Influence of experience on procedure steps, safety, and functional results in edge to edge mitral valve repair—a single center study

Hamm, Karsten; Zacher, Michael; Hautmann, Martina B.; Gietzen, Frank; Halbfaß, Philipp; Kerber, Sebastian; Diegeler, Anno; Schieffer, Bernhard; Barth, Sebastian

doi:10.1002/ccd.26806

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…Surprisingly, the mortality (24.3%) and CHF admissions (54.6%) at 1 year almost doubled the reported rates in several international registries. Along with our results, MITRA-FR results probably reflected the pivotal role of patient selection in FMR patients [15]. In contrast to MITRA-FR, COAPT patients were on maximal medical treatment before the procedure, baseline MR severity was higher, LV enlargement was lower, and both acute and 12 month residual MR after Mitraclip were lower All these factors translated into better mortality (29.1%) and CHF admission (35.7%) rates at 24 months compared to optimal medical treatment alone [9].…”

Section: Discussionsupporting

confidence: 88%

“…In contrast, in our series, the NT cohort presented a lower rate of the composite of death, surgery, and admission for CHF at 1 year as compared to the control group. This difference was mainly driven by a reduction in the need for CHF admissions after the procedure and might translate not only the effects of device design improvement but also the learning curve for both procedural and patient selection aspects [11,15,16]. In fact, as shown in Table 1, the main difference in patient selection was the higher rate of DMR in the NT group.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Mitral Valve Repair: Outcome Improvement with Operator Experience and a Second-Generation Device

Freixa

Estévez‐Loureiro

Carrasco-Chinchilla

et al. 2021

JCM

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Background and aim: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. Methods: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT system. Results: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively; p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group; p = 0.032). Conclusions: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Percutaneous Mitral Valve Repair: Outcome Improvement with Operator Experience and a Second-Generation Device

Freixa

Estévez‐Loureiro

Carrasco-Chinchilla

et al. 2021

JCM

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“…Conversely, Schillinger and colleagues 8 reported on the first 75 patients undergoing TEER at their institution and showed a decrease in TSP time from 75 min in the first third of the experience to 40 min in the final third. A decrease in TSP time was also shown by Hamm et al 9 with time to TSP decreasing from 22 ± 15 min in the first group of 42 patients to 13 ± 10 min in the second group of 42 patients, and no change in the third group of 42 patients.…”

Section: Discussionsupporting

confidence: 69%

Transseptal Puncture Learning Curve for Transcatheter Edge-to-Edge Mitral Valve Repair

Quinn

Vesely

Dawood

et al. 2021

Innovations�(Phila)

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Objective This study examined the learning curve for transseptal puncture (TSP) during transcatheter edge-to-edge mitral valve repair (TEER) performed by a dedicated mitral valve structural heart team. Effective TSP is mandatory for TEER but can be time-consuming and associated with complications including pericardial effusion and cardiac tamponade. Methods TSP was performed on 107 consecutive patients (76 ± 1 years, 52% male) undergoing TEER between 2014 and 2019. TSP was performed by each structural heart team member (1 cardiologist, 2 cardiac surgeons) on a rotating case-by-case basis. No team member had prior independent TSP experience. Data collected included total procedure time, TSP time (time elapsed between procedure start and septal crossing), and number of TSP attempts before successful puncture. Cumulative sum (CUSUM) of deviations from the mean across sequential cases were used to examine learning curves. Results Median total procedure time was 107 min, and the median TSP time was 14 min. Greater case number was significantly associated with both lower TSP time ( r s = −0.22, P = 0.022) and lower total procedure time ( r s = −0.29, P = 0.003). The majority of patients required only 1 TSP attempt (79%). There was a significant quadratic relationship between case number and the CUSUM for TSP time, with the learning curve peaking at 49 cases. Conclusions TSP for TEER has a substantial learning curve, requiring >50 cases to achieve acceptable efficiency. Even once proficiency is demonstrated, TSP remains a time-consuming component of TEER. Improvements in transseptal access technology may significantly decrease the time needed to master TSP and may improve the safety and precision of the procedure.

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“…Other “chordal devices” have been developed, but they did not reach the market yet 23 . Considering transcatheter technique is imperative in the modern era and even in this scenario, the paradigm “low procedural volume correlates to worse outcomes” remains valid as shown by Yeo et al, 24 Mahabir et al, 25 and Hamm et al 26 in their analysis about Mitraclip. However, some words must be spent on the peculiarities of transcatheter procedures.…”

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confidence: 99%

“Learning curve and procedural volume in mitral valve disease”

Saccocci

Colli

2021

J Card Surg

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Influence of experience on procedure steps, safety, and functional results in edge to edge mitral valve repair—a single center study

Abstract: Safety and duration of procedure steps improved substantially with experience. MR reduction was sustained from the beginning without further improvement. Patient selection is a key factor for success. © 2016 Wiley Periodicals, Inc.

Cited by 4 publications

References 23 publications

Percutaneous Mitral Valve Repair: Outcome Improvement with Operator Experience and a Second-Generation Device

Percutaneous Mitral Valve Repair: Outcome Improvement with Operator Experience and a Second-Generation Device

Transseptal Puncture Learning Curve for Transcatheter Edge-to-Edge Mitral Valve Repair

“Learning curve and procedural volume in mitral valve disease”

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