Courtesy of Dr. Carlos Fava. Severe or moderate mitral regurgitation is associated to worse evolution after TAVR. However, we should not forget the tricuspid valve that, even though not extensively researched, is also associated to a negative impact in its evolution. A meta-analysis of 12 studies with a total 41485 patients was carried out. …
Mitral Valve Repair with MirtaClip Was Feasible and Safe
Transcatheter mitral valve repair (TMVR) with MitraClip was shown feasible and safe, and therefore a viable option for symptomatic patients with severe mitral valve regurgitation of prohibitive risk. In this regard, the procedure alleviates symptoms, cardiac regurgitation and has a potential benefit on ventricular remodeling. However, many patients presented atrial fibrillation (AF) and mitral valve…
Good Outcomes for MitraClip “Off Label”
Courtesy of Dr. Carlos Fava. Mitral regurgitation is the most frequent type of valve disease, accounting for >6% of patients over 65 years old. Surgery is currently the strategy of choice, but percutaneous treatment is a valid alternative. The long-term progress of symptomatic patients at high surgical risk who do not meet the formal indications for…
Continuous Monitoring of Left Atrial Pressure during MitraClip, Regardless Echocardiography
The aim of this study was to assess the use of measuring left atrial pressure to complement transesophageal echocardiography and doppler imaging. Procedure efficacy is measured in the cath lab by echocardiography. However, these measurements are operator dependent and might be influenced by left ventricular function and changes in left atrial compliance. The study…
TCT 2018 | COAPT: MitraClip in Patients with Secondary Mitral Regurgitation
The prognosis of patients with heart failure and mitral regurgitation secondary to ventricular dysfunction and dilation is guarded. Percutaneous mitral valve treatment of these patients may at least improve their symptoms. This study was conducted in 78 sites in the United States and Canada, and included patients with moderate-to-severe (3+) or severe (4+) mitral regurgitation who…
TCT 2018 | REDUCE-FMR: Indirect Annuloplasty in Secondary Mitral Regurgitation
Prior studies such as the AMADEUS, TITAN or TITAN II have shown reduction of mitral valve regurgitation (MR) with the Carillon device. This sham-controlled randomized study tested the efficacy of this device in secondary mitral regurgitation. Primary end point was echocardiographic MR reduction (blind core lab) and secondary end point were hospitalization for cardiac failure,…
Mitral Valve Repair in Patients with Cardiac Failure
The mitral valve is a complex apparatus dependent on left atrium and left ventricle functionality. Dilation of these cavities might affect mitral annulus morphology and lead to valve dysfunction, generating mitral regurgitation (MR). This type of MR has been called functional, since leaflets and tendinous chordae do not present lesions themselves; instead, they malfunction ‘secondary’…
Surgical Redo Mitral Valve Replacement vs. Valve-in-Valve in Failed Bioprosthetic Valves
Despite their higher surgical risk, patients who underwent transcatheter mitral valve replacement (TMVR) presented 1-year mortality rates similar to those of patients who had redo surgical mitral valve replacement for bioprosthetic valve failure. At one month, echocardiographic findings were similar; however, at one year, patients who underwent TMVR presented a gradient increase that had no…
MITRA-FR: Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation
Courtesy of Dr. Adolfo Ferrero. INTRODUCCION: In patients with chronic heart failure and reduced left ventricular ejection fraction, severe secondary mitral valve regurgitation is associated with bad prognosis. Whether percutaneous mitral valve repair improves clinical results in this patient population, remains unclear, despite prior multicenter studies supporting this view. METHODS: Patients with severe secondary mitral…
ESC 2018 | MITRA FR: Testing MitraClip for Secondary Mitral Regurgitation
Courtesy of Dr. Carlos Fava. In secondary mitral regurgitation, mitral-valve leaflets and chordae are structurally normal and mitral regurgitation results from alterations in left ventricular geometry and function. At present, prognosis is based on ventricular function and the regular course of action is optimal medical treatment. Even though some studies have shown edge-to-edge percutaneous repair…
Balloon Mitral Valvuloplasty at Very Long Term
With a mean follow up of 15 years, and some patients that survived over 20 years, this study shows that more than 75% of patients with rheumatic mitral stenosis show sustained results with balloon valvuloplasty. Predictors of this excellent long-term outcome are many, but they are determined mainly by age, prior symptoms and valve area…