Durable Robotic Mitral Repair of Degenerative Primary Regurgitation With Long-Term Follow-Up.

Background: Variation in degenerative mitral morphology may contribute to suboptimal repair rates. This study evaluates outcomes of a standardized mitral repair technique.

Methods: An institutional clinical registry was used to identify 1036 consecutive patients undergoing robotic mitral surgery between 2005 and 2020: 87% (n = 902) had degenerative disease.

Right-to-Left Shunt Through Iatrogenic Atrial Septal Defect After MitraClip Procedure.

Objectives: The aim of this study was to investigate the incidence, characteristics, hemodynamic conditions, and clinical significance of right-to-left (R-L) shunt through an iatrogenic atrial septal defect (iASD) after the MitraClip procedure.

Background: R-L shunt through an iASD after the MitraClip procedure has not been well investigated.

Methods: From 2014 to 2017, 385 consecutive patients with mitral regurgitation underwent the MitraClip procedure.

Comparison of mitral valve geometrical effect of percutaneous edge-to-edge repair between central and eccentric functional mitral regurgitation: clinical implications.

Aims: Percutaneous edge-to-edge repair alters mitral valve (MV) geometry in functional mitral regurgitation (FMR). We sought to characterize MV morphology in patients with central and eccentric FMR, compare the geometrical effect of MitraClip therapy, and elucidate different mechanisms of MR improvement according to FMR subtypes.

Methods And Results: Seventy-six symptomatic patients with Grade 3 to 4+ FMR (central, n = 39; eccentric, n = 37) underwent three-dimensional transoesophageal echocardiography during MitraClip implantation.

Incidence, Characteristics, and Clinical Course of Device-Related Thrombus After Watchman Left Atrial Appendage Occlusion Device Implantation in Atrial Fibrillation Patients.

Objectives: This study investigated characteristics and clinical impact of device-related thrombus formation after Watchman device implantation in atrial fibrillation (AF) patients.

Background: Left atrial appendage occlusion using the Watchman device is an effective alternative to anticoagulation for stroke prevention in AF patients. However, device-related thrombus formation remains an important concern after Watchman implantation.

Relation of Residual Mitral Regurgitation Despite Elevated Mitral Gradients to Risk of Heart Failure Hospitalization After MitraClip Repair.

Achieving minimal residual mitral regurgitation (MR) after percutaneous MitraClip repair is limited by iatrogenic mitral stenosis. It is unknown whether allowing moderately elevated postprocedural mean mitral gradients (MMGs) to achieve < moderate residual MR is preferable to moderate residual regurgitation. Patients with less-than-moderate residual MR but a MMG of ≥5 mm Hg (Group 1) were compared with patients with moderate residual MR (Group 2).

Impact of Forward Stroke Volume Response on Clinical and Structural Outcomes After Percutaneous Mitral Valve Repair With MitraClip.

Background: An increase of systolic forward flow was frequently observed after successful MitraClip implantation in patients with significant mitral regurgitation. However, the impact of systolic forward flow improvement on post-MitraClip outcomes remains unknown.

Methods And Results: Study population included 160 patients who underwent successful MitraClip implantation.

Effect of Percutaneous Edge-to-Edge Repair on Mitral Valve Area and Its Association With Pulmonary Hypertension and Outcomes.

Percutaneous edge-to-edge repair using the MitraClip system causes reduction in mitral valve area (MVA). However, its clinical impact is not fully elucidated. This study assessed the impact of postprocedural MVA reduction on pulmonary hypertension and outcomes.

Mitral annular calcification is not associated with decreased procedural success, durability of repair, or left ventricular remodelling in percutaneous edge-to-edge repair of mitral regurgitation.

Aims: Mitral annular calcification (MAC) negatively influences outcomes in surgical mitral valve (MV) repair for mitral regurgitation (MR). However, there are no data on whether MAC impacts on outcomes of MitraClip percutaneous MV edge-to-edge repair. This study sought to investigate whether the presence of MAC impacts on the procedural success and durability of percutaneous transcatheter repair of MR using the MitraClip.

Transcatheter Procedure for Residual Mitral Regurgitation After MitraClip Implantation Using Amplatzer Duct Occluder II.

Objectives: This study reports a novel transcatheter procedure for residual mitral regurgitation (MR) after MitraClip implantation using the Amplatzer Duct Occluder II (ADO II).

Background: Although the MitraClip procedure is a transcatheter treatment option for patients at high surgical risk with severe MR, management of significant residual MR after MitraClip implantation is still challenging.

Methods: We describe a case series of 9 consecutive patients who underwent transcatheter deployment of the ADO II plug for significant residual MR after MitraClip implantation from April to October 2015.

Impact of pulmonary hypertension on outcomes in patients with functional mitral regurgitation undergoing percutaneous edge-to-edge repair.

Preexisting pulmonary hypertension (PH) is associated with poor outcomes after surgical mitral valve repair for functional mitral regurgitation (FMR). However its clinical impact on MitraClip therapy remains unknown. The aim of this study was therefore to evaluate the impact of preexisting PH on MitraClip therapy for patients with FMR.

Optimizing procedural outcomes in percutaneous mitral valve therapy using transesophageal imaging: a stepwise analysis.

Moderate or severe mitral regurgitation is the most common valve disease in the USA. Without treatment, severe mitral regurgitation has a 5-year survival rate of approximately 40%. Surgery plays a pivotal role in the treatment of these patients.

Comparison between transradial and transfemoral percutaneous coronary intervention in acute ST-elevation myocardial infarction.

Transradial (TR) access is increasingly being used in percutaneous coronary intervention (PCI). However, its role in PCI for ST-segment elevation myocardial infarction remains controversial because of concerns of procedural complexity adversely affecting the promptness of reperfusion. In this study, 150 consecutive patients who underwent PCI for acute ST-segment elevation myocardial infarction over a period of 24 months were prospectively evaluated; 46 had TR access (31%) and 104 (69%) had transfemoral (TF) access.

MitraClip: a novel percutaneous approach to mitral valve repair.

As life expectancy increases, valvular heart disease is becoming more common. Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population. Recent years have brought a progression of surgical treatments toward less invasive strategies.

Contemporary application of cardiovascular hemodynamics: transcatheter mitral valve interventions.

Since the development and refinement of echocardiography, this technique has, for some time, been the mainstay for hemodynamic assessment of the mitral valve. This article discusses the key components of the invasive hemodynamic assessment of mitral valve disease and illustrates their utility through percutaneous transluminal mitral valvuloplasty for mitral stenosis and the novel transcatheter mitral valve repair using the MitraClip for mitral regurgitation. Changes in left atrial pressure and waveform, mean gradient, and cardiac output are critical assessment parameters for both safety and efficacy.

Utility of combined two-dimensional and three-dimensional transesophageal imaging for catheter-based mitral valve clip repair of mitral regurgitation.

Background: Catheter-based mitral valve clip repair (CBMCR) is feasible for selected patients with mitral regurgitation (MR). Two-dimensional (2D) transesophageal echocardiography (TEE) is the standard modality for evaluating MR and procedural guidance. Recently, real-time three-dimensional TEE became available.

Percutaneous mitral valve repair: potential in heart failure management.

As a large portion of the US demographic advances into the later decades of life, the incidence of valvular heart disease is expected to increase. Mitral regurgitation (MR) caused by primary valve abnormality (degenerative) or secondary to cardiomyopathy (functional) is an important cause of heart failure. Management of valvular heart disease is expected to account for a large segment of services provided to heart failure patients.