Secondary Mitral Regurgitation in Heart Failure: Pathophysiology, Prognosis, and Therapeutic Considerations

Outcomes With Transcatheter Mitral Valve Repair in the United States: An STS/ACC TVT Registry Report.

Objectives The goal of this study was to compare survival between transcatheter mitral valve (MV) repair using MitraClip system (Abbott Vascular, Santa Clara, California), MV-surgery, and conservative treatment in high-surgical-risk patients symptomatic with severe mitral valve regurgitation (MR). Background Up to 50% of patients with symptomatic severe MR are denied for surgery due to high perioperative risk. Transcatheter MV repair might be an alternative. Methods Consecutive patients (n = 139) treated with transcatheter MV repair were included. Comparator surgically (n = 53) and conservatively (n = 59) treated patients were identified retrospectively. Surgical risk was based on the logistic European System for Cardiac Operative Risk Evaluation (log EuroSCORE) or the presence of relevant risk factors, as judged by the heart team. Results The log EuroSCORE was higher in the transcatheter MV repair group (23.9 ± 16.1%) than in the surgically (14.2 ± 8.9%) and conservatively (18.7 ± 13.2%, p  Conclusions Despite a higher log EuroSCORE, high-surgical-risk patients with symptomatic severe MR treated with transcatheter MV repair show similar survival rates compared with surgically treated patients, with both displaying survival benefit compared with conservative treatment.

Survival of transcatheter mitral valve repair compared with surgical and conservative treatment in high-surgical-risk patients.

Percutaneous mitral valve repair (PMVR) using the MitraClip System is feasible and entails clinical improvement even in patients with high surgical risk and severe functional mitral regurgitation (MR). The aim of this study was to assess survival rates and clinical outcome of patients with severe, functional MR treated with optimal medical therapy (OMT) compared with those who received MitraClip device. Sixty patients treated with OMT were compared with a propensity-matched cohort of 60 patients who underwent PMVR. Baseline demographics and echocardiographic variables were similar between the 2 groups. The mean age of patients was 75 years, and 67% were men. The median logistic EuroSCORE and EuroSCORE II were 17% and 6%, respectively, because of the presence of several co-morbidities. The mechanism of MR was functional in all cases with an ischemic etiology in 52% of patients. Median left ventricle ejection fraction was 34%. All the patients were symptomatic for dyspnea with 63% and 12% in the New York Heart Association class III and IV, respectively. In PMVR group, the procedure was associated with safety and very low incidence of procedural complications with no occurrence of procedural and inhospital mortality. After a median follow-up of 515 days (248 to 828 days), patients treated with PMVR demonstrated overall survival, survival freedom from cardiac death and survival free of readmission due to cardiac disease curves higher than patients treated conservatively (log-rank test p = 0.007, p = 0.002, and p = 0.04, respectively). In conclusion, PMVR offers a valid option for selected patients with high surgical risk and severe, functional MR and entails better survival outcomes compared with OMT.

Comparison of Percutaneous Mitral Valve Repair Versus Conservative Treatment in Severe Functional Mitral Regurgitation.

Background: Mitral regurgitation (MR) is the second most common valvular heart disease after aortic stenosis. Without intervention, prognosis is poor in patients with severe symptomatic MR. While surgical repair is recommended for many patients with severe degenerative MR (DMR), as many as 49% of patients do not qualify as they are at high surgical risk. Furthermore, surgical correction for functional MR (FMR) is controversial with suboptimal outcomes and significant perioperative mortality. The percutaneous MitraClip implantation can be seen as a viable option in high surgical risk patients. The purpose of this meta-analysis is to compare the safety, clinical efficacy, and survival outcomes of MitraClip implantation with surgical correction of severe MR. Methods: Six electronic databases were searched for original published studies from January 2000 to August 2013. Two reviewers independently appraised studies, using a standard form, and extracted data on methodology, quality criteria, and outcome measures. All data were extracted and tabulated from the relevant articles’ texts, tables, and figures and checked by another reviewer. Results: Overall 435 publications were identified. After applying selection criteria and removing serial publications with accumulating number of patients or increased length of follow-up, four publications with the most complete dataset were included for quality appraisal and data extraction. There was one randomized controlled trial (RCT) and three prospective observational studies. At baseline, patients in the MitraClip group were significantly older (P=0.01), had significantly lower LVEF (P=0.03) and significantly higher EuroSCORE (P 2 was significantly higher in the MitraClip group compared to the surgical group (17.2% vs. 0.4%; P<0.0001). 30-day mortality was not statistically significant (1.7% vs. 3.5%; P=0.54), nor were neurological events (0.85% vs. 1.74%; P=0.43), reoperations for failed MV procedures (2% vs. 1%; P=0.56), NYHA Class III/IV (5.7% vs. 11.3; P=0.42) and mortality at 12 months (7.4% vs. 7.3%; P=0.66).
 Conclusions: Despite a higher risk profile in the MitraClip patients compared to surgical intervention, the clinical outcomes were similar although surgery was more effective in reducing MR in the early post procedure period. We conclude the non-inferiority of the MitraClip as a treatment option for severe, symptomatic MR in comparison to conventional valvular surgery.

