3�ISCHEMIC MITRAL VALVE REPAIR: THE IMPACT OF THE MECHANISM OF MITRAL REGURGITATION ON LATE POSTOPERATIVE RESULTS

2004 ◽  
Vol 21 (1) ◽  
pp. 104-104
Author(s):  
E. Ereminienė ◽  
J. Vaskelyte ◽  
R. Jurkevicius
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Postoperative Results ◽  
The Impact

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 Asymmetric leaflet tethering is associated with worse outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Stolz ◽  
M Orban ◽  
D Braun ◽  
P Doldi ◽  
M Orban ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Cox Regression ◽  
Cox Model ◽  
Operating Characteristics ◽  
Valve Repair ◽  
Cox Regression Analysis ◽  
Secondary Mitral Regurgitation ◽  
The Impact

Abstract Background The impact of mitral valve (MV) tethering patterns on outcomes of patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for severe secondary mitral regurgitation (SMR) is unknown. Purpose The purpose of this study was to evaluate the impact of asymmetric postero-anterior and medio-lateral MV leaflet tethering on procedural and survival outcomes after TEER for SMR. Methods Symmetry of postero-anterior leaflet tethering was defined as the ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in the central MV segment 2. The ratio of the tenting area between MV segments 3 and 1 (S3/S1 ratio) was defined as medio-lateral tethering symmetry. We used receiver operating characteristics and a proportional Cox model to identify cut-off values of asymmetric postero-anterior and medio-lateral tethering for prediction of two-year survival after TEER. Results 178 patients receiving TEER for SMR were included. Asymmetric postero-anterior tethering was observed in 67 patients (37.6%, PLA/ALA ratio cut-off >1.54). Medio-lateral tethering was asymmetric in 49 patients (27.5%, S3/S1 ratio cut-off >1.49). MR was reduced to MR ≤2+ in 91.6% of patients, while postprocedural MR remained higher in the presence of asymmetric postero-anterior tethering (p=0.01). After adjustment for potential clinical and echocardiographic confounders, multivariable Cox regression analysis confirmed asymmetric postero-anterior tethering (HR=2.77, CI=1.43–5.38, p<0.01) and asymmetric medio-lateral tethering (HR=2.90, CI=1.54–5.45, p<0.01) as independent predictors for two-year survival. Conclusions Asymmetric postero-anterior and medio-lateral MV leaflet tethering patterns independently increase two-year all-cause mortality in patients undergoing TEER for SMR. Detailed echocardiographic patient selection might improve outcomes after TEER. FUNDunding Acknowledgement Type of funding sources: None. Postero-anterior tethering Medio-lateral tethering

Impact of recurrent mitral regurgitation after mitral valve repair for functional mitral regurgitation: long-term analysis of competing outcomes

2019 ◽  
Vol 40 (27) ◽  
pp. 2206-2214 ◽  
Author(s):  
Annelieke H J Petrus ◽  
Olaf M Dekkers ◽  
Laurens F Tops ◽  
Eva Timmer ◽  
Robert J M Klautz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
History Of ◽  
The Impact

Abstract Aims Recurrent mitral regurgitation (MR) has been reported after mitral valve repair for functional MR. However, the impact of recurrent MR on long-term survival remains poorly defined. In the present study, mortality-adjusted recurrent MR rates, the clinical impact of recurrent MR and its determinants were studied in patients after mitral valve repair with revascularization for functional MR in the setting of ischaemic heart disease. Methods and results Long-term clinical and echocardiographic outcome was evaluated in 261 consecutive patients after restrictive mitral annuloplasty and revascularization for moderate to severe functional MR, between 2000 and 2014. The cumulative incidence of recurrent MR ≥ Grade 2, assessed by competing risk analysis, was 9.6 ± 1.8% at 1-year, 20.3 ± 2.5% at 5-year, and 27.6 ± 2.9% at 10-year follow-up. Cumulative survival was 85.8% [95% confidence interval (CI) 81.0–90.0] at 1-year, 67.3% (95% CI 61.1–72.6%) at 5-year, and 46.1% (95% CI 39.4–52.6%) at 10-year follow-up. Age, preoperative New York Heart Association Class III or IV, a history of renal failure, and recurrence of MR expressed as a time-dependent variable [HR 3.28 (1.87–5.75), P < 0.001], were independently associated with an increased mortality risk. Female gender, a history of ST-elevation myocardial infarction, a preoperative QRS duration ≥120 ms, a higher preoperative MR grade, and a higher indexed left ventricular end-systolic volume were independently associated with an increased likelihood of recurrent MR. Conclusion Mitral valve repair for functional ischaemic MR resulted in a low incidence of recurrent MR with favourable clinical outcome up to 10 years after surgery. Presence of recurrent MR at any moment after surgery proved to be independently associated with an increased risk for mortality.

scholarly journals Transcatheter mitral valve repair devices - in vitro studies on the influence of device-width on mitral regurgitation

2020 ◽  
Vol 6 (3) ◽  
pp. 217-220
Author(s):  
Robert Ott ◽  
Sebastian Kaule ◽  
Swen Großmann ◽  
Michael Stiehm ◽  
Klaus-Peter Schmitz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Hydrodynamic Performance ◽  
Water Mixture ◽  
Valve Repair ◽  
Glycerol Water ◽  
The Impact

