Institutional Experience With Transcatheter Mitral Valve Repair and Clinical Outcomes

Multisociety expert consensus systems of care document 2019 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter mitral valve intervention: A Joint Report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and The Society of Thoracic Surgeons

“…The transcatheter edge‐to‐edge clip repair device has been commercially available since 2013, following FDA approval of its use for selected patients with primary MR. The pool of individuals trained in this procedure has expanded significantly over time and may increase further in the wake of the March 2019 FDA approval of the use of the edge‐to‐edge clip device for treatment of selected patients with secondary MR. Clinical experience with the edge‐to‐edge clip device is reflected in the Society of Thoracic Surgeons‐America College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry . Approximately 18% of patients treated with the edge‐to‐edge clip device and reported to the STS/ACC TVT Registry have had secondary MR …”

“…There is a recognized need to track survival and assess objectively whether transcatheter MV intervention improves functional state and QoL compared with baseline. The STS/ACC TVT Registry has reported clinical outcomes (e.g., death, stroke, rehospitalization for HF) following transcatheter edge‐to‐edge clip device repair . Incorporation of patient‐reported health status using the Kansas City Cardiomyopathy Questionnaire (KCCQ) is an additional feature .…”

“…In a 2017 STS/ACC TVT Registry report of patients with MR treated with edge‐to edge clip repair, factors associated with mortality or rehospitalization for HF after multivariate adjustment were increasing age, lower baseline LVEF, worse postprocedural MR, moderate or severe lung disease, dialysis, and severe tricuspid regurgitation . In the 2019 STS/ACC TVT Registry report of 12,334 edge‐to‐edge clip device repairs performed at 275 sites between November 2013 and September 2017, overall mortality was 2.1% (mean age 81 years, STS Predicted Risk of Mortality Score for MVR 8.3%), whereas the rates of any stroke, single leaflet detachment, and conversion to open surgery were < 1% …”

“…A search in the STS/ACC TVT Registry in July 2019 showed that 361 STS/ACC TVT Registry sites in the US offer transcatheter MV repair with the edge‐to‐edge clip device (Figure ). The 2019 STS/ACC TVT Registry report showed that optimal procedural success increased across tertiles of case experience, whereas procedural time and procedural complications decreased. In a learning‐curve analysis, visual inflection points for procedural time, procedural success, and procedural complications were evident after approximately 50 institutional cases, with continued improvements observed up to 200 cases.…”

The Role of Nitric Oxide in Preventing Cardiopulmonary Bypass-associated Acute Kidney Injury

“…[1][2][3] In contrast to right ventricular pacingÀinduced mitral regurgitation, which is attributed to the loss of atrioventricular (AV) synchrony or an inappropriately timed AV interval, an increase in tricuspid regurgitation often is attributed to mechanical interference from the right ventricular lead. [4][5][6] However, mechanical interference to valve closure was not identified as a factor in the publication by Vaturi et al and does not explain the increase in tricuspid regurgitation associated with temporary epicardial ventricular pacing. 7 Our recent experience during a mitral valve replacement is consistent with the findings by Vaturi et al…”