With the growing prevalence of heart valve diseases, it is important to better understand the biomechanical behavior of normal and pathological heart valve tissues. Recent studies showed that heart valve leaflets exhibited a unique functionally elastic behavior, in which valvular tissues exhibited minimal hysteretic and creep behaviors under biaxial loading, yet allowed stress relaxation similar to other types of collagenous tissues. This unique behavior is in favor of heart valve function, enabling leaflets to bear peak physiological loading without time-dependent deformation.
Background. Native valve endocarditis is frequently managed with antibiotics alone, but prosthetic valve endocarditis usually requires an early operation. What is the best treatment of endocarditis after mitral valve repair?
The contradictory results of transcatheter therapies in the MITRA-FR and COAPT trials have generated much controversy. Our understanding of the results of these two trials is that percutaneous edge to edge repair is beneficial in selected patients with severe FMR who remained symptomatic despite guideline medical therapy, but precise criteria to identify these patients remain to be defined.
Transcatheter mitral valve technology represents one of the most promising markets in medtech, likely even surpassing that of aortic transcatheter devices. But so far, no consensus has emerged on the optimum approach. Half Moon Medical, a novel build-to-buy project that brings together The Foundry and Medtronic, is making the case for repair rather than replacement.
Patient interest in robotic mitral valve repair surgery continues to increase. Now, more than ever, I’m getting patient questions about robot-assisted therapies and the surgeons that focus on this super-specialized approach to mitral valve repair. For example, I’m just getting off the phone with Elaine from Georgia. She asked me, “Adam, I have mitral regurgitation. I want a repair not a replacement. What do you think about surgery using the robot?”
The pioneering robot-assisted mitral valve repair ended in catastrophe, with a cascade of failures resulting in the death of retired conductor Stephen Pettitt at Freeman Hospital in Newcastle, according to a continuing inquest as reported in the Daily Mail. Lead surgeon Sukumaran Nair and assisting surgeon Thasee Pillay could hardly hear each other due to a "tinny" sound emanating from the robot console Nair was operating. Nair had to shout to warn his colleague that the robot, called Da Vinci, was stitching up the valve incorrectly – and then shout again when he saw the robot "knocked" one of the surgical assistants' arms.
Cedars-Sinai received the top rating from the Society of Thoracic Surgeons for mitral surgery again this year. The team recently presented their experience from more than 1,000 robotic mitral repairs with near 100% early survival and repair rates at the 2021 Society of Thoracic Surgeons Annual Meeting.
There are two types of treatment available for mitral valve prolapse:
In this propensity-matched analysis, there was no significant difference in 2-years survival between TMVr and SMVr. Compared with SMVr, TMVr resulted in inferior MR reduction and LVEF improvement, and worse functional status at 2 years.
Heart valves open when the heart pumps to allow blood to flow. They close quickly between heartbeats to make sure blood does not flow backward. Any trouble in this normal flow pattern will make it hard for the heart to pump the blood where it needs to go.
The Tria valves reimagine the heart valve by incorporating a new, proprietary biopolymer—LifePolymer—with innovative valve designs intended to resist calcification, withstand stresses and strains without failure, and restore patient quality of life without lifelong use of anticoagulants. Tria is also the first and only heart valve to be robotically produced, which is possible due to its polymer leaflets that can be consistently manufactured with precise thicknesses and are designed to achieve a valve with predictable performance that lasts a lifetime.
Max Super Speciality Hospital, Saket has conducted a mitral valve repair (a leaking heart valve) surgery using the transcatheter technique. A MitraClip, a small, implanted clip, was attached to the mitral valve to close/repair it thereby restoring normal blood flow through the heart. It is the world’s first transcatheter mitral valve repair (TMVr) therapy that delivers a minimally invasive treatment option.
Unique au monde, Electroducer Sleeve s’appuie sur une technique médicale appelée Direct Wire Pacing (DWP®), développée par le fondateur de l’entreprise, le Dr Benjamin Faurie, et utilisée pour la première fois au monde en 2011. Elle consiste à remplacer l’étape d’implantation d’un pacemaker temporaire dans le cœur, traumatique et douloureuse pour le patient, par une stimulation effectuée directement sur l’instrument porteur de la valve, appelé « fil guide ».
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.