Transcatheter mitral valve repair for primary and secondary mitral regurgitation: new insights from a nationwide registry

Iung, Bernard; Ureña, Marina

doi:10.1002/ejhf.2203

Cited by 3 publications

(6 citation statements)

References 16 publications

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“…Diminished annular area movement may also lead to heightened tethering. 7,9,11,12,15 The following points demonstrate increased tethering in AFMR.…”

Section: Assessment Of Mechanism Of Mitral Regurgitation Related To A...mentioning

confidence: 81%

“…81 Evidence of secondary ischaemic mitral regurgitation complicated by AF treated with cardioversion supports these data. 7,9,34,52,82 Another study found that 47 patients with paroxysmal or persistent AF following catheter ablation and/or electrical cardioversion had a mean decrease in vena contracta width from 0.40 to 0.21 cm. 14 Research found that over three-quarters of patients with moderate AFMR saw improvement of at least one MR grade after catheter ablation.…”

Section: Treatment Of Afmrmentioning

confidence: 99%

“…Even mild MR has a negative prognostic value, and as the severity of VFMR rises, patient outcomes worsen. 7–10 Medical therapy for HF, including resynchronization therapy in suitable patients, has been found to reduce MR severity. 11–15 However, the reduction in MR through surgical intervention has not yet shown any enhancement in clinical results.…”

Section: Introductionmentioning

confidence: 99%

“…On the contrary, the important trial evidence from two randomized clinical trials evaluating transcatheter edge-to-edge repair has produced conflicting results. 7,8 Various factors have been suggested to account for the divergent outcomes, such as differences in study design, extent of mitral regurgitation and left ventricular size. 9 It is now acknowledged that there exist distinct subtypes of VFMR that exhibit varying responses to medical treatment.…”

Section: Introductionmentioning

confidence: 99%

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Assessing emerging causes of mitral regurgitation: atrial functional mitral regurgitation

Nappi

2024

J Int Med Res

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Functional or secondary mitral regurgitation is linked to increased cardiovascular morbidity and mortality. From a mechanical perspective, secondary mitral regurgitation occurs due to an imbalance between the forces that tether the mitral leaflets and those that close them. This results in incomplete coaptation. Most commonly, functional mitral regurgitation, which occurs in both ischaemic and non-ischaemic disease states, is usually caused by dysfunction and changes in the left ventricle. Atrial functional mitral regurgitation (AFMR) is a disease state that has been more recently recognized. It occurs when mitral annular enlargement is associated with left atrial dilatation, preserving left ventricular geometry and function. AFMR is typically seen in patients with chronic atrial fibrillation or heart failure who have a conserved ejection fraction. Published reports and ongoing investigations vary in how they define AFMR. This publication examines the pathophysiology of AFMR and highlights the importance of having a common working standard for the definition of AFMR to ensure consistency in the data reported and to drive forward the much needed research into the outcomes and treatment strategies in this area. Several studies have reported that restrictive annuloplasty and transcatheter edge-to-edge repair can reduce mitral regurgitation and improve symptoms. This narrative review will explore the pathophysiology, echocardiographic diagnosis and treatment of AFMR.

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“…Diminished annular area movement may also lead to heightened tethering. 7,9,11,12,15 The following points demonstrate increased tethering in AFMR.…”

Section: Assessment Of Mechanism Of Mitral Regurgitation Related To A...mentioning

confidence: 81%

Section: Treatment Of Afmrmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing emerging causes of mitral regurgitation: atrial functional mitral regurgitation

Nappi

2024

J Int Med Res

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“…In the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, the addition of TEER to goal-directed medical therapy (GDMT) resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality when compared with GDMT alone at 24 and 36-month follow-up [43,45 ▪▪ ]. In contrast, the Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation (MITRA-FR) trial showed no significant differences between the TEER and GDMT and GDMT-alone groups with regards to a composite outcome of death from any cause or unplanned hospitalization for heart failure at 1 and 2-year follow-up [44,46].…”

Section: Percutaneous Management Of Severe Functional Mitral Regurgit...mentioning

confidence: 99%

Ischemic mitral regurgitation: when should one intervene?

