scholarly journals Impact of the implantation of one MitraClip on the mitral valve anatomy: NTR vs. XTR

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Kassar
Keyword(s):  
Mitral Valve ◽  
Vena Contracta ◽  
Funding Sources ◽  
Mitral Repair ◽  
Before And After ◽  
Vena Contracta Area ◽  
The Impact ◽  
Device Size ◽  
Valve Area ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Percutaneous mitral repair using MitraClips (MC) for severe symptomatic regurgitation (MR) has emerge as an alternative treatment for selected high risk surgical patients. Despite the high number of cases treated with both iterations of the MC, the small NTR and the big XTR, the impact of the device size on the mitral valve area (MVA), the morphology of the annulus, the severity of the MR and the use of multiple device is still unknown. Methods High quality volume focused on the MV were acquired during each intervention. Using a dedicated 3-D analysis software the dimensions of the annulus, the MVA and the 3-D vena contracta area (VCA) were evaluated before and after clipping. After implantation, the area of both orifices were measured independently and summed. Results A total of 120 patients were included, 63 received a NTR and 57 a XTR. Before clipping, XTR cases had bigger MVA (5.9+/-1.7 vs. 4.9+/-1.3 cm2, p .001), a trend toward bigger VCA (0.56+/-0.7 vs. 0.51+/-0.9 cm2, p .073) and no difference in the anteroposterior (AP, 3.5 [3.1-4] vs. 3.5 [3.3-3.8] cm, p .47) and the lateromedial (LM, 4.2 [3.8-4.5] vs. 4.3 [4.0-4.5] cm) diameter of the annulus compared to NTR cases. One MC implantation produced a significant decrease of all these parameters but only MVA was significantly more reduce by XTR (Figure 1). The patients receiving a NTR as first MC did not need more often a second clip (31/63 vs. 26/57, p .072). Conclusions On average, both devices produce a MVA reduction of more than 50% and an indirect annuloplasty mainly in the anteroposterior direction. The use of an XTR as first MC do not decrease the probability of the necessity of a second one. All these parameters should be carefully taken into account when defining the implantation strategy. Abstract Figure.

scholarly journals Anatomical predictors of mitral valve area reduction after the implantation of one MitraClip: the spot matter

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Kassar
Keyword(s):  
Mitral Valve ◽  
Structural Parameters ◽  
Mitral Valve Area ◽  
Funding Sources ◽  
Area Reduction ◽  
Before And After ◽  
The Mean ◽  
Reduction Percentage ◽  
Anatomical Parameters ◽  
Valve Area

Abstract Funding Acknowledgements Type of funding sources: None. Introduction To avoid significant stenosis after edge-to-edge therapy of severe mitral regurgitation (MR) using MitraClip (MC), according to the EVEREST criteria, patients with a mitral valve area (MVA) <4 cm2 should not be treated with this technique. Instead of basing the decision on only one parameter, the anatomical predictors of the reduction percentage should be defined. It is the purpose of this study Methods During the last two years interventions, volume of the MV were acquired by the guiding echocardiographer and, using a dedicated 3-D software MVA before and after clipping were measured and the percentage of reduction calculated. Several baseline anatomical parameters were also evaluated: MV annulus surface and diameters, leaflets surface, percentage of fibrosed/calcified leaflet, tenting volume. The ratio between the two orifices after clipping was also calculated. Results During the study period, 120 patients were evaluated, 69 primary (PMR) and 51 secondary (SMR) mitral regurgitations. The mean reduction of the MVA after one MC was 53.6+/-8.5% with a range of 25-69% and there was no difference when SMR were compared with PMR. Of all the structural parameters that we correlated with the percentage of MVA reduction, the ratio between the two orifices created after the MC implantation was the only one statistically linked. The relation is U-shaped with a maximal MVA reduction for a ratio of the orifices of about 3/5 (figure 1). The correlation was even better for the PMR cases (figure 2). Conclusions The range of MVA reduction following the implantation of one MC is very variable and the only predictor of the percentage of MVA reduction we found was the spot of implantation. Abstract Figure.

