共查询到20条相似文献，搜索用时 31 毫秒
1.
Matteo Pagnesi Francesco Moroni Alessandro Beneduce Francesco Giannini Antonio Colombo Giora Weisz Azeem Latib 《JACC: Cardiovascular Interventions》2019,12(23):2388-2401
Severe mitral regurgitation (MR) is fairly common in the general population and is associated with significant morbidity and mortality. Although surgical mitral valve (MV) repair and replacement are well established treatment options for MV disease, as much as one-half of patients with severe, symptomatic MR are not referred for surgery due to prohibitive procedural risk. Novel transcatheter alternatives are therefore being developed to provide an alternative treatment for these patients. A growing experience with transcatheter MV replacement (TMVR) strategies is accumulating and promising early results have been reported. However, the risk of transcatheter heart valve (THV) thrombosis seems to be relevant after TMVR, potentially higher than that observed after transcatheter aortic valve replacement, and routine anticoagulant therapy appears to be necessary to mitigate this risk. Hereafter, the authors: 1) review available evidence on thrombotic risk after TMVR (including new dedicated THVs for native MV, valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification); and 2) discuss the antithrombotic treatment strategies after TMVR. 相似文献
2.
3.
4.
5.
6.
7.
8.
Christian Besler Stephan Blazek Karl-Philipp Rommel Thilo Noack Maximilian von Roeder Christian Luecke Joerg Seeburger Joerg Ender Michael A. Borger Axel Linke Matthias Gutberlet Holger Thiele Philipp Lurz 《JACC: Cardiovascular Interventions》2018,11(12):1142-1151
Objectives
The present study aimed to test the clinical benefit of combined transcatheter mitral plus tricuspid valve edge-to-edge repair (TMTVR) as compared with transcatheter mitral valve edge-to-edge repair (TMVR) alone in patients with both significant mitral (MR) and tricuspid regurgitation (TR) at high surgical risk.Background
A growing number of patients with severe MR at increased surgical risk are treated by transcatheter techniques. Evidence suggests that residual TR remains a predictor of adverse outcome in these patients.Methods
Sixty-one patients (mean age 79.5 ± 8.4 years, EuroSCORE II 8.6 ± 5.9%) underwent TMTVR (n = 27) or TMVR (n = 34). Echocardiographic and cardiac magnetic resonance imaging was performed before and after the procedure.Results
Reduction of MR was similar in patients undergoing TMTVR and TMVR. Effective regurgitant orifice area of TR was reduced from 0.51 to 0.29 cm2 in patients with TMTVR (p < 0.01), but remained unchanged after TMVR. On cardiac magnetic resonance imaging, only patients in the TMTVR group exhibited improved effective right and left ventricular stroke volume, and increased cardiac index (2.1 vs. 2.5 l/min/m2; p < 0.01). TMTVR led to superior improvement in New York Heart Association functional class, NT-proBNP levels, and 6-min walking distance as compared with TMVR. After up to 18 months of follow-up, patients with TMTVR experienced fewer hospitalizations for heart failure when compared with patients with TMVR (p = 0.02), whereas rates of death were comparable between both groups of patients.Conclusions
TMTVR appears superior to TMVR in terms of cardiac output and functional improvement early after the intervention, and improves clinical outcome up to 18 months of follow-up. 相似文献9.
10.
