scholarly journals Mitraclip therapy in patients with functional mitral regurgitation and missing leaflet coaptation: is it still an exclusion criterion?

2016 ◽  
Vol 18 (10) ◽  
pp. 1278-1286 ◽  
Author(s):  
Marianna Adamo ◽  
Ermanna Chiari ◽  
Salvatore Curello ◽  
Cristian Maiandi ◽  
Giuliano Chizzola ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Exclusion Criterion ◽  
Leaflet Coaptation ◽  
Mitraclip Therapy

scholarly journals The acute haemodynamic effect of the MitraClip therapy: afterload mismatch evaluation in functional mitral regurgitation

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P5383-P5383 ◽  
Author(s):  
G. Melisurgo ◽  
S. Ajello ◽  
M. Kawaguchi ◽  
A. Latib ◽  
O. Alfieri ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Haemodynamic Effect ◽  
Functional Mitral Regurgitation ◽  
Mitraclip Therapy

Functional and Degenerative Mitral Regurgitation: One Ring Fits All?

2019 ◽  
Vol 68 (06) ◽  
pp. 470-477
Author(s):  
Konstantinos Sideris ◽  
Johannes Boehm ◽  
Bernhard Voss ◽  
Thomas Guenther ◽  
Ruediger S. Lange ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Three Dimensional ◽  
Cumulative Risk ◽  
Functional Mitral Regurgitation ◽  
Combined Procedures ◽  
Echocardiographic Assessment ◽  
Leaflet Coaptation ◽  
Mid Term Results

Abstract Background Three-dimensional saddle-shaped annuloplasty rings have been shown to create a larger surface of leaflet coaptation in mitral valve repair (MVR) for functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR) which may increase repair durability. For the first time, this study reports mid-term results after MVR for DMR and FMR using a rigid three-dimensional ring (Profile 3D, Medtronic). Methods Between June 2009 and June 2012, 369 patients with DMR (n = 326) or FMR (n = 43) underwent MVR (mean age 62.3 ± 12.6 years). A total of 205 patients (55.6%) underwent isolated MVR and 164 patients (44.4%) a combined procedure. Follow-up examinations were performed in 94.9% (mean 4.9 ± 0.9 years). Echocardiographic assessment was complete in 93.2% (mean 4.3 ± 1.2 years). Results The 30-day mortality was 1.5% (5/326) for DMR (1.5% for isolated and 1.6% for combined procedures) and 9.3% (4/43) for FMR (0% for isolated and 10.5% for combined procedures). Survival at 6 years was 92.1 ± 1.9% for DMR (92.9 ± 2.6% for isolated and 90.7 ± 2.7% for combined procedures) and 66.4 ± 7.9% for FMR (80.0 ± 17.9% for isolated and 63.7 ± 8.9% for combined procedures). Cumulative risk for mitral valve-related reoperation at 6 years was 0% for FMR and 7.1 ± 1.5% for DMR. At echocardiographic follow-up, one patient presented with mitral regurgitation (MR) more than moderate. The only predictor of recurrent MR after MVR for DMR was residual mild MR at discharge. Conclusion Repair of FMR with the three-dimensional Profile 3D annuloplasty ring shows excellent mid-term results with regard to recurrence of MR. In cases of DMR, the results are conforming to the current literature.

The impact of residual mitral regurgitation after MitraClip therapy in functional mitral regurgitation

2020 ◽  
Vol 22 (10) ◽  
pp. 1840-1848 ◽  
Author(s):  
Daniel Reichart ◽  
Daniel Kalbacher ◽  
Nicole Rübsamen ◽  
Eike Tigges ◽  
Christina Thomas ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
The Impact ◽  
Mitraclip Therapy

Severe Functional Mitral Regurgitation with Missing Leaflet Coaptation

2012 ◽  
pp. 443-447
Author(s):  
Antti Saraste ◽  
Juha Lund ◽  
Markku Saraste ◽  
Matti Luotolahti ◽  
Juhani Airaksinen ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Leaflet Coaptation

scholarly journals P1364 Contractile reserve predicts reverse remodelling after successful percutaneous mitral valve repair in patients with functional mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Mortelmans ◽  
P Debonnaire ◽  
B P Paelinck ◽  
D De Bock ◽  
P Coussement ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Functional Mitral Regurgitation ◽  
Contractile Reserve ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
Reverse Remodelling ◽  
Mitraclip Therapy

