis, IN, United States of America
| | - Kostas Marmagkiolis
- University of Texas in Houston, MD Anderson Cancer Center, Houston, TX, United States of America; Department of Cardiology, University of South Florida, Tampa, FL, United States of America
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20
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Eleid MF, Nkomo VT, Pislaru SV, Gersh BJ. Valvular Heart Disease: New Concepts in Pathophysiology and Therapeutic Approaches. Annu Rev Med 2023; 74:155-170. [PMID: 36400067 DOI: 10.1146/annurev-med-042921-122533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development and assessment of valvular disease, strategies for global prevention of rheumatic heart disease, understanding and management of secondary mitral regurgitation, the updated classification of bicuspid aortic valve disease, recognition of heightened cardiovascular risk associated with moderate aortic stenosis, and a growing armamentarium of transcatheter therapies.
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
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21
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Li W, Long Y, Pan W, Wei L, Pan C, Guan L, Zhou D, Ge J. Transcatheter edge to edge repair using the ease-of-use valve clamp system for functional mitral regurgitation: a primary report. Surg Today 2023; 53:90-7. [PMID: 36088621 DOI: 10.1007/s00595-022-02559-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The ValveClamp system is a novel edge-to-edge mitral valve repair system designed for the ease of operation. We report the outcomes of our initial experience of treating functional mitral regurgitation (MR) with the ValveClamp system. METHODS The subjects of this study were patients with symptomatic functional MR despite standard medical therapy, who were treated with transapical ValveClamp implantation. The patients were divided into an atrial functional mitral regurgitation (AFMR) group and a ventricular functional mitral regurgitation (VFMR) group. Clinical and echocardiographic outcomes were evaluated at baseline and then at the 3-month follow up. RESULTS Twelve patients, with a median age of 71 years (range 65-78 years), were assigned to the AFMR group (n = 5) or the VFMR group (n = 7). The device implantation rate was 100%, and 10 (83.3%) patients required implantation of only one clamp. The catheter time was less than 10 min in half of the patients, the fastest time being 5 min. There were no procedure-related complications. At the 3-month follow up, all patients were free from all-cause mortality, surgery, and rehospitalization. MR improved to ≤ 2 + in all 12 patients with MR grade 3 + or 4 + at baseline, (100%) and to ≤ 1 + in 9 of these patients (75%), with a low-pressure gradient. The left atrial diameter and the left ventricular end diastolic diameter decreased significantly in both the AFMR and VFMR groups. The left ventricular eject fraction at the 3-month follow up showed a rising trend in both the AFMR and VFMR groups, whereas PASP decreased remarkably. All 12 patients with baseline NYHA functional class III/IV (100%) showed improvement of at least 1 class, and 2 of these patients (16.7%) showed improvement of at least 2 classes. CONCLUSIONS The ValveClamp system is simple and effective for transapical transcatheter edge to edge repair in patients with functional MR.
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22
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Li CHP, Estévez-Loureiro R, Freixa X, Teles R, Molina-Ramos AI, Pan M, Nombela-Franco L, Melica B, Amat-Santos IJ, Cruz-González I, Asmarats L, Alarcón R, Sanchis L, Fernández-Peregrina E, Baz JA, Millán X, Menduiña I, Arzamendi D. Iberian experience with PASCAL transcatheter edge-to-edge repair for mitral valve regurgitation. Rev Esp Cardiol (Engl Ed) 2023; 76:25-31. [PMID: 35691867 DOI: 10.1016/j.rec.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/26/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The PASCAL system is a novel device for transcatheter mitral valve repair based on the edge-to-edge concept. The unique features of this device might have a relevant impact on the repair outcomes. There are few data on clinical outcomes in real-life registries. The aim of this study was to report the early Iberian experience (Spain and Portugal) of the PASCAL system. METHODS Procedural and 30-day outcomes were investigated in consecutive patients with symptomatic severe mitral regurgitation (MR) treated with the PASCAL system at 10 centers. Primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE) at 30 days. RESULTS We included 68 patients (age, 75 [68-81] years; 38% women; EuroSCORE II 4.5%). MR etiology was degenerative in 25%, functional in 65%, and mixed in 10%. A total of 71% of patients were in New York Heart Association (NYHA) functional class≥III. Technical success was achieved in 96% and independent capture was used in 73% of procedures. In the treated population, MR at discharge was≤2+ in 100%, with no in-hospital deaths. At 30 days, the MAE rate was 5.9%, the all-cause mortality rate was 1.6%, 98% were in NYHA functional class≤II, and 95% had MR≤2+ (P<.001). CONCLUSIONS Transcatheter mitral valve repair with the PASCAL system was safe and effective, with high procedural success and low rates of MAE. At 30 days, MR was significantly reduced, with a significant improvement in functional status.
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Affiliation(s)
- Chi-Hion Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain.
| | | | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain
| | - Rui Teles
- Serviço de Cardiologia, Hospital de Santa Cruz, Lisboa, Portugal
| | - Ana I Molina-Ramos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain; Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Manuel Pan
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Bruno Melica
- Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Lluís Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain
| | - Robert Alarcón
- Servicio de Cardiología, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Laura Sanchis
- Servicio de Cardiología, Hospital Clínic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain
| | - Estefanía Fernández-Peregrina
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain
| | - Irene Menduiña
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain
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23
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Lim DS, Smith RL, Gillam LD, Zahr F, Chadderdon S, Makkar R, von Bardeleben RS, Kipperman RM, Rassi AN, Szerlip M, Goldman S, Inglessis-Azuaje I, Yadav P, Lurz P, Davidson CJ, Mumtaz M, Gada H, Kar S, Kodali SK, Laham R, Hiesinger W, Fam NP, Keßler M, O'Neill WW, Whisenant B, Kliger C, Kapadia S, Rudolph V, Choo J, Hermiller J, Morse MA, Schofer N, Gafoor S, Latib A, Koulogiannis K, Marcoff L, Hausleiter J. Randomized Comparison of Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC Cardiovasc Interv 2022; 15:2523-2536. [PMID: 36121247 DOI: 10.1016/j.jcin.2022.09.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe symptomatic degenerative mitral regurgitation (DMR) has a poor prognosis in the absence of treatment, and new transcatheter options are emerging. OBJECTIVES The CLASP IID (Edwards PASCAL Transcatheter Valve Repair System Pivotal Clinical Trial) randomized trial (NCT03706833) is the first to evaluate the safety and effectiveness of the PASCAL system compared with the MitraClip system in patients with significant symptomatic DMR. This report presents the primary safety and effectiveness endpoints for the trial. METHODS Patients with 3+ or 4+ DMR at prohibitive surgical risk were assessed by a central screening committee and randomized 2:1 (PASCAL:MitraClip). Study oversight also included an echocardiography core laboratory and a clinical events committee. The primary safety endpoint was the composite major adverse event rate at 30 days. The primary effectiveness endpoint was the proportion of patients with mitral regurgitation (MR) ≤2+ at 6 months. RESULTS A prespecified interim analysis in 180 patients demonstrated noninferiority of the PASCAL system vs the MitraClip system for the primary safety and effectiveness endpoints of major adverse event rate (3.4% vs 4.8%) and MR ≤2+ (96.5% vs 96.8%), respectively. Functional and quality-of-life outcomes significantly improved in both groups (P < 0.05). The proportion of patients with MR ≤1+ was durable in the PASCAL group from discharge to 6 months (PASCAL, 87.2% and 83.7% [P = 0.317 vs discharge]; MitraClip, 88.5% and 71.2% [P = 0.003 vs discharge]). CONCLUSIONS The CLASP IID trial demonstrated safety and effectiveness of the PASCAL system and met noninferiority endpoints, expanding transcatheter treatment options for prohibitive surgical risk patients with significant symptomatic DMR.
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Affiliation(s)
- D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA.
| | - Robert L Smith
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Molly Szerlip
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | - Hemal Gada
- UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | | | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | | | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | | | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
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24
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Mauri V, Sugiura A, Spieker M, Iliadis C, Horn P, Öztürk C, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, Pfister R. Early Outcomes of 2 Mitral Valve Transcatheter Leaflet Approximation Devices: A Propensity Score-Matched Multicenter Comparison. JACC Cardiovasc Interv 2022; 15:2541-2551. [PMID: 36543448 DOI: 10.1016/j.jcin.2022.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND In addition to the edge-to-edge MitraClip repair system, the edge-to-spacer PASCAL repair system was approved for percutaneous treatment of severe mitral regurgitation (MR). Comparative data are lacking. OBJECTIVES The aim of this study was to compare procedural and short-term safety and efficacy of 2 leaflet-based transcatheter mitral valve repair systems. METHODS Procedural and 30-day outcomes were investigated in a propensity score-matched cohort of 307 PASCAL and 307 MitraClip patients at 10 sites. Matching criteria included sex, age, left ventricular ejection fraction, New York Heart Association functional class, MR etiology, left ventricular end-diastolic diameter, left atrial volume index, and vena contracta width. The primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE). RESULTS Technical success was 97.0% in the PASCAL group and 98.0% in the MitraClip group (P = 0.624). MR ≤2+ at discharge was comparable in both groups (PASCAL: 93.8% vs MitraClip: 92.4%; P = 0.527), with more patients exhibiting MR ≤1+ in the PASCAL group (70.5% vs 56.6%; P < 0.001). The postprocedural mean gradient was significantly higher in the MitraClip group (3.3 ± 1.5 mm Hg vs 3.9 ± 1.7 mm Hg; P < 0.001). At 30 days, all-cause mortality and MAE rates were similar (mortality: 1.7% vs 3.3%; P = 0.299; MAE: 3.9% vs 5.2%; P = 0.562). CONCLUSIONS In this first large propensity score-matched comparison, procedural success rates and MAE did not differ significantly between patients treated with the PASCAL or MitraClip valve repair system. Procedural results with less than moderate MR and no elevated transmitral gradient were more common in the PASCAL group, which might have an impact on long-term outcome.
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Affiliation(s)
- Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Max Spieker
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Osamah Al-Hammadi
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Muhammed Gerçek
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany; Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christoph Mues
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Niklas Boeder
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Felix Kreidel
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Kai Friedrichs
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Holger M Nef
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany.
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So CY, Kang G, Lee JC, Frisoli TM, O'Neill B, Wang DD, Eng MH, O'Neill W, Villablanca PA. Transcatheter Edge-to-Edge Repair for Acute Mitral Regurgitation With Cardiogenic Shock Secondary to Mechanical Complication. Cardiovasc Revasc Med 2022; 45:44-50. [PMID: 35882600 DOI: 10.1016/j.carrev.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Acute MR due to mechanical mitral valve (MV) complications frequently results in cardiogenic shock and requires emergency surgical intervention. There was limited evidence for alternative treatment like MitraClip for patients at prohibitive surgical risk. We aimed to study the technical features and outcomes of emergency transcatheter edge-to-edge repair (TEER) using the MitraClip system for patients with cardiogenic shock (CS) secondary to acute mitral regurgitation (MR) and mechanical MV complication. MATERIAL AND METHODS We performed institutional review and systemic literature review to identify all TEER for CS patients due to acute mitral regurgitation and mechanical MV complication. Clinical endpoints included device success rate assessed at the end of procedure, ability to wean off MCS, all-cause and cardiovascular mortality at 30-day. RESULTS Eight patients were identified from institutional review. Detail anatomical analysis found that patients with mechanical MV complications related to myocardial infarction had a lower transseptal height achieved during MitraClip (3.6 ± 0.1 cm vs 4.3 ± 0.3 cm, p = 0.03) than those not related. Pooled analysis for cases from institutional review (n = 8) and systemic literature review (n = 16) was performed. The device success rate was 68.8 %. Seventy-five percent (n = 18) cases required mechanical circulatory support (MCS), and 94.4 % were able to wean off MCS. At 30-day, the cardiovascular mortality was 4.5 % and the all-cause mortality was 9.1 %. CONCLUSIONS In CS patients due to acute MR and mechanical MV complications, TEER with/without MCS was feasible with a reasonable device success rate.