/pdf/a-meta-analysis-of-mitraclip-system-versus-surgery-for-1vjvlieb2i.pdf

A meta-analysis of MitraClip system versus surgery for treatment of severe mitral regurgitation

OBJECTIVES
Surgical mitral repair is the conventional treatment for severe symptomatic functional mitral regurgitation (FMR). Mitraclip therapy is an emerging option for selected high-risk patients with FMR. The aim of this study was to report the outcomes of patients who underwent a surgical mitral repair and Mitraclip therapy for FMR in our experience.


METHODS
From March 2000 and April 2011, 143 patients with FMR were treated in our institution: 91 patients (63.6%) underwent surgical mitral repair (49% ischaemic; 51% idiopathic) and 52 (36.4%) underwent Mitraclip implantation (71% ischaemic; 29% idiopathic). Associated procedures in the surgical group were myocardial revascularization in 35%, tricuspid repair in 25% and atrial fibrillation ablation in 26%. Follow-up was 100% complete (median 18; 6.4-45 months for surgery and 8.5; 4-12 months for Mitraclip).


RESULTS
Mitraclip patients were older (P = 0.04), had higher log EuroSCORE (P < 0.0001), lower LVEF (P = 0.006) and higher left ventricular diameter (P = 0.01 for left ventricular end-diastolic diameter and P = 0.05 for left ventricular end-systolic diameter). Major postoperative infection or sepsis occurrence was higher in the surgical group (16.3 vs. 3.8%; P = 0.01), while no differences were observed in terms of acute renal failure, cardiogenic shock, cerebrovascular accident and acute myocardial infarction. Length-of-stay was 11 days (IQR: 7-19 days) for surgery and 5 days (IQR: 4-9 days) for MitraClip (P < 0.0001). In-hospital mortality was 6.6% for surgery (6/91) and 0% for Mitraclip (P = 0.01). Surgery was identified as a predictor of in-hospital death (OR: 2.61; P = 0.01). Residual MR ≥ 3+ at discharge was 0% for surgery and 9.6% for Mitraclip (P = 0.002). At follow-up, actuarial survival at 1 year was 88.9 ± 3.5% for surgery and 87.5 ± 7% for Mitraclip (P = 0.6). Actuarial freedom from MR ≥ 3+ at 1 year was 79.1 ± 8% for MitraClip and 94 ± 2% for surgery (P = 0.01). At last follow-up, most of the survivors were in NYHA class I-II.


CONCLUSIONS
Mitraclip therapy is a safe therapeutic option in selected high-risk patients with FMR, and it is associated with a lower hospital mortality and shorter length-of-stay compared with surgery, in spite of worse preoperative conditions. Early and 1-year rates of recurrent MR are higher with Mitraclip. Further studies are needed to determine the long-term clinical impact.

Mitraclip therapy and surgical mitral repair in patients with moderate to severe left ventricular failure causing functional mitral regurgitation : a single-centre experience CONFERENCE DISCUSSION

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Taramasso

Author Tools

Chat about Author

Papers

Mitraclip therapy and surgical mitral repair in patients with moderate to severe left ventricular failure causing functional mitral regurgitation : a single-centre experience CONFERENCE DISCUSSION