scholarly journals Percutaneous edge-to-edge mitral repair in the presence of mitral annulus calcification

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Fernandez Peregrina ◽  
I P Pascual ◽  
X F Freixa ◽  
G T C Tirado-Conte ◽  
R R E Rodriguez-Estevez ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Cardiovascular Mortality ◽  
Mitral Annulus ◽  
Functional Class ◽  
High Morbidity ◽  
Valve Repair ◽  
One Year ◽  
Mitraclip System

Abstract Background Mitral annular calcification (MAC) is commonly found in patients affected with mitral regurgitation (MR) and it's associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge mitral valve repair with the MitraClip system has been stablished as a valid alternative to surgery in high risk patients with severe MR. However, its efficacy in patients affected with MAC remains uncertain as this population has been excluded from trials. Objectives To analyze the safety, efficacy and mid-term durability of the treatment of MR with the MitraClip system in patients affected with moderate or severe MAC. Methods Data was obtained from a multicenter spanish registry that prospectively included consecutive patients with MR grade ≥3 undergoing transcatheter mitral valve repair with the MitraClip system. Sixty-one patients with moderate or severe MAC were included in the “MAC” group and 791 with no-or-mild MAC were allocated in the “NoMAC” group. Results Procedural success was similar in both groups (91.8% vs 95.06%, p=0.268, in MAC and NoMAC respectively) with a very low rate of complications beside a higher residual mean gradient in the MAC group (3.0 vs 3.6mmHg, p=0.001). At one-year follow-up, 79.5% of NoMAC and 90.6% of MAC patients had MR grade ≤2 (p=0.129). Only 9 patients (1,14%), all in NoMAC group, required reintervention during follow up. Eighty percent of patients in both groups remained in NYHA functional class ≤II and a significant reduction in readmissions for heart failure was also observed (65% vs 78% respectively, p=0.145). One-year mortality was slightly higher in MAC patients (19.67% vs 11.25%, p=0.050) with no difference in cardiovascular mortality (15.25% vs 9.21%, p=0.129). Conclusions Transcatheter edge-to-edge repair with the MitraClip system in selected patients with moderate or severe MAC is safe and feasible with a mid-term durability similar to those without MAC. These patients also benefit clinically from this treatment with a sustained mid-term subjective clinical improvement and no increase in cardiovascular mortality as compared to NoMAC patients. FUNDunding Acknowledgement Type of funding sources: None.

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

Percutaneous mitral valve repair with the MitraClip system in the elderly: One-year outcomes from the GRASP registry

2016 ◽  
Vol 224 ◽  
pp. 440-446 ◽  
Author(s):  
Salvatore Scandura ◽  
Piera Capranzano ◽  
Anna Caggegi ◽  
Carmelo Grasso ◽  
Giuseppe Ronsivalle ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
The Elderly ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
One Year ◽  
Mitraclip System

scholarly journals Safety and efficacy outcomes at 1 year after MitraClip therapy for percutaneous mitral valve repair in patients with severe mitral regurgitation: the Egyptian experience

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Radwa Abdullah Elbelbesy ◽  
Ahmed Mohsen Elsawah ◽  
Ahmed Shafie Ammar ◽  
Hazem Abdelmohsen Khamis ◽  
Islam Elsayed Shehata
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Valve Repair ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Mitral Valve Repair

