Percutaneous Mitral Valve Repair in Patients with Severe Mitral Regurgitation and Acute Decompensated Heart Failure

The role of percutaneous mitral valve repair (PMVr) in management of high-risk patients with severe mitral regurgitation (MR) and acute decompensated heart failure (ADHF) is undetermined. We screened all patients who underwent PMVr between October 2015 and March 2020. We evaluated immediate, 30-day, and 1-year outcomes in patients who underwent PMVr during hospitalization due to ADHF as compared to elective patients. From a cohort of 237 patients, we identified 46 patients (19.4%) with severe MR of either functional or degenerative etiology who underwent PMVr during index hospitalization due to ADHF, including 17 (37%) critically ill patients. Patients’ mean age was 75.2 ± 9.8 years, 56% were males. There were no differences in background history between ADHF and elective patients. Patients with ADHF were at higher risk for surgery, reflected in higher mean EuroSCORE II, compared with elective patients. After PMVr, we observed higher 30-day mortality rate in ADHF patients as compared to the elective group (10.9% vs. 3.1%, respectively, p = 0.042). One-year mortality rate was similar between the groups (21.7% vs. 17.9%, p = 0.493). Clinical and echocardiographic follow-up showed improvement of NYHA functional class and sPAP reduction in both groups ((54 ± 15 mmHg to 50 ±15 in the elective group (p = 0.02), 58 ± 13 mmHg to 52 ± 12 in the ADHF group (p = 0.02)). PMVr could be an alternative option for treatment of patients with severe MR and ADHF.

Download Full-text

Austrian syndrome, ceftriaxone-induced agranulocytosis and COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-239355 ◽

2021 ◽

Vol 14 (1) ◽

pp. e239355

Author(s):

James Edward McCulloch ◽

Alexandra Miller ◽

Marius Borcea ◽

Jeremy Reid

Keyword(s):

Heart Failure ◽

Streptococcus Pneumoniae ◽

Mitral Valve ◽

Surgical Repair ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Severe Mitral Regurgitation ◽

Drug Induced ◽

Neutrophil Recovery ◽

Mitral Valve Vegetation

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to Streptococcus pneumoniae. Transoesophageal echocardiogram demonstrated a large mitral valve vegetation with severe mitral regurgitation. She was treated with intravenous ceftriaxone and listed for surgical repair of her mitral valve. Preoperatively, she developed an idiosyncratic drug-induced agranulocytosis secondary to ceftriaxone, which resolved on cessation of the medication. However, while awaiting neutrophil recovery, she developed an acute deterioration, becoming critically unwell. This deterioration was multifactorial, with acute decompensated heart failure alongside COVID-19. After multidisciplinary discussion, she was considered too unwell for surgery and palliated.

Download Full-text

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

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2019.06.008 ◽

2020 ◽

Vol 21 (1) ◽

pp. 52-60 ◽

Cited By ~ 4

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

Download Full-text

Percutaneous mitral valve repair with the MitraClip system in a patient with subacute severe mitral regurgitation caused by papillary muscle rupture

Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology ◽

10.5152/akd.2014.5352 ◽

2014 ◽

Author(s):

Mehmet Bilge ◽

Recai Alemdar ◽

Sina Ali ◽

Ayse Saatci Yasar

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Papillary Muscle ◽

Severe Mitral Regurgitation ◽

Valve Repair ◽

Papillary Muscle Rupture ◽

Percutaneous Mitral Valve Repair ◽

Muscle Rupture ◽

Mitraclip System

Download Full-text

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

Austin Cardio & Cardiovascular Case Reports ◽

10.26420/austincardiocardiovasccaserep.2021.1039 ◽

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.