Vinayak Bapat Vivek Rajagopal Christopher Meduri R. Saeid Farivar Antony Walton Stephen J. Duffy Robert Gooley Aubrey Almeida Michael J. Reardon Neal S. Kleiman Konstantinos Spargias Stratis Pattakos Martin K. Ng Michael Wilson David H. Adams Martin Leon Michael J. Mack Sharla Chenoweth Simon Redwood 《Journal of the American College of Cardiology》2018,71(1):12-21
Background
Transcatheter mitral valve replacement (TMVR) is a potential therapy for patients with symptomatic, severe mitral regurgitation (MR). The feasibility of this therapy remains to be defined.Objectives
The authors report their early experience with TMVR using a new valve system.Methods
The valve is a self-expanding, nitinol valve with bovine pericardial leaflets that is placed using a transapical delivery system. Patients with symptomatic MR who were deemed high or extreme risk by the local heart teams were enrolled in a global pilot study at 14 sites (United States, Australia, and Europe).Results
Fifty consecutively enrolled patients (mean age: 73 ± 9 years; 58.0% men; 84% secondary MR) underwent TMVR with the valve. The mean Society for Thoracic Surgery score was 6.4 ± 5.5%; 86% of patients were New York Heart Association functional class III or IV, and the mean left ventricular ejection fraction was 43 ± 12%. Device implant was successful in 48 patients with a median deployment time of 14 min (interquartile range: 12 to 17 min). The 30-day mortality was 14%, with no disabling strokes, or repeat interventions. Median follow-up was 173 days (interquartile range: 54 to 342 days). At latest follow-up, echocardiography confirmed mild or no residual MR in all patients who received implants. Improvements in symptom class (79% in New York Heart Association functional class I or II at follow-up; p < 0.0001 vs. baseline) and Minnesota Heart Failure Questionnaire scores (56.2 ± 26.8 vs. 31.7 ± 22.1; p = 0.011) were observed.Conclusions
TMVR with the valve was feasible in a study group at high or extreme risk for conventional mitral valve replacement. These results inform trial design of TMVR in lower-risk patients with severe mitral valve regurgitation (Evaluation of the Safety and Performance of the Twelve Intrepid Transcatheter Mitral Valve Replacement System in High Risk Patients with Severe, Symptomatic Mitral Regurgitation – The Twelve Intrepid TMVR Pilot Study; NCT02322840) 相似文献11.
12.
James S. Gammie Krzysztof Bartus Andrzej Gackowski Michael N. D’Ambra Piotr Szymanski Agata Bilewska Mariusz Kusmierczyk Boguslaw Kapelak Jolanta Rzucidlo-Resil Neil Moat Alison Duncan Rashmi Yadev Steve Livesey Paul Diprose Gino Gerosa Augusto D’Onofrio Demetrio Pitterello Paolo Denti Piotr Kolsut 《Journal of the American College of Cardiology》2018,71(1):25-36
Background
Conventional mitral valve (MV) operations allow direct anatomic assessment and repair on an arrested heart, but require cardiopulmonary bypass, aortic cross-clamping, sternotomy or thoracotomy, and cardioplegic cardiac arrest, and are associated with significant perioperative disability, and risks of morbidity and mortality.Objectives
This study evaluated safety and performance of a transesophageal echocardiographic-guided device designed to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on mitral leaflets in the beating heart.Methods
In a prospective multicenter study, 30 consecutive patients with severe degenerative mitral regurgitation (MR) were treated with a mitral valve repair system (MVRS) via small left thoracotomy. The primary (30-day) endpoint was successful implantation of cords with MR reduction to moderate or less.Results
The primary endpoint was met in 27 of 30 patients (90%). Three patients required conversion to open mitral surgery. There were no deaths, strokes, or permanent pacemaker implantations. At 1 month, MR was mild or less in 89% (24 of 27) and was moderate in 11% (3 of 27). At 6 months, MR was mild or less in 85 % (22 of 26), moderate in 8% (2 of 26), and severe in 8% (2 of 26). Favorable cardiac remodeling at 6 months included decreases in end-diastolic (161 ± 36 ml to 122 ± 30 ml; p < 0.001) and left atrial volumes (106 ± 36 ml to 69 ± 24 ml; p < 0.001). The anterior-posterior mitral annular dimension decreased from 34.7 ± 5.8 mm to 28.2 ± 5.1 mm; p < 0.001 as did the mitral annular area (10.0 ± 2.7 cm2 vs. 6.9 ± 2.0 cm2; p < 0.0001).Conclusions
MVRS ePTFE cordal implantation can reduce the invasiveness and morbidity of conventional MV surgery. The device’s safety profile is promising and prospective trials comparing the outcomes of the MVRS to conventional MV repair surgery are warranted. (CE Mark Study for the Harpoon Medical Device [TRACER]; NCT02768870) 相似文献13.