Abstract Background Our aim was to assess safety and efficacy outcomes at 1 year after MitraClip for percutaneous mitral valve repair in patients with severe mitral regurgitation. Twenty consecutive patients with significant MR (GIII or GIV) were selected according to the AHA/ACC guidelines from June 2016 to June 2019 and underwent percutaneous edge-to-edge mitral valve repair using MitraClip with a whole 1 year follow-up following the procedure. The primary acute safety endpoint was a 30-day freedom from any of the major adverse events (MAEs) or rehospitalization for heart failure. The primary efficacy endpoint was acute procedural success defined as clip implant with an improvement of MR to ≤ grade II, based on current guidelines, NYHA class, ejection fraction, and the left atrium size during follow-up. Results Mean age of the studied population was 66.8 ± 10 years and about 85% were males. All patients presented with NYHA > 2. EuroSCORE ranged between 7 and 15. Patients varied regarding their HAS-BLED score. None of them experienced MAEs at 30 days. Patients showed significant improvement of NHYA functional class, and all echocardiographic measurements such as left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction, left atrium volume index and MR grade. They also showed significant improvement of right-side heart failure manifestations (lower limb edema, S3 gallop, neck veins congestion), and laboratory value (the mean Hb levels significantly increased from 11.96 ± 1.57 to 12.97 ± 1.36, while the median CRP significantly decreased from 7 (3-9) to 2 (1-3). As well, the median Pro-BNP significantly decreased from 89.5 (73-380) to 66.5 (53.5-151) following MV clipping. During the whole follow-up period, there was dramatic improvement in the NHYA functional class, echocardiographic assessment including left ventricular ejection fraction, and mitral regurge grade. During follow-up, four patients (20%) developed complications. There was no statistical difference between patients who developed complications and those who did not regarding their age (75.25 ± 12.42 versus 64.63 ± 9.21, respectively), BSA (1.69 ± 0.11 versus 1.79 ± 0.22, respectively), gender (75% versus 87.5% males respectively), MR etiology (75% versus 50% ischemic, 25% versus 50% non-ischemic), or NYHA pre- or post-mitral clipping. However, the median EuroSCORE was significantly higher in the complicated group (13, IQR= 11.5-14.5) than the non-complicated group (9.5, IQR=8.5-11.5). Conclusion Percutaneous usage of MitraClip for mitral valve repair showed favorable reliability and better clinical outcomes. Trial registration ZU-IRB#2481-17-2-2016 Registered 17 February 2016, email: [email protected]

Risk factors and etiology of recurrent mitral regurgitation after edge-to-edge mitral valve repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Sugiura ◽  
M.W Weber ◽  
N.T Tabata ◽  
C.O Oeztuerk ◽  
S.Z Zimmer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
End Diastolic Volume ◽  
Increased Risk ◽  
Mitraclip System ◽  
Annulus Diameter

Abstract Background Recurrent MR has been associated with poor prognosis after transcatheter mitral valve repair (TMVR) with the MitraClip system. However, little is known about risk factors and etiology of recurrent mitral regurgitation (MR) after transcatheter edge-to-edge mitral repair with the MitraClip system. Methods Among consecutive patients who underwent MitraClip for MR from January 2011 to March 2019, we identified 240 patients who had MR ≤2+ at discharge and follow-up echocardiography within three years after the procedure. Recurrent MR was defined as MR ≥3+ during the follow-up period. To investigate the risk factors for recurrent MR, we conducted a Cox proportional hazard model. Results During the follow-up period (median 491 days), 38 patients (15.8%) had recurrent MR (≥3+). The most frequent etiology of recurrent MR was degenerative (n=20, 52.6%), including single leaflet detachment (n=2, 5.3%), loss of leaflet insertion (n=11, 28.9%), and leaflet tear or prolapse (n=7, 18.4%), followed by functional MR (n=18, 47.4%). The risk factors for recurrent MR were greater LV end-diastolic volume (adjusted-HR 1.01, 95% CI 1.00–1.02, p=0.03), higher LV ejection fraction (LVEF) (adjusted-HR 1.05, 95% CI 1.01–1.08, p=0.005), and moderate MR upon discharge (adjusted-HR 2.98, 95% CI 1.50–5.95, p=0.002).After stratification according to the etiology of MR, the association of LVEF was more pronounced in patients with degenerative MR (adjusted-HR 1.07, 95% CI 1.02–1.12, p=0.003), while the association of moderate MR upon discharge was more pronounced in patients with functional MR (adjusted-HR 5.02, 95% CI 1.95–12.8, p<0.001). Furthermore, patients with recurrent MR had an increased antero-posterior annulus diameter regardless of the baseline etiology of the MR. Conclusions Greater LV volume, higher LVEF, and moderate MR at discharge were associated with an increased risk of recurrent MR after the MitraClip procedure. A significant increase of the annulus diameter was observed regardless of the baseline etiology of the MR. Etiology of recurrent MR Funding Acknowledgement Type of funding source: None

scholarly journals Very Long-Term Results (More Than 20 Years) of Valve Repair With Carpentier’s Techniques in Nonrheumatic Mitral Valve Insufficiency

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
E. Braunberger ◽  
A. Deloche ◽  
A. Berrebi ◽  
A. Fayssoil ◽  
J.A Celestin ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Heart Association ◽  
Mitral Valve Insufficiency ◽  
Functional Class ◽  
Long Term Results ◽  
Valve Repair

