scholarly journals Cost-Effectiveness of Transcatheter Mitral Valve Repair Versus Medical Therapy in Patients With Heart Failure and Secondary Mitral Regurgitation

Circulation ◽  
2019 ◽  
Vol 140 (23) ◽  
pp. 1881-1891 ◽  
Author(s):  
Suzanne J. Baron ◽  
Kaijun Wang ◽  
Suzanne V. Arnold ◽  
Elizabeth A. Magnuson ◽  
Brian Whisenant ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Patients With Heart Failure ◽  
Secondary Mitral Regurgitation

scholarly journals Clinical Trial Perspective: Cost-effectiveness of Transcatheter Mitral Valve Repair Versus Medical Therapy in Patients with Heart Failure and Secondary Mitral Regurgitation. Results From the COAPT Trial

2020 ◽  
Vol 14 ◽  
Author(s):  
Suzanne J Baron
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Percutaneous Therapy ◽  
Secondary Mitral Regurgitation

Treatment of secondary (or functional) mitral regurgitation had traditionally been limited to optimal medical therapy because studies have failed to show a survival benefit with mitral valve surgery for this condition. However, recently the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial demonstrated a significant decrease in heart failure hospitalizations and mortality in patients with severe secondary mitral regurgitation treated with percutaneous edge-to-edge mitral valve repair (TMVr) using the MitraClip device compared with medical therapy. Based o the results of the COAPT trial, the Food and Drug Administration granted approval for MitraClip treatment of patients with severe secondary mitral regurgitation in March 2019. In an attempt to understand the economic impact of treating this patient population with TMVr using the MitraClip device, a formal cost-effectiveness analysis was performed alongside the COAPT trial. This review summarizes the methods and results of the economic substudy of the COAPT trial and discusses the value of the MitraClip device from the perspective of the US healthcare system in the treatment of patients with symptomatic heart failure and secondary mitral regurgitation.

scholarly journals Health Status After Transcatheter Mitral-Valve Repair in Heart Failure and Secondary Mitral Regurgitation

2019 ◽  
Vol 73 (17) ◽  
pp. 2123-2132 ◽  
Author(s):  
Suzanne V. Arnold ◽  
Khaja M. Chinnakondepalli ◽  
John A. Spertus ◽  
Elizabeth A. Magnuson ◽  
Suzanne J. Baron ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Status ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Secondary Mitral Regurgitation

Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical Therapy for Mitral Regurgitation in Heart Failure

2021 ◽  
Author(s):  
Ioanna Kosmidou ◽  
JoAnn Lindenfeld ◽  
William T. Abraham ◽  
Michael J. Rinaldi ◽  
Samir R. Kapadia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair

Secondary mitral regurgitation: pathophysiology, proportionality and prognosis

Heart ◽  
2020 ◽  
Vol 106 (10) ◽  
pp. 716-723 ◽  
Author(s):  
Omar Chehab ◽  
Ross Roberts-Thomson ◽  
Clarissa Ng Yin Ling ◽  
Michael Marber ◽  
Bernard D Prendergast ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Left Ventricular ◽  
Heart Team ◽  
Valve Repair ◽  
Transcatheter Intervention ◽  
Secondary Mitral Regurgitation

Secondary mitral regurgitation (SMR) occurs as a result of multifactorial left atrioventricular dysfunction and maleficent remodelling. It is the most common and undertreated form of mitral regurgitation (MR) and is associated with a very poor prognosis. Whether SMR is a bystander reflecting the severity of the cardiomyopathy disease process has long been the subject of debate. Studies suggest that SMR is an independent driver of prognosis in patients with an intermediate heart failure (HF) phenotype and not those with advanced HF. There is also no universal agreement regarding the quantitative thresholds defining severe SMR and indeed there are challenges with echocardiographic quantification. Until recently, no surgical or transcatheter intervention for SMR had demonstrated prognostic benefit, in contrast with HF medical therapy and cardiac resynchronisation therapy. In 2018, the first two randomised controlled trials (RCTs) of edge-to-edge transcatheter mitral valve repair versus guideline-directed medical therapy in HF (Percutaneous Repair with the MitraClip Device for Severe (MITRA-FR), Transcather mitral valve repair in patients with heart failure (COAPT)) reported contrasting yet complimentary results. Unlike in MITRA-FR, COAPT demonstrated significant prognostic benefit, largely attributed to the selection of patients with disproportionately severe MR relative to their HF phenotype. Consequently, quantifying the degree of SMR in relation to left ventricular volume may be a useful discriminator in predicting the success of transcatheter intervention. The challenge going forward is the identification and validation of such parameters while in parallel maintaining a heart-team guided holistic approach.

Prognostic value of pre-operative atrial fibrillation in patients with heart failure and secondary mitral regurgitation undergoing percutaneous mitral valve repair with MitraClip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Sisinni ◽  
C Godino ◽  
C.A Pivato ◽  
M Adamo ◽  
M Taramasso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Cardiac Death ◽  
Valve Repair ◽  
Patients With Heart Failure ◽  
Secondary Mitral Regurgitation ◽  
Secondary Mr

Abstract Background Limited data are available regarding the independent prognostic role of atrial fibrillation (AF) after transcatheter mitral valve repair with MitraClip. Aims We sought to evaluate the real impact of pre-operative AF in a wide series of patients with heart failure (HF) and secondary mitral regurgitation (MR) after MitraClip treatment. Methods The study included 605 patients with severe secondary MR from a multicenter international registry. Patients were stratified into two groups according to the presence or absence of pre-operative AF. The overall prevalence of pre-operative AF was 44%. Primary endpoint was 5-year overall death, secondary endpoints were 5–year cardiac death and first re-hospitalization for acute HF. Results At 5-year Kaplan-Meier (KM) analysis conducted in the entire study cohort, compared to patients without AF those with AF had significantly more adverse events in term of overall death (67% vs. 43%; p<0.001) (KM curve A) and cardiac death (65% vs. 37%; p=0.001) (KM curve B) and, moderately more re-hospitalization for acute HF (64% vs. 50%; p=0.048) (KM curve C). To account for baseline differences, patients were propensity score matched 1:1. After matching, 342 adequately matched patients were identified: compared to patients without AF, those with AF had higher rates of death and cardiac mortality but similar rates of re-hospitalization for acute HF. Conclusion In this large 5-year analysis of patients with HF undergoing MitraClip treatment for severe secondary MR, AF is common and associated with higher rates of both overall- and cardiac-death. However, AF doesn't seem to affect the benefit of the procedure in term of re-hospitalization for HF. Funding Acknowledgement Type of funding source: None

Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

2020 ◽  
Vol 21 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Tomás Benito-González ◽  
Rodrigo Estévez-Loureiro ◽  
Pedro A. Villablanca ◽  
Patrizio Armeni ◽  
Ignacio Iglesias-Gárriz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair

The Novel Use of Mitraclip in a Patient with Combined Multiple Myeloma and Heart Failure with Severe Mitral Regurgitation

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Abu Ghosh Z ◽  
◽  
Beeri R ◽  
Falah B ◽  
Pertz A ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Severe Mitral Regurgitation ◽  
The Novel ◽  
Valve Repair ◽  
Oncological Treatment ◽  
Patients With Heart Failure

Oncology patients with Heart Failure (HF) and severe Mitral Regurgitation (MR) are often considered to have a prohibitive risk for surgical mitral valve repair/replacement. We describe a patient with active multiple myeloma and significant HF and MR who was treated with MitraClip, which improved symptoms and allowed delivery of optimal oncological treatment.

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