Transcatheter Treatment of Mitral Regurgitation

Review of the echocardiogram by an experienced echocardiologist revised the diagnosis to microbubbles formation phenomenon with mechanical mitral prosthesis (Figure 1 and Video 1). A transesophageal echocardiogram performed on the same day demonstrated a normal-functioning prosthetic mitral valve and diagnosis of microbubbles formation was confirmed. Frame-by-frame analysis or reducing the frame rate of the recorded echocardiographic loop is vital to demonstrate the growing or dissipation of microbubbles and hence to avoid inadvertent thrombolytic therapy or surgical intervention. The patient remained asymptomatic and persistence of microbubbles formation continued to be observed in a transthoracic echocardiogram at 6-month follow-up.

To identify risk factors for pediatric mechanical mitral valve replacement (mMVR) to improve management in this challenging population.From 1993 to 2019, 93 children underwent 119 mMVR operations (median age, 8.8 years [interquartile range [IQR]: 2.1-13.3], 54.6% females) at our institution.

The description of subclinical leaflet thrombosis following transcatheter aortic valve implantation (TAVI) created great drama and controversy for the field because of a potential association with cerebral embolic disease1; however, subsequent systematic studies have alleviated such concerns2,3. Transcatheter mitral valve implantation (TMVI) (using a balloon-expandable transcatheter SAPIEN prosthesis [Edwards Lifesciences, Irvine, CA, USA]) is a highly effective, minimally invasive treatment for degenerated mitral bioprostheses, but may also be applied to native leaflet failure in the presence of a surgical mitral ring or mitral annular calcification (MAC)4. Studies with dedicated prostheses are continuing for TMVI in native mitral valves i

Of patients who had mitral surgery after TEER—nearly all of which would have been done with the MitraClip (Abbott) during the study period—only 4.8% underwent surgical repair rather than replacement, Joanna Chikwe, MD (Cedars-Sinai Medical Center, Los Angeles, CA), reported during the virtual American Association for Thoracic Surgery 2021 meeting over the weekend.

Foreign citizens are increasingly undergoing medical treatment in India as hospitals in India offer competitive and transparent pricing that allows international patients to save money on medical procedures. In some cases, they may be placed in a situation that forces them to have to pay high to even for a complex medical procedure. Though many patients are initially drawn to India for affordable mitral valve repair in India so that they can save money on medical procedures, it is also crucial to note that patients are also very impressed by the quality of services as well. Top hospitals for heart treatment in India have state-of-the-art infrastructure and medical facilities. Top heart valve replacement surgeons in India are one of the major reasons for attracting a huge number of international patients in India. Patients from the Middle East and other western countries are drawn to India because the technology or medical expertise is lacking in their own countries.

There is an open Centers for Medicare and Medicaid Services National Coverage Decision for Transcatheter Mitral Valve Repair (TMVr) and a recent multisociety consensus document suggesting that TMVr centers should achieve prespecified mitral valve replacement or repair (MVRr). Yet, little is known about the MVRr volume–TMVr outcome relationship.

There is no relationship between MVRr volumes and TMVr outcomes. Additionally, adoption of an annual MVRr volume ≥40 for performance of TMVr disproportionately impacts geographic access in the Midwest and Southeast and their large black and Hispanic populations.

Mitral regurgitation (MR) is a rather common valvular heart disease. The purpose of this meta-analysis is to compare the outcomes, and complications of mitral valve replacement (MVR) with surgical mitral valve repair (MVr) of non-ischemic MR (NIMR).

Patients suffering from severe mitral regurgitation should be carefully screened and counselled before undergoing transcatheter edge-to-edge mitral repair (TEER), as data show that as many as 95% of patients who needed surgery after failed TEER could not have their valves repaired and needed mitral valve replacement to resolve the issue.

In both abdominal aorta and iliac artery of porcine, cBRS was entirely endothelialized within 1 month and maintained target vessels with good patency in the 12-month follow-up. The in vivo degradation profile of the cBRS is consistent with static degradation results in vitro. It is also demonstrated that there is minimal impact of pulsatile pressure of blood flow and variation of radial force on the degradation rate of the cBRS. Moreover, the lumen of cBRS implanted vessels were enlarged after 6 months, and significantly larger than the vessels implanted with metallic stent in 12 months.

The reSept ASD Occluder is the first structural heart occluder with a metal-free, bioresorbable frame. The novel implant is designed to overcome the limitations of current transcatheter occluders. It is hoped the design will reduce the risk of complications associated with the long-term presence of metal in the heart and to preserve future treatment options requiring transseptal intervention. Initial clinical experience demonstrates long-term clinically effective closure of the ASDs treated with the company's device, the company said.

SCAI 2021 late-breaking presentations included the data on the Medtronic Harmony transcatheter pulmonary valve, cutting radial access hemostasis time by 50 percent, improving cardiogenic shock survival to 71 percent, and data showing very high mortality in COVID patients who suffer a STEMI.

Transcatheter mitral valve (MV) repair, specifically the edge-to-edge leaflet repair, is a less invasive treatment of symptomatic mitral regurgitation (MR) in patients with high or prohibitive surgical risk. In cases with severe leaflet calcification, small mitral orifice area, and/or extremely wide regurgitation across the entire MV commissure, transcatheter MV repair may rather cause suboptimal or potentially hazardous outcomes.

