Transcatheter Treatment of Mitral Regurgitation

While frailty in mitral/tricuspid valve repair patients was linked to higher bleeding, infection, and hospital stay, it independently predicted long-term mortality, suggesting mechanisms beyond complications need further investigation to help this vulnerable population.

The progress made in heart valve replacements is an incredible advancement for the medical world. By further expanding their research and technology, doctors will be able to help a larger population of patients with fewer risks or complications associated with the procedure.

Mitral annular disjunction (MAD) refers to atrial displacement of the hinge point of the mitral valve annulus from the ventricular myocardium. MAD leads to paradoxical expansion of the annulus in systole and may often be associated with mitral valve prolapse (MVP), leaflet degeneration, myocardial and papillary muscle fibrosis, and, potentially, malignant cardiac arrhythmias. Patients with MAD and MVP may present similarly, and MAD is potentially the missing link in explaining why some patients with MVP experience adverse outcomes.

The management of patients with heart failure has changed markedly in the past several years, with evidence for four life prolonging classes of drugs for patients with reduced LVEF and the benefit of SGLT2 inhibitors for those with mildly reduced and preserved LVEF. Device management and other non-drug management have evolved as results from new clinical trials are published. Identification of appropriate candidates for treatment requires accurate diagnosis, which can be challenging for patients with heart failure and preserved ejection fraction. Additional questions remain—in particular, how best to implement these new treatment recommendations into clinical practice.

In this cross-sectional study, MV repair was the preferred option for degenerative mitral valve disease but was only slightly more commonly performed than MVR for isolated anterior leaflet pathologic status. A large proportion of MVR was performed without an MV repair attempt, suggesting reluctance to repair this pathologic condition.

Many people overlook common lifestyle factors that impact their heart health. The survey, conducted by Ipsos, reveals around three in 10 adults are unaware that alcohol (32 percent), smoking (27 percent), and lack of sleep (27 percent) are linked to heart disease.

In this cross-sectional study, the surgical treatment of anterior leaflet abnormalities most commonly was noted with concomitant surgical procedures, and MV repair was only slightly more commonly performed than MVR. No attempt at MV repair was made before MVR in 81.7% of MVR cases. Neochordae repair and annuloplasty emerged as the predominant approach. Repair rates were higher in centers with higher volumes of anterior leaflet cases. There appear to be opportunities for improvement in the management of anterior leaflet abnormalities by the cardiac surgical community.

Leveraging Vivasure Medical’s PerQseal technology, the PerQseal Elite vascular closure system is designed exclusively for sutureless and fully absorbable large-bore venous vessel closure following percutaneous cardiovascular procedures, such as transcatheter mitral valve repair or replacement (TMVR), transcatheter tricuspid valve repair or replacement (TTVR) and leadless pacemaker implants.

Different predictors for long-term mortality have been identified: while severe tricuspid regurgitation and NYHA class IV at baseline remained independently associated with an increased long-term mortality over the past decade, severe left ventricular dilatation and severe pulmonary hypertension predicted long-term mortality only in patients treated in the early M-TEER era. Although current guidelines recommend the procedure only for patients who remain symptomatic despite optimal medical therapy, our results suggest that timely treated patients benefit most from M-TEER before the onset of irreversible cardiac remodeling and severe pulmonary hypertension.

The complications of AMI represent high-acuity, time-sensitive conditions associated with elevated morbidity and mortality rates. Early recognition and decisive intervention remain the cornerstones in the quest for optimal patient outcomes. Given the dramatic presentations associated with complications and the urgent need for intervention, early revascularization has become the standard of care, resulting in a reduced incidence of complications of less than 0.1%. Furthermore, emphasizing patient-centered planning and the judicious timing of appropriate interventions, including surgical procedures, percutaneous technologies, and mechanical circulatory support involvement, holds the potential to significantly enhance both disease- and patient-centered outcomes (Table 1). As a result, a multidisciplinary heart team emerges as a crucial entity in guiding the care of patients post-AMI with complications.

The SSi Mantra Surgical Robotic System, the first surgical robotic system to be made in India, and one of the few cost-effective global options with a wide range of surgical applications, has received regulatory approval in India, Indonesia and Guatemala, and is clinically validated for over 50 different types of surgical procedures. To date, more than 800 surgical procedures have been conducted using the system. SS Innovations has initiated the regulatory approval process in the United States and the EU, with approvals anticipated in the latter half of 2024 or 2025.

Bleeding complications and infections were more frequent in frail patients undergoing transcatheter mitral and tricuspid valve repair and partly explained the longer hospital stay. Albeit some of the complications were associated with higher long-term mortality, this did not explain the strong association between frailty and mortality. Further research is warranted to explore interventions targeting periprocedural complications to improve outcomes in this vulnerable population.

The heart, is a vital organ beating rhythmically, fuels life throughout our bodies. However, for millions worldwide, heart valve diseases disrupt this vital rhythm. Fortunately, recent years have witnessed groundbreaking progress in heart valve replacement surgery in India, offering renewed hope and an enhanced quality of life for those in need. Raising awareness about these advancements is crucial for optimal utilization and patient benefit.