Background Mitral valve repair is considered the gold standard in surgery of degenerative mitral valve insufficiency (MVI), but the long-term results (>20 years) are unknown. Methods and Results We reviewed the first 162 consecutive patients who underwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacterial endocarditis in 16 patients (10%). MVI was isolated or, in 18 cases, associated with tricuspid insufficiency. The mean age of the 162 patients (104 men and 58 women) was 56±10 years (age range 22 to 77 years). New York Heart Association functional class was I, II, III, and IV in 2%, 39%, 52%, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58±0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier’s functional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier’s ring annuloplasty in all cases, a valve resection in 126 patients, and shortening or transposition of chordae in 49 patients. During the first postoperative month, there were 3 deaths (1.9%) and 3 reoperations (2 valve replacements and 1 repeat repair [1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a median of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kaplan-Meier survival rate was 48% (95% CI 40% to 57%), which is similar to the survival rate for a normal population with the same age structure. The 20-year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardiac cause, stroke, and reoperation). During the 20 years of follow-up, 7 patients were underwent surgery at 3, 7, 7, 8, 8, 10, or 12 years after the initial operation. Valve replacement was carried out in 5 patients, and repeat repair was carried out in 2 patients. At the end of the study, 65 patients remained alive (median follow-up 19 years). Their median age was 76 years (age range 41 to 95 years). All except 1 were in New York Heart Association functional class I/II. Conclusions Mitral valve repair using Carpentier’s technique in patients with nonrheumatic MVI provides excellent long-term results with a mortality rate similar to that of the general population and a very low incidence of reoperation.

scholarly journals Išeminės kilmės mitralinio vožtuvo nesandarumo korekcija: ankstyvieji ir vėlyvieji rezultatai

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Eglė Gatelienė ◽  
Giedrius Uždavinys ◽  
Loreta Ivaškevičienė ◽  
Irena Butkuvienė ◽  
Giedrė Šemetienė ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Reoperation Rate ◽  
Functional Class ◽  
Mitral Insufficiency ◽  
Valve Repair ◽  
Nyha Functional Class ◽  
Vilnius University ◽  
One Year