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Affiliation(s)
- Chak-Yu So
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA; Divison of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Guson Kang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - James C Lee
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Tiberio M Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Brian O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI, USA
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Kriechbaum SD, Birmes J, Wiedenroth CB, Adameit MSD, Gruen D, Vietheer J, Richter MJ, Guth S, Roller FC, Rademann M, Fischer-Rasokat U, Rolf A, Liebetrau C, Hamm CW, Keller T, Rieth AJ. Exercise MR-proANP unmasks latent right heart failure in CTEPH. J Heart Lung Transplant 2022; 41:1819-1830. [PMID: 36210266 DOI: 10.1016/j.healun.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/31/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The present study was designed to investigate the dynamics of right atrial pressure (RAP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) during physical exercise in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to determine whether these parameters might serve as a tool to measure exercise-dependent atrial stress as an indicator of right heart failure. METHODS This prospective observational cohort study included 100 CTEPH patients who underwent right heart catheterization during physical exercise (eRHC). Blood samples for MR-proANP measurement were taken prior, during, and after eRHC. MR-proANP levels were correlated to RAP levels at rest, at peak exercise (eRAP), and during recovery. RAP at rest ≤7 mmHg was defined as normal and eRAP >15 mmHg as suggestive of right heart failure. RESULTS During eRHC mean RAP increased from 6 mmHg (standard deviation, SD 4) to 16 mmHg (SD 7; p < 0.001). MR-proANP levels and dynamics correlated with RAP at rest (rs = 0.61; p < 0.001) and at peak exercise (rs = 0.66; p < 0.001). Logistic regression analysis revealed the peak MR-proANP level (B = 0.058; p = 0.004) and the right atrial area (B = 0.389; p < 0.001) to be associated with eRAP dynamics. A peak MR-proANP level ≥139 pmol/L (AUC = 0.81) and recovery level ≥159 pmol/L (AUC = 0.82) predicted an eRAP >15 mmHg. Physical exercise unmasked right heart failure in 39% of patients with normal RAP at rest; these patients were also characterized by a more distinct increase in MR-proANP levels (p = 0.005) and higher peak (p < 0.001) and recovery levels (p < 0.001). CONCLUSIONS RAP and MR-proANP dynamics unmask manifest and latent right heart failure in CTEPH patients.
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Affiliation(s)
- Steffen D Kriechbaum
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany.
| | - Judith Birmes
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Christoph B Wiedenroth
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Miriam S D Adameit
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Dimitri Gruen
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - J Vietheer
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Manuel J Richter
- Department of Pneumology, Kerckhoff-Klinik, Bad Nauheim, Germany; Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Stefan Guth
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Fritz C Roller
- Justus Liebig University Giessen, Department of Radiology, Giessen, Germany
| | - Matthias Rademann
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Ulrich Fischer-Rasokat
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Andreas Rolf
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Christoph Liebetrau
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Christian W Hamm
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Till Keller
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Andreas J Rieth
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
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Basman C, Johnson J, Pirelli L, Patel NC, Reimers C, Singh VP, Scheinerman SJ, Kliger CA. Mitral Regurgitation in the High-Risk Patient: Integrating an Expanding Armamentarium of Transcatheter Devices Into the Treatment Algorithm. Cardiol Rev 2022; 30:299-307. [PMID: 34380944 DOI: 10.1097/crd.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last decade, multiple transcatheter mitral valve repair and replacement strategies have emerged, yet there is only 1 US Food and Drug Administration approved device, the MitraClip (Abbott Vascular, Inc., Santa Clara, CA). Current guidelines support the use of the MitraClip in high or prohibitive surgical risk patients, but there are many patients that are not anatomically suited for the device. This review article discusses the approach to degenerative and functional mitral regurgitation in the high-prohibitive risk patient, how to choose transcatheter treatment options (both approved and investigational), and potential management for therapy failure.
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Affiliation(s)
- Craig Basman
- From the Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY
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Estévez-Loureiro R, Tavares Da Silva M, Baz-Alonso JA, Caneiro-Queija B, Barreiro-Pérez M, Calvo-Iglesias F, González-Ferreiro R, Puga L, Piñón M, Íñiguez-Romo A. Percutaneous mitral valve repair in patients developing severe mitral regurgitation early after an acute myocardial infarction: A review. Front Cardiovasc Med 2022; 9:987122. [PMID: 36211549 PMCID: PMC9537753 DOI: 10.3389/fcvm.2022.987122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Acute mitral regurgitation (MR) may develop in the setting of an acute myocardial infarction (AMI) because of papillary muscle dysfunction or rupture. Severe acute MR in this scenario is a life-threatening complication associated with hemodynamic instability and pulmonary edema, and has been linked to a worse prognosis even after reperfusion. Patients treated solely with medical therapy have the highest mortality rates. Surgery has been the only treatment strategy until recently, but the results of the technique are hindered by high rates of morbidity and mortality. Therefore, the development of less invasive interventions for correcting MR would be ideal. We aimed to review the current role of transcatheter interventions in this clinical setting.
