scholarly journals Transcatheter Mitral Valve Replacement: Current Evidence and Concepts

2021 ◽  
Vol 16 ◽  
Author(s):  
Ozan M Demir ◽  
Mhairi Bolland ◽  
Jonathan Curio ◽  
Lars Søndergaard ◽  
Josep Rodés-Cabau ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ease Of Use ◽  
Current Evidence ◽  
Efficacy And Safety ◽  
The Past ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk ◽  
Transcatheter Devices ◽  
High Level ◽  
Level Of Experience

Over the past decade, several transcatheter devices have been developed to address the treatment of severe mitral regurgitation (MR) in patients at high surgical risk, mainly aimed at repairing the native mitral valve (MV). MV repair devices have recently been shown to have high efficacy and safety. However, to replicate promising trial results, specific anatomical and pathophysiological criteria have to be met and operators need a high level of experience. As yet, the longer-term durability of transcatheter MV repair remains unknown. Transcatheter MV replacement (TMVR) might be a treatment option able to target various anatomies, reliably abolish MR, and foster ease of use with a standardised implantation protocol. This review presents upcoming TMVR devices and available data and discusses how TMVR might further advance the field of transcatheter treatment of MR

scholarly journals Acute and Short-Term Outcomes of Percutaneous Transcatheter Mitral Valve Replacement in Children

2021 ◽  
Author(s):  
Nicola Maschietto ◽  
Ashwin Prakash ◽  
Pedro del Nido ◽  
Diego Porras
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Pediatric Patients ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Surgical Risk ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk ◽  
Valve In Valve

Background: Despite the improvement of surgical techniques for mitral valve (MV) repair in children, mitral valve replacement (MVR) is sometimes still necessary. MVR and redo-MVR continue to be burdened by early postoperative mortality and long-term morbidity with only about 75% of these patients being alive or transplant-free 10 years after the initial MVR. Although transcatheter MVR (TMVR) is a well-established intervention in high surgical risk adults, only a few pediatric valve-in-valve case reports have been published. The purpose of this study was to describe our initial experience with the off-label use of the Sapien S3 valve for TMVR in a highly selected pediatric patient population. Methods: We conducted a retrospective analysis of pediatric patients who underwent TMVR at Boston Children’s Hospital between October 2018 and July 2020. Results: Eight consecutive high surgical risk pediatric patients (median age, 9 years; range, 8–15) underwent TMVR (7 as valve-in-valve, 1 in a native MV). Each patient previously underwent multiple MV surgeries or MVR (median 4, range 2–5) and was highly symptomatic (Ross functional class 3 or 4). The indication for TMVR was mitral stenosis in 4 patients, regurgitation in 1, and mixed disease in 3. TMVR was successful in each patient, effectively reduced the left atrium and pulmonary hypertension ( P =0.012 and 0.043 respectively), and was carried out without significant complications. Conclusions: TMVR is an attractive alternative to MVR in high surgical risk patients. In this small series, TMVR was acutely effective and safe, with very encouraging early results.

scholarly journals Transcatheter Mitral Valve Devices – Functional Mechanical Designs

2011 ◽  
Vol 9 (1) ◽  
pp. 49 ◽  
Author(s):  
Chad Kliger ◽  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
High Risk Patient ◽  
Efficacy And Safety ◽  
Invasive Treatment ◽  
Complex Disorder ◽  
Transcatheter Mitral Valve Replacement ◽  
Suitable Treatment ◽  
Valve In Valve ◽  
Mitral Apparatus

Mitral regurgitation is a complex disorder involving a multitude of components of the mitral apparatus. With the desire for less invasive treatment approaches, transcatheter mitral valve therapies (TMVT) are directed at these components and available at varying stages of development. Therapeutic advancements and the potential to combine technologies may further improve their efficacy and safety. Transcatheter mitral valve replacement, while preserving the mitral apparatus, may emerge as an alternative or even a more suitable treatment option. In addition, early data on transcatheter mitral valve-in-valve and valve-in-ring implantation are encouraging and this approach may be an alternative to reoperation in the high-risk patient. This review details the expanding functional mechanical designs of current active TMVT.