Eglė Gatelienė1, Giedrius Uždavinys2, Loreta Ivaškevičienė2, Irena Butkuvienė2, Giedrė Šemetienė1, Giedrė Nogienė21 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g, 2, LT-08661 Vilnius2 Vilniaus universiteto Širdies chirurgijos centrasEl paštas: [email protected]; [email protected] Įvadas / tikslas Darbo tikslas – įvertinti ligonių išgyvenimą, funkcinės būklės pokyčius po išeminio mitralinio vožtuvo nesandarumo chirurginės korekcijos. Nustatyti atsinaujinusio reikšmingo mitralinio vožtuvo nesandarumo dažnį, kartotinių operacijų skaičių. Ligoniai ir metodai Išanalizuoti 70 ligonių, sirgusių koronarine širdies liga esant reikšmingam išeminės kilmės mitralinio vožtuvo nesandarumui, duomenys. Vilniaus širdies chirurgijos centre 2000–2006 metais atliktos kombinuotos aortokoronarinių jungčių suformavimo ir mitralinio vožtuvo plastinių procedūrų operacijos. Vertinti bendrieji klinikiniai duomenys, Niujorko širdies asociacijos funkcinė klasė, kairiojo skilvelio išmetimo frakcija, mitralinio nesandarumo chirurginės korekcijos metodai, echokardiografinio tyrimo duomenys prieš ir po operacijos. Rezultatai Išgyvenimas po vienų, dvejų ir šešerių metų – atitinkamai 65%, 61% ir 50%. Didelis operacinis ir pooperacinis mirštamumas – 21,4% aiškinamas labai sunkia ligonių priešoperacine būkle. Šešerių metų laikotarpiu mirštamumas nedidelis – 7,2%. Neatsižvelgiant į taikytą chirurginio mitralinio vožtuvo plastikos metodą, reikšmingas mitralinio vožtuvo nesandarumo pokytis: nuo 2,83 ± 0,38 iki 0,87 ± 0,34 (p < 0,001) ankstyvuoju laikotarpiu, nuo 2,83 ± 0,38 iki 1,03 ± 0,59 (p < 0,001) vėlyvuoju periodu. Reikšmingai mažėjo Niujorko širdies asociacijos funkcinė klasė – nuo 3,73 ± 0,51 iki 2,27 ± 1,12 (p < 0,001). Kairiojo skilvelio išstūmimo frakcija didėjo nuo 29,28 ± 9,27% iki 32,03 ± 11,36%, (p < 0,01). Ankstyvuoju periodu atsinaujinęs reikšmingas mitralinio vožtuvo nesandarumas nustatytas 12,7%. Atliktos trys (5,5%) pakartotinės operacijos. Ateityje būtina įvertinti tuos rizikos veiksnius, kurie lėmė atsinaujinusį išeminį mitralinį nesandarumą, ir išsiaiškinti, ar mitralinio vožtuvo plastikos tipas lemia vožtuvo nesandarumo atsinaujinimo dažnį. Išvados Išeminio mitralinio vožtuvo plastinės procedūros (valvuloplastikos ar / ir anuloplastikos, neimplantuojant sintetinio žiedo) – veiksmingas chirurginio gydymo metodas. Tiek vožtuvo nesandarumas (p < 0,001), tiek funkcinė klasė (p < 0,001), tiek kairiojo skilvelio išstūmimo frakcija (p < 0,01) pakito statistiškai patikimai. Nors operacinis (8,6%) ir ankstyvasis pooperacinis mirštamumas (12,8%) didelis, tačiau vėlyvieji šių procedūrų rezultatai geri. Atsinaujinęs mitralinio vožtuvo nesandarumas (12,7%), pakartotinių operacijų skaičius (5,4%) – priimtini. Išgyvenimas po vienų, dvejų, šešerių metų – 65%, 61%, 50%. Pagrindiniai žodžiai: koronarinė širdies liga, išeminis mitralinis nesandarumas, mitralinio vožtuvo plastika, mitralinio vožtuvo žiedo plastika Mitral valve repair for ischemic mitral insufficiency: early and late results Eglė Gatelienė1, Giedrius Uždavinys2, Loreta Ivaškevičienė2, Irena Butkuvienė2, Giedrė Šemetienė1, Giedrė Nogienė21 Cardiac Surgery Centre of Vilnius University Hospital „Santariškių klinikos“,Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Cardiac Surgery Centre of Vilnius UniversityE-mail: [email protected]; [email protected] Objective The aim of the study was to evaluate the patients’ (pts) survival and functional status changes after ischemic mitral insufficiency (IMI) repair; to determine residual mitral regurgitation (MR) and reoperation rate. Patients and methods The study group consisted of 70 pts who underwent mitral valve (MV) repair for IMI with concomitant coronary artery bypass grafting (CABG) at Vilnius University Cardiac Surgery Centre between 2000 and 2006. We analysed general clinical data, NYHA functional class, LVEF, mitral valve repair procedures, data of echocardiography before and after the operation. Results The one-year survival was 65%, two-year survival 61%, and 6-year survival 50%. In-hospital mortality was high (21.4%) due to the poor preoperative status. Late mortality was rather low – 7.2 % in 6 years. Regardless of the mitral valve repair technique, a significant reduction of MR: early – from 2.83 ± 0.38 to 0.87 ± 0.34 (p < 0,001) and late – from 2.83 ± 0.38 to 1.03 ± 0.59 (p < 0.001) – was observed. The NYHA functional class changed from 3.73 ± 0.51 to 2.27 ± 1.12 (p < 0.001), the LVEF – from 29.28 ± 9.27% to 32.03 ± 11.36% (p < 0.01). In our series we had 12.7% (7 pts) of residual MR after repair and 5.5% (3 pts) of reoperations. Conclusions Ring-free mitral valve repair is an effective method of treatment for ischemic mitral insufficiency: the patients’ postoperative status improved significantly in terms of MR, NYHA functional class, LVEF. One-year survival was 65%, two-year survival 61%, and 6-year survival 50%. Residual MR after repair (12.7%) and reoperation rate (5.5%) were acceptable. Key words: ischemic heart disease, ischemic mitral insufficiency, mitral valve repair

scholarly journals LONG-TERM DURABILITY OF PERCUTANEOUS MITRAL VALVE REPAIR USING MITRACLIP SYSTEM: 8-YEAR FOLLOW-UP

2017 ◽  
Vol 69 (11) ◽  
pp. 1263
Author(s):  
Yoshifumi Nakajima ◽  
Krissada Meemook ◽  
Mamoo Nakamura ◽  
Asma Hussaini ◽  
Saibal Kar
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
Mitraclip System
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