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Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
Surgical intervention usually includes the implantation of an undersized annular ring. Mitral valve replacement and combined surgical repair techniques are under investigation. However, most of the time these patients are at high surgical risk and surgical mitral valve repair has not shown survival benefit.34 Therefore, transcatheter edge-to-edge mitral valve repair with MitraClip has been used for patients with HF and reduced LVEF, albeit with conflicting results. The COAPT trial has shown significant survival benefit,35 whereas the Mitra-FR trials showed no mortality benefit with MitraClip.36 However, these two studies included patients with different characteristics and these results indicate that a subgroup of patients with disproportionate FMR, characterized by low LV end-diastolic and end-systolic volume and large EROA, may benefit from transcatheter interventions.
Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
This can occur 1–2 weeks after cardiac surgery, most often after CABG and mitral valve replacement. The most common symptoms are new/worsening pericardial effusions, pleuritic chest pain, and fever with raised inflammatory markers. Its features are identical to Dressler's syndrome following myocardial infarction. Surgical trauma and cardiopulmonary bypass trigger the systemic inflammatory response, with antiheart autoantigen release and the deposition of immune complexes in the pericardium thereby provoking the occurrence of PPS. Conservative treatment is associated with a higher recovery rate. Therapeutic options for the refractory cases are long-term oral corticoids or pericardiectomy. Cardiac tamponade or constriction develops in 0.1–6% of patients requiring surgery. Coronary artery and bypass graft occlusion, unstable angina and persistent pericardial pain have been described. The majority of patients respond to anti-inflammatory agents, and only a small proportion require pericardial drainage or pericardiectomy.
Mitral Valve Pathology in Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Kevin Hodges, Nicholas Smedira, Per Wierup
Mitral valve replacement has long been known to alleviate LVOT obstruction in HOCM. Excision or posterior translocation of the anterior mitral leaflet eliminates the possibility of SAM and effectively opens the outflow tract [13, 14]. However, with adequate myectomy and the appropriate use of other mitral valve interventions, mitral valve replacement has become the procedure of last resort. In the modern era, mitral valve replacement should be reserved for patients with irreparable intrinsic valve disease or mitral stenosis, prior myectomy, or persistent LVOT obstruction after all other options have been exhausted.
Long-term outcomes of mechanical versus biological valve prosthesis in native mitral valve infective endocarditis
Published in Scandinavian Cardiovascular Journal, 2022
Markus Malmberg, Vesa Anttila, Päivi Rautava, Jarmo Gunn, Ville Kytö
This retrospective, nationwide, population-based cohort study found that in patients who underwent mitral valve replacement for native valve IE, biological valves were associated with increased long-term mortality. Deciding between mechanical and biological valve prostheses for patients requiring MVR can be challenging. According to current guidelines, a mechanical mitral valve prosthesis should be considered for a patient under 65 years of age if there is no contraindication to long-term anticoagulation, taking into account the patient’s medical history and personal preference [7,10]. However, there are no specific guidelines to support a decision when selecting a prosthesis type for surgical IE treatment; rather, this judgement is made individually according to general guidelines and the patient’s overall medical status and lifestyle [4,5,7,10]. In experienced hands, mitral valve repair with good long-term results can be feasible in cases of native mitral valve IE; however, IE patients often require infected valve replacement [6,11].
The Revolution in Heart Valve Therapy: Focus on Novel Imaging Techniques in Intra-Procedural Guidance
Published in Structural Heart, 2021
Michaela M. Hell, Felix Kreidel, Martin Geyer, Tobias F. Ruf, Alexander R. Tamm, Jaqueline G. da Rocha e Silva, Thomas Münzel, Ralph Stephan von Bardeleben
Transcatheter mitral valve replacement (TMVR) offers an alternative therapeutic option for the treatment of severe mitral regurgitation in suboptimal repair candidates with a prohibitive or high surgical risk.27 The experience with TMVR is still at an early stage with approximately 600 human implants which are mainly related to the challenges when developing this technology, including the complex non-planar geometry of the mitral valve, its subvalvular apparatus, the risk of left ventricular outflow tract obstruction as well as the large, required prostheses and delivery systems. The procedure is performed via a transfemoral-transseptal or transapical approach. So far, transcatheter mitral valve replacement has been shown to have a high rate of technical success in selected patients with excellent hemodynamic results. However, procedure‐related complications and midterm mortality remain still relatively high.27 Echocardiography-CT fusion for guidance of transcatheter mitral valve replacement has been found to be particularly beneficial for catheter crossing of the annular plane avoiding the subvalvular apparatus, the position check of the delivery system before and during final deployment, and to assess the left ventricular outflow tract impact after deployment of recapturable and retrievable prosthesis.28
Evaluating the Cost-Effectiveness of Transcatheter Mitral Valve Therapies for the Treatment of Mitral Regurgitation: “To Infinity and Beyond”
Published in Structural Heart, 2020
If a mitral device is being compared to surgery (either mitral valve repair or mitral valve replacement), then previous TAVR studies suggest that the device will have to be at least minimally clinically superior and the cost of the device 3itself will need to be partially offset by cost-savings in other areas.2–4 For example, in patients at high-surgical risk treated with TAVR vs. surgical aortic valve replacement (SAVR), the differential in index procedure cost of 23,661 USD between the two treatment strategies (due in large part to the cost of the TAVR implant) was recouped in part with a shorter length of stay during index hospitalization (4.4 days less on average) and lower post-acute care costs (-$3,881) associated with TAVR treatment.3 It is important to note that the majority of lesser costs were associated primarily with TAVR patients who were treated via a transfemoral approach; indeed, patients treated with a non-transfemoral approach (either trans-apical, subclavian, or direct aortic access) did not consistently see either better clinical outcomes2 or lower non-procedural or follow-up costs.2–4 Hence, a new percutaneous mitral valve device is most likely to be cost-effective when compared with surgery if it is delivered via a transfemoral approach.