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Ten Berg JM, Overduin DC, van Ginkel DJ. Best Oral Anticoagulant for Transcatheter Mitral Valve Replacement. J Am Coll Cardiol 2024; 83:347-349. [PMID: 38199712 DOI: 10.1016/j.jacc.2023.11.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Jurriën M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; Department of Cardiology, University Medical Center Maastricht, Maastricht University Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Daniël C Overduin
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
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Urena M, Lurz P, Sorajja P, Himbert D, Guerrero M. Transcatheter mitral valve implantation for native valve disease. EUROINTERVENTION 2023; 19:720-738. [PMID: 37994096 PMCID: PMC10654769 DOI: 10.4244/eij-d-22-00890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 10/12/2022] [Accepted: 08/07/2023] [Indexed: 11/24/2023]
Abstract
Mitral regurgitation is the second most frequent heart valve disease in Europe and the most frequent in the US. Although surgery is the therapy of choice when intervention is indicated, transcatheter mitral valve repair or replacement are alternatives for patients who are not eligible for surgery. However, the development of transcatheter mitral valves is slower than expected. Although several transcatheter heart valves have been developed, only one has been commercialised. Indeed, most of these devices are being evaluated in clinical studies, with promising initial results. In this review, we propose an overview on transcatheter mitral valve replacement for the treatment of native mitral valve disease, from indication to results, including patients with severe annular calcification, and we provide you with a glimpse into the future of these therapies.
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Affiliation(s)
- Marina Urena
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philipp Lurz
- Department of Cardiology, Zentrum für Kardiologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Dominique Himbert
- Department of Cardiology, Hôpital Bichat Claude-Bernard, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Delhomme C, Urena M, Chong-Nguyen C, Brochet E, Ducrocq G, Iung B, Himbert D. Emergent transcatheter mitral valve implantation: Early and mid-term outcomes. Arch Cardiovasc Dis 2023; 116:300-308. [PMID: 37225555 DOI: 10.1016/j.acvd.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 02/18/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Transcatheter mitral valve implantation (TMVI) may be attractive to treat high-risk patients with mitral bioprosthesis or annuloplasty ring failure or severe mitral annular calcification. AIM To report the outcomes of patients after valve-in-valve/ring/mitral annular calcification TMVI using balloon expandable transcatheter aortic valves, according to the degree of urgency of the procedure. METHODS All patients who underwent TMVI in our centre from 2010 to 2021 were classified into three groups: elective, urgent or emergent/salvage TMVI. RESULTS A total of 157 patients were included: 129 (82.2%) had elective, 21 (13.4%) urgent and 7 (4.4%) had emergent/salvage TMVI. Patients with emergent/salvage TMVI had a higher EuroSCORE II: elective, 7.3%; urgent, 9.7%; emergent/salvage, 54.5% (P<0.0001). The indication for TMVI was bioprosthesis failure in all of the emergent/salvage group, in 13 of the urgent group (61.9%) and in 62 of the elective group (48.1%). Overall, the technical success rate of TMVI was 86%, and was similar in the three groups (elective, 86.1%; urgent, 95.2%; emergent/salvage, 71.4%). The cumulative survival rate at 2-year follow-up was lower in the emergent/salvage group than in the elective or urgent group (42.9% vs 71.2% for the elective group; 76.2% for the urgent group; log-rank test, P=0.012). The excess mortality in the emergent/salvage group occurred during the first month postprocedure. Thereafter, the 30-day landmark analysis did not show any more statistical difference between the three groups (log-rank test, P=0.94). CONCLUSIONS Emergent/salvage TMVI was associated with high early mortality, but 1-month survivors had similar outcomes to patients with elective/urgent TMVI. The degree of urgency of the procedure should not prevent TMVI in high-risk patients.
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Affiliation(s)
- Clémence Delhomme
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France.
| | - Marina Urena
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France; University of Paris Cité, 75018 Paris, France
| | | | - Eric Brochet
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Grégory Ducrocq
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France; University of Paris Cité, 75018 Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France; University of Paris Cité, 75018 Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, 75018 Paris, France
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Hayes DE, Bamira D, Vainrib AF, Staniloae C, Jilaihawi H, Williams M, Saric M. Mitral Valve-in-Ring Leaflet Thrombosis: A Multimodality Imaging Primer. CASE 2022; 6:301-308. [PMID: 36172479 PMCID: PMC9510672 DOI: 10.1016/j.case.2022.05.009] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Echocardiography and CT help to detect mitral THVT. Hypoattenuated leaflet thickening on CT indicates mitral thrombosis. Duration of anticoagulation to prevent mitral transcatheter valve thrombosis is unclear.
