-
Journal of the American College of... Dec 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 34886962
DOI: 10.1016/j.jacc.2021.10.010 -
Journal of the American College of... Nov 2020
Topics: Acute Kidney Injury; Cardiac Surgical Procedures; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 33213726
DOI: 10.1016/j.jacc.2020.10.017 -
JACC. Cardiovascular Imaging Apr 2021This study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR)...
OBJECTIVES
This study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR) to primary mitral regurgitation (PMR).
BACKGROUND
AFMR remains poorly defined clinically.
METHODS
Consecutive patients who underwent transesophageal echocardiography at our institution between 2011 and 2018 for severe mitral regurgitation with preserved left ventricular function were screened. We excluded patients with endocarditis, any form of cardiomyopathy, or prior mitral intervention. The absence of leaflet pathology defined AFMR. Outcomes included death and heart failure hospitalizations.
RESULTS
A total of 283 patients were included (AFMR = 14%, PMR = 86%). Compared to PMR, patients with AFMR had more comorbidities, including hypertension (94.9% vs. 76.2%; p = 0.015), diabetes mellitus (46.2% vs. 18.4%; p < 0.001), long-standing atrial fibrillation (28.2% vs. 13.1%; p = 0.015), prior nonmitral cardiac surgery (25.6% vs. 9.8%; p = 0.004), and pacemaker placement (33.3% vs. 13.5%; p = 0.002). They also had higher average E/e' (median [interquartile range]:16.04 [13.1 to 22.46] vs. 14.1 [10.89 to 19]; p = 0.036) and worse longitudinal left atrial strain peak positive value (16.86 ± 12.15% vs. 23.67 ± 14.09%; p = 0.002) compared to PMR. During follow-up (median: 22 months), patients with AFMR had worse survival (log-rank p = 0.009) and more heart failure hospitalizations (log-rank p = 0.002). They were also less likely to undergo mitral valve intervention (59.0% vs. 83.6%; p = 0.001), although surgery was associated with improved survival (log-rank p = 0.021). On multivariable regression analysis, AFMR was independently associated with mortality [adjusted odds ratio: 2.61, 95% confidence interval: 1.17 to 5.83; p = 0.02].
CONCLUSIONS
AFMR constitutes an under-recognized high-risk group, with significant comorbidities, limited therapeutic options, and poor outcomes.
Topics: Echocardiography; Heart Atria; Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests
PubMed: 33832663
DOI: 10.1016/j.jcmg.2021.02.008 -
ESC Heart Failure Oct 2021We investigated short and mid-term safety and efficacy of the PASCAL system for percutaneous mitral valve repair (PMVr) in severe mitral regurgitation (MR) in an...
AIMS
We investigated short and mid-term safety and efficacy of the PASCAL system for percutaneous mitral valve repair (PMVr) in severe mitral regurgitation (MR) in an all-comer population.
METHODS AND RESULTS
In the first consecutive 41 patients undergoing PMVr using the PASCAL system in our centre, procedural success and safety were assessed. Efficacy in improving MR and functional class were evaluated. Median patient age was 74 years, 58.5% were male patients, and median European System for Cardiac Operative Risk Evaluation Score II was 5.1%. All patients suffered from severe MR with 59% functional MR, 29% degenerative MR, and 12% of mixed aetiology MR. The technical success rate was 90%, limited by four cases where PASCAL implantation was aborted due to a prohibitive mitral gradient. On average, 1.16 PASCAL devices per patient were implanted. All patients successfully implanted with a PASCAL device were discharged with MR grade ≤ 2 and 79% with MR grade ≤ 1. Mean follow-up was 8.7 ± 4.9 months. Ninety-seven per cent of patients remained at MR ≤ 2 at follow-up, which translated into a significantly improved New York Heart Association functional class as well as a significant reduction of systolic pulmonary artery pressure and brain natriuretic peptide levels. The procedure-related rate for major adverse events was 3%. Neither early nor late single-leaflet detachment was found. In one patient, air embolism occurred, resulting in modification of the PASCAL instructions for use.
CONCLUSIONS
Percutaneous mitral valve repair using PASCAL in a real-world, all-comer population was feasible and safe, resulting in a significant mid-term reduction of MR with persistent clinical improvement.
Topics: Aged; Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 34448541
DOI: 10.1002/ehf2.13569 -
General Thoracic and Cardiovascular... Sep 2022This study aimed to elucidate the mid-term outcomes and risk factors for recurrent mitral regurgitation after mitral valve (MV) surgery for atrial functional mitral...
