Publications by authors named "Maurice Enriquez Sarano"

Background: The prevalence and impact of right ventricular dysfunction (RVD) in degenerative mitral regurgitation (DMR) is unknown. We aimed to determine whether RVD assessed by echocardiography in routine clinical practice is independently associated with mortality in patients with DMR.

Methods And Results: We used data from the MIDA-Q (Mitral Regurgitation International DAtabase-Quantitative) registry, which included patients with isolated DMR due to mitral valve prolapse from January 2003 to January 2020 from 5 tertiary centers across North America, Europe, and the Middle East.

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Background: Assessment of coronary artery disease (CAD) is critical in managing severe aortic stenosis. Unplanned coronary angiography after TAVR, with or without percutaneous coronary intervention, may present significant challenges.

Objectives: The aim of this study was to evaluate the incidence, predictors, and outcomes of unplanned coronary angiography after transcatheter aortic valve replacement (TAVR).

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Background: Transcatheter tricuspid valve intervention (TTVI) has been increasingly adopted in recent years for the treatment of patients with tricuspid regurgitation (TR). However, no dedicated risk stratification has been established for patients undergoing TTVI.

Objectives: The aim of the present study was to propose a dedicated risk score for patients affected by severe TR undergoing TTVI.

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Backgroud: Degenerative-mitral-stenosis (DMS) is due to degenerative mitral-annular (MAC) and valvular calcification. However, DMS impacts on outcome, and therefore potential treatment needs are poorly-known. We aimed at evaluating survival after DMS diagnosis by Doppler-Echocardiography in routine-practice.

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Background And Aims: Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery.

Methods: In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, and high: ≥6).

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Article Synopsis
  • The study compares patients with degenerative mitral regurgitation (DMR) from Asian institutions (AsIs) and European/American institutions (EAIs) to understand differences in their presentation, management, and outcomes.
  • AsI patients were generally younger, had fewer symptoms, and presented with smaller heart dimensions, yet underwent fewer interventions and experienced higher mortality rates compared to EAI patients.
  • The findings suggest that imaging may not accurately reflect the severity of DMR in AsI patients due to their smaller body size, indicating a potential issue with under-treatment in this population.
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Aims: In patients with degenerative mitral regurgitation (DMR), left ventricular (LV) dysfunction is associated with increased risk of heart failure and excess mortality. LV end-systolic diameter (LVESD) is an established trigger for intervention, yet recommended LVESD thresholds apply poorly to patients with small body size. Whether LV normalization to body surface area (BSA) may be used as a trigger for DMR correction is unknown.

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Article Synopsis
  • The study evaluated the long-term survival outcomes of 2833 patients with severe degenerative mitral regurgitation (DMR) who underwent surgical correction, guided by various surgical indications.
  • Results indicated that patients classified under Class-I triggers experienced significantly lower postoperative survival rates compared to those under Class-IIa triggers or no triggers, with a median follow-up of 8.5 years showing a stark difference in survival percentages.
  • Overall, operating on patients with Class-I criteria resulted in a considerable loss of postoperative survival time, suggesting that immediate surgery based on these guidelines may not be the best approach for improving long-term outcomes in DMR patients.
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Background: Aortic-valve-stenosis (AS) is a frequent degenerative valvular-disease and carries dismal outcome under-medical-treatment. Transvalvular pressure gradient reflects severity of the valve-disease but is highly dependent on flow-conditions and on other valvular/aortic characteristics. Alternatively, aortic-valve-area (AVA) represents a measure of aortic-valve lesion severity conceptually essential and practically widely-recognized but exhibits multiple-limitations.

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Background: Clinical outcomes of bicuspid aortic valve (BAV) patients with ascending aortic diameters ≥50 mm who are under surveillance are poorly defined.

Objectives: The purpose of this study was to assess clinical outcomes in BAV patients with ascending aorta ≥50 mm.

Methods: Multicenter retrospective cohort study of BAV adults with ascending aorta diameters ≥50 mm by transthoracic echocardiography (TTE).

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Background: European and U.S. clinical guidelines diverge regarding pulmonary hypertension (PHTN) in degenerative mitral regurgitation (DMR).

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Article Synopsis
  • Aortic valve calcification (AVC) is a significant predictor of survival in patients with non-severe aortic stenosis (AS), and specific cut-offs were identified for men (1185 AU) and women (850 AU) which are lower than those for severe AS.
  • In a study of 395 patients, those with sub-severe and severe AVC had a significantly higher risk of death compared to those with low AVC, regardless of other health factors.
  • The findings suggest that sub-severe AVC can guide the timing of aortic valve interventions, as these procedures reduced mortality risks in patients with higher AVC levels.
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Background: There are no sex-specific guidelines for chronic aortic regurgitation (AR). This retrospective study examined sex-specific differences and propose treatment criteria from an Asian AR cohort.

Methods and results: Consecutive 1,305 patients with moderate-severe AR or greater at 3 tertiary centers in Taiwan and Japan (2008-2022) were identified.

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Background: Currently, no clear impact of sex on short- and long-term survival following transcatheter edge-to-edge mitral valve repair (TEER) is evident, although no data are available on postprocedural life expectancy. Our aim was to assess sex-specific differences in outcomes of patients with mitral regurgitation (MR) treated by TEER.

Methods And Results: Short-term and 5-year outcomes in men and women undergoing TEER between 2011 and 2018 who were included in the large, multicenter, real-world MitraSwiss registry were analyzed.

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The diagnostic approach toward the management of cardiac implantable electronic device-related tricuspid regurgitation is challenging and undefined. Functional cardiac computed tomography angiography provides a complementary role to echocardiography in the evaluation of lead-leaflet interaction which can help the clinical decision-making process, as presented in this case series.

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Article Synopsis
  • * It found that patients with mild residual TR had an 85% survival rate, while those with moderate and severe TR had significantly lower rates of 70% and 44%, respectively.
  • * The research emphasizes the need for a more detailed classification of TR severity to better predict patient outcomes and highlights the goal of achieving at least mild to moderate residual TR for successful interventions.
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Background And Aims: Presentation, outcome, and management of females with degenerative mitral regurgitation (DMR) are undefined. We analysed sex-specific baseline clinical and echocardiographic characteristics at referral for DMR due to flail leaflets and subsequent management and outcomes.

Methods: In the Mitral Regurgitation International Database (MIDA) international registry, females were compared with males regarding presentation at referral, management, and outcome (survival/heart failure), under medical treatment, post-operatively, and encompassing all follow-up.

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Mitral annular disjunction (MAD), a separation between the left atrium/mitral valve annulus and the left ventricular myocardium, is frequently seen in patients with arrhythmic mitral valve prolapse. Although an association exists between MAD and ventricular arrhythmias, little is known regarding the identification of individuals at high risk. Multimodality imaging including echocardiography, computed tomography, cardiac magnetic resonance, and positron emission tomography can play an important role in both the diagnosis and risk stratification of MAD.

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