Pre-procedural predictors for multiple clips in percutaneous edge-to-edge mitral valve repair

Abstract Background Percutaneous mitral valve (MV) clipping for mitral regurgitation (MR) revolutionized MV repair; however, valve anatomies and pathologies vary. Often multiple clips are required, and predicting this pre-procedurally would be useful. We evaluated pre-procedural predictors for multiple clips. Results We retrospectively analyzed 127 severe MR patients treated by mitral clipping between January 2011 and August 2018. Patients were grouped according to the use of a single (group I) or multiple clips (group II) and pre-procedure echocardiographs compared. No demographic differences existed except group II had more males (68.1%) than group I (48.3%). Mean left atrial diameter was larger in group II, 51 ± 9 mm, than group I, 48 ± 5 mm, p = 0.026. Mean mitral annular diameter differed: 34 ± 4mm (group II) versus 33 ± 3 mm (group I), p = 0.017. The vena contracta was broader in group II than group I (6.6 ± 1 mm vs. 6 ± 0.9 mm, p = 0.001). Severe mitral annular calcification occurred more in group I (36.2%) than group II (10.1%), p = 0.0001. On multivariate analysis, vena contracta width correlated positively with multiple clips (B 0.125, p = 0.013), but severe annular calcification correlated inversely (B − 0.35, p = 0.002). Conclusions Vena contracta width and severe annular calcification are factors to consider when planning MV clipping.

Download Full-text

CONCOMITANT PROCEDURE OF ATRIAL FIBRILLATION ABLATION WITH AND WITHOUT LEFT ATRIOPLASTY DURING SURGICAL CORRECTION OF THE MITRAL VALVE DISEASE: PROSPECTIVE, RANDOMIZED TRIAL

Siberian Medical Journal ◽

10.29001/2073-8552-2018-33-3-63-70 ◽

2018 ◽

Vol 33 (3) ◽

pp. 63-70

Author(s):

A. V. Bogachev-Prokophiev ◽

S. I. Zheleznev ◽

M. A. Ovcharov ◽

A. V. Afanasyev ◽

R. M. Sharifulin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Left Atrium ◽

Mitral Valve Disease ◽

Left Atrial ◽

Valve Disease ◽

Atrial Ablation ◽

Group I ◽

Group Ii

Objective. Main objective of this prospective randomized study was to assess safety and efficiency of the combined approach for the left atrial ablation in combination with and without reduction left atrioplasty in patients with mitral valve disease.Material and Methods. The study was performed from September, 2014 to February, 2017. A total of 120 patients with mitral valve disease, permanent atrial fibrillation (AF), and left atriomegaly were enrolled in the study. Patients were randomized to two groups: group I comprised patients who received correction of mitral valve disease in combination with AF ablation and without reduction atrioplasty of the left atrium (MV+MAZE); group II (n=60) comprised patients with correction of mitral valve disease in combination with AF ablation and with reduction atrioplasty of the left atrium (MV+MAZE+AP). Patient characteristics did not differ between groups.Results. There were no significant differences between groups in the early mortality rates (2 patients in group I versus 5 patients in group II, p=0.64); bleeding rates (total 5 cases including 2 patients in group I and 3 patients in group II, p=0.34), and the rates of AF recurrence in the early postoperative period. Permanent pacemakers were implanted in 8 patients (13.3%) of group I and in 4 patients (6.7%) of group II. Total long-term mortality was 4 patients including 1 and 3 patients in group I and II, respectively, which did not significantly differed. The rates of one-year freedom from AF were 84.8 and 86.2% in group I and II, respectively. No new onsets of atrial fibrillation were observed for 36 months in both groups. The rates of freedom from thromboembolic events during the time of observation were 88.6% in group I and 96.5% in group II. Conclusion. The left atrial reduction concomitant with the left atrial ablation and correction of mitral valve disease is safe and effective procedure. However, this procedure did not impact the rates of long-term freedom from AF.

Download Full-text

Advanced experience allows robotic mitral valve repair in the presence of extensive mitral annular calcification

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.10.099 ◽

2021 ◽

Vol 161 (1) ◽

pp. 80-88 ◽

Cited By ~ 6

Author(s):

Didier F. Loulmet ◽

Neel K. Ranganath ◽

Siyamek Neragi-Miandoab ◽

Michael S. Koeckert ◽

Aubrey C. Galloway ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Annular Calcification ◽

Advanced Experience ◽

Annular Calcification

Download Full-text

Impact of mitral annular calcification on early and late outcomes following mitral valve repair of myxomatous degeneration

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivt163 ◽

2013 ◽

Vol 17 (1) ◽

pp. 120-125 ◽

Cited By ~ 19

Author(s):

V. Chan ◽

M. Ruel ◽

M. Hynes ◽

S. Chaudry ◽

T. G. Mesana

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Annular Calcification ◽

Myxomatous Degeneration ◽

Annular Calcification

Download Full-text

Abstract 17000: Quantifying Mitral Annular Calcification Using Echocardiography: Comparison to MAC Calcium Score From Gated Computed Tomography