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Affiliation(s)
- Rodrigo Estévez-Loureiro
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
- *Correspondence: Rodrigo Estévez-Loureiro ;
| | - Marta Tavares Da Silva
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - José Antonio Baz-Alonso
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Berenice Caneiro-Queija
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Manuel Barreiro-Pérez
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Francisco Calvo-Iglesias
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Rocio González-Ferreiro
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Luis Puga
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Miguel Piñón
- Department of Cardiovascular Surgery, University Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Andrés Íñiguez-Romo
- Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
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Nettersheim FS, Omran H, Pfister R, Rudolph V. Sekundäre AV-Klappeninsuffizienzen – Stellenwert der interventionellen Therapie. Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1820-8213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungSekundäre Mitral- und Trikuspidalklappeninsuffizienzen treten häufig im Kontext des Herzinsuffizienz-Syndroms auf durch geometrische oder funktionelle Veränderungen der Herzkammern und/oder
-vorhöfe trotz strukturell intakter Klappe. Durch Volumenbelastung der Ventrikel können diese entscheidend zur Symptomatik und Progression der Herzinsuffizienz beitragen und sind dadurch von
erheblicher prognostischer Bedeutung. Aufgrund des hohen OP-Risikos waren die Therapieoptionen traditionell oft auf eine Behandlung der Herzinsuffizienz beschränkt. Die Entwicklung von
kathetergestützten Techniken ermöglicht die Behandlung der sekundären AV-Klappeninsuffizienz mit akzeptablem Risiko und ist aufgrund aktueller Studienergebnisse ein wichtiger Bestandteil der
Herzinsuffizienz-Therapie. Im Folgenden geben wir einen Überblick über interventionelle Strategien zur Behandlung der sekundären AV-Klappeninsuffizienzen und deren aktuellen Stellenwert in
der klinischen Praxis.
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Affiliation(s)
| | - Hazem Omran
- Klinik für allgemeine und interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
| | - Roman Pfister
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universität zu Köln Medizinische Fakultät, Köln, Deutschland
| | - Volker Rudolph
- Klinik für allgemeine und interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
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30
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Li CP, Estévez-loureiro R, Freixa X, Teles R, Molina-ramos AI, Pan M, Nombela-franco L, Melica B, Amat-santos IJ, Cruz-gonzález I, Asmarats L, Alarcón R, Sanchis L, Fernández-peregrina E, Baz JA, Millán X, Menduiña I, Arzamendi D. Experiencia ibérica con PASCAL para la reparación percutánea borde a borde en insuficiencia mitral. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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31
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Bruoha S, Assafin M, Ho E, Tang GH, Latib A. Transcatheter Mitral Valve Repair. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch64.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Nappi F, Avtaar Singh SS. Subannular repair or transcatheter edge-to-edge repair for secondary mitral regurgitation? More data for international guidelines. JTCVS Open 2022; 10:176-180. [PMID: 36004223 PMCID: PMC9390218 DOI: 10.1016/j.xjon.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Moonen A, Chuang A, Simmons L, Plunkett BT, Fam NP, Webb JG, Ng MK. One-Year Outcomes of Early, Compassionate Use of the PASCAL Ace Implant System for Transcatheter Mitral Valve Repair. Struct Heart 2022; 6:100030. [PMID: 37273745 PMCID: PMC10236790 DOI: 10.1016/j.shj.2022.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/01/2022] [Accepted: 03/17/2022] [Indexed: 06/06/2023]
Abstract
Background Continued development of transcatheter mitral repair technologies is needed to address the large and diverse population of high-risk patients with symptomatic mitral regurgitation (MR). The new PASCAL Ace implant system, with its narrower profile, complements the original PASCAL transcatheter valve repair system. The aim of this study is to report 1-year outcomes from the early, compassionate-use observational experience with the novel PASCAL Ace implant system. Methods After heart team assessment, adults with symptomatic moderate-to-severe (3+) or severe (4+) MR despite optimal medical therapy were treated under compassionate use at 3 hospitals internationally. Data were prospectively collected, and outcomes were assessed over a 12-month follow-up period. Results Seventeen patients (mean age 76 years, 65% male, mean Society of Thoracic Surgeons Predicted Risk of Operative Mortality score 9.6) were treated. MR etiology was degenerative in 29%, functional in 65%, and mixed in 6%; 59% were in New York Heart Association (NYHA) class III-IV. Technical success was achieved in 100%, and procedural success in 94%. At 1 year, MR grade ≤2+ was achieved in 93% (p < 0.001) with 88% survival rate and 94% free from heart failure hospitalization. The composite major adverse event rate was 6% and 100% of patients had ≤NYHA class II symptoms (p < 0.001). Conclusions At 1 year, the PASCAL Ace implant system demonstrated feasibility in this early, compassionate use experience in a small group of symptomatic patients with anatomically complex MR. The unique features of the PASCAL Ace implant may expand the treatable MR population.
