Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States

Sorajja, Paul; Mack, Michael J.; Vemulapalli, Sreekanth; Holmes, David R.; Stebbins, Amanda; Kar, Saibal; Lim, D. Scott; Thourani, Vinod H.; McCarthy, Patrick M.; Kapadia, Samir; Grayburn, Paul A.; Pedersen, Wesley; Ailawadi, Gorav

doi:10.1016/j.jacc.2015.12.054

Cited by 175 publications

(109 citation statements)

References 33 publications

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“…Previous studies evaluating anatomic predictors of short‐term procedural success have been small, and many consisted of predominantly secondary (functional) MR 14, 15. A recent study using Transcatheter Valve Therapies Registry data of the early US experience with TMVR showed that left ventricular end‐diastolic dimension, A2‐P2 clip location, MR severity, and case volume were predictive of procedural success 16. One limitation of this large cross‐sectional cohort is that quantitative measurements of mitral valve anatomical features were not available for evaluation.…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Anatomic Predictors of Hemodynamic Success With Transcatheter Mitral Valve Repair

Thaden

Malouf

Nkomo

et al. 2018

JAHA

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BackgroundMitral regurgitation is a heterogeneous disease. Determining which patients derive optimal outcomes from transcatheter edge‐to‐edge mitral valve repair (TMVR) remains challenging. We sought to determine whether baseline mitral valve anatomic characteristics are predictive of left atrial pressure (LAP) changes during TMVR with MitraClip.Methods and ResultsConsecutive patients with severe mitral regurgitation undergoing TMVR (n=112) underwent continuous intraprocedural LAP monitoring and retrospective echocardiographic analysis for specific mitral anatomic characteristics. Procedural success (optimal LAP reduction) was defined as ≥40% reduction in left atrial V‐wave pressure compared with baseline. Echocardiographic predictors of optimal LAP reduction and increased postprocedure mean diastolic gradient were evaluated. Mean age was 79±14 years, and 36 patients (32%) were women. Primary, mixed, and secondary mitral regurgitation were present in 78 patients (70%), 22 patients (20%), and 12 patients (10%), respectively. Baseline mean LAP and V‐wave were 22±6 and 38±13 mm Hg; after TMVR, these decreased to 19±5 and 27±10 mm Hg, respectively (P<0.0001 for both). Independent predictors of optimal LAP reduction were the presence of a flail scallop, mitral regurgitation localized to a single scallop, and high‐quality 3‐dimensional echocardiographic imaging. Independent predictors of elevated postprocedure mean diastolic gradient were elevated preprocedure mean diastolic gradient, mitral annular calcification, and implantation of multiple clips.ConclusionsMitral valve pathoanatomic features, including a flail leaflet and single jet, are predictive of optimal LAP reduction with TMVR. High‐quality 3‐dimensional imaging may help select patients with the highest likelihood of optimal hemodynamic results with TMVR. These data expand current knowledge about patient selection for TMVR and deserve further study in larger cohorts.

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Section: Discussionmentioning

confidence: 99%

Mitral Valve Anatomic Predictors of Hemodynamic Success With Transcatheter Mitral Valve Repair

Thaden

Malouf

Nkomo

et al. 2018

JAHA

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“…30 Patient eligibility (including assessment for concomitant coronary artery disease) is assessed with TTE, TEE, 3D TTE, exercise testing of various types, and coronary angiography, all of which are rated Appropriate. If there is concern regarding an intracardiac mass, thrombus, or vegetation, this is assessed with TEE, as Appropriate, whereas TTE is rated as May Be Appropriate, as is 3D TTE.…”

Section: Section 3: Transcatheter Intervention For Vhdmentioning

confidence: 99%

ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease

Doherty

Kort

Mehran

et al. 2017

Journal of Nuclear Cardiology

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“…The procedural success rate, nonetheless, was 91% deined as MR less than or equal to grade 2 and surviving the hospital stay. A majority of patients were discharged home with moderate or less MR than prior [108]. Patients with severe frailty who are bedridden and/or require constant nursing care may be too disabled to achieve meaningful beneit from MitraClip and may also be considered prohibitive for TAVR [101].…”

Section: Frailty and Valvular Heart Disease (Vhd)mentioning

confidence: 99%

Frailty and Cardiovascular Disease

Chainani¹,

Riehl²,

Chainani³

et al. 2017

Frailty and Sarcopenia - Onset, Development and Clinical Challenges

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Cardiovascular disease (CVD) comprises a vast spectrum of disease states ranging from hypertension (HTN) to valvular heart disease (VHD). CVD is known to be the leading cause of morbidity, mortality, and health-care expenditure throughout the world. According to the World Health Organization, coronary artery disease (CAD) and stroke, both subsets of CVD, are the world's biggest killers, accounting for a combined 15 million deaths in 2015. These diseases have remained the leading causes of death globally in the last 15 years. In 2010, CAD alone was projected to cost the U.S. $108.9 billion including the cost of health-care services, medications, and lost productivity. The presence of frailty signiicantly worsens outcomes for patients sufering from CAD. With just this one example of how frailty afects CVD, it is clear that understanding the impact of frailty upon patients alicted with the spectrum of cardiovascular disease is integral for the care of this very signiicant patient population.

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Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States

Cited by 175 publications

References 33 publications

Mitral Valve Anatomic Predictors of Hemodynamic Success With Transcatheter Mitral Valve Repair

Mitral Valve Anatomic Predictors of Hemodynamic Success With Transcatheter Mitral Valve Repair

ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease

Frailty and Cardiovascular Disease

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