scholarly journals Change in Invasively Measured Mean Pulmonary Artery Pressure After Transcatheter Mitral Valve Repair Is Associated With Heart Failure Readmission

2021 ◽  
Vol 12 (5) ◽  
pp. 302-308
Author(s):  
David M. Tehrani ◽  
Jiexi Wang ◽  
Parntip Lai ◽  
Pooja S. Desai ◽  
Heajung L. Nguyen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Artery Pressure ◽  
Transcatheter Mitral Valve Repair ◽  
Mean Pulmonary Artery Pressure

Abstract 14830: Edge-to-edge Transcatheter Mitral Valve Repair is Associated With Lower Pulmonary Artery Pressure in Cardiomems TM -monitored Patients With Heart Failure and Mitral Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David Shavelle ◽  
J Thomas T Heywood ◽  
Ajay Srivastava ◽  
Rahul Agarwal ◽  
Julie Prillinger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Additional Tool ◽  
Artery Pressure ◽  
Transcatheter Mitral Valve Repair

Introduction: Transcatheter mitral valve repair (TMVr) reduces heart failure (HF) hospitalizations and improves survival in patients with HF and secondary mitral regurgitation (MR), but the hemodynamics of TMVr are not well studied. Patients with a pulmonary artery pressure (PAP) monitor (CardioMEMS TM ) provide a unique opportunity to study ambulatory hemodynamics following TMVr. Methods: TMVr implants occurring July 2014 to Sept 2019 were identified from Medicare claims data and were linked to PAP data from CardioMEMS TM . Patients with CardioMEMS TM implant ≥3 mo prior to TMVr and with ≥3 mo PAP data post TMVr were included. Diastolic PAP (DPAP) and area under the curve (AUC) at 3 and 6 mo post TMVr were compared to 4 wks prior to TMVr (baseline). Analysis was repeated for those with elevated baseline DPAP, defined as ≥15 mmHg. Results: The cohort included 32 patients (74 ± 8 yrs, 66% male) with high prevalence of hypertension, ischemic heart disease, AF, and kidney disease. LVEF was available in 17 patients (32 ± 14%). Compared to baseline, DPAP was significantly lower at 3 mo (-2.1 ± 4.7 mmHg, p=0.019) and remained lower at 6 mo post TMVr (-2.5 ± 6.7 mmHg, p=0.070). AUC showed a cumulative reduction in DPAP of -129 ± 257 mmHg-days (p=0.008) at 3 mo and -438 ± 719 mmHg-days (p=0.005) at 6 mo post TMVr. Similar trends were observed for mean PAP. Sub-group analyses suggested lower DPAP after TMVr in patients with elevated baseline DPAP (3 mo Δ: -2.6 ± 4.6 mmHg, p=0.009; 6 mo Δ: -3.8 ± 6.3 mmHg, p=0.014, 3 mo AUC: -158 ± 255 mmHg-day, p=0.004; 6 mo AUC: -575 ± 721 mmHg-day, p=0.002). Conclusions: In CardioMEMS TM -monitored patients with significant MR, TMVr is associated with a clinically relevant and sustained reduction in DPAP, including patients with an elevated baseline DPAP. Although the clinical and survival benefits of TMVr are paramount, these data add to our understanding of the hemodynamic improvements of TMVr. CardioMEMS TM is an additional tool to improve filling pressures in those with HF.

scholarly journals Transcatheter Mitral-Valve Repair in Patients with Heart Failure

2018 ◽  
Vol 379 (24) ◽  
pp. 2307-2318 ◽  
Author(s):  
Gregg W. Stone ◽  
JoAnn Lindenfeld ◽  
William T. Abraham ◽  
Saibal Kar ◽  
D. Scott Lim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Patients With Heart Failure

scholarly journals Mitral Regurgitation International Database (MIDA) Score Predicts Outcome in Patients With Heart Failure Undergoing Transcatheter Edge‐to‐Edge Mitral Valve Repair

2021 ◽  
Author(s):  
Refik Kavsur ◽  
Maximilian Spieker ◽  
Christos Iliadis ◽  
Clemens Metze ◽  
Moritz Transier ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Rank Test ◽  
International Database ◽  
Valve Repair ◽  
Log Rank Test ◽  
Transcatheter Mitral Valve Repair

