Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial

Lipiecki, Janusz; Siminiak, Tomasz; Sievert, Horst; Müller‐Ehmsen, Jochen; Degen, Hubertus; Wu, Justina; C, Schandrin; Kałmucki, Piotr; Hofmann, Ilona; Reuter, David G.; Goldberg, Steven L.; Haude, Michael

doi:10.1136/openhrt-2016-000411

Cited by 114 publications

(95 citation statements)

References 22 publications

(18 reference statements)

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“…Several studies have shown the safety and efficacy of the device with reduction in mitral regurgitation grade and improvement in exercise capacity, quality of life, [9][10][11] and left ventricular (LV) reverse remodelling. 11,12 The device also reduces MA dilation, but there are no data on the treatment effect on left atrial (LA) enlargement. LA enlargement, however, is associated with a heightened risk of cardiovascular events and mortality.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

et al. 2020

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Aims Mitral annuloplasty using the Carillon Mitral Contour System (CMCS) reduces secondary mitral regurgitation (SMR) and leads to reverse left ventricular remodelling. The aim of this study was to evaluate the effect of the CMCS on the mitral valve annulus (MA) and left atrial volume (LAV). Methods and results We retrospectively evaluated the data of all patients treated with the CMCS at our centre. Using transthoracic echocardiography, MA diameters were assessed by measuring the anterolateral to posteromedial extend (ALPM) and the anterior to posterior (AP) dimensions, respectively. Also, LAV and left ventricular end-diastolic volume (LVEDV) were assessed. Patients were examined at three time points: baseline, at 20-60 days (30dFUP), and at 9-15 months (1yFUP), using paired analysis. From July 2014 until March 2019, 75 cases of severe SMR were treated using CMCS. Cases in which other devices were used in combination (COMBO therapy, n = 35) or in which the device could not be implanted (implant failure, n = 3) were excluded, leaving 37 patients in the present analysis. Analysis at 30dFUP showed a significant reduction of 16% in the mean ALPM diameter (7.27 ± 5.40 mm) and 15% in the AP diameter (6.57 ± 5.33 mm). Analysis of LAV also showed a significant reduction of 21% (36.61 ± 82.67 mL), with no significant change in LVEDV. At 1yFUP, the reduction of both the mean ALPM diameter of 14% (6.24 ± 5.70 mm) and the mean AP diameter of 12% (5.46 ± 4.99 mm) remained significant and stable. The reduction in LAV was also maintained at 23% (37.03 ± 56.91 mL). LAV index was significantly reduced by 17% at 30dFUP (15.44 ± 40.98 mL/m 2) and by 13% at 1yFUP (11.56 ± 31.87 mL/m 2), respectively. LVEDV index showed no significant change at 30dFUP and a non-significant 10% reduction at 1yFUP (17.75 ± 58.79 mL/m 2). Conclusions The CMCS successfully treats symptomatic SMR with a stable reduction of not only the AP diameter of the MA, but the current study also demonstrates an additional reduction of the ALPM dimension at both 30dFUP and 1yFUP. We have also shown for the first time that LAV and LAV index are significantly reduced at both 30dFUP and 1yFUP and a non-significant positive remodelling of the LVEDV. This positive left atrial remodelling has not been looked for and demonstrated in earlier randomized studies of CMCS.

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Section: Introductionmentioning

confidence: 99%

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

et al. 2020

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“…After the deployment of device, manual traction is performed on the delivery system to compress the periannular tissue neighboard of posterior annulus. Several limitations of this device have been reported, including reports of potential nitinol wire fracture with or without clinical events and especially compression of circumflex coronary artery [7]. This technique peri-procedural success is lower than MitraClip according to published studies.…”

Section: Transcatheter Direct or Indirect Mitral Annuloplasty Systemsmentioning

confidence: 93%

Transcatheter mitral valve repair and replacement; current therapies and general evaluation of new approaches

Alsancak¹,

Gürbüz²,

Düzenli³

2017

Journal of Surgery and Medicine

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There has been a revolution in catheter based therapies for structural valvular heart diseases in last decade and many incredible improvements in the percutaneous treatment of mitral and aortic valve diseases. The use of transcatheter mitral valve repair has gained widespread acceptance in worldwide. More than 50.000 patients have been treated with percutaneous edgeto-edge repair system or annuloplasty systems. Although the most experience has been obtained with MitraClip®, using of percutaneous direct and indirect annuloplasty devices have been on the forefront in recent years. In addition, the percutaneous mitral valve replacement, like the transcathater aortic valve replacement (TAVI), will also be mentioned more in the near future.

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“…After 12 months, there was sustained MR reduction and functional capacity. A second‐generation device to avoid previously observed anchor fractures was safe and similarly effective in 36 patients (TITAN II trial) . The effects on clinical outcomes are unknown.…”

Section: Transcatheter Mitral Valve Interventionsmentioning

confidence: 99%

Mitral valve interventions in heart failure

et al. 2018

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Secondary mitral regurgitation (MR) results from left ventricular dilatation and dysfunction. Quantification of secondary MR is challenging because of the underlying myocardial disease. Clinical and echocardiographic evaluation requires a multi‐parametric approach. Severe secondary MR occurs in up to one‐fourth of patients with heart failure with reduced ejection fraction, which is associated with a mortality rate of 40% to 50% in 3 years. Percutaneous edge‐to‐edge mitral valve repair (MitraClip) has emerged as an alternative to surgical valve repair to improve symptoms, functional capacity, heart failure hospitalizations, and cardiac haemodynamics. Further new transcatheter strategies addressing MR are evolving. The Carillion, Cardioband, and Mitralign devices were designed to reduce the annulus dilatation, which is a frequent and important determinant of secondary MR. Several transcatheter mitral valve replacement systems (Tendyne, CardiAQ‐Edwards, Neovasc, Tiara, Intrepid, Caisson, HighLife, MValve System, and NCSI NaviGate Mitral) are emerging because valve replacement might be more durable compared with valve repair. In small studies, these interventional therapies demonstrated feasibility and efficiency to reduce MR and to improve heart failure symptoms. However, neither transcatheter nor surgical mitral valve repair or replacement has been proven to impact on the prognosis of heart failure patients with severe MR, which remains high with a mortality rate of 14–20% at 1 year. To date, the primary indication for treatment of secondary severe MR is the amelioration of symptoms, reinforcing the value of a Heart Team discussion. Randomized studies to investigate the treatment effect and long‐term outcome for any transcatheter or surgical mitral valve intervention compared with optimized medical treatment are urgently needed and underway.

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Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial

Cited by 114 publications

References 22 publications

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

Transcatheter mitral valve repair and replacement; current therapies and general evaluation of new approaches

Mitral valve interventions in heart failure

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