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Reviews in Cardiovascular Medicine Dec 2021Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) of the mitral valve (MV) occurs in 70% of hypertrophic cardiomyopathy (HCM)...
Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) of the mitral valve (MV) occurs in 70% of hypertrophic cardiomyopathy (HCM) patients. In individuals undergoing septal myectomy, concomitant MV surgery is considered for SAM with residual LVOT obstruction or mitral regurgitation (MR); however, the optimal approach remains debated. A literature search was performed in Pubmed, EMBASE, Ovid, and the Cochrane library of published articles through June 2021 reporting on combined septal myectomy and edge-to-edge MV repair for obstructive HCM. Continuous variables were weighted and compared using a student's -test, and categorical variables using a chi-square test with Yates correction. Six studies with 158 total patients were included. The mean follow-up was 2.8 ± 2.7 years. Compared with pre-operative values, there were significant reductions in the LV ejection fraction (69 ± 10 vs 59 ± 8%), peak LVOT gradient (82 ± 34 vs 16 ± 13 mmHg), prevalence of moderate or greater MR (84 vs 5 %), and presence of SAM (96% vs 0) ( < 0.001 for all). There was no change in LV internal diastolic diameter (4.2 ± 1.3 vs 4.4 ± 1.5 cm, = 0.32). There were 2 (1%) operative mortalities. At follow-up, the survival rate was 97%, there were 3 (2%) re-operative MV replacements, 4 (3%) patients remained in New York Heart Association functional class III/IV, and 8 (6%) required permanent pacemaker implantation. In conclusion, combined septal myectomy and edge-to-edge MV repair is a safe and effective treatment strategy in carefully selected patients requiring surgical HCM management.
Topics: Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Heart Septum; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 34957786
DOI: 10.31083/j.rcm2204151 -
Catheterization and Cardiovascular... Feb 2024There is currently little evidence for transcatheter edge-to-edge mitral valve repair (TEER) for mitral regurgitation (MR) in patients with cardiogenic shock (CS).... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is currently little evidence for transcatheter edge-to-edge mitral valve repair (TEER) for mitral regurgitation (MR) in patients with cardiogenic shock (CS). Therefore, this study investigated the characteristics and outcomes of CS patients who underwent TEER for MR.
METHODS
PubMed, EMBASE were searched in July 2023. Case series and observational studies reporting clinical characteristics and outcomes in CS patients with MR who underwent TEER were included. We performed a one-group meta-analysis using a random effects model.
RESULTS
A total of 4060 patients from 7 case series and 5 observational studies were included. The mean age was 68.2 (95% confidence interval [CI]: 64.1-72.2) years, and 41.4% of patients (95% CI: 39.1%-43.7%) were female. Pre-TEER, severe MR was present in 85.3% (95% CI: 76.1%-91.3%) of patients. Mean left ventricular ejection fraction was 36.7% (95% CI: 29.2%-44.2%), and 54.6% (95% CI: 36.9%-71.2%) of patients received mechanical circulatory support. The severity of MR post-TEER was less than 2+ in 88% (95% CI: 87%-89%) of patients. In-hospital mortality was 11% (95% CI: 10%-13%), whereas 30-day and 1-year mortality rates were 15% (95% CI: 13%-16%), and 36% (95% CI: 21%-54%), respectively.
CONCLUSIONS
This systematic review and meta-analysis assessed the clinical characteristics and outcomes of TEER in CS patients with MR. TEER for MR in patients with CS has been successful in reducing MR in most of the patients, but with a high mortality rate. Randomized controlled trials of TEER for MR and CS are needed.
Topics: Humans; Female; Aged; Male; Mitral Valve; Mitral Valve Insufficiency; Shock, Cardiogenic; Stroke Volume; Ventricular Function, Left; Treatment Outcome; Heart Valve Prosthesis Implantation
PubMed: 38156508
DOI: 10.1002/ccd.30944 -
Infection Oct 2023Progress of interventional cardiology has boosted the use of newer cardiac devices. These devices are perceived to be less prone to infections compared to traditional... (Review)
Review
PURPOSE
Progress of interventional cardiology has boosted the use of newer cardiac devices. These devices are perceived to be less prone to infections compared to traditional surgical prostheses, but little data are currently available. In this systematic review (SR), we summarize current literature regarding the clinical characteristics, management, and outcomes of patients with MitraClip-related infective endocarditis (IE).
