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11 pages, 1218 KiB

Open AccessArticle

Transcatheter Mitral Valve-in-Valve Implantation with the Balloon-Expandable Myval Device

by Sara Blasco-Turrión, Ana Serrador-Frutos, John Jose, Gunasekaran Sengotuvelu, Ashok Seth, Victor G. Aldana, Juan Pablo Sánchez-Luna, Jose Carlos Gonzalez-Gutiérrez, Mario García-Gómez, Javier Gómez-Herrero, Cristhian Aristizabal, J. Alberto San Román and Ignacio J. Amat-Santos

J. Clin. Med. 2022, 11(17), 5210; https://doi.org/10.3390/jcm11175210 - 2 Sep 2022

Cited by 3 | Viewed by 3230

Abstract

Background: The vast majority of transcatheter valve-in-valve (ViV) mitral procedures have been reported with the SAPIEN family. We aimed to report the preliminary experience with the Myval balloon-expandable device in this setting. Methods: Multicenter retrospective study of high-risk surgical patients with mitral bioprosthesis [...] Read more.

Background: The vast majority of transcatheter valve-in-valve (ViV) mitral procedures have been reported with the SAPIEN family. We aimed to report the preliminary experience with the Myval balloon-expandable device in this setting. Methods: Multicenter retrospective study of high-risk surgical patients with mitral bioprosthesis degeneration undergoing transcatheter ViV implantation with Myval device. Results: A total of 11 patients from five institutions were gathered between 2019 and 2022 (age 68 ± 7.8, 63% women). The peak and mean transvalvular gradients were 27 ± 5 mmHg and 14.7 ± 2.3 mmHg, respectively, and the predicted neo-left ventricular outflow tract (neo-LVOT) area was 183.4 ± 56 mm² (range: 171 to 221 mm²). The procedures were performed via transfemoral access in all cases (through echocardiography-guided transeptal puncture (81.8% transesophageal, 11.2% intracardiac)). Technical success was achieved in all cases, with no significant residual mitral stenosis in any of them (peak 7.2 ± 2.7 and mean gradient 3.4 ± 1.7 mmHg) and no complications during the procedure. There were no data of LVOT obstruction, migration, or paravalvular leak in any case. Mean hospital stay was 3 days, with one major vascular complication and no stroke. At 6-month follow-up, there was one case with suboptimal anticoagulation presenting an increase in the transmitral gradients (mean 15 mmHg) that normalized after optimization of the anticoagulation, but no other relevant events. Conclusions: Transseptal ViV mitral implantation with the balloon-expandable Myval device was feasible and safe avoiding redo surgery in high-risk patients with bioprosthesis degeneration. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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15 pages, 1647 KiB

Open AccessArticle

Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience

by Ignacio Cruz-González, Pablo Luengo-Mondéjar, Blanca Trejo-Velasco, Jean C. Núñez-García, Rocío González-Ferreiro, José C. Moreno-Samos, Mónica Fuertes-Barahona, Juan C. Rama-Merchán, Pablo Antúnez-Muiños, Sergio López-Tejero, Gilles Barreira de Sousa, Javier Rodríguez-Collado, Javier Martín-Moreiras, Alejandro Diego-Nieto, Jesús Herrero-Garibi, Manuel Barreiro-Pérez, Elena Díaz-Peláez and Pedro L. Sánchez Fernández

J. Clin. Med. 2022, 11(16), 4835; https://doi.org/10.3390/jcm11164835 - 18 Aug 2022

Cited by 6 | Viewed by 1936

Abstract

Background: Paravalvular leak occurs in 5–17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and [...] Read more.

Background: Paravalvular leak occurs in 5–17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis. Methods: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified. Results: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up. Conclusions: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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10 pages, 3728 KiB

Open AccessArticle

Correlation of Intraprocedural and Follow Up Parameters for Mitral Regurgitation Grading after Percutaneous Edge-to-Edge Repair

by Eduardo Pozo Osinalde, Alejandra Salinas Gallegos, Ximena Gordillo, Luis Nombela Franco, Pedro Marcos-Alberca, Patricia Mahía, Gabriela Tirado-Conte, José Juan Gómez de Diego, Pilar Jiménez Quevedo, Antonio Fernández-Ortíz, Julián Pérez-Villacastín and Jose Alberto de Agustín Loeches

J. Clin. Med. 2022, 11(9), 2276; https://doi.org/10.3390/jcm11092276 - 19 Apr 2022

Cited by 3 | Viewed by 1880

Abstract

Background: There is no consensus on the best intraprocedural parameter to evaluate residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral repair (TEER). Thus, our aim was to evaluate the predictive value of different MR parameters from intraprocedural transesophageal echocardiogram (TEE) for grading in [...] Read more.

