Acute hemodynamic effects of iatrogenic inter-atrial shunts after percutaneous edge-to-edge mitral valve repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Koschutnik ◽  
G Goliasch ◽  
C Nitsche ◽  
A.A Kammerlander ◽  
C Dona ◽  
...  
Keyword(s):  
Blood Flow ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Vascular Function ◽  
Left Ventricular ◽  
Pulmonary Vasculature ◽  
Lv Function ◽  
Hemodynamic Effects ◽  
Valve Repair ◽  
Beneficial Effects

Abstract Background Implantable interatrial shunt devices improve pulmonary vascular function in patients with heart failure by transferring richly oxygenated blood to the right heart. Whether iatrogenic atrial septum defects (iASDs) after percutaneous edge-to-edge mitral valve repair (pMVR) are also associated with beneficial hemodynamic effects has not been investigated. Methods We consecutively enrolled patients with relevant functional (FMR) and degenerative mitral regurgitation (DMR) scheduled for pMVR. Invasive hemodynamic assessments were performed prior to and immediately after the procedure. Results 97 consecutive patients (75.4±9.1 years; 58% female) were prospectively included, 65 (66%) presented with relevant FMR. At baseline when compared to the DMR group, FMR was associated with worse left ventricular (LV) function (LV ejection fraction: 39 vs. 49%; p=0.001), higher NT-proBNP levels (7404 vs. 5214 pg/mL; p=0.023), worse renal function (serum creatinine: 1.7 vs. 1.3 mg/dL; p=0.019), and higher usage of spironolactone (68 vs. 42%; p=0.018) and sacubitril/valsartan (33 vs. 0%; p<0.001). Following pMVR, cardiac output (CO) and systemic blood flow (Qs) increased significantly (CO: 4.6 to 5.5 L/min; p<0.001; Qs: 4.9 to 5.8 L/min; p=0.002), with more pronounced changes in the FMR subgroup (ΔCO: 1.0 vs. 0.6 L/min; Figure 1A; ΔQs: 1.2 vs. 0.1 L/min), when compared to DMR. Pulmonary blood flow (Qp) increased by 26% (4.3 to 5.4 L/min; p=0.008), accompanied by a raise in pulmonary artery (PA) oxygen (O2) saturation from 73 to 77% (p<0.001). Arterial O2 saturation levels remained unchanged (98.3 to 98.7%; p=0.165), confirming no significant changes in systemic oxygenation. These changes were associated with a slight decline in pulmonary vascular resistance (PVR: 250 to 225 dynes*sec/cm5; p=0.369, Figure 1B), and a tendency towards improvement of pulmonary compliance (PAC: 3.6 to 4.0 mL/mmHg; p=0.414). Conclusions Invasively measured CO, Qs, Qp, and mixed-venous PA O2 saturation increased immediately after pMVR, alongside with potentially beneficial effects on pulmonary vasculature with marked improvements in PVR and PAC. These changes were more pronounced in the FMR subgroup. Further studies are required to assess long-term hemodynamic effects and underlying mechanisms of persistent iASDs on pulmonary vascular function. Figure 1. Invasive hemodynamics Funding Acknowledgement Type of funding source: None

scholarly journals Visualization and Hemo-Dynamic Evaluation of Edge-to-Edge Mitral Valve Repair Within Reanimated Swine Hearts

2009 ◽  
Vol 3 (2) ◽  
Author(s):  
M. G. Bateman ◽  
J. L. Quill ◽  
J. St. Louis ◽  
P. A. Iaizzo
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Imaging Modality ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Lv Function ◽  
Valve Repair ◽  
Regurgitant Fraction ◽  
Orifice Area ◽  
Leaflet Coaptation