METHODS
We conducted a SR of PubMed, Google Scholar, Embase, and Scopus between January 2003 and March 2022. MitraClip-related IE was defined according to 2015 ESC criteria whereas MitraClip involvement as vegetation on the device or on the mitral valve. Risk of bias was assessed through standardized checklist and potential bias of underestimation cannot be excluded. Data regarding clinical presentation, echocardiography, management, and outcome were collected.
RESULTS
Twenty-six cases of MitraClip-related IE were retrieved. The median age of patients was 76 [61-83] years with a median EuroScore of 41%. Fever was present in 65.8% of patients followed by signs and symptoms of heart failure (42.3%). IE occurred early in 20 (76.9%) cases with a median time between MitraClip implantation and IE symptom onset of 5 [2-16] months. Staphylococcus aureus was the major causative microorganism (46%). Surgical mitral valve replacement was needed in 50% of patients. A conservative medical approach was considered in the remainder. The overall in-hospital mortality rate was 50% (surgical group: 38.4%; medical group: 58.3%; p = 0.433).
CONCLUSION
Our results suggest that MitraClip-related IE affects elderly, comorbid patients, is mostly due to Staphylococcus aureus, and has a poor prognosis irrespective of the therapeutic approach. Clinicians must be aware of the features of this new entity among cardiovascular infections.
Topics: Humans; Aged; Middle Aged; Aged, 80 and over; Heart Valve Prosthesis; Treatment Outcome; Endocarditis, Bacterial; Endocarditis; Mitral Valve; Mitral Valve Insufficiency
PubMed: 37386329
DOI: 10.1007/s15010-023-02067-y -
Hellenic Journal of Cardiology : HJC =... 2023Mitral valve repair or replacement (MVr/R) are procedures that aim to correct mitral regurgitation. The three techniques, namely conventional, minimally invasive, and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Mitral valve repair or replacement (MVr/R) are procedures that aim to correct mitral regurgitation. The three techniques, namely conventional, minimally invasive, and robotic each present their advantages and setbacks. Previous studies had compared each technique with the other but mostly focused on two techniques. In this systematic review and meta-analysis, we attempt to compare all three techniques, to provide a reference for the clinical selection of the best surgical scheme.
METHODS
The literature search was performed in databases including PubMed, Scopus, Google Scholar, EBSCOHost, Wiley, ProQuest, and Embase, up to June 1, 2022. Critical appraisal of studies was performed using Newcastle Ottawa Scale converted by Agency for Healthcare Research and Quality (AHRQ). We used bayesian network meta-analysis and conventional meta-analysis (random effects model) to rank and analyze pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Forest plots of pooled effect estimates comparing each treatment and ranking panel using Surface Under the Cumulative Ranking (SUCRA) were used for the intervention measures.
RESULTS
A total of 18 studies with 60,331 patients were included in this systematic review and meta-analysis. Hospital stay was significantly lower in the group with robotic procedure compared to the conventional interventions in terms of ICU stay and overall length of stay. The mean difference of length of hospital stay days of the conventional group was 2.27 (1.31-3.30) days and of the minimally invasive -0.364 (-2.31-1.53) days compared to the robotic group. The robotic procedure was associated with longer cross-clamp and cardiopulmonary bypass (CPB) times. Nevertheless, the robotic procedure was associated with lower infection (OR = 0.60 [95% CI 0.50-0.73)] rates and in-hospital mortality compared to conventional techniques (OR=0.53 [95% CI 0.40-0.70)] but not the minimally invasive techniques (OR = 1.74 [95% CI 0.48-6.31]).
CONCLUSION
Robotic surgery showed more favorable surgical outcomes, including hospital stay, post-operational complications and in-hospital mortality, although it was associated with longer cross-clamp time and CPB time compared to other interventions. However, its high cost is a difficult consideration for its widespread clinical implementation.
Topics: Humans; Mitral Valve; Robotic Surgical Procedures; Bayes Theorem; Cardiac Surgical Procedures; Mitral Valve Insufficiency; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 36639122
DOI: 10.1016/j.hjc.2022.12.011 -
Echocardiography (Mount Kisco, N.Y.) Mar 2022Mitral annular disjunction (MAD) is a structural abnormality involving a distinct separation of the left atrium/mitral valve annulus and myocardium continuum. The... (Review)
Review
BACKGROUND
Mitral annular disjunction (MAD) is a structural abnormality involving a distinct separation of the left atrium/mitral valve annulus and myocardium continuum. The literature around MAD has increased over recent years, thus we sought to review the current data on the definition, prevalence, and clinical outcomes of MAD.