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Affiliation(s)
- Avalon Moonen
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Anthony Chuang
- Flinders University School of Medicine, Adelaide, Australia
- Department of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Lisa Simmons
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Australia
| | - Brian T. Plunkett
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil P. Fam
- Department of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - John G. Webb
- Department of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Martin K.C. Ng
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Australia
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schäfer A, Reichenspurner H, Lubos E, Conradi L. Interventioneller Mitralklappenersatz. Z Herz- Thorax- Gefäßchir 2022; 36:70-76. [DOI: 10.1007/s00398-022-00490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Schneider L, Nita N, Dahme T, Markovic S, Keßler M, Rottbauer W, Tadic M. Epidemiological Trends in Patients Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair over the Last Decade: Functional vs. Structural Mitral Regurgitation. J Clin Med 2022; 11:1422. [PMID: 35268513 PMCID: PMC8911032 DOI: 10.3390/jcm11051422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: We aimed to investigate the demographic, clinical and hemodynamic characteristics of patients who underwent percutaneous mitral valve (MV) repair over the last decade, as well as to determine the potential changes in trends of these parameters among patients with structural and functional MR (SMR and FMR). Methodology: We analyzed all patients who underwent interventional MV repair in our institution between January 2010 and March 2021. Our study included both SMR and FMR patients. All data were obtained from a local registry. Results: Nine hundred and seventeen patients (357 SMR patients and 563 FMR patients) were involved in this study. We did not find significant differences in demographical, clinical and hemodynamic characteristics among SMR and FMR patients. Left ventricular remodeling and systolic dysfunction were more pronounced in FMR patients. Systemic vascular resistance was the only hemodynamic parameter that differed between SMR and FMR patients; it was higher in SMR group. An evaluation of the trend between the first and last five years of our experience revealed that the number of patients treated with this technique is constantly increasing, but that this is more pronounced in SMR patients. It was also found that the operative risk of SMR and FMR patients was significantly higher in the first five years. Additionally, our results showed change in medical therapy in MR patients over the last decade in terms of increased use of angiotensin II receptor blockers and the introduction of angiotensin receptor II blocker-neprilysin inhibitor. Conclusion: SMR and FMR patients who underwent interventional MV repair have similar clinical and hemodynamic characteristics. The percentage of SMR patients increased more significantly than FMR patients over the last five years.
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Geis NA, Schlegel P, Heckmann MB, Katus HA, Frey N, Crespo López P, Raake PWJ. One-year results following PASCAL-based or MitraClip-based mitral valve transcatheter edge-to-edge repair. ESC Heart Fail 2022; 9:853-865. [PMID: 35170230 PMCID: PMC8934931 DOI: 10.1002/ehf2.13849] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/21/2021] [Accepted: 02/04/2022] [Indexed: 12/11/2022] Open
Abstract
Aims Mitral valve transcatheter edge‐to‐edge repair (TEER) has been established as a suitable alternative to mitral valve surgery in patients with severe mitral regurgitation (MR) and high surgical risk. The PASCAL system represents a novel device, potentially augmenting the toolkit for TEER. The aim of this study was to assess and compare short and 1 year safety and efficacy of the PASCAL and MitraClip systems for TEER. Methods and results Procedural, short, and 1 year outcomes of a 1:2 propensity‐matched cohort including 41 PASCAL and 82 MitraClip cases were investigated. Matching was based on clinical, laboratory, echocardiographic, and functional characteristics. The primary endpoints assessed were procedural success [as defined by the Mitral Valve Academy Research Consortium (MVARC)], residual MR, functional class, and a composite endpoint comprising death, heart failure hospitalization, and mitral valve re‐intervention. We found for the PASCAL and the matched MitraClip cohort no significant differences in MVARC defined technical (90.2% vs. 95.1%, P = 0.44), device (90.2% vs. 89.0%, P = 1.0), or procedural (87.8% vs. 80.5%, P = 0.45) success rates. Accordingly, the overall MR reduction and improvement in New York Heart Association (NYHA) class were comparable (1 year follow‐up: MR ≤ 2 95% vs. 93.6%, P = 1.0; NYHA ≤ 2 57.1% vs. 66.7%, P = 0.59). The composite outcome revealed no statistically significant difference between both devices (1 year follow‐up: 31.7% vs. 37.8%, P = 0.55). Interestingly, we found at both short and 1 year follow‐up a significantly higher rate of patients with none or trace MR in the PASCAL‐treated cohort (short follow‐up: 17.9% vs. 0%, P = 0.0081; 1 year follow‐up: 25% vs. 0%, P = 0.0016). Conversely, the rate of aborted device implantations due to an elevated transmitral gradient was higher in PASCAL interventions (9.8% vs. 1.2%, P = 0.04). Conclusions Transcatheter edge‐to‐edge repair using the PASCAL or MitraClip device results in favourable and comparable outcomes regarding safety, efficacy, and clinical improvement after 1 year.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Philipp Schlegel
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Markus B Heckmann
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Patricia Crespo López
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Barth S, Hautmann MB, Munoz-Perez C, Kerber S, Kikec J, Zacher M, Foldyna B, Lehmkuhl L, Halbfass P, Lüsebrink U, Hamm K. Functional and hemodynamic result with the PASCAL Ace percutaneous mitral valve repair: a single-center experience. Hellenic J Cardiol 2022; 65:8-14. [DOI: 10.1016/j.hjc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/20/2022] [Accepted: 02/20/2022] [Indexed: 11/04/2022] Open
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Wild MG, Kreidel F, Hell MM, Praz F, Mach M, Adam M, Reineke D, Ruge H, Ludwig S, Conradi L, Rudolph TK, Bleiziffer S, Kellermair J, Zierer A, Nickenig G, Weber M, Petronio AS, Giannini C, Dahle G, Rein KA, Coisne A, Vincentelli A, Dubois C, Duncan A, Quarto C, Unbehaun A, Amat‐Santos I, Cobiella J, Dumonteil N, Estevez‐Loureiro R, Fumero A, Geisler T, Lurz P, Mangieri A, Monivas V, Noack T, Nombela Franco L, Pinon MA, Stolz L, Tchétché D, Walter T, Unsöld B, Baldus S, Andreas M, Hausleiter J, Bardeleben RS. Transapical mitral valve implantation for treatment of symptomatic mitral valve disease: a real‐world multicentre experience. Eur J Heart Fail 2022; 24:899-907. [DOI: 10.1002/ejhf.2434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mirjam G. Wild
