Background This study analyzed the effects on long‐term outcome of residual mitral regurgitation ( MR ) and mean mitral valve pressure gradient ( MVPG ) after percutaneous edge‐to‐edge mitral valve repair using the MitraClip system. Methods and Results Two hundred fifty‐five patients who underwent percutaneous edge‐to‐edge mitral valve repair were analyzed. Kaplan–Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical end point (all‐cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used. After percutaneous edge‐to‐edge mitral valve repair, mean MVPG increased from 1.6±1.0 to 3.1±1.5 mm Hg ( P <0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive of the combined end point while elevated MVPG >4.4 mm Hg was not according to Kaplan–Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities. In the cohort with degenerative MR , elevated MVPG was associated with increased occurrence of the primary end point, whereas this was not observed in the cohort with functional MR . Conclusions MVPG >4.4 mm Hg after MitraClip implantation was predictive of clinical outcome in the patient cohort with degenerative MR . In the patient cohort with functional MR , MVPG >4.4 mm Hg was not associated with increased clinical events.
BackgroundPercutaneous edge‐to‐edge mitral valve repair (PMVR) has become an established treatment option for mitral regurgitation in patients not eligible for surgical repair. Currently, most procedures are performed under general anesthesia (GA). An increasing number of centers, however, are performing the procedure under deep sedation (DS). Here, we compared patients undergoing PMVR with GA or DS.Methods and ResultsA total of 271 consecutive patients underwent PMVR at our institution between May 2014 and December 2016. Seventy‐two procedures were performed under GA and 199 procedures under DS. We observed that in the DS group, doses of propofol (743±228 mg for GA versus 369±230 mg for DS, P<0.001) and norepinephrine (1.1±1.6 mg for GA versus 0.2±0.3 mg for DS, P<0.001) were significantly lower. Procedure time, fluoroscopy time, and dose area product were significantly higher in the GA group. There was no significant difference between GA and DS with respect to overall bleeding complications, postinterventional pneumonia (4% for GA versus 5% for DS), or C‐reactive protein levels (361±351 nmol/L for GA versus 278±239 nmol/L for DS). Significantly fewer patients with DS needed a postinterventional stay in the intensive care unit (96% for GA versus 19% for DS, P<0.001). Importantly, there was no significant difference between DS and GA regarding intrahospital or 6‐month mortality.Conclusions DS for PMVR is safe and feasible. No disadvantages with respect to procedural outcome or complications in comparison to GA were observed. Applying DS may simplify the PMVR procedure.
BackgroundPatients after transcatheter aortic valve replacement (TAVR) and persistent severe mitral regurgitation (MR) are increasingly treated with percutaneous edge-to-edge mitral valve repair (PMVR). The impact of a former TAVR on PMVR procedures is not clear.Methods and resultsWe retrospectively analyzed 332 patients undergoing PMVR using the MitraClip system with respect to procedural and clinical outcome. 21 of these 332 patients underwent TAVR before PMVR. Intra-procedural transthoracic (TTE) and transesophageal echocardiograms (TEE) immediately before and after clip implantation as well as invasive hemodynamic measurements were evaluated. At baseline, we found a significantly smaller mitral valve anterior-posterior diameter in the TAVR cohort (p < 0.001). A reduction of MR by at least three grades was achieved in a smaller fraction in the TAVR cohort as compared to the cohort with a native aortic valve (p = 0.02). Accordingly, we observed a smaller post-procedural cardiac output in the TAVR cohort (p = 0.02).ConclusionPMVR in patients who had a TAVR before, is associated with altered MR anatomy before and a reduced improvement of MR after the procedure. Future larger and prospective studies will have to determine, whether a previous TAVR influences long-term clinical outcome of patients undergoing PMVR.
Results and Discussion: Delirium occurred in 29 patients (15%). Before surgery 8% and 20% of patients were dependent in at least one activity in instrumental and personal ADL, respectively. Patients dependent in at least one ADL had more frequently delirium after surgery (31 % versus 11%, p=0.004) but mortality and length of hospital and PACU stay was not higher from other patients with no dependency in ADL. Patients with postoperative delirium had worse scores in three SF-36 domains before surgery: physical function (p<0.001), bodily pain (p=0.011) and social functioning (p=0.045). Conclusion(s):This study shows that patients with dependency in ADL have more frequently delirium after surgery. Patients that develop delirium after surgery had worse scores in some SF-36 domains.Background and Goal of Study: Delirium is a common, probably underdiagnosed, complication following cardiac surgery and is associated with increased morbidity, mortality and costs. There is no optimal regime defined for its treatment. The goal of our audit was to look at incidence, risk factors, implications and treatment of delirium in the cardiac ICU. Materials and Methods: We retrospectively audited 101 consecutive patients, aged 66 (11) in the period of January to July 2009. We collected data on: delirium score (ICDSC-Intensive Care delirium screening checklist), past-medical history, pre-op medications, CPB time, X-clamp time, circulatory arrest time, type of operation, consequences and treatment received. The statistical tests used were chi-squared test with continuity correction for nominal categorical data and logistic regression for continuous data. Results and Discussion: 26/101 (26%) patients developed delirium, defined as delirium score ICDSC of 4 or more. Data in Table 1 are number (%) or mean (SD). The most common implications secondary to delirium were noncompliance with oxygen therapy 20/26 (76%) and medications 15/26(57%), removal of lines 10/26 (38.4%), drains 2/26 (7.7%) and assault to the ICU staff 3/26(11.5%). There was no consistency in treatment and no regular medication regime following an episode of delirium. 21/26 of patients received pharmacological treatment. Our study may be too small to show any other risk factors for developing delirium.
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