METHODS
A search of MEDLINE and EMBASE was conducted to identify studies which evaluated MAD in any patient cohort. The study results were synthesized narratively.
RESULTS
A total of 12 studies were included with 3925 patients (average age 62 years, 63% male). The pooled prevalence of MAD in patients with mitral valve prolapse and/or Barlow's disease was 30.1%. In a general population, MAD prevalence was 8.7%. The definition of MAD was not consistent across all studies. In terms of clinical outcomes, only one study reported MAD to be associated with ventricular arrhythmias.
CONCLUSIONS
MAD is an increasingly recognized finding amongst patients undergoing cardiac imaging. This review highlights the need for agreed definitions for clinically significant MAD and how identified MAD should be managed. At present, there is insufficient evidence that MAD is associated adverse clinical outcomes.
Topics: Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Prevalence
PubMed: 35122307
DOI: 10.1111/echo.15299 -
The Heart Surgery Forum Feb 2021To summarize comparative studies of MitraClip versus surgical repair in typical, real-world elderly patients with severe mitral regurgitation (MR) and analyze the safety...
PURPOSE
To summarize comparative studies of MitraClip versus surgical repair in typical, real-world elderly patients with severe mitral regurgitation (MR) and analyze the safety and effectiveness of these therapeutic options.
METHODS
PubMed, Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) were searched for comparative studies of transcatheter mitral-valve repair (TMVR) versus surgical mitral-valve repair (SMVR) in elderly patients with severe MR from January 2000 to June 2020. Statistical pooling for incidence estimates was performed according to a random-effects model with generic inverse-variance weighting, computing risk estimates with 95% confidence intervals (CIs), using RevMan 5.3.
RESULTS
A total of 14 reports comparing MitraClip with SMVR, enrolling 3355 patients with severe MR, were included in this study. Mean age, Logistic EuroSCORE, and incidence of diabetes mellitus (DM) were significantly higher in the MitraClip group, except the rate of patients with New York Heart Association (NYHA) class of >II and mean value of ejection fraction (EF). The arithmetic mean of freedom from acute mobility was similar. The 2 groups had equal all-cause mortality at 30 days, but different at 1 year (14% versus 9%) and 3 years in 7 studies (37% versus 25%). The freedom from recurrent MR ≥3+ was 88% and 97.3% at 30 days, 76.0% and 90.0% at 1 year, and 79% and 95% at 3 years in the MitraClip and surgical repair group, respectively.
CONCLUSION
Although MitraClip is safe and effective in selected high-risk patients, the surgery may be the only gold standard for "gray" patients. Further studies are needed to determine whether MitraClip should be recommended.
Topics: Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency
PubMed: 33635244
DOI: 10.1532/hsf.3433 -
Journal of Cardiac Surgery Sep 2020Minimally invasive cardiac surgery (MICS) for mitral valve repair (MVRp) has been increasingly used. This study aimed to evaluate the early and late results of MICS for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM OF THE STUDY
Minimally invasive cardiac surgery (MICS) for mitral valve repair (MVRp) has been increasingly used. This study aimed to evaluate the early and late results of MICS for MVRp vs conventional sternotomy.
MATERIALS AND METHODS
A systematic review of randomized controlled trials or observational studies (with matched populations) comparing MICS and conventional MVRp reporting any of the following outcomes: mortality, MVRp failure, complications, blood transfusion, readmission within 30 days after discharge, long-term reoperation for mitral regurgitation, operative times, mechanical ventilation time, intensive care unit (ICU) stay, or hospital stay. The pooled treatment effects were calculated using a random-effects model.
RESULTS
Ten studies involving 6792 patients (MICS: 3396 patients; Conventional: 3296 patients) met the eligibility criteria. In the pooled analysis, MICS significantly reduced the risk for blood transfusion (odds ratio [OR], 0.654; 95% confidence interval [CI] 0.462-0.928; P = .017) and readmission within 30 days after discharge (OR, 0.615; 95% 0.456-0.829; P = .001). MICS was associated with a significantly longer cross-clamp time (mean difference 14 minutes; 95% CI, 7.4-21 minutes; P < .001), CPB time (24 minutes; 95% CI, 14-35 minutes; P < .001), and total operative time (36; 95% CI, 15-56 minutes; P < .001), but a significantly shorter ICU stay (-8.5; 95% CI -15; -1.8; P = .013) and hospital stay (-1.3, 95% CI -2.1; -0.45; P = .003). This meta-analysis found no significant difference regarding the risk of in-hospital and long-term mortality, nor complications.