Background Optimizing risk stratification in patients undergoing transcatheter mitral valve repair is an ongoing challenge. The Mitral Regurgitation International Database (MIDA) score represents a user‐friendly mortality risk stratification tool that is validated on a large‐scale registry of patients with degenerative mitral regurgitation (MR). We here assessed the potential benefit of the MIDA risk score for patients with functional or degenerative MR undergoing transcatheter mitral valve repair. Methods and Results In total, 680 patients undergoing MitraClip implantation were stratified according to MIDA score tertiles into a low (0–7), intermediate (8–9), and a high (10–12) MIDA score group. MR was assessed in follow‐up echocardiograms in 416 patients at 323±169 days after transcatheter mitral valve repair. During 2‐year follow‐up, 8.2% (15/182) of patients with low, 21.3% (64/300) with intermediate, and 26.3% (52/198) with high MIDA score died (log‐rank test P <0.001). Hazard of all‐cause mortality increased by 13% (95% CI, 3%–25%) with every additional point of the MIDA score. Subanalysis of 431 patients with functional MR showed similar results. Furthermore, rates of a combined end point of mortality and hospitalization for heart failure were higher with increasing MIDA score (30% [54/182], 38% [113/300] and 48% [94/198], respectively, log‐rank test P =0.001). Frequency of residual MR ≥II at follow‐up increased with increasing MIDA score group (33%, 44%, and 59%, respectively, P <0.001). Conclusions The MIDA mortality risk score maintains its predictive utility in patients undergoing transcatheter mitral valve repair, regardless of MR cause. Moreover, it was predictive of worse event‐free survival regarding a combined end point of mortality and hospitalization for heart failure, and was associated with postprocedural residual MR ≥II and MR recurrence.

scholarly journals Transcatheter Mitral Valve Repair in Patients with Heart Failure: A Meta-Analysis

Cardiology ◽  
2020 ◽  
pp. 1-7
Author(s):  
Ajay Vallakati ◽  
Ayesha K Hasan ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Valve Repair ◽  
Heart Failure Patients ◽  
Transcatheter Mitral Valve Repair ◽  
Secondary Mr

<b><i>Background:</i></b> Severe secondary mitral regurgitation (MR) is associated with poor prognosis in heart failure patients with left ventricular systolic dysfunction. Few observational and randomized controlled studies demonstrated the efficacy of transcatheter mitral valve repair in heart failure patients with significant MR. A meta-analysis of published studies was performed to evaluate the role of transcatheter mitral valve repair using the MitraClip device in heart failure patients with significant secondary MR. <b><i>Methods:</i></b> A literature search was performed using PubMed, Cochran CENTRAL, and Embase databases using the search terms “percutaneous mitral valve repair” or “transcatheter mitral valve repair” and “heart failure.” Studies that compared medical therapy plus transcatheter mitral valve repair using MitraClip to medical therapy alone in heart failure patients with significant secondary MR were included for pooled analysis. A random-effects model with the Mantel-Haenszel method was used to analyze the data. <b><i>Results:</i></b> Four studies, 2 randomized controlled and 2 nonrandomized studies met the criteria for analysis. Pooled analysis included a total of 1,421 patients, of which 746 patients underwent transcatheter mitral valve repair and 675 patients received medical therapy alone. When compared to medical therapy, transcatheter mitral valve repair significantly decreased all-cause mortality (OR 0.58, 95% CI 0.37–0.91; <i>p</i> = 0.02). A trend toward significant reduction in rehospitalizations (OR 0.35, 95% CI 0.12–1.00; <i>p</i> = 0.05) was also observed. Periprocedural complications ranged from 7.5 to 12.6%. <b><i>Conclusion:</i></b> Evidence from pooled analysis suggests that transcatheter mitral valve repair using MitraClip on top of medical therapy, in appropriately selected symptomatic heart failure patients with significant secondary MR, provides survival benefit and may decrease hospitalizations when compared with guideline-directed medical therapy alone.

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