MVR performed with the On-X valve is an attractive surgical option for patients with mitral valve IE, with its associated mortality and morbidity rates being comparable to those associated with the use of the SJM valve plus its superior hemodynamic performance. EOA appears to be of independent predictive value for the occurrence of late-new-onset AF in patients who have undergone MVR for IE. The EOA achieved with the use of the On-X valve in the mitral position may reduce the incidence of new-onset AF in the late phase.

We have successfully developed, tested, and, for the first time, implanted a novel H-TEHV featuring a permanent elastomeric scaffold in sheep. Our initial findings suggest that the H-TEHV demonstrates resilience under high-pressure conditions at the mitral position, exhibiting no signs of shrinkage or valve decomposition. While these short-term results may suggest the feasibility of the H-TEHV concept in vivo, it is crucial to acknowledge that given the current stage of development and the limited scope of a single animal implant, no definitive conclusions can be drawn regarding the long-term suitability of the H-TEHV.

A novel technology called intravascular lithotripsy-facilitated percutaneous balloon mitral valvuloplasty (IVL-PBMV) shows promise for treating patients with severe calcific mitral stenosis (MS) and no other surgical or transcatheter treatment options. But until recently, evidence of its value has been sparse, consisting mainly of isolated case reports from various centers.

The complications of AMI represent high-acuity, time-sensitive conditions associated with elevated morbidity and mortality rates. Early recognition and decisive intervention remain the cornerstones in the quest for optimal patient outcomes. Given the dramatic presentations associated with complications and the urgent need for intervention, early revascularization has become the standard of care, resulting in a reduced incidence of complications of less than 0.1%. Furthermore, emphasizing patient-centered planning and the judicious timing of appropriate interventions, including surgical procedures, percutaneous technologies, and mechanical circulatory support involvement, holds the potential to significantly enhance both disease- and patient-centered outcomes (Table 1). As a result, a multidisciplinary heart team emerges as a crucial entity in guiding the care of patients post-AMI with complications.

The following is a summary of “Valve unit instead of intensive or intermediate care unit admission following transcatheter edge-to-edge mitral valve repair is safe and reduces postprocedural complications,” published in the February 2024 issue of Cardiology by Gröger et al.

The global mitral valve stenosis market is expanding over time, owing to reasons such as rising heart disease prevalence, rising rheumatic fever cases, technical improvements, the launch of innovative mitral valves, Cardiac Valve, and an expanding number of significant industry players. North and South America are expected to dominate the global mitral valve stenosis market thanks to their high adoption of innovative medical devices, rising healthcare expenditure, and increased occurrence of heart diseases.

Tissue engineering aims to overcome the current limitations of heart valves by providing a viable alternative using living tissue. Nevertheless, the valves constructed from either decellularized xenogeneic or purely biologic scaffolds are unable to withstand the hemodynamic loads, particularly in the left ventricle. To address this, we have been developing a hybrid tissue-engineered heart valve (H-TEHV) concept consisting of a nondegradable elastomeric scaffold enclosed in a valve-like living tissue constructed from autologous cells.

A less-traumatic alternative to the traditional open-heart surgery, minimally-invasive structural heart interventions have made significant advances in the last few years. Interestingly, there is a wide range of cardiac diseases -- such as valvular heart disease, congenital defects and heart failure -- that can be treated with this approach. Dr Haresh G Mehta, director-interventional cardiology and Dr Kayan Siodia, consultant interventional cardiology, S L Raheja Hospital, Mahim -- a Fortis associate say that for patients with valvular heart disease, valve replacement or repair through open heart surgery was the only option, which had a "high procedural risk" and longer recovery time.

As the first self-expanding TPVR product approved in China and Europe, VenusP-Valve carries remarkable clinical value. Uniquely designed with both flared ends, the product ensures the blood flow of branchial artery with bare stents at the outflow end. It provides a stable multi-point anchoring system and enables easy delivery, with no need for pre-stenting before the procedure. Available in a variety of specifications with extensive applicability, VenusP-Valve is able to meet the needs of 85% of patients in the case of large RVOT.

Left atrial appendage occlusion (LAAO) is an increasingly used alternative to oral anticoagulation in patients with atrial fibrillation, especially in patients with absolute/relative contraindications to these therapies. This review will cover three main aspects of the procedure. In the fist part of the manuscript, we focus on patient selection. We describe three main categories of patients with primary indication to LAAO, namely patients with previous or at a high risk of intracerebral bleeding, patients with a history of major gastrointestinal bleeding and patients with end-stage renal disease and absolute contraindication to novel oral anticoagulants.

Tampa General Hospital is one of just five health care systems across the nation approved by the Food and Drug Administration (FDA) to participate in a feasibility study using the AltaValve technology for TMVR. As an academic health system, Tampa General and USF Health combine clinical care, academics and research to deliver the best possible patient outcomes. This robust research enterprise enables providers to use cutting-edge technologies, resources and therapies to address some of the most complex health conditions.

Climate change-related CV burden represents one of the latest challenges in preventive cardiology that physicians are facing. Although the impact of climate change on human health remains to be accurately estimated, several studies have demonstrated its negative effects on the risk and progression of CV diseases. Therefore, serious strategies should be planned to contrast global warming and climate change, involving physicians, researchers, public health professionals, political scientists, legislators, and national leaders who have to work together to alleviate the impacts of climate change and preserve public health.