Abstract Background Recent randomised trials have shown conflicting results regarding the usefulness of percutaneous mitral valve repair using MitraClip in patients with severe functional mitral regurgitation (FMR). At present, it remains unclear whether patients with FMR and advanced heart failure might benefit from MitraClip therapy. Moreover, it has been shown that left ventricular reverse remodelling (LVRR) post-MitraClip is associated with a favourable outcome. Purpose We sought to assess whether baseline contractile reserve (CR) can predict LVRR and improvement of LV ejection fraction (EF) in FMR patients undergoing MitraClip therapy. Methods Consecutive patients with symptomatic severe FMR referred for MitraClip were recruited in two tertiary centres. All patients were scheduled for a semi-supine bicycle exercise echocardiography before and 6 months after the intervention. Patients who were not able to perform an exercise test and who did not complete 6 month follow up were excluded from further analysis. Baseline CR was obtained by subtracting peak exercise LVEF from LVEF at rest. LVRR was defined as a 10% decrease in LV end systolic volume (ESV) at follow-up. Results 34 patients completed 6 month follow up (61% male, age 71 ± 10 years, LVEF 32 ± 8%). LVRR was observed in 15 patients (44%). We found a trend towards a moderate correlation between baseline CR and relative decrease in LVESV at 6 months (Pearson Rho -0.321, p = 0.064). This correlation became significant in a sub-analysis considering only patients with post-procedural FMR grade ≤2 (n = 27; Pearson Rho -0.444, p = 0.020). In contrast, LVRR was not related to baseline LVEF, LV dimensions or volumes. Furthermore, baseline CR was strongly correlated with an increase of LVEF at 6 months post-MitraClip in these patients (Pearson Rho 0.653, p < 0.001). Conclusion CR predicts LVRR and improvement of LVEF in patients with FMR after successful MitraClip therapy (reduction of FMR towards grade ≤2), in contrast to resting indices of LV dysfunction and dilatation. More studies with outcome data are needed to determine whether CR is a useful parameter to identify patients with FMR who might benefit from MitraClip therapy.

EFFECT OF PAPILLARY MUSCLE DISPLACEMENT AND ANNULAR DILATION ON DEVELOPMENT OF FUNCTIONAL MITRAL REGURGITATION

2018 ◽  
Vol 18 (07) ◽  
pp. 1840020
Author(s):  
WOOJAE HONG ◽  
HYUNGGUN KIM
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Lv Dysfunction ◽  
Simulation Based ◽  
Normal Human ◽  
Biomechanical Evaluation ◽  
Normal Mitral Valve ◽  
Annular Dilation ◽  
Leaflet Coaptation

Functional mitral regurgitation (FMR) occurs following left ventricle (LV) dysfunction with normal mitral valve (MV) leaflet. The progress and severity of FMR are closely related to LV dilatation, which often results in displacement of the papillary muscles (PMs) and enlargement of the mitral annulus. We investigated the effect of PM displacement and annular dilation on FMR development to better understand the complex intercorrelation between these pathologic alterations leading to FMR. Virtual MV modeling was performed to create a normal human MV, and several different types of PM displacement, annular dilation, and the combination of PM displacement and annular dilation mimicking the pathology of FMR were modeled. Dynamic finite element evaluation of MV function was performed across the complete cardiac cycle for the normal and FMR MV models. PM displacement to both lateral and apical directions revealed markedly reduced leaflet coaptation and large stress distribution in the P2 scallop. Annular dilation greater than 2% demonstrated the occurrence of leaflet malcoaptation and increased stresses near the anterior saddle-horn region. The pathologic MV model with annular dilation combined with PM displacement provides physiologically realistic biomechanical characteristics as the MVs having FMR. Simulation-based biomechanical evaluation of MV pathology related to LV chamber dilatation provides an excellent tool to better understand the pathophysiologic mechanism of FMR.

Anesthesiological Management in Transcatheter Mitral Valve Repair With MitraClip: Beyond the EVEREST Criteria

2019 ◽  
Vol 23 (4) ◽  
pp. 413-417 ◽  
Author(s):  
Paola Elvira Mocavero ◽  
Enrico Melillo ◽  
Clelia Esposito ◽  
Luigi Ascione ◽  
Mario Crisci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Therapeutic Option ◽  
Functional Mitral Regurgitation ◽  
Exclusion Criterion ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
Left Ventricle Remodeling ◽  
Procedural Success

Percutaneous mitral valve repair with the MitraClip system recently emerged as a viable and less invasive therapeutic option in patients with severe mitral regurgitation deemed to be high-risk surgical candidates. Mitral valve morphology and geometry features are key elements for MitraClip eligibility. In the setting of functional mitral regurgitation, the presence of a leaflet coaptation gap due to advanced left ventricle remodeling can be a potential exclusion criterion for MitraClip therapy. In this article, the authors present a case of successful MitraClip implantation in a patient with severe functional mitral regurgitation and a significant coaptation gap. Periprocedural and intraoperative pharmacological and anesthesiological management were fundamental for successful grasping and procedural success.

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