The 2017 ESC/EACTS guidelines on the management of valvular heart disease

Baumgartner, Helmut

doi:10.1007/s00508-017-1297-5

Cited by 157 publications

(266 citation statements)

References 20 publications

(21 reference statements)

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“…Mitral valve regurgitation (MR), the most common type of valvular heart disease, affects nearly 10% of people above the age of 75 years [ 1 ]. It is—aside from aortic valve stenosis—the second most frequent indication for heart valve surgery in Europe [ 2 ]. MR is classified as primary, when the underlying pathology includes a structural or degenerative abnormality of the mitral valve itself.…”

Section: Introductionmentioning

confidence: 99%

The effects of interventional mitral valve repair using the MitraClip System on the results of pulmonary function testing, pulmonary pressure and diffusing capacity of the lung

Kretzler

Große²,

Wiedemann³

et al. 2021

BMC Cardiovasc Disord

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Background The study analyzes changes in lung function, pulmonary pressure and diffusing capacity of the lung in patients with mitral valve regurgitation (MR) treated by MitraClip implantation. Methods A total of 43 patients (19 women and 24 men with an average age of 78.0 ± 6.6 years) who were able to perform pulmonary function testing including diffusing capacity of the lung for carbon monoxide (DLCO), vital capacity (VC), total lung capacity (TLC), residual volume (RV) and forced expiratory volume in 1 s (FEV1) before and 6 weeks after MitraClip implantation participated in this study. Furthermore, clinical and echocardiographic parameters including systolic pulmonary artery pressure (sPAP), left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) measurements were recorded in all patients. Results The procedure was performed successfully in all 43 patients leading to a reduction of MR in 97.7% of cases. One patient died on day 4 after the intervention most likely due to pulmonary artery embolism. Six weeks after the implantation 79.1% of patients showed a MR of at most mild to moderate. Furthermore, we could demonstrate a significant reduction of systolic pulmonary artery pressure during follow-up (from 48.8 ± 11.4 mmHg to 42.9 ± 9.0 mmHg (t(41) = − 2.6, p = 0.01). However, no changes in LVEF were detected. Comparing pre and post implant lung function tests, no significant alterations were seen for VC, TLC, DLCO and FEV1. Though, in a subgroup of patients with moderate to severe preexisting deterioration of DLCO at the baseline (max. 50%) the MitraClip procedure resulted in a significant improvement in DLCO (37.8% ± 9.0 to 41.6% ± 10.0, p < 0.001). Conclusions Treatment of MR with the MitraClip system successfully reduces MR severity in the vast majority of patients. Consecutively, a reduction in pulmonary pressure could be observed, however no changes in LVEF were obvious. Lung function tests remained unaltered during follow-up. However, in a subgroup of patients with severe preexisting deterioration of DLCO the MitraClip procedure resulted in a significant improvement in DLCO. Trial registration Name of the registry: Die Auswirkung der interventionellen Mitralklappenreparatur mit MitraClip-System auf die Ergebnisse der Lungenfunktionsmessung. Trial registration number DRKS00022435; Date of registration: 09/07/2020 'Retrospectively registered'; URL of trial registry record: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022435.

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Section: Introductionmentioning

confidence: 99%

The effects of interventional mitral valve repair using the MitraClip System on the results of pulmonary function testing, pulmonary pressure and diffusing capacity of the lung

Kretzler

Große²,

Wiedemann³

et al. 2021

BMC Cardiovasc Disord

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“…The MitraClip procedure reduces the MV area and generates, at least two new orifices, followed by an increase of the mean transmitral pressure gradient (MG). An MG over five mmHg after clip attachment has been shown to be associated with adverse outcomes and should thus be avoided according to the current guidelines (4), (5). On the contrary, some recent studies found no predictive value of MG for clinical outcomes after interventional therapy for functional MR (6), (7).…”

Section: Introductionmentioning

confidence: 99%

Dynamics of the mean transmitral pressure gradient and its impact on clinical outcomes after MitraClip

Öztürk¹,

Sprenger²,

Tabata³

et al. 2021

Preprint

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Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.

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“…2 The utility of cardiac CT is recognised in international guidelines, which emphasise that cardiac CT is particularly well-placed to diagnose valve thrombosis and pannus formation. 3 In this pictorial review, we illustrate how cardiac CT provides a detailed structural information across a variety of prosthetic valve complications, thereby allowing physicians to more accurately diagnose the mechanism of prosthetic valve dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Cardiac CT in prosthetic aortic valve complications

Andrews

Cartlidge

Dweck

et al. 2018

The British Journal of Radiology

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In the current era of transcatheter device therapy, the prevalence of prosthetic aortic valves and their associated complications is increasing. Echocardiography remains the first-line imaging investigation for the assessment of prosthetic valve complications, however, this often fails to identify the underlying mechanism of prosthesis failure. Recently, cardiac CT has emerged as an imaging technique capable of providing high isotropic spatial resolution of the prosthetic valve and its utility can provide important complementary diagnostic information. In this pictorial review, we present a series of common prosthetic aortic valve complications imaged with cardiac CT and demonstrate how use of this modality can enhance diagnostic accuracy.

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The 2017 ESC/EACTS guidelines on the management of valvular heart disease

Cited by 157 publications

References 20 publications

The effects of interventional mitral valve repair using the MitraClip System on the results of pulmonary function testing, pulmonary pressure and diffusing capacity of the lung

The effects of interventional mitral valve repair using the MitraClip System on the results of pulmonary function testing, pulmonary pressure and diffusing capacity of the lung

Dynamics of the mean transmitral pressure gradient and its impact on clinical outcomes after MitraClip

Cardiac CT in prosthetic aortic valve complications

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