- Medizinische Klinik I LMU University Hospital Munich Germany
- Department of Cardiology Inselspital University Hospital Bern Bern Switzerland
| | - Felix Kreidel
- Department of Cardiology University Medical Center Mainz Mainz Germany
| | - Michaela M. Hell
- Department of Cardiology University Medical Center Mainz Mainz Germany
| | - Fabien Praz
- Department of Cardiology Inselspital University Hospital Bern Bern Switzerland
| | - Markus Mach
- Department of Cardiac Surgery Medical University of Vienna Vienna Vienna Austria
| | - Matti Adam
- Department of Cardiology University Hospital Cologne Cologne Germany
| | - David Reineke
- Department of Cardiac Surgery Inselspital University Hospital Bern Bern Switzerland
| | - Hendrik Ruge
- Department of Cardiovascular Surgery German Heart Center, Munich, Technical University Munich Germany
| | - Sebastian Ludwig
- Department of Cardiology University Hospital Hamburg Hamburg Germany
| | - Leonard Conradi
- Department of Cardiology University Hospital Hamburg Hamburg Germany
| | - Tanja K. Rudolph
- Department of Cardiology Heart‐ und Diabetes Center Nordrhine‐Westfalia, Bad Oeynhausen, Ruhr‐University Bochum Germany
| | - Sabine Bleiziffer
- Department of Cardiology Heart‐ und Diabetes Center Nordrhine‐Westfalia, Bad Oeynhausen, Ruhr‐University Bochum Germany
| | - Jörg Kellermair
- Department of Cardiology Kepler University Hospital Linz Austria
| | - Andreas Zierer
- Department of Cardiology Kepler University Hospital Linz Austria
| | - Georg Nickenig
- Department of Cardiac Surgery University Hospital Bonn Bonn Germany
| | - Marcel Weber
- Department of Cardiology University Hospital Bonn Bonn Germany
| | | | | | - Gry Dahle
- Department of Cardiothoracic surgery Oslo University Hospital Oslo Norway
| | - Kjell A. Rein
- Department of Cardiothoracic surgery Oslo University Hospital Oslo Norway
| | - Augustin Coisne
- Université Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐ EGID Lille France
| | - André Vincentelli
- Université Lille, Inserm, CHU Lille, Institut Pasteur de Lille U1011‐ EGID Lille France
| | - Christophe Dubois
- Department of cardiovascular medicine acute and interventional cardiology, UZ Leuven Leuven Belgium
| | - Alison Duncan
- Department of Cardiology Royal Brompton Hospital London United Kingdom
| | - Cesare Quarto
- Department of Cardiac Surgery Royal Brompton Hospital London United Kingdom
| | - Axel Unbehaun
- Department of Cardiac Surgery German Heart Center Berlin Germany
| | - Ignacio Amat‐Santos
- Department of Cardiology CIBER‐CV, University Clinic Hospital Valladolid Valladolid Spain
| | - Javier Cobiella
- Department of Cardiology Hospital Clínico San Carlos Madrid Spain
| | | | | | - Andrea Fumero
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele‐Milan, Italy; Humanitas Research Hospital IRCCS Rozzano‐Milan Italy
| | - Tobias Geisler
- Department of Cardiology University Hospital Tuebingen Tuebingen Germany
| | - Philipp Lurz
- Department of Cardiology Heart Center Leipzig Leipzig Germany
| | - Antonio Mangieri
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele‐Milan, Italy; Humanitas Research Hospital IRCCS Rozzano‐Milan Italy
| | - Vanessa Monivas
- Department of Cardiology Puerta de Hierro Hospital Madrid Spain
| | - Thilo Noack
- University Department of Cardiac Surgery Heart Center Leipzig Leipzig Germany
| | | | - Miguel A. Pinon
- Department of Cardiology University Hospital Alvaro Cunqueiro Vigo Spain
| | - Lukas Stolz
- Medizinische Klinik I LMU University Hospital Munich Germany
| | | | - Thomas Walter
- Department of Cardiac Surgery University Hospital Frankfurt Frankfurt Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany
| | - Stephan Baldus
- Department of Cardiology University Hospital Cologne Cologne Germany
| | - Martin Andreas
- Department of Cardiac Surgery Medical University of Vienna Vienna Vienna Austria
| | - Jörg Hausleiter
- Medizinische Klinik I LMU University Hospital Munich Germany
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Koschutnik M, Dannenberg V, Donà C, Nitsche C, Kammerlander AA, Koschatko S, Zimpfer D, Hülsmann M, Aschauer S, Schneider M, Bartko PE, Goliasch G, Hengstenberg C, Mascherbauer J. Transcatheter Versus Surgical Valve Repair in Patients with Severe Mitral Regurgitation. J Pers Med 2022; 12:jpm12010090. [PMID: 35055405 PMCID: PMC8779938 DOI: 10.3390/jpm12010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background. Transcatheter edge-to-edge mitral valve repair (TMVR) is increasingly performed. However, its efficacy in comparison with surgical MV treatment (SMV) is unknown. Methods. Consecutive patients with severe mitral regurgitation (MR) undergoing TMVR (68% functional, 32% degenerative) or SMV (9% functional, 91% degenerative) were enrolled. To account for differences in baseline characteristics, propensity score matching was performed, including age, EuroSCORE-II, left ventricular ejection fraction, and NT-proBNP. A composite of heart failure (HF) hospitalization/death served as primary endpoint. Kaplan-Meier curves and Cox-regression analyses were used to investigate associations between baseline, imaging, and procedural parameters and outcome. Results. Between July 2017 and April 2020, 245 patients were enrolled, of whom 102 patients could be adequately matched (73 y/o, 61% females, EuroSCORE-II: 5.7%, p > 0.05 for all). Despite matching, TMVR patients had more co-morbidities at baseline (higher rates of prior myocardial infarction, coronary revascularization, pacemakers/defibrillators, and diabetes mellitus, p < 0.009 for all). Patients were followed for 28.3 ± 27.2 months, during which 27 events (17 deaths, 10 HF hospitalizations) occurred. Postprocedural MR reduction (MR grade <2: TMVR vs. SMV: 88% vs. 94%, p = 0.487) and freedom from HF hospitalization/death (log-rank: p = 0.811) were similar at 2 years. On multivariable Cox analysis, EuroSCORE-II (adj.HR 1.07 [95%CI: 1.00–1.13], p = 0.027) and residual MR (adj.HR 1.85 [95%CI: 1.17–2.92], p = 0.009) remained significantly associated with outcome. Conclusions. In this propensity-matched, all-comers cohort, two-year outcomes after TMVR versus SMV were similar. Given the reported favorable long-term durability of TMVR, the interventional approach emerges as a valuable alternative for a substantial number of patients with functional and degenerative MR.