Background: There is no consensus on the best intraprocedural parameter to evaluate residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral repair (TEER). Thus, our aim was to evaluate the predictive value of different MR parameters from intraprocedural transesophageal echocardiogram (TEE) for grading in consecutive transthoracic echocardiogram (TTE) during the follow up. Methods: All the consecutive patients who underwent TEER with MitraClip between 2010 and 2020 in our center were considered. TEE-derived immediate postprocedural MR parameters were reassessed to blindly compare them with follow up MR grading in sequential TTE. Results: We finally included 88 patients (64.8% males; 76 ± 10 years-old). Significant MR was detected in 14.3% of the cases at 6 months, in similar proportion than at postprocedural at 1 month. Among all the intraprocedural TEE quantitative parameters only additive and maximum VC were associated with significant MR persistence. Moreover, on ROC analysis maximum VC demonstrated an excellent discriminatory power (AUC 0.96; p < 0.001) to identify MR ≥ III at 6 months. Thus, a cut-off point of 0.45 cm demonstrated 88% sensitivity and 89% specificity. Conclusion: Among intraprocedural TEE parameters to evaluate residual MR in TEER, maximum and additive VC were the most reliable to predict persistence of significant insufficiency. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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Review

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13 pages, 3793 KiB

Open AccessReview

New Percutaneous Approaches for the Treatment of Heavily Calcified Mitral Valve Stenosis

by Ricardo Sanz-Ruiz, María Eugenia Vázquez-Álvarez, Enrique Gutiérrez-Ibañes, Felipe Díez-delHoyo, María Tamargo-Delpon, Jorge García-Carreño, Javier Soriano-Trigueros, Jaime Elízaga-Corrales and Francisco Fernández-Avilés

J. Clin. Med. 2022, 11(21), 6444; https://doi.org/10.3390/jcm11216444 - 30 Oct 2022

Viewed by 1729

Abstract

Important breakthroughs have considerably improved the outcomes of the percutaneous treatment of valvular heart diseases during the last decades. However, calcium deposition and progressive calcification of the left-sided heart valves present a challenge with prognostic implications that have not been addressed until recently. [...] Read more.

Important breakthroughs have considerably improved the outcomes of the percutaneous treatment of valvular heart diseases during the last decades. However, calcium deposition and progressive calcification of the left-sided heart valves present a challenge with prognostic implications that have not been addressed until recently. In the case of native mitral stenosis with no surgical options, a compelling need for tackling heavily calcified valves has led to the development of novel debulking techniques and to the use of aortic balloon-expandable bioprosthesis in the mitral position. In this section of the special issue “Mitral Valve Disease: State of the Art”, we will review standard approaches and indications for the treatment of native mitral stenosis; summarize these two innovative solutions and their evidence, describing both procedures in a “step-by-step” fashion; and briefly comment on future directions in this field. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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14 pages, 4770 KiB

Open AccessReview

Acute Ischaemic Mitral Valve Regurgitation

by Breda Hennessey, Nestor Sabatovicz, Jr. and Maria Del Trigo

J. Clin. Med. 2022, 11(19), 5526; https://doi.org/10.3390/jcm11195526 - 21 Sep 2022

Cited by 7 | Viewed by 3159

Abstract

Acute ischaemic mitral regurgitation (IMR) is an increasingly rare and challenging complication following acute myocardial infarction. Despite recent technical advances in both surgical and percutaneous interventions, a poor prognosis is often associated with this challenging patient cohort. In this review, we revisit the [...] Read more.

Acute ischaemic mitral regurgitation (IMR) is an increasingly rare and challenging complication following acute myocardial infarction. Despite recent technical advances in both surgical and percutaneous interventions, a poor prognosis is often associated with this challenging patient cohort. In this review, we revisit the diagnosis and typical echocardiographic features, and evaluate current surgical and percutaneous treatment options for patients with acute IMR. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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11 pages, 1763 KiB

Open AccessReview

Complications of the Percutaneous Mitral Valve Edge-To-Edge Repair: Role of Transesophageal Echocardiography

by Guisela Flores, Dolores Mesa, Soledad Ojeda, Javier Suárez de Lezo, Rafael Gonzalez-Manzanares, Guillermo Dueñas and Manuel Pan

J. Clin. Med. 2022, 11(16), 4747; https://doi.org/10.3390/jcm11164747 - 14 Aug 2022

Cited by 6 | Viewed by 2566

Abstract

The use of transcatheter edge-to-edge repair for the treatment of mitral regurgitation has markedly increased in the last few years. The rate of adverse events related to the procedure is low; however, some of the complications that may occur are potentially dangerous. Due [...] Read more.

