Ischemic mitral regurgitation

Krishnaswamy, Amar; Gillinov, A. Marc; Griffin, Brian P.

doi:10.1097/mca.0b013e3283441d3f

Cited by 10 publications

(3 citation statements)

References 82 publications

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“…Historically, SMR was referred to as "a problem of the ventricle" with left ventricular (LV) dilation causing apical displacement and tethering of the MV leaflets and/or dilation of the MV annulus (MVA) (5). While pathologic LV dilation is an important part of mitral regurgitation (MR), the contemporary understanding additionally implicates either idiopathic annular dilation without LV dilation or atrial fibrillation/flutter alone as the primary etiology in more than one-third of SMR patients (6).…”

Section: Anatomic Basis For Coronary Sinus (Indirect) Mitral Annuloplmentioning

confidence: 99%

Indirect Mitral Annuloplasty Using the Carillon Device

Krishnaswamy

Kapadia

2020

Front. Cardiovasc. Med.

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Patients with functional, or secondary, mitral regurgitation (FMR, SMR) often face significant symptoms that lead to functional decline as well as hospitalization and even death. Traditional mitral annuloplasty is an important treatment option for patients with FMR, but surgical risk and durability are important limitations. Percutaneous strategies are therefore a welcome alternative. The Carillon device utilizes the relationship of the coronary sinus and the mitral annulus to effect an “indirect” annuloplasty. Early series' and recent randomized trials suggest echocardiographic and clinical benefit with a relatively straight-forward implantation technique and low rate of significant complications.

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Section: Anatomic Basis For Coronary Sinus (Indirect) Mitral Annuloplmentioning

confidence: 99%

Indirect Mitral Annuloplasty Using the Carillon Device

Krishnaswamy

Kapadia

2020

Front. Cardiovasc. Med.

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“…FMR increases mortality and decreases functional capacity. There are only a few targeted treatment modalities available addressing FMR (4)(5)(6). Current guidelines indicate that patients with FMR, who are candidates for coronary artery bypass grafting, should undergo surgical mitral valve (MV) repair if feasible.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of percutaneous annuloplasty for treatment of functional mitral regurgitation: A retrospective study

Görmel¹,

Yaşar²,

Asil³

et al. 2021

Anatolian J Cardiol

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Objective: The management of severe functional mitral regurgitation (FMR) in patients with heart failure (HF) and low ejection fraction is controversial, but percutaneous transcatheter procedures are promising. In this retrospective analysis, we aimed to assess the efficacy of the Carillon Mitral Contour System in patients with "inoperable" severe FMR. Methods: Seventy three patients (mean age 66.89, range 31-90 years) with congestive heart failure (CHF), severe FMR, and reduced ejection fraction (<35%) who underwent Carillon device implantation were examined. The study group consisted of patients with successfully implanted devices whereas the control group comprised patients in whom the device could not be deployed. The primary endpoint was combined allcause mortality and first hospitalization for HF (whichever came first). Results: The median (Q1, Q3) follow-up was 31 (11-49) months. The device was deployed successfully in 50 patients (implant group) and not in 23 patients (non-implant group). Both the primary endpoint and all-cause mortality were lower in the "implant" group, but the differences were not significant. The median to primary endpoint was 21 [95% confidence interval (CI) 8.8-33.2] and six (95% CI 0.1-11.9) months for the implant group and the non-implant group, respectively (p=0.078). Conclusion: Carillon Mitral Contour System implantation is a safe procedure and results in the reduction of all-cause mortality and combined endpoint of mortality and hospitalizations for HF in inoperable patients with severe FMR and low ejection fraction, although the difference did not meet the significance level.

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“…Although FMR can lead to increased mortality, reduced functional capacity and increased healthcare cost, only a few targeted treatments, addressing FMR, are available. There is ongoing debate about the optimal intervention for FMR, its timing and effectiveness [ 7 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

Borisenko¹,

Haude

Hoppe

et al. 2015

BMC Cardiovasc Disord

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BackgroundTo determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the prolongation of optimal medical treatment (OMT).MethodsCost-utility analysis using a combination of a decision tree and Markov process was performed. The clinical effectiveness was determined based on the results of the Transcatheter Implantation of Carillon Mitral Annuloplasty Device (TITAN) trial. The mean age of the target population was 62 years, 77 % of the patients were males, 64 % of the patients had severe FMR and all patients had New York Heart Association functional class III. The epidemiological, cost and utility data were derived from the literature. The analysis was performed from the German statutory health insurance perspective over 10-year time horizon.ResultsOver 10 years, the total cost was €36,785 in the PMVR arm and €18,944 in the OMT arm. However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years. The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY. Results were robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective.ConclusionsPercutaneous mitral valve repair may be cost-effective in inoperable patients with FMR due to heart failure.

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Ischemic mitral regurgitation

Cited by 10 publications

References 82 publications

Indirect Mitral Annuloplasty Using the Carillon Device

Indirect Mitral Annuloplasty Using the Carillon Device

Evaluation of percutaneous annuloplasty for treatment of functional mitral regurgitation: A retrospective study

Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

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