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Affiliation(s)
- Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Varius Dannenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Andreas A. Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Sophia Koschatko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Stefan Aschauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
- Department of Internal Medicine, Franziskus Hospital Margareten, Nikolsdorfergasse 32, 1050 Vienna, Austria
| | - Matthias Schneider
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin (Campus Virchow-Klinikum), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philipp E. Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (M.K.); (V.D.); (C.D.); (C.N.); (A.A.K.); (S.K.); (M.H.); (S.A.); (M.S.); (P.E.B.); (G.G.); (C.H.)
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 St. Poelten, Austria
- Correspondence: ; Tel.: +43-1-40400-46140; Fax: +43-1-40400-42160
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Ganatra R, Smith R. Transcatheter mitral valve intervention. Br J Cardiol 2021; 28:51. [PMID: 35747066 PMCID: PMC9063698 DOI: 10.5837/bjc.2021.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Mitral regurgitation is a common valvular heart disorder increasing with age. Many patients are ineligible for mitral valve surgery due to their age and other comorbidities. Left untreated, patients develop severe disease with a poor prognosis. The development of lower risk percutaneous mitral valve interventions has helped meet the needs of this previously untreated patient group. This review explores the recent and more established developments that have expanded the armamentarium for transcatheter mitral valve intervention.
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Affiliation(s)
- Rea Ganatra
- Internal Medicine Trainee Royal Brompton and Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, Hill End Road, Harefield, UB9 6JH
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Vogelhuber J, Weber M, Nickenig G. Transcatheter Leaflet Strategies for Tricuspid Regurgitation TriClip and CLASP. Interv Cardiol Clin 2021; 11:51-66. [PMID: 34838297 DOI: 10.1016/j.iccl.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the recognition of the impact of significant tricuspid regurgitation on the clinical course and mortality, intensive efforts have been made in identifying and developing individually suitable and catheter-based therapy strategies to offer those often older and multimorbid patients at high surgical risk safe, feasible, and efficacious treatment options with justifiable risk. Up to now, transcatheter edge-to-edge repair with leaflet approximation devices such as TriClip (Abbott, Santa Clara, CA, USA) and PASCAL Implant System (Edwards Lifesciences, Irvine, CA, USA) have been evaluated best and several clinical trials could prove safety, feasibility, and efficacy of said devices leading to their recent CE mark. However, further randomized controlled trial are pending and necessary to evaluate their impact on clinical course and outcome in comparison to established treatment recommendations.
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Affiliation(s)
- Johanna Vogelhuber
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Marcel Weber
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Georg Nickenig
- Heart Centre, Department of Cardiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 277] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Yousef S, Arnaoutakis GJ, Gada H, Smith AJC, Sanon S, Sultan I. Transcatheter mitral valve therapies: State of the art. J Card Surg 2021; 37:225-233. [PMID: 34532900 DOI: 10.1111/jocs.15995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Abstract
Mitral regurgitation (MR) is one of the most prevalent valvular pathologies in the developed world. There continues to be a growing population of aging patients with MR who may be too high risk for surgical management. The rapid adoption and remarkable success of transcatheter aortic valve replacement (TAVR) generated enthusiasm for transcatheter mitral valve therapies; however, the complex anatomy and pathophysiology of the mitral valve confers several unique challenges for a fully percutaneous approach. Nevertheless, several devices are under development and in various phases of preclinical or clinical testing, both for transcatheter mitral valve replacement and repair. MitraClip (Abbott Vascular), which has received FDA approval, is the most established percutaneous repair strategy and has been performed in over 80,000 patients as of 2019. The following article serves as a review of the available and upcoming devices for the various etiologies of mitral valvular disease, as well as the unique challenges and potential complications of transcatheter mitral valve intervention.
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Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - George J Arnaoutakis
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Hemal Gada
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anson Jay Conrad Smith
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Saurabh Sanon
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Granata G, Rubbio AP, De Marco F, Barletta M, Salvatore T, Bedogni F, Maurizio T. Transcatheter Mitral Valve Repair with the PASCAL System after Early Edge-to-Edge Surgical Failure. J Cardiovasc Echogr 2021; 31:102-103. [PMID: 34485037 PMCID: PMC8388324 DOI: 10.4103/jcecho.jcecho_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
We report the challenging case of percutaneous treatment of early recurrent mitral regurgitation after Alfieri edge-to-edge surgical procedure.