The use of transcatheter edge-to-edge repair for the treatment of mitral regurgitation has markedly increased in the last few years. The rate of adverse events related to the procedure is low; however, some of the complications that may occur are potentially dangerous. Due to the growing popularity of the technique, which is no longer limited to high-volume centers, knowledge of the complications related to the procedure is fundamental. Transesophageal echocardiography has a key role in the guidance of the intervention while allowing for the avoidance of most of these adverse events, as well as enabling us to diagnose them early. In this article, we review the main complications that might present during a transcatheter mitral edge-to-edge repair procedure (tamponade, thromboembolic events, single leaflet device attachment, device embolization, vascular injury…) while highlighting key aspects of transesophageal echocardiographic monitoring in the prevention and prompt diagnosis of these complications. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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20 pages, 2041 KiB

Open AccessReview

Transcatheter Mitral Valve Repair or Replacement: Competitive or Complementary?

by Zhang Xiling, Thomas Puehler, Lars Sondergaard, Derk Frank, Hatim Seoudy, Baland Mohammad, Oliver J. Müller, Stephanie Sellers, David Meier, Janarthanan Sathananthan and Georg Lutter

J. Clin. Med. 2022, 11(12), 3377; https://doi.org/10.3390/jcm11123377 - 13 Jun 2022

Cited by 5 | Viewed by 3688

Abstract

Over the last two decades, transcatheter devices have been developed to repair or replace diseased mitral valves (MV). Transcatheter mitral valve repair (TMVr) devices have been proven to be efficient and safe, but many anatomical structures are not compatible [...] Read more.

Over the last two decades, transcatheter devices have been developed to repair or replace diseased mitral valves (MV). Transcatheter mitral valve repair (TMVr) devices have been proven to be efficient and safe, but many anatomical structures are not compatible with these technologies. The most significant advantage of transcatheter mitral valve replacement (TMVR) over transcatheter repair is the greater and more reliable reduction in mitral regurgitation. However, there are also potential disadvantages. This review introduces the newest TMVr and TMVR devices and presents clinical trial data to identify current challenges and directions for future research. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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20 pages, 5453 KiB

Open AccessReview

Transcatheter Treatment of Mitral Regurgitation

by Angela McInerney, Luis Marroquin-Donday, Gabriela Tirado-Conte, Breda Hennessey, Carolina Espejo, Eduardo Pozo, Alberto de Agustín, Nieves Gonzalo, Pablo Salinas, Iván Núñez-Gil, Antonio Fernández-Ortiz, Hernan Mejía-Rentería, Fernando Macaya, Javier Escaned, Luis Nombela-Franco and Pilar Jiménez-Quevedo

J. Clin. Med. 2022, 11(10), 2921; https://doi.org/10.3390/jcm11102921 - 22 May 2022

Cited by 7 | Viewed by 4499

Abstract

Mitral valve disease, and in particular mitral regurgitation, is a common clinical entity. Until recently, surgical repair and replacement were the only therapeutic options available, leaving many patients untreated mostly due to excessive surgical risk. Over the last number of years, huge strides [...] Read more.

Mitral valve disease, and in particular mitral regurgitation, is a common clinical entity. Until recently, surgical repair and replacement were the only therapeutic options available, leaving many patients untreated mostly due to excessive surgical risk. Over the last number of years, huge strides have been made regarding percutaneous, catheter-based solutions for mitral valve disease. Transcatheter repair procedures have most commonly been used, and in recent years there has been exponential growth in the number of devices available for transcatheter mitral valve replacement. Furthermore, the evolution of these devices has resulted in both smaller delivery systems and a shift towards transeptal access, negating the need for surgical incisions. In line with these advancements, and clinical trials demonstrating promising outcomes in carefully selected cases, recent guidelines have strengthened their recommendations for these devices. It is appropriate, therefore, to now review the current transcatheter repair and replacement devices available and the evidence for their use. Full article

(This article belongs to the Special Issue Mitral Valve Disease: State of the Art)

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