Rahmouni

Shahinian

Deng

et al. 2021

Current Opinion in Cardiology

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Purpose of reviewOptimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral regurgitation, and their implications on current practice and future research. Recent findingsMechanistically, ischemic mitral regurgitation can present as Type I, Type IIIb or mixed Type I and IIIb disease. Severity of mitral regurgitation is typically quantified with echocardiography, either transthoracic or transesophageal echocardiography, but may also be assessed via cardiac MRI. In patients with moderate ischemic mitral regurgitation, revascularization can lead to left ventricular reverse remodeling in some. In patients with severe ischemic mitral regurgitation, mitral valve replacement may be associated with fewer adverse events related to heart failure and cardiovascular readmissions, compared with valve repair, although reverse remodeling may be better in patients following successful mitral repair. Transcatheter edge-to-edge repair also further complements the treatment of ischemic mitral regurgitation. SummaryA tailored approach to patients should be considered for each patient presenting with ischemic mitral regurgitation.

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Transkatheterverfahren zur Behandlung der primären und sekundären Mitralklappeninsuffizienz. Wie sind die Ergebnisse in klinischen Studien?

Barth

2022

Kardiologie

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Zusammenfassung Hintergrund Die perkutanen Verfahren (z. B. Pascal, MitraClip und Tendyne) werden zur Behandlung der symptomatischen primären und sekundären Mitralklappeninsuffizienz („MI“) verschiedener Schweregrade gemäß der europäischen Leitlinie angewendet. Die chirurgischen Verfahren haben unter definierten Bedingungen einen höheren Empfehlungsgrad. Die vorliegende Arbeit analysiert die Vor- und Nachteile der perkutanen Verfahren, die Ergebnisse aus klinischen Studien und gibt einen Ausblick auf die Bedeutung von neueren Verfahren wie den Transkathetermitralklappenersatz (TMVR). Methoden Die Effektivität und Sicherheit (z. B. MI-Reduktion, Komplikationsraten) der Verfahren im Vergleich zu Behandlungsalternativen in klinischen Studien werden anhand einer Literaturanalyse (2003–2022) und der BfArM-Datenbank bewertet. Ergebnisse Die Behandlung mit MitraClip hat sich in den letzten Jahren auch in klinischen Studien (z. B. MI-Reduktion ≤ 1+) bewährt. Inzwischen wird das Produkt zur Therapie der primären und sekundären Mitralklappeninsuffizienz verwendet. Im Vergleich zeigt die Analyse einer Studie aus der BfArM-Datenbank zur direkten Anuloplastie (2-Jahres-Follow-up, Anwendung bei Hochrisiko-OP-Patienten, sekundäre MR ≥ 3+) die spezifischen Vorteile (insgesamt deutliche Besserung der NYHA-Klassen und MI-Grade) und Risiken (z. B. Ankerablösungen mit z. T. ineffektiver MI-Reduktion bei 8,3 % der implantierten Patienten). Diskussion In den letzten Jahren hat eine rasante Entwicklung bei den perkutanen Verfahren zur Therapie der Mitralklappeninsuffizienz stattgefunden. Sie haben Vorteile, bergen aber auch produktspezifische Risiken (z. B. bei TMVR die LVOT-Obstruktion). Bei MitraClip wird die erweiterte Indikation (intermediäres Operationsrisiko) derzeit in einer klinischen Studie (REPAIR MR) untersucht. Das BfArM begrüßt die Ausweitung entsprechender Evidenz und wird die weitere Entwicklung im Hinblick auf die Verfügbarkeit sicherer und leistungsfähiger Medizinprodukte für Patientinnen und Patienten im Blick behalten.

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Transcatheter mitral valve repair for primary and secondary mitral regurgitation: new insights from a nationwide registry

Cited by 3 publications

References 16 publications

Assessing emerging causes of mitral regurgitation: atrial functional mitral regurgitation

Assessing emerging causes of mitral regurgitation: atrial functional mitral regurgitation

Ischemic mitral regurgitation: when should one intervene?

Transkatheterverfahren zur Behandlung der primären und sekundären Mitralklappeninsuffizienz. Wie sind die Ergebnisse in klinischen Studien?

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