scholarly journals Transcatheter Mitral Valve Replacement and Thrombosis: A Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Guido Ascione ◽  
Paolo Denti
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Anticoagulation Therapy ◽  
Unmet Need ◽  
Left Ventricular ◽  
Current Evidence ◽  
Thrombotic Risk ◽  
Transcatheter Mitral Valve Replacement

Mitral regurgitation is the most prevalent form of moderate or severe valve disease in developed countries. Surgery represents the standard of care for symptomatic patients with severe mitral regurgitation, but up to 50% of patients are denied surgery because of high surgical risk. In this context, different transcatheter options have been developed to address this unmet need. Transcatheter mitral valve replacement (TMVR) is an emergent field representing an alternative option in high complex contexts when transcatheter mitral valve repair is not feasible or suboptimal due to anatomical issues. However, TMVR is burdened by some device-specific issues (device malposition, migration or embolization, left ventricular outflow tract obstruction, hemolysis, thrombosis, stroke). Here we discuss the thrombotic risk of TMVR and current evidence about anticoagulation therapy after TMVR.

Abstract 17193: Acute and Short-Term Outcomes of Percutaneous Transcatheter Mitral Valve Replacement in Children

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicola Maschietto ◽  
Ashwin Prakash ◽  
Pedro J Del Nido ◽  
Diego Porras
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Pediatric Patients ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Surgical Risk ◽  
Small Series ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk

Introduction: Despite the improvement of surgical techniques for mitral valve (MV) repair in children, mitral valve replacement (MVR) is sometimes still necessary. MVR and redo-MVR continue to be burdened by early postoperative mortality and long-term morbidity with only about 75% of these patients being alive or transplant-free 10 years after the initial MVR. Although trans-femoral mitral valve replacement (TMVR) is a well-established intervention in high surgical risk adults, only a few pediatric Valve-in-Valve (ViV) case reports have been published. Hypothesis: We hypothesized that trans-venous transcatheter mitral valve replacement is feasible, safe, and effective in pediatric patients. Methods: Retrospective analysis of pediatric patients who underwent TMVR at Boston Children's Hospital between October 2018 and May 2020 Results: 7 consecutive high surgical risk pediatric patients (median age 9 years, range 8-15) underwent TMVR (6 as ViV, 1 in a native MV). Each patient previously underwent multiple MV surgeries or MVR (median 4, range 2-5) and was highly symptomatic (Ross functional class 3 or 4). The indication for TMVR was mitral stenosis in 5 patients, regurgitation in 1, and mixed disease in 1. TMVR was successful in each patient, effectively reduced the left atrium hypertension (p=0.018), and was carried out without significant complications. Conclusion: Trans-venous trans-catheter mitral valve replacement is an attractive alternative to MVR in high surgical risk patients. In this small series, TMVR was acutely effective and safe, with very encouraging early results.

scholarly journals Current Status of Catheter-based Mitral Valve Replacement

2021 ◽  
Vol 23 (8) ◽  
Author(s):  
Elias Rawish ◽  
Tobias Schmidt ◽  
Ingo Eitel ◽  
Christian Frerker
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Current Status ◽  
Bleeding Complications ◽  
Thrombotic Risk ◽  
Surgical Risk ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk

Abstract Purpose of review Transcatheter mitral valve replacement (TMVR) has been developed to address the need for an alternative therapeutic option to surgery in patients suffering from severe mitral regurgitation who are at high surgical risk. The present review illustrated the state-of-the-art of catheter-based mitral valve replacement evaluating technical characteristics and early clinical experience of different devices to outline prospects and challenges of TMVR. Recent findings Several devices are currently under clinical assessment. Early experience has demonstrated high procedural success of TMVR. However, TMVR faces several possible hurdles such as left ventricular outflow tract obstruction (LVOTO) after prosthesis deployment, access site complications, and thrombotic risk requiring anticoagulatory therapy. Summary Future studies should assess long-term prosthesis stability, optimal anticoagulation regime, and occurrence of paravalvular leakage. The development of smaller TMVR prostheses suitable for transseptal implantation could overcome bleeding complications. In perspective, TMVR may emerge to a clinically relevant therapeutic approach for patients with severe MR at high surgical risk.