Multiple studies have demonstrated the high risks for repeat mitral valve surgery across the board, with procedural mortality ranging from 6.3% to 15%, the researchers noted. Despite growing experience with these procedures, contemporary 30-day mortality rates linked with repeat mitral surgery remains higher than first mitral valve operations, Guerrero and colleagues added, citing figures suggesting the rates are 11.1% vs. 6.5% (p < 0.0001), respectively.

Many patients with mitral regurgitation are denied open-heart surgery due to perceived high risk. Transcatheter mitral valve replacement is a therapeutic alternative for patients at high surgical risk. This study aimed to assess the feasibility of a new self-expanding valved stent for transcatheter mitral valve replacement via apex in an acute animal model.

A new study, presented today at the AATS 101st Annual Meeting, and simultaneously published in the Journal of the American College of Cardiology, finds that patients suffering from severe mitral regurgitation should be carefully screened and counselled before undergoing transcatheter edge-to-edge mitral repair (TEER). Data showed that up to 95 percent of patients who needed surgery after failed TEER could not have their valves repaired, and needed mitral valve replacement to resolve the issue. The findings highlight the need to select patients carefully for TEER.

In select patients with severe, eccentric mitral regurgitation (MR), we have observed that the regurgitant jet may entrain blood along the left atrial wall to produce a Chinese yin-yang symbol on color Doppler. The Chinese yin-yang symbol consists of a circle divided by an S-shaped line into black (yin) and white (yang) segments, with yin (representing darkness) and yang (representing light) complementing each other harmoniously. Classically, this symbol has been described to represent the color Doppler appearance of circular blood flow related to high-flow arterial pseudoaneurysms.

BACE is the only surgical device with long-term clinical data demonstrating significant benefit by addressing the root cause of FMR, Phoenix Cardiac Devices said in a press release, adding that the CE Mark serves as approval by the European Union (EU) to commercialise BACE. Supporting clinical data, show significant efficacy in reduction of MR grade and size of the left ventricle that was sustained out to 24 months, and will be presented as a late-breaking presentation at the virtual American Association for Thoracic Surgery 101st annual meeting (AATS 2021, April 30–2 May, virtual).

Patients with congestive HF and grade 2 to 4 functional mitral regurgitation despite medical therapy who underwent transcatheter mitral valve repair (TMVR) with the mitral contour system (Carillon, Cardiac Dimensions) experienced favorable survival rates at 5 years.

Join us for a virtual round-table discussion with experts to explore the technicalities of mitral valve repair. Participants will join specialists in their field to discuss and review literature in order to better understand techniques and surgical strategy for this procedure in order to improve repair rate and identify pitfalls.

Bioprosthetic valve thrombosis (BPVT) is not uncommon but can be under diagnosed due to the lack of awareness and technical limitations of echocardiography. When suspecting BPVT, it is imperative to consider multimodality imaging to establish the diagnosis as early treatment can alter the clinical course. Here we present a case series of two patients with a history of rheumatic heart disease status post bioprosthetic mitral valve replacement who presented with acute heart failure symptoms. In both cases, supplemental imaging with real-time 3D echocardiography was critical in establishing a diagnosis of BPVT, resulting in timely treatment. These cases support updating current guidelines for the management of patients with bioprosthetic valve replacement to include more frequent surveillance imaging even if patients are asymptomatic.

MitraClip edge-to-edge (E2E) repair system is the only transcatheter device recommended in the current guidelines for treating mitral regurgitation (MR). The percutaneous femoral venous transseptal access of MitraClip requires a complex steerable delivery system and may thus be technically complex to optimally position and deploy the clip onto the mitral valve. A transapical approach for E2E repair has been devised to treat MR for the ease of operation (ValveClamp system, Hanyu Medical Technology, Shanghai).

Despite growing experience with TMVR, only a small subset of patients is anatomically amenable to TMVR, leaving a substantial number of patients on medical treatment only. We found a high 1-year mortality rate in these patients, underlining an unmet need for adequate therapeutic alternatives in this substantial portion of patients with severe MR. TMVR devices adapting to broader annular size ranges with smaller ventricular profiles might fill this gap in the future.

Transseptal MViV in high-risk patients was associated with 100% technical success, low procedural complication rates, and very low mortality at 1 year. The vast majority of patients experienced significant symptom alleviation, and THV performance remained stable at 1 year.

We conclude that, after SMR and failed TMVR, reclipping is an appropriate treatment option for symptomatic patients. For PMR patients, surgery must be favoured over a reclipping procedure. However, patients with atrial fibrillation, prior open heart surgery and chronic obstructive pulmonary disease are at risk of reduced survival after reinterventions.

One half of the patients with severe symptomatic mitral regurgitation (MR) are not referred for surgery, due either to frailty, multiple comorbidities, or prohibitively high surgical risk1,2. The mortality rate in this cohort of patients reaches 50% at five years of follow-up, and up to 90% of surviving patients require hospitalisation for heart failure within five years after the diagnosis of severe MR1,2. In recent years, transcatheter mitral valve repair (TMVr) using the MitraClip® device (Abbott Vascular, Santa Clara, CA, USA) has become a valid and prevalent therapeutic option in patients who are inoperable or deemed to be at hig