This project aims to investigate the performance of edge-to-edge mitral valve repair (MVR) within reanimated swine hearts. Direct imaging and hemodynamic data of the mitral valve during normal cardiac function (Normal), after an induced prolapse (Prolapse), and post surgical repair (E2E) was obtained. Isolated swine hearts (n=6) were reanimated using a clear Krebs–Henseleit buffer. Mitral prolapse, and regurgitation, in the P2 region was induced by cutting chordae tendinae of the posterior leaflet. An edge-to-edge MVR procedure was performed, suturing the prolapsed P2 region to the A2 region of the anterior leaflet. The mitral valve was imaged using endoscopic cameras in the left atrium and ventricle allowing verification of stitch placement and leaflet coaptation. Analysis of the endoscopic images provided measures of annulus area, orifice area, and regurgitant area. Echocardiography, the standard clinical imaging modality, was used to determine the hemodynamic performance of the valve. Additionally, ECG and left chamber pressures were recorded at a sample rate of 5 kHz. Prolapse of the P2 region was consistently created, and edge-to-edge repair of the mitral leaflet showed full leaflet coaptation. The annulus area of the valve was tracked throughout the procedure and did not show significant variation. The orifice area, defined as the area of the annulus that does not contain leaflets, normalized to the corresponding annulus area for Normal, Prolapse and E2E were: 41±13%, 44±14% and 21±13%, p=0.02. The regurgitant area, normalized to the corresponding annulus area, increased from 2±2% for Normal to 8±3% for the Prolapse and then decreased to 1±1% for the E2E group. The regurgitant fraction, normalized against the maximum observed, for Normal, Prolapse and E2E was 10±6%, 57±26% and 13±13%, p<0.01. Over the course of the experiment the left ventricular (LV) systolic pressure and negative dP/dt reduced from 95 to 54 mm Hg and 743 to 402 mm Hg/s, respectively. Our results show that orifice area was significantly smaller after MVR when compared to Normal and Prolapse periods. There was no significant change in regurgitant area and regurgitant fraction from the Normal to repaired valve as compared to a significant increase in regurgitant area and regurgitant fraction during Prolapse. Low gradients were observed for all three groups, with no indications for symptomatic stenosis. The reduction of LV function was caused by global ischemia and the progressive onset of edema. In this acute assessment of edge-to-edge repair of P2 prolapse, repair does not affect annulus area, decreases orifice area, and successfully eliminates regurgitant area with no evidence of mitral stenosis.

Direct Endoscopy-Guided Mitral Valve Repair in the Beating Heart An Acute Animal Study

2011 ◽  
Vol 6 (2) ◽  
pp. 122-125
Author(s):  
Tetsuya Horai ◽  
Kiyotaka Fukamachi ◽  
Hideyuki Fumoto ◽  
Tohru Takaseya ◽  
Akira Shiose ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Animal Study ◽  
Mitral Valve Repair ◽  
Median Sternotomy ◽  
Left Ventricular ◽  
Beating Heart ◽  
Pulmonary Vasculature ◽  
Left Heart ◽  
Valve Repair ◽  
Endoscopic Clip

Objective The purpose of this study was to develop a new method for minimally invasive mitral valve repair under direct endoscopic visualization in the beating heart. Methods Fiberoptic cardioscopy of the left heart was conducted in 12 calves. Systemic perfusion was maintained by cardiopulmonary bypass through a median sternotomy. A clear solution (Ringer's lactate) was temporarily administered via the pulmonary artery to flush out the pulmonary vasculature, and additional perfusion of the left heart chambers enhanced visualization of the intracardiac anatomy. The endoscope, with an open-ended transparent flexible outer sheath, was inserted through the left ventricular apex, and an endoscopic clip was used for edge-to-edge mitral valve repair. Hemodilution was avoided by the drainage of irrigation fluid via a left ventricular cannula. Results Direct endoscopic visualization of the mitral valve in an in vivo beating heart was obtained clearly, avoiding systemic hemodilution. In the last experiment, edge-to-edge repair using an endoscopic clip was successfully performed. Use of an effective intracardiac irrigation method was important for successful image acquisition and achievement of repair procedures. Conclusions This acute animal study showed the technical feasibility of beating-heart mitral valve surgery under direct endoscopic imaging. Although this study was performed under open-chest conditions, our successful experiment is a first step toward closed-chest intracardiac surgery with direct endoscopic visualization.

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

scholarly journals MIDA mortality risk score in patients undergoing percutaneous edge-to-edge mitral repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Kavsur ◽  
C Iliadis ◽  
C Metze ◽  
M Spieker ◽  
V Tiyerili ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Risk Score ◽  
Patient Selection ◽  
Mortality Risk ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Valve Repair ◽  
Ventricular Ejection Fraction

Abstract Background Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR). Aim We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure. Methods In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation. Results During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p&lt;0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029). Conclusion The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients. Funding Acknowledgement Type of funding source: None

Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

2019 ◽  
Vol 14 (3) ◽  
pp. 281-285 ◽  
Author(s):  
Burak Onan ◽  
Ersin Kadirogullari ◽  
Zeynep Kahraman ◽  
Onur Sen
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Da Vinci Surgical System ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Valve Repair ◽  
Septal Myectomy ◽  
Mitral Repair

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

Surgery for Degenerative Mitral Regurgitation Valve Repair v. Valve Replacement with Chordal Preservation

1994 ◽  
Vol 2 (2) ◽  
pp. 90-94
Author(s):  
Masaharu Shigenobu ◽  
Shunji Sano
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Valve Repair ◽  
Repair Group

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.

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