Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation

Doldi, Philipp M.; Stolz, Lukas; Orban, Mathias; Karam, Nicole; Praz, Fabien; Kalbacher, Daniel; Lubos, Edith; Braun, Daniel; Adamo, Marianna; Giannini, Cristina; Melica, Bruno; Näbauer, Michael; Higuchi, Satoshi; Wild, Mirjam G.; Neuß, Michael; Butter, Christian; Kassar, Mohammad; Petrescu, Aniela; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Thiele, Holger; Baldus, Stephan; Bardeleben, Ralph Stephan von; Schofer, Niklas; Hagl, Christian; Petronio, Anna Sonia; Maßberg, Steffen; Windecker, Stephan; Lurz, Philipp; Metra, Marco; Hausleiter, Jörg

doi:10.1016/j.jcmg.2022.05.009

Cited by 51 publications

(39 citation statements)

References 26 publications

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“…Although the best treatment modality of patients with atrial SMR is not yet known, emerging evidence shows atrial reverse remodelling and an improvement of symptoms after M-TEER 54 . In EuroSMR, the prevalence of atrial SMR was 7.8%, and the outcomes were encouraging in patients considered at high risk for surgery, particularly if advanced HF symptoms (e.g., NYHA Class IV) or RV dysfunction were absent 55 .…”

Section: Mitral Valve Teermentioning

confidence: 94%

Mitral valve transcatheter edge-to-edge repair

Hausleiter¹,

Stocker²,

Adamo³

et al. 2023

EuroIntervention

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Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER. KEYWORDS• acute heart failure • chronic heart failure • mitral regurgitation • TEER • transcatheter edge-to-edge repair

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Section: Mitral Valve Teermentioning

confidence: 94%

Mitral valve transcatheter edge-to-edge repair

Hausleiter¹,

Stocker²,

Adamo³

et al. 2023

EuroIntervention

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“…Atrial functional MR is a distinct entity most frequently observed in HFpEF 111,112 . New evidence supports M-TEER in this setting 112,113 …”

Section: Comorbidities and Special Conditionsmentioning

confidence: 92%

“…An improvement in RV function at early follow-up (median time 4 months) was observed in almost 40% of patients undergoing successful M-TEER and was associated with lower risk of both death/heart transplantation and HF hospitalization 110 . Atrial functional MR is a distinct entity most frequently observed in HFpEF 111,112 . New evidence supports M-TEER in this setting 112,113 …”

Section: Comorbidities and Special Conditionsmentioning

confidence: 99%

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Cimino

Pancaldi

Tomasoni

et al. 2022

Journal of Cardiovascular Medicine

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Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.

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“…In the so far largest published cohort study of severe AFMR patients with follow-up, it has been shown that these patients had worse overall survival, more heart failure hospitalizations (and more diastolic dysfunction), and underwent valve surgery less often than similarly aged patients with severe primary MR and normal LV function. 10 Recently, the results of percutaneous edge-to-edge repair in 126 patients with AFMR were published, with good procedural success and symptomatic improvement 13 ; however, whether this translates into improved prognosis cannot be currently determined.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Atrial functional mitral regurgitation: Insufficiently understood and recognized

Flachskampf¹

2022

Adv Clin Exp Med

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Atrial functional mitral regurgitation (AFMR) is a form of functional mitral regurgitation that is still insufficiently recognized and characterized. The driving cause of AFMR is atrial, not ventricular dilatation, usually due to long-standing atrial fibrillation, and often in association with left ventricular diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF). An increase in mitral annular area leads to a loss of central coaptation of the leaflets, often resulting in an "override" configuration and flattening of the annulus, as well as a loss of annular contraction. The left ventricle (LV) has a normal size; thus, there is usually only minor tenting of the leaflets. The regurgitant jet is mostly central, although posterior jet direction also occurs, frequently in a subform with posterior leaflet tethering and a marked localized dilatation of the posterior annulus. Because of the normal-sized and normally or nearly normally contracting LV, the amount of regurgitation is typically not more than moderate (or moderate-to-severe). Over time, functional mitral regurgitation may become mixed atrial and ventricular, with remodeling of the LV. However, the time course and the relation to symptoms have yet to be elucidated. This review presents current concepts and published insights into this form of mitral regurgitation.

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Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation

Cited by 51 publications

References 26 publications

Mitral valve transcatheter edge-to-edge repair

Mitral valve transcatheter edge-to-edge repair

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Atrial functional mitral regurgitation: Insufficiently understood and recognized

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