As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to ...As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.展开更多
Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients...Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery.However,clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery.The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes.Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program.The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017.Since the initiation of the MitraClip program in 2015,the volume of both mitral valve replacement and mitral valve repair also increased(43 vs.60 and 110 vs.154,respectively).Importantly,we observed improved surgical outcomes,including fewer perioperative complications and lower operative mortality and in-hospital mortality.Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes.The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.展开更多
Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation pl...Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation play an important role in prediction of morbidity and mortality in patients on dialysis. Percutaneous mitral valve repair (MVR) with the MitraClip system, which has begun to be used in severe mitral insufficiency patients with multiple comorbid medical conditions, including renal disease, is a new, alternative method. This intervention is not associated with cardiopulmonary bypass, thus;it has been proven to be safe and effective in risky patients. In this report, we would like to share our anesthetic experience in successful mitral valve repair by MitraClip system in a patient who had undergone renal transplantation twice.展开更多
BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated ...BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated the temporal trend of patient characteristics and outcomes in comparison with the published randomized trials.AIM To investigate the temporal trend in baseline characteristics and outcomes of patients with secondary MR who underwent transcatheter edge-to-edge repair of the mitral valve in the real world compared with those from the published landmark trials.METHODS A comprehensive systematic literature search was conducted using MEDLINE,EMBASE,and CENTRAL databases,and the identified observational studies were divided into two five-year recruitment periods.The first period included 36 studies that enrolled patients between 2008 and 2012,and the second period included 25 studies that recruited patients between 2013 and 2017-2018.Pooled variables of each five-year recruitment period were compared with those of the landmark trials.A random-effects model was used for statistical comparisons.RStudio and RevMan software were used for the analysis.RESULTS Overall,there were no major variations in the findings between the first and the second five-year recruitment periods.EVEREST program vs observational studies:Patients in the EVEREST program were more likely to have non-ischemic MR etiology[odds ratio(OR)=3.59,95%confidence interval(CI):2.92-4.42]and atrial fibrillation(OR=1.71,95%CI:1.42-2.06).They were less likely to receive angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers(OR=0.72,95%CI:0.58-0.90)and implantable cardiac device(OR=0.41,95%CI:0.33-0.49)as well as less likely to be symptomatic at hospital presentation without a difference in MR grade≤2+or mortality at 12-month follow-up.COAPT trial vs observational studies:COAPT patients were more likely to have prior myocardial infarction(OR=1.62,95%CI:1.27-2.06)and renal insufficiency(OR=2.66,95%CI:2.05-3.45).They were more likely to receive beta-blockers(OR=2.54,95%CI:1.68-3.85)and an implanted cardiac device(OR=2.20,95%CI:1.71-2.84).There was no difference in procedure success or mortality.MITRA-FR trial vs observational studies:MITRA-FR patients were less likely to have atrial fibrillation(OR=0.49,95%CI:0.34-0.69)and renal insufficiency(OR=0.18,95%CI:0.11-0.28)but more likely to have a history of myocardial infarction(OR=1.48,95%CI:1.06-2.05)and to receive diuretics(OR=19.81,95%CI:2.75-142.48)and implantable cardiac devices(OR=1.69,95%CI:1.21-2.37).At hospital presentation,they were less likely to be symptomatic(OR=0.25,95%CI:0.18-0.35)without a difference in MR grades 3+and 4+.There was no difference in terms of MR grade or mortality at 12-month follow-up.CONCLUSION Patients in the landmark studies may have favourable or unfavourable characteristics when compared to those in the observational studies,but this did not translate into different outcomes over time.展开更多
BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-o...BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.展开更多
文摘As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.