The underrepresentation of female participants in studies assessing the impact of high-dose exercise on cardiovascular outcomes: a scoping review

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
R Patel ◽  
CL Kemp ◽  
M Hafejee ◽  
N Peckham ◽  
...  
Keyword(s):  
Scoping Review ◽  
High Volume ◽  
Cardiovascular Outcomes ◽  
High Dose ◽  
Funding Sources ◽  
Review Protocol ◽  
The Mean ◽  
The Impact ◽  
Over Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular adaptations as a result of exercise conducted at high-intensity and high-volume are often termed the ‘Athlete’s heart’. Studies have shown that these cardiovascular adaptations vary between sexes. It is important that both sexes are well represented in this literature. However, many studies assessing the impact of high-dose exercise on cardiovascular outcomes under-recruit female participants. Purpose This scoping review aimed to evaluate the representation of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and demonstrate how this has changed over time. Methods The scoping review protocol as outlined by Arksey and O’Malley was used. OVID and EMBASE databases were searched and studies independently reviewed by two reviewers. Studies must have investigated the effects of high-dose exercise on cardiovascular outcomes. To assess how the recruitment of females has changed over time, two methods were used. One, the median study date was used to categorise studies into two groups. Two, studies were divided into deciles to form ten equal groups over the study period. Mean percentage of female recruitment and percentage of studies that failed to include females were calculated. Results Overall, 250 studies were included. Over half the studies (50.8%, n = 127) did not include female participants. Only 3.2% (n = 8) did not include male participants. Overall, mean percentage recruitment was 18.2%. The mean percentage of recruitment was 14.5% before 2011 and 21.8% after 2011. The most recent decile of studies demonstrated the highest mean percentage of female recruitment (29.3%) and lowest number of studies that did not include female participants (26.9%). Conclusion Female participants are significantly underrepresented in studies assessing cardiovascular outcomes caused by high-dose exercise. The most recent studies show that female recruitment may be improving, however, this still falls significantly short for equal representation. Risk factors, progression and management of cardiovascular diseases vary between sexes, hence, translating findings from male dominated data is not appropriate. Future investigators should aim to establish barriers and strategies to optimise fair recruitment. Mean percentage females recruited per study (%) Percentage studies that do not include women (%) Overall (n = 250) 18.2 50.8 (n = 127) Studies before 2011 (n = 121) 14.5 59.5 (n = 72) Studies after 2011 (n = 129) 21.8 42.6 (n = 55) Table 1: Female recruitment characteristics. The year 2011 (median study year) was chosen as this divides all included studies into two equal groups.

scholarly journals Impact of the COVID-19 pandemic on electrophysiological procedures at a national referral center

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Cueva-Parra ◽  
G Munoz-Benavides ◽  
W Ortiz-Solis ◽  
J Gomez-Flores ◽  
MF Marquez ◽  
...  
Keyword(s):  
Electronic Devices ◽  
Referral Center ◽  
Funding Sources ◽  
Cardiac Implantable Electronic Devices ◽  
Electrophysiological Studies ◽  
Electrophysiological Procedures ◽  
The Impact ◽  
Large Groups ◽  
Made In ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background - Introduction: The COVID-19 pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide. Objectives Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center.  Methods We made a retrospective review of our data base and we compared procedures made in the last 3 years since 2017 to 2019 with the procedures made in the 2020. We divide the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures (which included implants, revisions, changes, upgrades and extractions) and electrophysiological studies and ablations (which included conventional and complex procedures). Other types of procedures were no included. Results There was a significant reduction in all procedures, the average of procedures performed in the last 3 previous years was 467 (there were 479 in 2017, 411 in 2018 and 511 in 2019), while in 2020 we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures performed in our center. There was no statistical difference regarding the CIED related procedures, the average of procedures of the last 3 previous years was 174 (there were 186 in 2017, 148 in 2018 and 188 in 2019), and in 2020 we performed 189 procedures, this value is near to the average of the last 3 previous years and very close to the value of the 2019 (p = 0.46). Regarding the electrophysiological studies and ablations, the average of procedures of the last 3 previous years was 293 (there were 293 in 2017, 263 in 2018 and 323 in 2019), while in 2020 we performed only 129 procedures, considerably decreasing compared to the previous years (p < 0.01). The reduction in the electrophysiological studies and ablations was 55.97%. The most affected months were April, May and June. Conclusions The COVID-19 pandemic considerably affected the number of electrophysiological procedures in our center, reducing it by 33.4% compared to the previous years. The reduction of procedures fundamentally affected the electrophysiological studies and ablations, reducing them by 55.97%. The number of CIED related procedures were no affected. Electrophysiological procedures Procedures2017201820192017-2019 average2020CIED related procedures186148188174189Electrophysiological studies and ablations293263323293129Total479411511467319Comparative table of the electrophysiological procedures performed in our center in recent years.Abstract Figure. Comparison of the procedures.