Download Full-text

Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

Scientific Reports ◽

10.1038/s41598-020-74407-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Alberto Polimeni ◽

Michele Albanese ◽

Nadia Salerno ◽

Iolanda Aquila ◽

Jolanda Sabatino ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Primary Endpoint ◽

Cardiovascular Death ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair ◽

Percutaneous Valve Repair ◽

Percutaneous Valve

Abstract Percutaneous mitral valve repair has been increasingly performed worldwide after approval. We sought to investigate predictors of clinical outcome in patients with mitral regurgitation undergoing percutaneous valve repair. The MITRA-UMG study, a single-centre registry, retrospectively collected consecutive patients with symptomatic moderate-to-severe or severe MR undergoing MitraClip therapy. The primary endpoint was the composite of cardiovascular death or rehospitalization for heart failure. Between March 2012 and July 2018, a total of 150 consecutive patients admitted to our institution were included. Procedural success was obtained in 95.3% of patients. The composite primary endpoint of cardiovascular death or rehospitalization for HF was met in 55 patients (37.9%) with cumulative incidences of 7.6%, 26.2%, at 30 days and 1-year, respectively. In the Cox multivariate model, NYHA functional class and left ventricular end-diastolic volume index (LVEDVi), independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan–Meier analysis, a LVEDVi > 92 ml/m2 was associated with an increased incidence of the primary endpoint. In this study, patients presenting with dilated ventricles (LVEDVi > 92 ml/m2) and advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis after percutaneous mitral valve repair.

Download Full-text

Percutaneous Mitral Valve Repair for Functional Mitral Regurgitation with End-Stage Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.08.071 ◽

2015 ◽

Vol 21 (10) ◽

pp. S157

Author(s):

Yukiko Mizutani ◽

Shunsuke Kubo ◽

Makar Moody ◽

Mamoo Nakamura ◽

Takahiro Shiota ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair ◽

End Stage Heart Failure ◽

End Stage

Download Full-text

Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction

Heart ◽

10.1136/heartjnl-2017-311813 ◽

2017 ◽

Vol 104 (6) ◽

pp. 525-532 ◽

Cited By ~ 23

Author(s):

Ki Hong Choi ◽

Ga Yeon Lee ◽

Jin-Oh Choi ◽

Eun-Seok Jeon ◽

Hae-Young Lee ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Ejection Fraction ◽

De Novo ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

First Year ◽

Preserved Ejection Fraction ◽

University Hospitals ◽

Reduced Ejection Fraction

ObjectiveThere are conflicting results among previous studies regarding the prognosis of heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). This study aimed to compare the outcomes of patients with de novo acute heart failure (AHF) or acute decompensated HF (ADHF) according to HFpEF (EF≥50%), or HFrEF (EF<40%) and to define the prognosis of patients with HF with mid-range EF (HFmrEF, 40≤EF<50%).MethodsBetween March 2011 and February 2014, 5625 consecutive patients with AHF were recruited from 10 university hospitals. A total of 5414 (96.2%) patients with EF data were enrolled, which consisted of 2867 (53.0%) patients with de novo and 2547 (47.0%) with ADHF. Each of the enrolled group was stratified by EF.ResultsIn de novo, all-cause death rates were not significantly different between HFpEF and HFrEF (HFpEF vs HFrEF, 206/744 (27.7%) vs 438/1631 (26.9%), HRadj 1.15, 95% CI 0.96 to 1.38, p=0.14). However, among patients with ADHF, HFrEF had a significantly higher mortality rate compared with HFpEF (HFpEF vs HFrEF, 245/613 (40.0%) vs 694/1551 (44.7%), HRadj 1.25, 95% CI 1.06 to 1.47, p=0.007). Also, in ADHF, HFmrEF was associated with a significantly lower mortality rate within 1 year compared with HFrEF (HFmrEF vs HFrEF, 88/383 (23.0%) vs 430/1551 (27.7%), HRadj 1.31, 95% CI 1.03 to 1.65, p=0.03), but a significantly higher mortality rate after 1 year compared with HFpEF (HFmrEF vs HFpEF, 83/295 (28.1%) vs 101/469 (21.5%), HRadj 0.70, 95% CI 0.52 to 0.96, p=0.02).ConclusionsHFpEF may indicate a better prognosis compared with HFrEF in ADHF, but not in de novo AHF. For patients with ADHF, the prognosis associated with HFmrEF was similar to that of HFpEF within the first year following hospitalisation and similar to HFrEF 1 year after hospitalisation.

Download Full-text