Philipp E. Bartko Henrike Arfsten Gregor Heitzinger Noemi Pavo Guido Strunk Marianne Gwechenberger Christian Hengstenberg Thomas Binder Martin Hülsmann Georg Goliasch 《JACC: Cardiovascular Imaging》2019,12(9):1728-1737
ObjectivesThis study sought to define interpapillary muscle dyssynchrony as a major contributing factor in functional mitral regurgitation (FMR) and prove the reversibility of FMR by interpapillary muscle resynchronization.BackgroundMechanistic features of FMR include papillary muscle displacement due to left ventricular remodeling. Intraventricular conduction delay might further augment this condition by introducing interpapillary muscle dyssynchrony.MethodsWe enrolled 269 chronic heart failure with reduced ejection fraction patients with conduction delay and comprehensively assessed dyssynchrony by complementary echocardiographic techniques covering the entire spectrum of dyssynchrony.ResultsPatients with severe FMR had markedly increased interpapillary longitudinal dyssynchrony (160 ms [interquartile range (IQR): 120 to 200 ms]) compared with those with moderate (70 ms [IQR: 40 to 110 ms]), no, or mild FMR (60 ms [IQR: 30 to 100 ms]; p < 0.001). Increased interpapillary muscle dyssynchrony was correlated with regurgitant volume (r = 0.50; p < 0.001) and vena contracta width (r = 0.49; p < 0.001). Restoration of longitudinal papillary muscle synchronicity by cardiac resynchronization therapy was correlated with FMR regression, as reflected by the reduction in regurgitant volume (r = 0.46; p < 0.001) and vena contracta width (r = 0.58; p < 0.001). Conversely, the improvement of FMR was associated with improved interpapillary radial (p = 0.006) and longitudinal (p < 0.001) dyssynchrony. The improvement of dyssynchrony-mediated FMR signified a better prognosis compared with no improvement in FMR during the 8-year follow-up period even after comprehensive adjustment by a bootstrap-selected confounder model (adjusted hazard ratio: 0.41; 95% confidence interval: 0.18 to 0.91; p = 0.028). The results remained virtually unchanged after adjustment for left bundle branch block.ConclusionsIntraventricular dyssynchrony introduces unequal contraction by papillary muscle bearing walls, which has an adverse effect on FMR. Cardiac resynchronization therapy can effectively restore interpapillary balance and thus create a less tented leaflet configuration, resulting in a clinically meaningful reduction of FMR. The restoration of papillary muscle synchronicity in dyssynchrony-mediated FMR translates into a significantly better prognosis. 相似文献
14.
Hyue Mee Kim Goo-Yeong Cho In-Chang Hwang Hong-Mi Choi Jun-Bean Park Yeonyee E. Yoon Hyung-Kwan Kim 《JACC: Cardiovascular Imaging》2018,11(9):1235-1244
Objectives
We investigated whether global longitudinal strain (GLS) is a better predictor of clinical events after surgery for mitral regurgitation (MR) than conventional parameters.Background
The optimal timing for surgery is guided by left ventricular (LV) dimension or left ventricular ejection fraction (LVEF), even though normal LVEF can mask depressed LV systolic function in severe mitral MR.Methods
From 2006 to 2016, 506 patients (age 58.5 ± 13.7 years, 54.3% male) with severe primary MR who underwent mitral valve surgery were included. We measured GLS and global circumferential strain. Cardiac events included admission for worsening heart failure (HF), reoperation for failure of MV surgery, and cardiac death.Results
During a median follow-up period of 3.5 years, 56 (11.1%) patients died, 41 (8.1%) were hospitalized for HF, and 10 (2.0%) underwent reoperation. In univariate analysis, LVEF, atrial fibrillation, left atrial dimension, age, previous ischemia, concomitant coronary artery bypass graft, and both GLS and global circumferential strain were predictive of cardiac events. On multivariate Cox models, age (hazard ratio [HR]: 1.429, 95% confidence interval [CI]: 1.116 to 1.831; p = 0.005), left atrial dimension (HR: 1.034, 95% CI: 1.006 to 1.063; p = 0.019) and GLS (HR: 1.229, 95% CI: 1.135 to 1.331; p < 0.001) were independent predictors of cardiac events. In subgroup analysis, LV GLS was a significant predictor of cardiac outcome, regardless of the presence of LV dysfunction, the presence of atrial fibrillation, and the type of surgery. Impaired GLS was associated with all-cause mortality (HR: 1.068, 95% CI: 1.003 to 1.136; p = 0.040).Conclusions
GLS appears to be a better predictor of cardiac events all-cause death than conventional parameters. Measuring preoperative GLS is helpful to predict post-operative outcome and determine optimal timing for surgery in patients with severe primary MR. 相似文献15.