AbstractMitral regurgitation (MR) is the most prevalent valvulopathy in the USA and the second most prevalent valvulopathy in Europe. Despite excellent clinical results of surgical mitral valve repair (SMVR), transcatheter-based mitral valve repair (MVR) procedures emerged as a feasible treatment option for surgically inoperable or high-risk patients suffering from clinically relevant MR. The current study investigates the impact of device-induced coaptationwidth on the hydrodynamic performance of insufficient mitral valves (MV) during left ventricular (LV) systole. A non-calcified, pathological MV model (MVM) featuring a D-shaped MV annulus with an area of 7.6 cm2 and a flail gap in the A2-P2 region was employed in an experimental setup. Pressure gradient-volumetric flow rate (Δp-Q) relations were investigated for steady-state backward flow with transvalvular pressure gradients ranging from (0.75 ≤ Δp ≤ 177.36) mmHg. Glycerol-water mixture (36 % (v/v) glycerol in water) at 37 °C with a density of (1 098.2 ± 1.3) kg·m-3 and a dynamic viscosity of 3.5 mPa∙s was used as circulatory fluid. In order to determine the impact of the width of transcatheter MVR devices during LV-systole Δp-Q relations were investigated for three MVM-configurations: (i) MVM without MVR device, (ii) MVM with one MVR device and (iii) MVM with two MVR devices implanted in the A2-P2 region. The MVR devices were manufactured from steel sheets with a thickness of 0.2 mm and feature arm lengths of 9.0 mm and a width of 5.0 mm. The conducted investigations show that the implantation of MVR devices in the A2-P2 region prevents the manifestation of an A2-P2 flail gap and thereby effectively reduces the retrograde blood flow during the LV-systole by 13 % with one MVR device and 27 % with two MVR devices implanted. Thus, the application of two MVR devices with a combined device-induced width of 10 mm results in a better MR reduction than the implantation of one MVR device with a device-induced width of 5 mm.

scholarly journals P337 Edge-to-edge mitral valve repair in patients with secondary mitral regurgitation: impact of tethering pattern on clinical, echocardiographic and procedure-related characteristics

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M J Oneto Fernandez ◽  
M Ruiz Ortiz ◽  
M Delgado Ortega ◽  
A M Rodriguez Almodovar ◽  
R Gonzalez Manzanares ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Valve Repair ◽  
Mitral Valve Leaflet ◽  
Ventricular Ejection Fraction ◽  
Secondary Mitral Regurgitation ◽  
The Impact

Abstract Edge-to-edge mitral valve repair (E2E-MVR) has emerged as a therapeutical option in patients with secondary mitral regurgitation (SMR). Two tethering patterns (TP) have been described in SMR: symmetric and asymmetric. However, information on the implications of these TP on E2E-MVR is limited. Our aim was to assess the impact of mitral valve TP on clinical, echocardiographic and procedure-related characteristics in patients undergoing E2E-MVR. We consecutively recruited 62 patients with at least moderate SMR who underwent E2E-MVR in our center between 2011 and 2019 and analysed clinical, echocardiographic and procedure-related characteristics according to TP, which we classified into symmetric and asymmetric considering jet direction and mitral valve leaflet position during systole by means of two-dimensional transesophageal echocardiography (Figure 1). In our series, 43 patients (69.3%) had symmetric TP and 19 (30.7%) had asymmetric TP. Asymmetric TP was associated with ischemic aetiology (52.6% vs 23.3%, p = 0.02) and a non-significant trend to higher frequency of male sex (89.5% vs 67.4%, p = 0.07), diabetes mellitus (52.6% vs 27.9%, p = 0.06), massive regurgitation (78.9% vs 58.1%, p = 0.11) and higher values of left ventricular ejection fraction (LVEF) (34 ± 9% vs 28 ± 11%, p = 0.06). There were no differences in procedure-related characteristic between groups, in particular in number of devices (1.63 [IQR 1-2] vs 1.52 [IQR 1-2], p = 0.27), number of graspings (3.21 [IQR 2-4] vs 2.78 [IQR 2-3], p = 0.16) and time of procedure (95 ± 38min vs 107 ± 43min, p = 0.29). Procedural success (defined as SMR severity reduction≥2) was high in both groups (89.5% vs 74.4%, p = 0.18). At discharge, there was a significant reduction in effective regurgitant orifice area (EROA) in (0.36 ± 0.16cm² vs 0.15 ± 0.10cm², p &lt; 0.001) and pulmonary artery systolic pressure (PASP) (46 ± 12mmHg vs 40 ± 12mmHg, p = 0.004). LVEF was impaired in patients with asymmetric TP but not in patients with symmetric TP (difference in LVEF after procedure: -5 ± 9% vs -0 ± 8%, p = 0.03). In our study, asymmetric TP was related to the ischemic aetiology of left ventricular dysfunction. Procedural characteristics, and EROA and PASP reductions at discharge were similar regardless of TP. However, patients with asymmetric TP had a significantly impairment in LVEF, probably because of afterload mismatch phenomenon. Abstract P337 Figure 1: example of tethering patterns

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