Randomized Comparison of Percutaneous Repair and Surgery for Mitral Regurgitation

Feldman, Ted; Kar, Saibal; Elmariah, Sammy; Smart, Steven C.; Trento, Alfredo; Siegel, Robert J.; Apruzzese, Patricia; Fail, Peter S.; Rinaldi, Michael; Smalling, Richard W.; Hermiller, James; Heimansohn, David; Gray, William A.; Grayburn, Paul A.; Mack, Michael J.; Lim, D. Scott; Ailawadi, Gorav; Herrmann, Howard C.; Acker, Michael A.; Silvestry, Frank E.; Foster, Elyse; Wang, Andrew; Glower, Donald D.; Mauri, Laura; Investigators, Everest Ii

doi:10.1016/j.jacc.2015.10.018

Cited by 716 publications

(498 citation statements)

References 22 publications

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“…However, the rate of residual mitral regurgitation up to 5 years is higher than with surgical repair. 130 Indications for intervention in severe primary mitral regurgitation …”

Section: Indications For Interventionmentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

602

925

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“…However, the rate of residual mitral regurgitation up to 5 years is higher than with surgical repair. 130 Indications for intervention in severe primary mitral regurgitation …”

Section: Indications For Interventionmentioning

confidence: 99%

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Baumgartner¹,

Falk²,

Bax³

et al. 2018

Revista Española de Cardiología (English Edition)

602

925

View full text Add to dashboard Cite

“…Since there is still a high rate of patients with an indication for mitral valve repair, who cannot receive surgical repair because of an increased perioperative risk,2 percutaneous edge‐to‐edge mitral valve reconstruction (PMVR) using the MitraClip system (Abbott Vascular) has become a safe and viable alternative to treat severe mitral regurgitation in these patients 3. The 5‐year results of the EVEREST II (Endovascular Valve Edge‐to‐Edge Repair Study II) randomized trial suggest that patients treated with PMVR more commonly required surgery for residual MR during the first year after treatment, while, afterwards, comparably low rates of surgery for mitral valve dysfunction with either PMVR or surgical therapy endorse the durability of MR reduction with both repair techniques 3. Most PMVR procedures are currently performed under general anesthesia (GA),4, 5 whereas other percutaneous interventional approaches to treat valve diseases such as transcatheter aortic valve replacement are increasingly performed under conscious sedation or deep sedation (DS) 6.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair

Patzelt

Ulrich

Magunia

et al. 2017

JAHA

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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.

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“…Transcatheter mitral valve repair techniques have emerged in recent years and appear to be safe, especially in elderly people with extensive comorbidities who are frequently denied surgery. 106 The future of percutaneous options may change the threshold for intervention and requires careful assessment.…”

Section: Discussionmentioning

confidence: 99%

Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of ‘‘watchful waiting’’ versus ‘‘early surgical intervention’’ for severe, asymptomatic, primary mitral regurgitation are addressed.

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Randomized Comparison of Percutaneous Repair and Surgery for Mitral Regurgitation

Cited by 716 publications

References 22 publications

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair

Primary mitral valve regurgitation: Update and review

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