Catheter-based intervention for symptomatic patient with severe mitral regurgitation and very poor left ventricular systolic function - Safe but no room for complacency (original) (raw)
Related papers
The American Journal of Cardiology, 2003
The goal of this study was to examine the frequency of mitral regurgitation (MR) in patients with left ventricular (LV) systolic dysfunction and to relate its presence and severity to long-term survival. Remodeling of the left ventricle after myocyte injury leads to a progressive change in LV size and shape, and it may lead to the development of MR. The frequency of MR and its relation to survival in patients with LV systolic dysfunction has not been completely characterized. We analyzed the histories, coronary anatomy, and degree of MR in patients with symptomatic heart failure and LV ejection fraction <40% who underwent cardiac catheterization between 1986 and 2000. Cox's proportional hazards modeling was used to assess the independent effect of MR on survival. Two thousand fifty-seven patients met study criteria; MR was common in this cohort (56.2%).
An Intriguing Case Report of Functional Mitral Regurgitation Treated With MitraClip
Medicine, 2015
Functional mitral regurgitation (FMR) is frequent in patients with heart failure (HF). It develops as a consequence of left ventricle (LV) geometry alterations, causing imbalance between increased tethering forces and decreased closing forces exerted on the mitral valve apparatus during systole. FMR is known to change at rest and during effort, due to preloadafterload changes, myocardial ischemia, and/or LV dysfunction. Despite optimized medical therapy, an FMR can be responsible of shortness of breath limiting quality of life and decompensation. In this report, we present a case of dynamic FMR treated with MitraClip. MitraClip implantation is a successful and innovative opportunity for HF patients with FMR.
2018
Congestive heart failure (CHF) is one of the leading causes of cardiovascular hospitalizations and mortality. In the United States alone, there are more than 5.8 million patients affected and more than 23 million patients worldwide.1 This highly morbid condition carries a grim prognosis, with survival estimates of 50% at 5 years and 10% at 10 years.1 Among the many complications of endstage cardiomyopathy is functional mitral regurgitation (FMR), which affects nearly all heart failure patients to some degree and, once it presents, has a mean survival of 12 months.2 The pathophysiology of nonischemic MR is hypothesized to be due to progressive annular dilation from ventricular remodeling, leading to a spiral of volume overload, ventricular dilation, and further annular dilation. In FMR, this is caused by malcoaptation from progressive dilation and is a fundamental difference from ischemic MR. Historically, patients with CHF were medically managed with aggressive diuresis and with sur...
Value of MitraClip in Reducing Functional Mitral Regurgitation
US Cardiology Review
Patients with heart failure who have secondary severe mitral regurgitation due to left ventricular dysfunction have a poor prognosis, with high rates of rehospitalization and mortality. Percutaneous mitral valve repair using the MitraClip (Abbott) has been shown to be safe and effective in secondary severe mitral regurgitation with heart failure. The number of MitraClip procedures performed has increased significantly, as recently published large, randomized clinical studies have shown. However, these studies have drawn different conclusions. This review aims to summarize the current evidence for the MitraClip procedure and provide information for its safe and successful implementation, comparing the studies that examined the use of MitraClip versus medical therapy alone or surgical repair for severe secondary mitral regurgitation.
European Journal of Cardio-Thoracic Surgery, 2008
Objective: For asymptomatic patients with severe mitral regurgitation, guidelines recommend surgery in selected patients. However, little is known on how the current practice fits with guidelines. Methods: Of the 5001 patients prospectively included in the Euro Heart Survey on valvular heart disease, 877 had isolated mitral regurgitation and 546 had severe mitral regurgitation (grade !3/4 with Doppler echocardiography). Of them, 101 were asymptomatic and had non-ischaemic mitral regurgitation. The decision to refer the patients to surgery or not operate was analysed by comparing patient characteristics with American College of Cardiology/American Heart Association guidelines. Results: Coronary angiography was performed in 21 out of 33 patients (64%) who were considered for surgery. Catheterisation was performed in 27 patients (27%). A decision to operate was taken in 33 patients (33%). Decisions to refer to surgery or not were in accordance with guidelines in 63 patients (62%). Regarding discordant decisions, intervention was considered 'over-used' in 9 patients (9%) and 'under-used' in 29 patients (29%), of whom 24 had a class I or IIa indication for surgery. Of the 68 non-operated patients, 44 (65%) received at least one drug with haemodynamic effect. Conclusions: In asymptomatic patients with severe mitral regurgitation, preoperative coronary angiography seems under-used and cardiac catheterisation is frequently used. Regarding the decision to operate or not, a large number of patients were not referred to surgery even though they fulfilled recommendation for surgery. Thus, to avoid too late surgical referral, implementation of existing guidelines should be improved.
Indian pacing and electrophysiology journal, 2014
Right ventricular apical pacing may cause or worsen mitral regurgitation (MR). Potential mechanisms for this adverse sequelae include intraventricular dyssynchrony, altered papillary muscle function, pacing-induced cardiomyopathy with left ventricular dilation, and annular dilation. In contrast, biventricular (BiV) pacing may improve MR presumably by opposing the negative effects. Whether or not left ventricular lead location is important in treating mitral regurgitation in patients with pacemakers is unknown. We report a case of severe MR and left ventricular (LV) systolic failure in a patient with right ventricular pacing. Multiple potential etiologies for the worsening valve function were noted, and a stepwise iterative optimizing scheme that included basal lateral LV pacing improved mitral valve function and ameliorated heart failure symptoms.
JACC: Cardiovascular Imaging, 2021
OBJECTIVES This study aimed to identify a subset of patients based on echocardiographic parameters who might have benefited from transcatheter correction using the Mitraclip system in the MITRA-FR (Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) trial. BACKGROUND It has been suggested that differences in the degree of mitral regurgitation (MR) and left ventricular (LV) remodeling may explain the conflicting results between the MITRA-FR and the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trials. METHODS In a post hoc analysis, we evaluated the interaction between the intervention and subsets of patients defined based on MR severity (effective regurgitant orifice [ERO], regurgitant volume [RVOL] and regurgitant fraction [RF]), LV remodeling (end-diastolic and end-systolic diameters and volumes) and combination of these parameters with respect to the composite of death from any cause or unplanned hospitalization for heart failure at 24 months. RESULTS We observed a neutral impact of the intervention in subsets with the highest MR degree (ERO 30mm2,RVOL30 mm 2 , RVOL 30mm2,RVOL45 ml or RF 5050%) as in patients with milder MR degree. The same was seen in subsets with the milder LV remodeling using either diastolic or systolic diameters or volumes. When parameters of MR severity and LV remodeling were combined, there was still no benefit of the intervention including in the subset of patients with an ERO/enddiastolic volume ratio 50 0.15 despite similar ERO and LV end-diastolic volume compared with COAPT patients. CONCLUSIONS In the MITRA-FR trial, we could not identify a subset of patients defined based on the degree of the regurgitation, LV remodeling or on their combination, including those deemed as having disproportionate MR, that might have benefited from transcatheter correction using the Mitraclip system. (Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation [MITRA-FR]; NCT01920698).