scholarly journals Helicobacter pyloriDiversity and Gastric Cancer Risk

mBio ◽  
2016 ◽  
Vol 7 (1) ◽  
Author(s):  
Timothy L. Cover
Keyword(s):  
Gastric Cancer ◽  
Cancer Risk ◽  
Chromosomal Region ◽  
Current Evidence ◽  
Gastric Cancer Risk ◽  
The Past ◽  
Cancer Pathogenesis ◽  
H Pylori ◽  
High Level ◽  
Development Of Gastric Cancer

ABSTRACTGastric cancer is a leading cause of cancer-related death worldwide.Helicobacter pyloriinfection is the strongest known risk factor for this malignancy. An important goal is to identifyH. pylori-infected persons at high risk for gastric cancer, so that these individuals can be targeted for therapeutic intervention.H. pyloriexhibits a high level of intraspecies genetic diversity, and over the past two decades, many studies have endeavored to identify strain-specific features ofH. pylorithat are linked to development of gastric cancer. One of the most prominent differences amongH. pyloristrains is the presence or absence of a 40-kb chromosomal region known as thecagpathogenicity island (PAI). Current evidence suggests that the risk of gastric cancer is very low among persons harboringH. pyloristrains that lack thecagPAI. Among persons harboring strains that contain thecagPAI, the risk of gastric cancer is shaped by a complex interplay among multiple strain-specific bacterial factors as well as host factors. This review discusses the strain-specific properties ofH. pylorithat correlate with increased gastric cancer risk, focusing in particular on secreted proteins and surface-exposed proteins, and describes evidence from cell culture and animal models linking these factors to gastric cancer pathogenesis. Strain-specific features ofH. pylorithat may account for geographic variation in gastric cancer incidence are also discussed.

Transcatheter mitral valve repair

2018 ◽  
pp. 607-628
Author(s):  
Michael Bellamy ◽  
Christopher Baker
Keyword(s):  
Mitral Valve ◽  
Left Ventricular ◽  
Surgical Approaches ◽  
Mitral Leaflet ◽  
Complex Anatomy ◽  
Transcatheter Mitral Valve Replacement ◽  
Percutaneous Device ◽  
Risk Patients ◽  
Transcatheter Devices ◽  
Secondary Mr

Transcatheter therapy has emerged as an option for the treatment of mitral regurgitation (MR) for selected, predominantly high-risk, patients. Most transcatheter procedures are less invasive modifications of existing surgical approaches with a lower procedural risk. The complex anatomy of the mitral valve and varying mechanisms of MR has led to a range of devices being developed that vary in their indications, complexity of delivery, efficacy, and potential complications. This chapter will discuss the treatment of MR using transcatheter leaflet repair and mitral annuloplasty techniques. Transcatheter mitral valve replacement is covered separately. The aetiology and mechanism of MR will determine the type of therapy possible. In primary MR, a leaflet disease, mitral leaflet plication using the edge-to-edge technique, MitraClip is the only currently available percutaneous device. Leaflet repair is also possible using the Neochord device, but this requires a transapical surgical approach with insertion of neochordae that are anchored to the left ventricular apex. In secondary MR, which may be ischaemic or non-ischaemic, the mitral leaflets are usually normal but are tethered and tented secondary to changes in left ventricular size, geometry, and annular size. Transcatheter repair options for secondary MR include MitraClip and percutaneous annuloplasty devices (direct and indirect). It is worth noting that a number of new transcatheter devices are currently in development and the field is likely to expand significantly in the future as these technologies develop.

Transapical mitral valve-in-valve implantation in patients with degenerated bioprostheses and high surgical risk

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
M Seiffert ◽  
L Conradi ◽  
S Baldus ◽  
J Schirmer ◽  
M Knap ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Valve In Valve ◽  
Valve Implantation
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