Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Atrial Functional Mitral Regurgitation from the GIOTTO Registry

Atrial functional mitral regurgitation (aFMR) has a peculiar pathophysiology that may have distinctive outcomes. We investigated the impact of transcatheter edge-to-edge repair in aFMR compared with other FMR etiologies. The GIOTTO (GIse registry Of Transcatheter treatment of MR) is a multicenter, prospective study enrolling patients with symptomatic MR treated with MitraClip up to 2020. We categorized patients with FMR as aFMR, ischemic FMR (iFMR), and nonischemic ventricular FMR (niFMR). The clinical end points were defined according to the Mitral Valve Academic Research Consortium. Of 1,153 patients, 6% had aFMR, 47% iFMR, and 47% niFMR. Patients with aFMR were older, mostly women, and had a higher atrial fibrillation rate. They had better left ventricular ejection fraction and smaller left ventricular volumes, with no difference in mitral effective regurgitant orifice area. The acute device and procedural success rates were similar among the groups. At the longest available follow-up (median 478 days, interquartile range 91 to 741 days), the rate of MR ≥2+ was similar among the groups. Patients with aFMR had a lower rate of cardiovascular death and heart failure than patients with iFMR (hazard ratio [HR] 0.43, p = 0.02) and niFMR (HR 0.45, p = 0.03). The aFMR etiology remained independently associated with the composite outcome, together with postprocedural MR ≤1+ (HR 0.63, p <0.01) and peripheral arteriopathy (HR 1.82, p = 0.003). The results of this GIOTTO subanalysis suggested that aFMR is less prevalent and associated with better outcomes compared with other causes of FMR treated by transcatheter edge-to-edge repair. Postprocedural MR >1+, peripheral vasculopathy, non-aFMR were independent predictors of worse outcomes.

Ankle resection arthrodesis in patients with bone tumors

The authors report 12 cases of bone tumors localized in the distal tibia treated by resection and reconstruction with ankle arthrodesis, using bone grafts and fixation with Kuntscher or Grosse-Kempf nail or plate. In seven cases autografts were used, and in five cases autografts combined with allografts were used. In three of these five patients, a vascularized fibula combined with a "gutter-like" allograft was used to reconstruct the bone defect. In all cases, the functional and oncologic results were good and all patients were disease free at an average follow-up of 68 months.

Current concepts on myocardial depressant factor

In the present work the authors have tried to offer a vast and detailed summary of theories and questions concerning the role of the MDF in shock. One of the major problems that surrounds this molecule is the myocardial contractility depression, the solution of which could allow a more rationalistic therapeutic approach to that which remains one of the most complex and delicate clinical framework.