almost all Asian countries (except Japan) affects the rate of uptake. Second, regulatory approvals take time and effort to obtain. Furthermore, some countries such as Japan and China require local trials before approval for use. Third, the conservative nature of Asian societies, both patients and physicians, may make adoption of relatively newer technologies a slower process. The first MitraClip procedure in the Asia-Pacific was performed at Sir Charles Gairdner Hospital, Australia, on 23 March 2011, while the first in Asia was performed soon after at the National Heart Centre Singapore on 14 April 2011 (Table 1). 19 This paved the way for other Asian countries to open their MitraClip programs. The most recent country to start the MitraClip program is Japan, which received regulatory approval for the MitraClip in 2017 and subsequently national reimbursement in 2018. This was only after completion of the Japanese AVJ-514 trial, which provided the regulatory authorities with the requisite data for approval of the use of the device. 20 Once the MitraClip was approved in Japan, the accompanying reimbursement allowed for rapid adoption of the therapy. Figure shows the gradual increase in MitraClip cases over the years for each region, with an exponential jump last year with the introduction of Japan. MitraClip Data in Asia Limited data on MitraClip therapy have been published in Asia (Table 2), 20-23 as compared with the extensive global experience and literature. The MitraClip Asia-Pacific Registry (MARS) is a multinational , multi-center registry started in February 2011 in an effort to describe the MitraClip experience in the Asia-Pacific region. Thus far, 17 centers from 10 countries (Australia,
Care coordination improved the rate of transition of post-PCI patients to primary care and improved LDL control, with no difference in the rate of hospital admissions due to cardiovascular causes. These findings support the implementation of a standardized follow-up protocol in patients who have undergone PCI.
Background Anatomical exclusion criteria for the MitraClip procedure have included rheumatic heart disease (RHD) involving the mitral valve. This was primarily because RHD is typically associated with mitral stenosis (MS). Case summary We report the case of an 85-year-old male who had recurrent heart failure admissions from severe rheumatic mitral regurgitation (MR). This was successfully treated with the MitraClip system. Discussion Our case demonstrated the possibility of rheumatic MR being treated by the MitraClip system in appropriately selected patients. Careful examination of the mechanism of MR to determine suitability for MitraClip must be done as well as exclusion of significant MS.
BackgroundThe MitraClip system has been used extensively in high-risk patients with severe degenerative mitral regurgitation (MR). Recent reports have demonstrated the feasibility of using the MitraClip device to treat systolic anterior motion (SAM) of the mitral valve in obstructive hypertrophic cardiomyopathy (HOCM).Case summaryWe report the case of a 76-year-old lady who had both symptomatic severe degenerative MR and HOCM that were refractory to medical therapy. Both pathologies were treated successfully using the MitraClip system.DiscussionIn patients who are deemed to be at high risk for open surgery, our case demonstrated the feasibility of a percutaneous avenue, the MitraClip system, to treat not just degenerative MR, but also SAM from HOCM in a single procedure.
Introduction:For suitable end-stage renal failure (ESRF) patients, renal transplantation gives better long term survival and quality of life as compared to dialysis. Prior to entry into the renal transplant wait list, potential candidates are screened for the presence of cardiovascular disease. However, the waiting time on the transplant list is long, and interval screening for cardiac fitness for surgery is not well defined. We aim to study the risk factors for the development of a cardiovascular event (CVE) and the time interval from recruitment to onset of a CVE that resulted in their removal from the transplant wait list.Methods:A retrospective study of all patients registered under the cadaveric renal transplant waiting list in Singapore General Hospital (SGH) from 16th April 1987 to 31st October 2010. We identified patients who developed a CVE among this cohort. We compared the demographics and clinical characteristics of patients who experienced a CVE versus those who did not. Univariable and multivariable cox regression were performed to investigate the significant variables for the development of a CVE. The time to development of CVE was estimated using Kaplan Meier estimation and log-rank test was used to compare the time to CVE between those with diabetes mellitus and those without.Results:1265 patients were enrolled in this study. 273 patients dropped out of the wait list due to medical reasons or death, of which 38.8% were due to CVE. The mean and median time duration from recruitment into the waiting list to development of a CVE was 14.42 (95% CI 13.72 to 15.11) and 15.69 (95% CI 13.86 to 17.51) years respectively. For patients with diabetes mellitus, this was 8.22 (95% CI 6.30 to 10.14) and 8.16 (95% CI 4.95 to 11.36) years respectively. Factors associated with an increased risk of developing a CVE included male gender (adjusted HR 2.21, 95% CI 1.43 to 3.41, p<0.001), presence of diabetes mellitus (adjusted HR 5.13, 95% CI 2.85 to 9.24, p<0.001) and patients who were either not working or working part-time as compared to their full-time counterparts (adjusted HR 1.76, 95% CI 1.14 to 2.72, p=0.010). In addition, hazard ratio for CVE significantly increased with advancing age quartile (p<0.001 by log rank test for trend).Conclusion:A significant proportion of patients exited from the renal transplant wait list due to a CVE. Being male, age 37 years old or more, presence of diabetes mellitus and non-working or part-time workers as compared to full-time workers were found to increase the risk of developing a CVE during the wait period for transplantation. The presence of diabetes mellitus significantly shortened the time to development of a CVE.
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