Circulation ◽

10.1161/circ.142.suppl_3.17000 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

William Harvey ◽

Sheldon Litwin

Keyword(s):

Computed Tomography ◽

Mitral Valve ◽

Left Atrial ◽

Left Atrial Volume ◽

Calcium Score ◽

Mitral Annulus ◽

Atrial Volume ◽

Mitral Annular Calcification ◽

Close Proximity ◽

Annular Calcification

Introduction: Mitral Annular Calcification (MAC) is present in 25-40% of people ≥ 60 years old and has associations with atrial fibrillation, stroke, endocarditis, mitral regurgitation, and mitral stenosis. MAC poses major challenges to surgical or transcatheter mitral valve interventions. Current echocardiographic methods for assessing MAC are limited. Goals: To assess transthoracic echocardiographic (TTE) approaches for quantifying MAC severity compared to a gold standard of MAC calcium score by gated computed tomography (CT). Methods: 75 patients undergoing evaluation for TAVR had TTE and CT in close proximity. MAC area and circumference were measured in parasternal long-axis (PLAX), parasternal short-axis (PSAX), and apical 2, 3, and 4-chamber views on TTE. Mitral valve gradients and left atrial volume were recorded. The curvilinear length of MAC in the PSAX view on TTE and cardiac CT were also measured. Associations between various TTE measures and MAC calcium score were assessed using linear regression. Results: Median age was 75.3, 50.4% female, 85.3% Caucasian. MAC area and circumference in PSAX on TTE showed moderate correlations (R 2 =0.32-0.37) with MAC calcium score. Curvilinear MAC length measures on SAX TTE and CT had improved correlation with MAC score (R 2 =0.41 & 0.78, Figure). Combined circumference of MAC from PLAX+PSAX had the strongest association (R 2 = 0.48). Interobserver variability on CT and TTE had coefficients of variation ranging 17-37%. Left atrial volume and mitral valve gradients had weak associations with MAC severity (R 2 =0.03-0.12). Tertiles of MAC calcium scores were 2650, 5150 and 7750. Conclusions: MAC length in the PSAX view showed the strongest association with MAC severity. Dedicated PSAX views of the mitral annulus may improve the ability to reproducibly grade MAC severity by echo.

Download Full-text

Mitral Annular Calcification and Transcatheter Mitral Valve Repair

Structural Heart Cases ◽

10.1016/b978-0-323-54695-9.00008-1 ◽

2019 ◽

pp. 16-17

Author(s):

Paul Sorajja

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Annular Calcification ◽

Transcatheter Mitral Valve Repair ◽

Annular Calcification

Download Full-text

Mitral valve repair without mitral annuloplasty with extensive mitral annular calcification

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivu306 ◽

2014 ◽

Vol 19 (6) ◽

pp. 1080-1082 ◽

Cited By ~ 5

Author(s):

Akimasa Morisaki ◽

Yasuyuki Kato ◽

Yosuke Takahashi ◽

Toshihiko Shibata

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Mitral Annular Calcification ◽

Mitral Annuloplasty ◽

Annular Calcification

Download Full-text

Taming of the Tiger: A Novel Technique to Deal With Mitral Annular Calcification —A Case Series

The Heart Surgery Forum ◽

10.1532/hsf.3223 ◽

2020 ◽

Vol 23 (6) ◽

pp. E793-E796

Author(s):

Varghese Panicker ◽

Renjith Sreekantan ◽

Sai Suraj Kotera

Keyword(s):

Mitral Valve ◽

Case Reports ◽

Treatment Options ◽

Case Series ◽

Mitral Valve Surgery ◽

Paravalvular Leak ◽

Valve Repair ◽

Mitral Annular Calcification ◽

Annular Reconstruction ◽

Annular Calcification

Background: Mitral valve surgery can be challenging for patients with mitral annular calcification (MAC). The prevalence of MAC in patients who undergo mitral valve replacement is 19.9%. The treatment options for MAC include complete decalcification and annular reconstruction with valve repair/replacement or performing a surgical valve repair or replacement without decalcification, accepting the risk of paravalvular leak. We describe three cases of mitral valve prolapse with posterior annular calcification, which were repaired using a unique technique that does not require decalcification. Case reports: The mitral annular calcification was heavy and involved most of the posterior annulus just sparing the commissures in all the three cases. Leaflet prolapse was dealt with by using neochordae, closing any clefts, and leaflet plication. Since the MAC ring was not complete and there was chance of further dilatation of the annulus, a partial annuloplasty was done using a PTFE felt (cut as strip). There was trivial to no mitral regurgitation with this technique in the immediate postoperative and five-year follow-up period echocardiography in all the three cases. Conclusion: This technique can benefit the major subset of pure mitral valve regurgitant lesions associated with MAC, which is limited to the posterior annulus.

Download Full-text