Acute severe valvular regurgitation is a surgical emergency, but accurate and timely diagnosis can be difficult. Although cardiovascular collapse is a common presentation, examination findings to suggest acute regurgitation may be subtle, and the clinical presentation may be nonspecific. Consequently, the presentation of acute valvular regurgitation may be mistaken for other acute conditions, such as sepsis, pneumonia, or nonvalvular heart failure. Although acute regurgitation may affect any valve, acute regurgitation of the left-sided valves is more common and has greater clinical impact than acute regurgitation of right-sided valves.
Significant mitral regurgitation (MR) is estimated to afflict >2 million Americans and is anticipated to increase in prevalence as the baby boomer population ages.1 Approximately 10% of people ≥75 years of age have significant MR,1 and these patients have decreased survival regardless of whether MR is caused by a primary leaflet abnormality2 or is secondary to left ventricular (LV) dysfunction.3–7
Valve replacement is not a curative procedure but introduces a new disease process with prosthetic valve-related complications. Structural valve deterioration is a clinically important long-term complication of bioprosthetic valves, causing stenosis, regurgitation or a combination of both, ultimately necessitating reintervention. Valve thrombosis, thromboembolic complications and pannus formation occur more frequently with mechanical valves. Periprosthetic regurgitation can lead to heart failure or haemolysis. The differential diagnosis of abnormally high transprosthetic gradients is crucial for a targeted management including medical, surgical and interventional therapeutic strategies.
In patients with NIMR, MV repair achieves higher survival and leads to fewer complications than surgical MV replacement. In light of these results, we suggest that MV repair surgery should be a priority for NIMR patients.
This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.
Approximately 40% to 50% of people will have no symptoms initially and if they do, they often chalk it up to aging. This is why clinicians need to be keen about asking the right questions during annual exams. Those exams are critical because doctors can examine the chest and listen for a heart murmur. If that’s detected, an echocardiogram and evaluation by a specialist is warranted.
Mitral regurgitation is still underdiagnosed and undertreated in a substantial number of patients who have poor survival. Therefore, the priority should be to identify and treat these patients to increase their survival and quality of life. To achieve this goal, general physicians and cardiologists must be aware of all the treatment options that are currently available in dedicated centres of excellence. Patients referred to these centres can benefit from a tailored heart team-based approach. The aim of this Review is to analyse the basic principles of mitral regurgitation, discussing new concepts on the pathophysiology of the mitral valve that have been developed to facilitate the selection of patients for transcatheter procedures.
Patients who undergo a transcatheter mitral valve intervention during a hospital stay that also includes TAVI fare worse over the short term than those who only receive an aortic intervention, an analysis of administrative claims data show.
Mitral valve repair with MitraClipTM NTR/XTR is safe. The rate of LAE is lower than previously reported using older generation devices. The proposed definitions and findings will help differentiate leaflet injury from inadequate leaflet insertion and SLDA, and provide guidance to consistently diagnose LAE post MitraClipTM.
Transcatheter mitral valve implantation (TMVI) has recently emerged as a treatment option for selected high-risk patients with symptomatic mitral regurgitation (MR). Although the feasibility of TMVI in patients with previous aortic valve (AV) prostheses has been reported1, the interaction between a TMVI and an AV prosthesis has not previously been well characterised. In particular, the risk of left ventricular outflow tract (LVOT) obstruction after TMVI may be higher in patients with a pre-existing aortic valve prosthesis, due to the presence of concomitant LV hypertrophy.
East End Medical has announced it has received US Food and Drug Administration (FDA) clearance for the company’s SafeCross transseptal radiofrequency (RF) puncture & steerable balloon introducer system. The three-in-one system, which includes a steerable introducer sheath with an ultra-visible positioning balloon and RF puncture dilator, aims to provide a predictable and safe solution for electrophysiology and structural heart interventions requiring left atrial access.
Among the many competitors within these markets, Abbott, Edwards Lifesciences, and Cardiac Dimensions are the global leaders. Abbott accounts for 100% of the overall market in North America and the majority of the share in Western Europe and other regions. Abbott is expected to retain its market-leading position over the forecast period despite increasing competition from new market entrants, as physicians are already comfortable performing the MitraClip™ procedure, and reimbursement for MitraClip™ is more favorable than for alternative devices.
Vivasure Medical®, a company pioneering novel fully absorbable technology for percutaneous vessel closure, today announced its development program for PerQseal® Blue, the company’s new investigational product. PerQseal Blue is designed exclusively for sutureless and fully absorbable large-bore venous vessel closure following percutaneous cardiovascular procedures, such transcatheter mitral valve repair or replacement (TMVR) and transcatheter tricuspid valve repair or replacement (TTVR). The PerQseal Blue technology is based on PerQseal, the company’s vascular closure device approved in Europe for use in femoral arteries.
The aim of this virtual round-table discussion is to review new literature and promote understanding of the technicalities of mitral valve repair. Expert cardiologists will share tips and tricks for durable mitral valve repair, particularly minimally invasive versus sternotomy procedures.
