Background
Transcatheter mitral valve repair (TMVR) has shown to improve symptoms and functional capacity in patients with severe mitral valve regurgitation (MR). Novel device developments provide the technology to treat patients with complex anatomies and large coaptation gaps. Nevertheless, the question of superiority of one device remains unanswered. We aimed to compare the MitraClip XTR and MitraClip NTR system in a real world setting.
Hypothesis
TMVR with the MitraClip XTR system is equally effective, but associated with a higher risk of leaflet injury.
Methods
We retrospectively analyzed peri‐procedural and mid‐term clinical and echocardiographic outcomes of 113 patients treated for severe MR between March 2018 and August 2019 at the University Hospital of Munich.
Results
Postprocedural MR reduction to ≤2+ was comparable in both groups (XTR: 96.1% vs. NTR: 97.6%, p = .38). There was a significant difference in a composite safety endpoint of periprocedural Major adverse cardiac and cerebrovascular events (MACCE) including leaflet injury between groups (XTR 14.6% vs. NTR 1.7%, 95% CI [2.7, 24.6], p = .012). After a median follow‐up of 8.5 (4.4, 14.0) months, durable reduction of MR was confirmed (XTR: in 91.9% vs. NTR: 96.8%, p = .31) and clinical and symptomatic improvement was comparable in both groups accordingly.
Conclusion
While efficacy was comparable in both treatment groups, patients treated with the MitraClip XTR systems showed more events of acute leaflet tear and single leaflet device attachment (SLDA). A detailed echocardiographic assessment should be done to identify risk candidates for acute leaflet injury.
Variant histologies of bladder cancer (BC) often present with advanced tumor stage and the status of perioperative therapy is unclear. Thereby, squamous cell carcinoma (SCC), adenocarcinoma (ADENO), and sarcomatoid urothelial carcinoma (SARCO) are the most frequent variants. Nectin-4 has emerged as a highly interesting target in BC and might guide therapeutic application of antibody–drug conjugates (ADC). We therefore aimed to investigate expression patterns and prognostic value of Nectin-4 in variant histologies of BC. A single-center retrospective analysis was conducted of patients who underwent radical cystectomy (RC) for BC and revealed variant histologies of BC in the final specimens. Immunohistochemical staining for Nectin-4 was performed on tissue microarrays with 59 SCC, 22 ADENO, and 24 SARCO, and Nectin-4 expression was scored using the histochemical scoring system (H-score). Overall survival (OS) and progression-free survival (PFS) was calculated by Kaplan–Meier method. Median expression of Nectin-4 was 150 (range 0–250) in SCC, 140.5 (range 30–275) in ADENO, and 10 (0–185) in SARCO, with significantly lower levels for SARCO compared to SCC or ADENO (p < 0.001). For SCC, ADENO or SARCO no differences regarding OS or PFS were observed based on Nectin-4 expression levels (p > 0.05). Multivariate analysis revealed nodal stage as an independent prognostic factor for OS and PFS and metastases for PFS but not Nectin-4 expression. In conclusion, Nectin-4 was not prognostic in histological subtypes of BC in our study cohort. However, the high expression of Nectin-4 in SCC and ADENO might guide future treatment with novel Nectin-4-directed ADCs and provide this high-risk patient collective with a new promising therapeutic option. Testing Nectin-4 expression as a biomarker should be considered in trials with SARCO, where low Nectin-4 expression has been observed.
Zusammenfassung: Laser haben ein umfangreiches Anwendungsspektrum in der endourologischen Therapie. Nicht nur in der Therapie von Steinen, auch in der Behandlung des benignen Prostatasyndroms (BPS) nimmt ihr Stellenwert immer weiter zu. Auf die endourologische Behandlung der BPS mit verschiedenen Laser-Techniken wird im weiteren Verlauf näher eingegangen. Dabei werden zuerst die physikalischen Unterschiede der einzelnen Laser erklärt, im weiteren Verlauf die Behandlungsmöglichkeiten an sich, die mit einem Laser durchgeführt werden können. Hauptaugenmerk soll auf dem konkreten Vergleich der Behandlungsmethoden vor allem im klinischen Kontext liegen. Insbesondere die OP-Dauer, Hospitalisierungsdauer, das Nachblutungsrisiko, die DK(Dauerkatheter)-Zeit, das Risiko eines Harnverhalts und das Risiko für postoperative Komplikationen wie retrograde Ejakulation, BH (Blasenhals)-Sklerose, HR (Harnröhren)-Striktur, Adenomrezidive sollen für die wichtigsten Methoden aufgeführt und miteinander verglichen werden. Dennoch liegt weiterhin die Verteilung von TURP zu Laser mit 30:1 zu Gunsten der TURP [1].
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