文摘Surgical repair has been the standard therapy for severe mitral regurgitation causing symptoms or left ventricular dysfunction.Percutaneous mitral valve repair has become an appealing alternative approach for patients who are not suitable for surgery.However,clinical trial data are not available on the institutional impact of a percutaneous mitral valve repair program on mitral valve surgery.The current study retrospectively evaluated the impact of the MitraClip program on the mitral valve surgery volume and outcomes.Patient data were retrieved from the 2 years before and the 2 years after initiation of the MitraClip program.The volume of MitraClip procedures increased from eight cases in 2015 to 91 cases in 2017.Since the initiation of the MitraClip program in 2015,the volume of both mitral valve replacement and mitral valve repair also increased(43 vs.60 and 110 vs.154,respectively).Importantly,we observed improved surgical outcomes,including fewer perioperative complications and lower operative mortality and in-hospital mortality.Data from our single-institution experience indicate that the introduction of the MitraClip program is associated with increased mitral valve surgery volume and improved outcomes.The establishment of the MitraClip program enables the hospital to provide higher quality of care and potentially become a referring center for structural heart patients.
文摘Chronic renal failure is strongly related to poor outcomes, in cardiovascular system, such as: cardiac dilatation, left ventricular dysfunction and mitral valve regurgitation. Mitral calcification and regurgitation play an important role in prediction of morbidity and mortality in patients on dialysis. Percutaneous mitral valve repair (MVR) with the MitraClip system, which has begun to be used in severe mitral insufficiency patients with multiple comorbid medical conditions, including renal disease, is a new, alternative method. This intervention is not associated with cardiopulmonary bypass, thus;it has been proven to be safe and effective in risky patients. In this report, we would like to share our anesthetic experience in successful mitral valve repair by MitraClip system in a patient who had undergone renal transplantation twice.
文摘BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated the temporal trend of patient characteristics and outcomes in comparison with the published randomized trials.AIM To investigate the temporal trend in baseline characteristics and outcomes of patients with secondary MR who underwent transcatheter edge-to-edge repair of the mitral valve in the real world compared with those from the published landmark trials.METHODS A comprehensive systematic literature search was conducted using MEDLINE,EMBASE,and CENTRAL databases,and the identified observational studies were divided into two five-year recruitment periods.The first period included 36 studies that enrolled patients between 2008 and 2012,and the second period included 25 studies that recruited patients between 2013 and 2017-2018.Pooled variables of each five-year recruitment period were compared with those of the landmark trials.A random-effects model was used for statistical comparisons.RStudio and RevMan software were used for the analysis.RESULTS Overall,there were no major variations in the findings between the first and the second five-year recruitment periods.EVEREST program vs observational studies:Patients in the EVEREST program were more likely to have non-ischemic MR etiology[odds ratio(OR)=3.59,95%confidence interval(CI):2.92-4.42]and atrial fibrillation(OR=1.71,95%CI:1.42-2.06).They were less likely to receive angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers(OR=0.72,95%CI:0.58-0.90)and implantable cardiac device(OR=0.41,95%CI:0.33-0.49)as well as less likely to be symptomatic at hospital presentation without a difference in MR grade≤2+or mortality at 12-month follow-up.COAPT trial vs observational studies:COAPT patients were more likely to have prior myocardial infarction(OR=1.62,95%CI:1.27-2.06)and renal insufficiency(OR=2.66,95%CI:2.05-3.45).They were more likely to receive beta-blockers(OR=2.54,95%CI:1.68-3.85)and an implanted cardiac device(OR=2.20,95%CI:1.71-2.84).There was no difference in procedure success or mortality.MITRA-FR trial vs observational studies:MITRA-FR patients were less likely to have atrial fibrillation(OR=0.49,95%CI:0.34-0.69)and renal insufficiency(OR=0.18,95%CI:0.11-0.28)but more likely to have a history of myocardial infarction(OR=1.48,95%CI:1.06-2.05)and to receive diuretics(OR=19.81,95%CI:2.75-142.48)and implantable cardiac devices(OR=1.69,95%CI:1.21-2.37).At hospital presentation,they were less likely to be symptomatic(OR=0.25,95%CI:0.18-0.35)without a difference in MR grades 3+and 4+.There was no difference in terms of MR grade or mortality at 12-month follow-up.CONCLUSION Patients in the landmark studies may have favourable or unfavourable characteristics when compared to those in the observational studies,but this did not translate into different outcomes over time.
文摘BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.