Transcatheter mitral valve repair experienced exponential growth, increasing from 150 to 5115 over the study period (P<.001 for trend), whereas MVr grew to a lesser degree. The median length of stay for TMVr decreased from 4 to 2 days; mortality declined from 3.3% to 1.6% (P<.001 for both). Both TMVr and MVr rates of discharge home increased over the study period. Total charges for TMVr increased from $149,582 to $178,109, whereas those for MVr increased to a lesser degree, from $149,426 to $157,146 (P<.001 for both). Discharge disposition, length of stay, and in-hospital mortality all exhibited favorable trends for both procedures. Caution must be exercised in direct comparisons between procedures as they target somewhat different populations. With expanded indications for TMVr, we anticipate further increases in procedural volume, although the effect on MVr remains unclear.
Highlights of the CV imaging workshop included understanding imaging for CT, Echo, MPI, CMR, CTA and more, as well as special considerations to be made when diagnosing coronary artery disease in women. In recent years, there has been rapid development and technologic advances in the field of cardiovascular imaging and MHIF research physicians have been influential leaders in this area. These advances are giving cardiologists more options to inform diagnoses, treatment and making less-invasive procedures, like transcatheter valve therapies, more accessible for patients. This opens options for older, more fragile patients who would not have had treatment options even a few years ago.
While transcatheter aortic valve replacement (TAVR) has become ubiquitous in valvular therapy during the past 10 years, we seldom hear about transcatheter mitral valve replacement (TMVR).One reason is that TMVR has yet to receive a Food & Drug Administration (FDA) approval in the United States. While there has been much interest and investment for the development of TMVR, we have yet to witness a successful device system that has yielded an FDA approval.
The PASCAL transcatheter mitral valve repair (TMVr) system (Edwards Lifesciences, Irvine, CA) enables repair of a regurgitant mitral valve through leaflet approximation around an anatomi
This is the 3rd module in a series of 4 webinars on transcatheter management of mitral and tricuspid regurgitation.
Mitral valve regurgitation sometimes doesn’t need any treatment or can be treated with medication. In moderate to severe cases the valve needs repair to make it close tighter and prevent blood from flowing backward. Mitral regurgitation can be severe enough to cause symptoms such as fatigue and feeling out of breath. If it isn’t treated, mitral valve regurgitation can lead to heart failure or arrhythmias.
TMVR is performed in at high-risk patients with attenuated long-term survival. MViV has the best success and survival rate, but long-term survival in MViR and ViMAC is guarded.
Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, it confers a poorer prognosis. Catheter-based repair therapies face some limitations like their applicability on challenging anatomies and the potential recurrence of significant MR over time. Transcatheter mitral valve replacement (TMVR) has emerged as a less invasive approach potentially overcoming some of the current limitations associated with transcatheter mitral valve repair. Several devices are under clinical investigation, and a growing number of systems allow for a fully percutaneous transfemoral approach. In this review, the authors aimed to delineate the main challenges faced by the TMVR field, to highlight the key aspects for procedural planning, and to describe the clinical results of the TMVR systems under clinical investigation. Finally, they also discuss what the future perspectives are for this emerging field.
Significant mitral regurgitation (MR) is estimated to afflict >2 million Americans and is anticipated to increase in prevalence as the baby boomer population ages. Approximately 10% of people ≥75 years of age have significant MR, and these patients have decreased survival regardless of whether MR is caused by a primary leaflet abnormality or is secondary to left ventricular (LV) dysfunction.
Bien que la prise en charge « standard » de l’insuffisance mitrale (IM) reste la chirurgie par plastie ou remplacement valvulaire mitral, 50% des patients porteurs d’une IM sévère ne sont pas référés à la chirurgie devant de multiples comorbidités. Ainsi, le développement de la réparation ou du remplacement valvulaire mitral percutané permet de prendre en charge les patients non opérables. Cependant, les résultats cliniques du traitement percutané mitral sont fortement dépendants du mécanisme de l’IM.
Tissue valves honestly continue to get better, but unfortunately the durability of these valves is a limiting factor. So you'll see a few number of valves fail within the first couple of years, but the durability is not much longer than 10, 15 years and so forth. So that's a major limitation for these patients that undergo surgery and have bioprosthetic valves placed.
Baylis Medical is a leader in the development and commercialization of innovative medical devices in the field of cardiology, with a focus on left-heart access.
As we live longer lives, patients with heart valve disease are considering the lifelong management of valvular conditions including aortic stenosis and mitral regurgitation. For this reason, patients are asking important questions if a re-operation, or second intervention, is required. Given recent innovations specific to non-invasive, transcatheter heart valve therapies, there is extensive patient interest to learn how these next generation devices – which do not require an incision to the chest – may be used if a valve needs to be re-replaced or re-repaired.
Valvular heart disease (VHD) is a major contributor to loss of physical function, quality of life and longevity. The epidemiology of VHD varies substantially around the world, with a predominance of functional and degenerative disease in high-income countries, and a predominance of rheumatic heart disease in low-income and middle-income countries. Reflecting this distribution, rheumatic heart disease remains by far the most common manifestation of VHD worldwide and affects approximately 41 million people.