Isabel Zegri-Reiriz Arístides de Alarcón Patricia Muñoz Manuel Martínez Sellés Victor González-Ramallo Jose M. Miro Carles Falces Claudia Gonzalez Rico Xabier Kortajarena Urkola José Antonio Lepe Regino Rodriguez Alvarez Jose Maria Reguera Iglesias Enrique Navas Fernando Dominguez Pablo Garcia-Pavia 《Journal of the American College of Cardiology》2018,71(24):2731-2740
Background
There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions.Objectives
This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions.Methods
This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89).Results
BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients.Conclusions
IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered. 相似文献16.
17.
18.
Jang Sun-Joo Truong Quynh A. Bergman Geoffrey Wong S. Chiu Mosadegh Bobak 《Current treatment options in cardiovascular medicine》2021,23(2):1-10
Purpose of review
Prenatal diagnosis of congenital heart disease (CHD) is continuously evolving with each passing decade. Early efforts in fetal cardiology focused on identifying CHD in mid-gestation and understanding of fetal circulation in pathologic conditions. Improving prenatal detection rates for CHD remains an ongoing challenge and increasingly the field of fetal cardiology is moving to not only diagnosing CHD prenatally but also assessing the impact of prenatal diagnosis of CHD outcomes. Future directions include earlier diagnosis of fetal CHD, improved diagnostic rates, widespread sonographer education, and a better understanding of antenatal factors that impact outcomes. Our goal in this review is to describe the past, present, and future of prenatal diagnosis of CHD.
Recent findingsThere has been a steady improvement in the prenatal diagnosis rate for CHD; however, there remains a significant variation between countries and within the USA. Prenatal diagnosis of CHD allows for counseling and delivery planning in those fetuses with critical CHD, thereby providing parents with resources and important tools while dealing with a challenging situation of carrying a child with heart disease and helping them with important decisions for their family and their future. There are several specific conditions which continue to pose a challenge from a diagnostic standpoint as they may appear mild at the time of initial diagnosis and may be missed but progress through the pregnancy and lead to significant CHD in the neonatal period.
SummaryIn summary, continued efforts aimed at collaborative research and education are needed in order to be able to improve CHD detection rates. We need to cautiously assess lesions that appear minor in mid-gestation but have the potential to progress in late gestation. Earlier detection of CHD by means of a transvaginal or a first-trimester fetal echocardiogram may further help families with delivery planning and decision-making.
相似文献19.
20.
Michael V. Holmes Iona Y. Millwood Christiana Kartsonaki Michael R. Hill Derrick A. Bennett Ruth Boxall Yu Guo Xin Xu Zheng Bian Ruying Hu Robin G. Walters Junshi Chen Mika Ala-Korpela Sarah Parish Robert J. Clarke Richard Peto Rory Collins Liming Li Zhengming Chen 《Journal of the American College of Cardiology》2018,71(6):620-632