OBJECTIVES
This study aimed to elucidate the mid-term outcomes and risk factors for recurrent mitral regurgitation after mitral valve (MV) surgery for atrial functional mitral regurgitation (AFMR).
METHODS AND RESULTS
We retrospectively analyzed data of 50 consecutive patients (median age 74 years; 29 men) who underwent mitral valve surgery for AFMR between January 2001 and January 2019. Mean atrial fibrillation duration was 12 years. During the follow-up period of 4.6 ± 4.4 years, 5 cardiac-related deaths were identified. Five- and 10-year freedom from cardiac-related death rate for all patients was 88.4% and 78.6%. In total, 42 patients underwent MV repair with mitral annuloplasty and 8 underwent MV replacement. Five- and 10-year freedom from cardiac-related death rate in patients who underwent MV repair was 93.1% and 82.7%, which was better than MV replacement (log rank p = 0.04). During the follow-up period, MR recurrence rate was 16.8% at 5 and 10 years for the patients who underwent MV repair. Univariate analysis showed that partial band annuloplasty and preoperative elevated left ventricular end-systolic volume index were risk factors for recurrent MR after MV repair. Multivariate analysis identified partial band annuloplasty as the independent predictor for recurrent MR during long-term follow-up after MV repair for AFMR.
CONCLUSION
Patients who underwent MV repair for AFMR could have an acceptable mid-term outcome. However, MVR might not improve the mid-term outcome in patients with AFMR. The use of partial bands for mitral annuloplasty would not be recommended in terms of recurrent MR mid-term.
Topics: Aged; Follow-Up Studies; Humans; Male; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Retrospective Studies; Treatment Outcome
PubMed: 35239104
DOI: 10.1007/s11748-022-01793-8 -
Medicina (Kaunas, Lithuania) May 2023Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral... (Review)
Review
Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US guidelines have identified common diagnostic and therapeutic pathways that do not consider patient sex in decision-making. The aim of this review is to summarize the current evidence on sex-related differences in non-rheumatic mitral regurgitation, particularly regarding incidence, imaging modalities, surgical-derived evidence, and outcomes of transcatheter edge-to-edge repair, with the goal of informing clinicians about sex-specific challenges to consider when making treatment decisions for patients with mitral regurgitation.
Topics: Humans; Female; Male; Mitral Valve Insufficiency; Mitral Valve; Heart Valve Prosthesis Implantation; Sex Characteristics; Cardiac Catheterization; Treatment Outcome
PubMed: 37374220
DOI: 10.3390/medicina59061017 -
The Journal of Thoracic and... Jun 2021
Topics: Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Tricuspid Valve Insufficiency
PubMed: 32008761
DOI: 10.1016/j.jtcvs.2019.12.053 -
BMJ Case Reports Feb 2022We present a 61-year-old man with severe primary mitral valve insufficiency who underwent MitraClip procedure without any immediate complications, although it was a...
We present a 61-year-old man with severe primary mitral valve insufficiency who underwent MitraClip procedure without any immediate complications, although it was a difficult attachment requiring multiple attempts. He was then found to have single leaflet device attachment 5 weeks later with excessive mobility of the mitral clip. No urgent intervention was done as patient remained stable without any new symptoms. This case demonstrated the importance of postprocedural imaging follow-up for patient with MitraClips.
Topics: Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 35228240
DOI: 10.1136/bcr-2021-247747 -
Revista Portuguesa de Cardiologia May 2020
Topics: Aged, 80 and over; Cardiology; History, 20th Century; Humans; Male; Mitral Valve Insufficiency; Mitral Valve Prolapse; South Africa
PubMed: 32507732
DOI: 10.1016/j.repc.2020.05.001 -
Multimedia Manual of Cardiothoracic... Apr 2021In recent years, the treatment of mitral valve disease with robotic surgery has been increasingly successful, having produced excellent postoperative results and...
In recent years, the treatment of mitral valve disease with robotic surgery has been increasingly successful, having produced excellent postoperative results and significant cost-savings. However, minimal experience exists with robotic mitral valve repair using transareolar access. We demonstrate mitral valve repair using the DaVinci Robot Xi through a transareolar approach, showing the technical details of our surgical technique.
Topics: Echocardiography; Female; Heart Valve Prosthesis Implantation; Humans; Middle Aged; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Robotic Surgical Procedures
PubMed: 33901351
DOI: 10.1510/mmcts.2021.022