CONCLUSIONS
Despite longer operative times, MICS for MVRp reduces ICU and hospital stay, as well as readmission rates and the need for transfusion.
Topics: Cardiac Surgical Procedures; Heart Valve Diseases; Humans; Length of Stay; Minimally Invasive Surgical Procedures; Mitral Valve; Mitral Valve Insufficiency; Retrospective Studies; Sternotomy; Treatment Outcome
PubMed: 32668091
DOI: 10.1111/jocs.14799 -
Cardiovascular Revascularization... Sep 2021Transcatheter Mitral Valve Repair (TMVr) offers clinically significant benefit to select symptomatic patients with severe mitral regurgitation (MR). We conducted a... (Meta-Analysis)
Meta-Analysis Review
Transcatheter Mitral Valve Repair (TMVr) offers clinically significant benefit to select symptomatic patients with severe mitral regurgitation (MR). We conducted a systematic review and meta-analysis of clinical trials and observational studies to identify the effect of pre-procedural Chronic Kidney disease (CKD) on short-term mortality in TMVr. We found CKD is a predictor of 30-day mortality in patients undergoing TMVr. Specifically, a GFR < 30 mL/min conveys a significant increase in 30-day mortality. This is significant for patient selection, prognostication, as well as identifies an area of need for further research. SUMMARY FOR ANNOTATED TABLE OF CONTENTS: A systematic review and meta-analysis looking at short-term mortality in patients undergoing Transcatheter Mitral Valve Repair with chronic kidney disease. Findings show severe renal disease is associated with increased 30-day mortality.
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Renal Insufficiency, Chronic; Treatment Outcome
PubMed: 33139220
DOI: 10.1016/j.carrev.2020.09.035 -
Heart Failure Reviews May 2021Atrial fibrillation (AF) is a common arrhythmia in patients with mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In this systematic... (Meta-Analysis)
Meta-Analysis Review
Atrial fibrillation (AF) is a common arrhythmia in patients with mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). In this systematic review, we aimed to investigate the outcomes of TMVR using MitraClip in AF patients. We performed a systematic search using PubMed, SCOPUS, EMBASE, and Google Scholar, from inception to May 10, 2020, for studies that reported outcomes following MitraClip, in patients with AF versus without AF. Seven studies with a total of 7678 patients met the inclusion criteria. The risk of 1-year all-cause mortality following TMVR was higher in AF patients (RR 1.40, 95% CI 1.27-1.54, p ≤ 0.001). Similarly, the risk of heart failure hospitalization was higher in patients with AF (RR 1.17, 95% CI 1.06-1.30, p = 0.002) and the risk of bleeding was elevated in AF patients (RR 1.29, 95% CI 1.15-1.45, p ≤ 0.001). The risk of procedural failure, in-hospital mortality, cardiovascular mortality, and stroke was not significantly different between the two groups. The higher risk of all-cause mortality, HF hospitalization, and risk of bleeding in AF patients undergoing MitraClip warrants attention.
Topics: Atrial Fibrillation; Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 33169339
DOI: 10.1007/s10741-020-10051-z -
Journal of Cardiac Surgery Jan 2022This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using the network meta-analysis... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using the network meta-analysis method, so as to provide reference for clinical selection of the best surgical scheme.
METHODS
The PubMed, EMBASE, the Cochrane Library, CNKI, and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery (3D-MVS), robot-assisted mitral valve surgery (R-MVS); totally thoracoscopic mitral valve surgery (T-MVS), small incision mitral valve surgery (M-MVS), and traditional thoracotomy mitral valve surgery (C-MVS). Stata16.0 and Addis1.16.8 software was used for network meta-analysis using the Bayesian approach.
RESULTS
A total of 31 studies were included, 12,998 patients, involving five surgical methods. Network meta-analysis showed that: in terms of complications (odds ratio [OR]: 0.65, 95% CI: 0.13-3.00, probability rank = 0.37) and MR (OR: 0.03, 95% CI: 0.0-8315, probability rank = 0.64), the 3D-MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16-1.84, probability rank = 0.45), T-MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R-MVS group has the best curative effect.
CONCLUSION
This minimally invasive surgery has their own advantages and disadvantages. Overall, 3D-MVS is most satisfactory, but more samples are needed.
Topics: Adult; Bayes Theorem; Heart Valve Prosthesis Implantation; Humans; Minimally Invasive Surgical Procedures; Mitral Valve Insufficiency; Network Meta-Analysis; Retrospective Studies; Treatment Outcome
PubMed: 34662452
DOI: 10.1111/jocs.16085