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Affiliation(s)
- Giuseppina Granata
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Marta Barletta
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Tanya Salvatore
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Tusa Maurizio
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
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Barth S, Shalla A, Kikec J, Kerber S, Zacher M, Reents W, Lehmkuhl L, Foldyna B, Halbfass P, Lüsebrink U, Hautmann MB. Functional and hemodynamic results after transcatheter mitral valve leaflet repair with the PASCAL device depending on etiology in a real-world cohort. J Cardiol 2021; 78:577-585. [PMID: 34479788 DOI: 10.1016/j.jjcc.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The PASCAL system (Edwards Lifescience, Irvine, CA, USA) is a novel device for edge-to-edge treatment of mitral regurgitation (MR). The aim of our study was to examine the functional and hemodynamic outcome after repair of functional (FMR) and degenerative mitral regurgitation (DMR) using the PASCAL system in a real-world setting. METHODS A total 92 consecutive patients with symptomatic MR 3+/4+ were treated in our institute using the PASCAL device. Primary endpoints included procedural success, clinical success, and major adverse event rate at 30 days and 7 months. RESULTS 68.5% had a functional and 31.5% a degenerative etiology. Overall success rate was achieved in 97.8% patients (98.4% FMR, 96.6% DMR). At follow-up, 85.7% of the patients (89.2% FMR, 78.3% DMR) had MR grade ≤ 1. 96.4% (97.4% FMR, 94.4% DMR) were in New York Heart Association class I or II. Six-minute walking distance improved by 96 m (92 m FMR, 106 m DMR), Kansas City Cardiomyopathy Questionnaire improved by 19 points (19 points FMR, 19 points DMR). Pro-B-type natriuretic peptide (proBNP) levels decreased from 4673 to 2179 pg/dl (5239-2018 pg/ml FMR, 3418-2530 pg/ml DMR) and mean pulmonary capillary wedge pressure from 21 to 16 mmHg (21-17 mmHg FMR, 19-13 mmHg DMR). At 30 days, there was 1 cardiovascular death (1.2%) with DMR. At 1 year, Kaplan-Meier survival was 86% (86% FMR, 86% DMR). CONCLUSIONS Severe MR can successfully and safely be treated with the PASCAL device regardless of etiologies. This interventional approach resulted in a sustained MR reduction, improvement in exercise capacity, quality of life, proBNP levels, and hemodynamics in FMR and DMR at follow-up.
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Affiliation(s)
- Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, D-97616 Bad Neustadt a. d. Saale, Germany.
| | - Alaa Shalla
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, D-97616 Bad Neustadt a. d. Saale, Germany
| | - Jan Kikec
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, D-97616 Bad Neustadt a. d. Saale, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, D-97616 Bad Neustadt a. d. Saale, Germany
| | - Michael Zacher
- Department of Medical Documentation, Cardiovascular Center Bad Neustadt, Germany
| | - Wilko Reents
- Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Germany
| | - Lukas Lehmkuhl
- Department of Radiology, Cardiovascular Center Bad Neustadt, Germany
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Martina B Hautmann
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, D-97616 Bad Neustadt a. d. Saale, Germany
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Fudim M, Abraham WT, von Bardeleben RS, Lindenfeld J, Ponikowski PP, Salah HM, Khan MS, Sievert H, Stone GW, Anker SD, Butler J. Device Therapy in Chronic Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:931-956. [PMID: 34446165 PMCID: PMC9941752 DOI: 10.1016/j.jacc.2021.06.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The regulatory landscape for device-based heart failure (HF) therapies has seen a major shift in the last 7 years. In 2013, the U.S. Food and Drug Administration released guidance for early feasibility and first-in-human studies, thereby encouraging device innovation, and in 2016 the U.S. Congress authorized the Breakthrough Devices Program to expedite access for Americans to innovative devices indicated for diagnosis and treatment of serious illnesses, such as HF. Since December 2016, there has been an increase in the number of HF devices for which manufacturers are seeking approval through the breakthrough designation pathway. This has led to a rapid uptake in the development and evaluation of device-based HF therapies. This article reviews the current and future landscape of device therapies for chronic HF and associated comorbidities and the regulatory environment that is driving current and future innovation.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Ralph Stephan von Bardeleben
- Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - JoAnn Lindenfeld
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Piotr P. Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland,Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Husam M. Salah
- Department of Medicine, University of Arkansas for Medical Sciences, AR, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany,Anglia Ruskin University, Chelmsford, United Kingdom
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, and the Cardiovascular Research Foundation, New York, NY, USA
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA.
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 1840] [Impact Index Per Article: 613.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Schlegel P, Crespo López P, Kreusser MM, Katus HA, Frey N, Geis NA, Raake PWJ. PASCAL-based mitral valve repair in an all-comer population: acute and mid-term clinical results. ESC Heart Fail 2021; 8:3530-3538. [PMID: 34448541 PMCID: PMC8497336 DOI: 10.1002/ehf2.13569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS We investigated short and mid-term safety and efficacy of the PASCAL system for percutaneous mitral valve repair (PMVr) in severe mitral regurgitation (MR) in an all-comer population. METHODS AND RESULTS In the first consecutive 41 patients undergoing PMVr using the PASCAL system in our centre, procedural success and safety were assessed. Efficacy in improving MR and functional class were evaluated. Median patient age was 74 years, 58.5% were male patients, and median European System for Cardiac Operative Risk Evaluation Score II was 5.1%. All patients suffered from severe MR with 59% functional MR, 29% degenerative MR, and 12% of mixed aetiology MR. The technical success rate was 90%, limited by four cases where PASCAL implantation was aborted due to a prohibitive mitral gradient. On average, 1.16 PASCAL devices per patient were implanted. All patients successfully implanted with a PASCAL device were discharged with MR grade ≤ 2 and 79% with MR grade ≤ 1. Mean follow-up was 8.7 ± 4.9 months. Ninety-seven per cent of patients remained at MR ≤ 2 at follow-up, which translated into a significantly improved New York Heart Association functional class as well as a significant reduction of systolic pulmonary artery pressure and brain natriuretic peptide levels. The procedure-related rate for major adverse events was 3%. Neither early nor late single-leaflet detachment was found. In one patient, air embolism occurred, resulting in modification of the PASCAL instructions for use. CONCLUSIONS Percutaneous mitral valve repair using PASCAL in a real-world, all-comer population was feasible and safe, resulting in a significant mid-term reduction of MR with persistent clinical improvement.
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Affiliation(s)
- Philipp Schlegel
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Patricia Crespo López
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Nicolas A Geis
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Philip W J Raake
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.,DZHK [German Centre for Cardiovascular Research], Partner site Heidelberg/Mannheim, Heidelberg, Germany
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