Prognostic Markers in Transcatheter Mitral Valve Repair

The Mitraclip procedure is at present the most widely available method for transcatheter correction of severe mitral regurgitation (MR). The efficacy and the safety of the device has been evaluated in the EVEREST II randomized control study1 (head to head comparison with traditional surgical repair or replacement of the mitral valve) and although not as effective in abolishing MR, it provided significant improvement in functional class, along with evidence of favorable ventricular remodeling and with low perioperative morbidity and mortality.

Next Generation Transcatheter Aortic Valve Systems: the PorticoTM Valve

Transcatheter aortic valve replacement (TAVR) is currently considered a valuable alternative for the treatment of severe symptomatic aortic stenosis patients who are inoperable or at excessively high surgical risk

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)-35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF \u3c 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p = 0.51 and 19% vs. 12%, p = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded

Hemodynamic and biochemical changes after transcatheter treatment of valvular heart disease

The transcatheter aortic valve replacement for severe aortic stenosis is a major breakthrough in structural interventional cardiology. The implantation of an aortic bioprosthesis in the beating heart represents a unique state from a pathophysiology point of view. The aim of this dissertation was to describe the hemodynamic and biochemical changes observed after successful transcatheter aortic valve replacement. More specifically, with the use of a pulmonary artery catheter multiple hemodynamic variables were recorded before and at 6 and 24 hours post valve implantation. In addition, left ventricular hemodynamics were assessed before, and immediately after, successful implantation. Furthermore, during the index hospitalization, the impact on biochemical markers was also studied. These included markers of kidney function, markers of myocardial injury, changes in natriuretic peptides and finally changes in platelet counts.Η διακαθετηριακή αντικατάσταση της αορτικής βαλβίδας για την αντιμετώπιση της σοβαρής αορτικής στένωσης αποτελεί επίτευγμα της σύγχρονης επεμβατικής καρδιολογίας. Η εμφύτευση βιοπροσθετικής αορτικής βαλβίδας σε πάλλουσα καρδιά είναι μοναδική, από άποψη παθοφυσιολογίας, κατάσταση. Σκοπός της διατριβής η περιγραφή των μεταβολών σε αιμοδυναμικές και βιοχημικές παραμέτρους που παρατηρούνται μετά την επιτυχή διαδερμική εμφύτευση αορτικής βαλβίδας. Ειδικότερα μελετήθηκαν με καθετήρα πνευμονικής αρτηρίας αιμοδυναμικές μεταβλητές πριν την εμφύτευση, και εν συνεχεία στις 6 ώρες και στις 24 ώρες μετά. Περαιτέρω μελετήθηκαν με καθετήρα εντός της αριστερής κοιλίας τα αιμοδυναμικά δεδομένα πριν και αμέσως μετά την εμφύτευση της βιοπρόθεσης. Σε ότι αφορά στις βιοχημικές εν γένει μεταβολές μελετήθηκαν (κατά τη διάρκεια της νοσηλείας) οι δείκτες της νεφρικής λειτουργίας, οι δείκτες μυοκαρδιακής βλάβης, οι μεταβολές στα νατριουρητικά πεπτίδια και οι μεταβολές στον αριθμό των αιμοπεταλίων

Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction.

AIMS  Severe mitral regurgitation (MR) following acute myocardial infarction (MI) is associated with high mortality rates and has inconclusive recommendations in clinical guidelines. We aimed to report the international experience of patients with secondary MR following acute MI and compare the outcomes of those treated conservatively, surgically, and percutaneously. METHODS AND RESULTS  Retrospective international registry of consecutive patients with at least moderate-to-severe MR following MI treated in 21 centres in North America, Europe, and the Middle East. The registry included patients treated conservatively and those having surgical mitral valve repair or replacement (SMVR) or percutaneous mitral valve repair (PMVR) using edge-to-edge repair. The primary endpoint was in-hospital mortality. A total of 471 patients were included (43% female, age 73 ± 11 years): 205 underwent interventions, of whom 106 were SMVR and 99 PMVR. Patients who underwent mitral valve intervention were in a worse clinical state (Killip class ≥3 in 60% vs. 43%, P < 0.01), but yet had lower in-hospital and 1-year mortality compared with those treated conservatively [11% vs. 27%, P < 0.01 and 16% vs. 35%, P < 0.01; adjusted hazard ratio (HR) 0.28, 95% confidence interval (CI) 0.18-0.46, P < 0.01]. Surgical mitral valve repair or replacement was performed earlier than PMVR [median of 12 days from MI date (interquartile range 5-19) vs. 19 days (10-40), P < 0.01]. The immediate procedural success did not differ between SMVR and PMVR (92% vs. 93%, P = 0.53). However, in-hospital and 1-year mortality rates were significantly higher in SMVR than in PMVR (16% vs. 6%, P = 0.03 and 31% vs. 17%, P = 0.04; adjusted HR 3.75, 95% CI 1.55-9.07, P < 0.01). CONCLUSIONS  Early intervention may mitigate the poor prognosis associated with conservative therapy in patients with post-MI MR. Percutaneous mitral valve repair can serve as an alternative for surgery in reducing MR for high-risk patients