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Le Ruz R, Guérin P, Leurent G, Leroux L, Lefevre T, Nejjari M, Champagnac D, Tchétché D, Lhermusier T, Senage T, Piriou PG, Caussin C, Delomez M, Bonnet G, Favereau X, Karam N, Gerbay A, Juthier F, Gilard M, Obadia JF, Iung B, Manigold T. Mitral valve-in-valve and valve-in-ring procedures: Midterm outcomes in a French nationwide registry. Catheter Cardiovasc Interv 2022; 99:1829-1838. [PMID: 35324050 DOI: 10.1002/ccd.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 10/23/2021] [Revised: 01/31/2022] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Report contemporary outcomes in patients included in the Mitragister registry and treated with transcatheter mitral valve implantation for failed surgical annuloplasty rings or deteriorated bioprosthesis. BACKGROUND Midterm survival rates have been reported, but little is known about contemporary morbimortality endpoints. METHODS The primary safety outcome was the technical success rate. The primary efficacy composite endpoint was a composite of cardiovascular mortality and heart failure hospitalizations. RESULTS From 2016 to 2021, 102 patients (median age: 81 [74;84] years, 61% female, Euroscore II 11.0% [7.8;16.0]) undergoing valve-in-valve (ViV; n = 89) or valve-in-ring (ViR; n = 13) procedures were consecutively included. At baseline, ViR group patients had worse left ventricular ejection fraction (50% vs. 60%; p = 0.004) and more frequently severe regurgitation (46% vs. 15%; p = 0.014). The primary safety outcome was 95%: 77% and 98% in the ViR and ViV populations, respectively, (p = 0.014). At intermediate follow-up (6-12 months) clinical improvement was notable, 88% of the patients were in NYHA class ≤ II (vs. 25% at baseline; p < 0.001). At a mean follow-up of 17.1 ± 11.0 months, the primary efficacy composite reached 27%. By multivariate analysis, paravalvular leak (PVL) was the only independent predictor (hazard ratio: 2.39, 95% confidence interval: 1.08-5.29; p = 0.031) while ViR was not found statistically associated (p = 0.456). CONCLUSIONS This study confirms the safety and efficacy of the mitral ViV procedure. ViR patients appear at higher risk of procedural complications. The presence of PVL could be associated with markedly worse midterm prognosis. Whatever the intervention, procedural strategies to reduce PVL incidence remain to be assessed to prevent latter adverse outcomes.
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Affiliation(s)
- Robin Le Ruz
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Patrice Guérin
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Guillaume Leurent
- Department of Cardiology, University Hospital of Rennes, Rennes, France
| | - Lionel Leroux
- CHU de Bordeaux, Service Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Chirurgie Cardiaque Adulte, Cardiologie Interventionnelle Structurelle Adulte, Bordeaux, France
| | - Thierry Lefevre
- Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Thomas Senage
- Department of Thoracic and Cardiovascular Surgery, PHU 2 Institut du Thorax et du Sytème Nerveux, CHU Nantes, Nantes, France
| | - Pierre-Guillaume Piriou
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | | | | | - Guillaume Bonnet
- Service de Cardiologie Interventionnelle, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Xavier Favereau
- Private Hospital of Parly II, Le Chesnay-Rocquencourt, France
| | - Nicole Karam
- Cardiology Department, Université de Paris, PARCC, INSERM, European Hospital Georges Pompidou, Paris, France
| | - Antoine Gerbay
- Division of Cardiology, Jean Monnet University (ADC, CD, JBG, AG, RP, CRB, and KI), Saint-Etienne, France
| | | | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Brest, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Bernard Iung
- Department of Cardiology, University Hospital Department Fire and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France
| | - Thibaut Manigold
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
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Urena M, Lemann T, Chong-Nguyen C, Brochet E, Ducrocq G, Carrasco JL, Iung B, Vahanian A, Himbert D. Causes and predictors of mortality after transcatheter mitral valve implantation in patients with severe mitral annulus calcification. Catheter Cardiovasc Interv 2021; 98:981-989. [PMID: 34263517 DOI: 10.1002/ccd.29874] [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: 04/13/2021] [Revised: 06/13/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the causes and predictors of mortality after valve-in-mitral annulus calcification (MAC) transcatheter mitral valve implantation (TMVI). BACKGROUND Conventional surgical mitral valve replacement is associated with a high risk in patients with mitral valve disease associated with severe MAC. In this population, TMVI may be an attractive alternative option. However, its prognostic factors are poorly understood. METHODS All patients undergoing valve-in-MAC TMVI from 2013 to 2018 in our center were included. Indication for TMVI relied on the judgment of the local heart team. Patients were followed at 30 days and 1 year. RESULTS A total of 34 patients underwent valve-in-MAC TMVI. The mean age was 79 ± 11 years and 73% of patients were women. Their mean EuroSCORE 2 was 8 ± 7%. The transseptal approach was used in 79% of patients and a hybrid transatrial in 29%. Balloon expandable transcatheter heart valves were used in all the patients. Technical success was achieved in 76% of the patients. Thirty-day and 1-year all-cause mortality rates were 14.7% and 32.4%, respectively. The main two causes of 1-year mortality were congestive heart failure (8.8%) and infective endocarditis (5.9%). In multivariate analysis, the only predictor of 1-year mortality was the presence of periprothetic mitral regurgitation grade 2 (HR, 5.69; 95%CI, 1.59-27.88, p = 0.032). CONCLUSION Early and mid-term mortality remains high after valve-in-MAC TMVI and seems to be associated with the presence of paravalvular mitral regurgitation. However, whether the latter is a prognostic factor or marker remains to be determined to improve clinical outcomes in this high-risk population.
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Affiliation(s)
- Marina Urena
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Thomas Lemann
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Eric Brochet
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Grégory Ducrocq
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Jose-Luis Carrasco
- Assistance Publique - Hôpitaux de Paris, Department of Anaesthesiology, Bichat-Claude Bernard Hospital, Paris, France
| | - Bernard Iung
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Alec Vahanian
- University of Paris, Paris, France.,INSERM U 1148, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
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Jilaihawi H. Transcatheter heart valve thrombosis on the mitral stage: "The Tempest" or "Much Ado About Nothing"? EUROINTERVENTION 2021; 16:1386-1387. [PMID: 33875407 PMCID: PMC9707525 DOI: 10.4244/eijv16i17a253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hasan Jilaihawi
- NYU Langone Health, Suite 9V, 530 1st Avenue, New York, NY 10016, USA
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