Accuracy of Two-Dimensional Echocardiographic Planimetry of the Mitral Valve Area before and after Balloon Valvuloplasty

Cardiology ◽  
1998 ◽  
Vol 90 (3) ◽  
pp. 227-230 ◽  
Author(s):  
Avinoam Shiran ◽  
Steven A. Goldstein ◽  
Samer Ellahham ◽  
Gary S. Mintz ◽  
Augusto D. Pichard ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Balloon Valvuloplasty ◽  
Two Dimensional ◽  
Mitral Valve Area ◽  
Before And After ◽  
Valve Area

scholarly journals P1560 Acute changes of mitral annular dimensions after transcatheter egde-to-edge repair: an indirect annuloplasty method?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Papadopoulos ◽  
I Ikonomidis ◽  
M Chrissoheris ◽  
A Chalapas ◽  
P Kourkoveli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Heart Team ◽  
Severe Mitral Regurgitation ◽  
Reduced Ejection Fraction ◽  
Device Implantation ◽  
Percentage Difference ◽  
Before And After ◽  
Acute Changes ◽  
The Impact

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) is a safe and alternative method for treating high-risk patients with severe mitral regurgitation (DMR or FMR). This transcatheter treatment aims at reducing the MR with a so-called "Alfieri stitch" method. However the impact on mitral annular dimensions after the device implantation is not well defined. The purpose of this study is to recognize the acute changes of mitral annular dimensions after transcatheter edge-to-edge repair. Methods We retrospectively analyzed 20 consecutive patients (aged 74 ± 10yrs) with degenerative or functional moderate-to-severe and severe mitral regurgitation (EROA 40.8 ± 20.5mm2, RV 52.6 ± 17.5ml) and reduced ejection fraction (EF 36.9 ± 15.4%). These patients were at high surgical risk or even inoperable in certain cases (logistic EuroSCORE 28.9 ± 18.2%) and evaluated by a heart team as candidates for transcatheter repair. All intraoperative transoesophageal echo studies were post processed with EchoPac v.203 or QLAB 9.0. 3D views of the mitral valve before and after the implantation of the device were analyzed with 4D AutoMVQ (GE) or MVQ (Phillips) software. Results PMVR was effective in treating the MR at the end of the operation (from 3.8 ± 0.4 to 1.3 ± 0.5 after the implantation, p < 0.05) in all patients. There was a significant reduction of the annulus area (from 12.25 ± 3.0cm2 to 10.18 ± 2.88cm2, p < 0.001) and circumference (from 13.23 ± 1.4cm to 12.18 ± 1.57cm, p < 0.001), in both DMR and FMR cases. The percentage reduction of annulus area and circumference after PMVR was 17.3 ± 0.8% and 8 ± 5% respectively and the number of the clips used for that purpose were 1.55 ± 0.6. Additionally, edge-to-edge repair significantly reduced the anterior-posterior diameter (from 3.49 ± 0.56cm to 3.02 ± 0.55cm, r = 0.86, p < 0.001) and the posteromedial-anterolateral diameter (from 4.15 ± 0.58cm to 3.88 ± 0.60cm, r = 0.9, p < 0.001). The number of the clips used did not play an important role in the percentage difference of the annulus dimensions (20% reduction with one clip vs 14.3 ± 7.6% with two or more, p < 0.05) and one possible explanation could be that patients receiving one clip had smaller annulus area comparing to the patients receiving two or more (11.2 ± 2.9mm2 vs 13.3 ± 2.7mm2 respectively, p < 0.05). Conclusions Transcatheter edge-to-edge repair is effective in treating MR in patients with DMR and FMR and has a direct impact on mitral annular dimensions acutely after the implantation.

Application of the Vena contracta Method for the Calculation of the Mitral Valve Area in Mitral Stenosis

Cardiology ◽  
2002 ◽  
Vol 98 (1-2) ◽  
pp. 50-59 ◽  
Author(s):  
Adnan Abacı ◽  
Abdurrahman Oguzhan ◽  
Şükrü Ünal ◽  
Burhanettin Kıranatlı ◽  
Namık Kemal Eryol ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Stenosis ◽  
Vena Contracta ◽  
Mitral Valve Area ◽  
Valve Area
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