Novel use of a transapical endovascular suction device for mitral valve endocarditis in a high-risk surgical patient with successful cerebral protection.
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ABSTRACT:
SUBMITTER: Rabenstein AP
PROVIDER: S-EPMC9737037 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Novel use of a transapical endovascular suction device for mitral valve endocarditis in a high-risk surgical patient with successful cerebral protection.
Rabenstein Andrew P AP Khalif Adnan A Lasorda David D Hughes-Doichev Rachel R Popeck Michael M Chakravarthy Mithun M McGregor Walter W
JTCVS techniques 20221013
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Project description:Transapical off-pump mitral valve repair (MVr) with NeoChord implantation has become widely applied in Europe for patients presenting with severe mitral regurgitation due to leaflet prolapse or flail. The procedure is performed under real-time 2D- and 3D-transesophageal echocardiography (TEE) for both implantation and neochordae tension adjustment allowing real-time monitoring of hemodynamic recovery. Preoperative anatomic and echocardiographic selection criteria, procedure refinement, as well as innovative ex-vivo surgical simulator training have been developed and strategically employed in the past few years, to generate a robust precision-based procedural framework with significantly enhanced operator use, patient safety and clinical outcomes. The procedure has evolved into a reproducibly successful and safe approach, which complements existing surgical treatment strategies available to eligible patients with chronic severe degenerative mitral regurgitation.
| S-EPMC6288219 | biostudies-literature
Project description:IntroductionNowadays micro-invasive-procedures (off-pump, beating-heart) for mitral valve repair (MVRe) are abruptly expanding with the potential to be adopted as a valuable alternative to surgery. In the present manuscript, the authors review the available technologies intended to treat mitral regurgitation (MR) through transapical approach, including annuloplasty and chordal-repair options.AnnuloplastyTo date, Valcare Amend is the only transapical MV ring to have been implanted in patients. The device allows for stabilization of the annulus through a complete semirigid d-shaped ring. The first-in-human successful procedure was performed in 2016 by our Group and subsequent clinical experience included a total of 14 implanted patients. Currently, the technology is under clinical trial evaluation to validate the efficacy and safety profile of the device.Chordal repairBeating-heart chordal implantation via transapical approach is a current feasible, safe and reproducible option. Neochord DS1000 is the most widely used technology in the field, with a solid procedural experience and good results in well-selected patients. Its clinical use has been validated in Europe since 2012, while it is still under clinical investigation in the United States. Harpoon MVRe system is a novel technology, recently CE-mark approved for clinical use.Discussion and conclusionsTransapical micro-invasive technologies are current viable therapies to treat MR in selected patients. Although there are still several limitations that preclude an extensive use of such procedures, their results are promising in well-selected patients. Embracing transcatheter MVRe therapies should guide the cardiac surgeon through the new revolution of micro-invasive MV tailored repair.
| S-EPMC10078712 | biostudies-literature
Project description: Not available
| S-EPMC8129053 | biostudies-literature
Project description:Microinvasive cardiac surgery includes procedures performed off-pump, on the beating heart, with limited or absent skin incision, and those that rely on live imaging techniques. Transapical off-pump beating heart neochordae implantation allows the repair of severe mitral valve regurgitation due to leaflet prolapse or flail with live three-dimensional echo guidance. This procedure has shown good results for up to 5 years and can be considered as a valid alternative to conventional surgery in selected patients with high prediction of success based on clinical and anatomical considerations. The aim of this review is to describe the devices, indications, patient screening process, clinical and echocardiographic results, and future perspectives of this procedure.
| S-EPMC10416619 | biostudies-literature
Project description:BackgroundTranscatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly because redo patients often present with multiple comorbidities and high operative risk. We sought to evaluate and compare our experience with transapical transcatheter mitral valve replacement (TA-TMVR) to conventional redo mitral valve replacement in patients presenting with degenerated biological mitral valve prostheses or failed valve annuloplasty.Methods and materialBetween March 2012 and November 2020, 74 consecutive high-risk patients underwent surgical redo mitral valve replacement (n = 33) or TA-TMVR (n = 41) at our institution. All patients presented with a history of a surgical mitral valve procedure. All transcatheter procedures were performed using the SAPIEN XT/3™ prostheses. Data collection was prospectively according to MVARC criteria.ResultsThe mean logistic EuroSCORE-II of the whole cohort was 19.9±16.7%, and the median STS-score was 11.1±12.5%. The mean age in the SMVR group was 63.7±12.8 years and in the TMVR group 73.6±9.7 years. Patients undergoing TA-TMVR presented with significantly higher risk scores. Echocardiography at follow up showed no obstruction of the left ventricular outflow tract, no paravalvular leakage and excellent transvalvular gradients in both groups (3.9±1.2 mmHg and 4.2±0.8 mmHg in the surgical and transcatheter arm respectively). There was no difference in postoperative major adverse events between the groups with no strokes in the whole cohort. Both methods showed similar survival rates at one year and a 30-day mortality of 15.2% and 9.8% in SAVR and TMVR group, respectively. Despite using contrast dye in the transcatheter group, the rate of postoperative acute kidney failure was similar between the groups.ConclusionDespite several contraindications for surgery, we showed the non-inferiority of TA-TMVR compared to conventional surgical redo procedures in high-risk patients. With its excellent hemodynamic and similar survival rate, TA-TMVR offers a feasible alternative to the conventional surgical redo procedure in selected patients.
| S-EPMC8386843 | biostudies-literature
Project description:Although Brucella endocarditis is a rare complication of human brucellosis, it is the main cause of the mortality in this disease. Traditionally, the therapeutic approach to endocarditis caused by Brucella species requires a combination of antimicrobial therapy and valve replacement surgery. In the literature, only a few cases of mitral prosthetic valve endocarditis caused by Brucella species have been successfully treated without reoperation. We present a case of a 42-year-old man with a prosthetic mitral valve infected by Brucella abortus who was cured solely by medical treatment.
| S-EPMC4248619 | biostudies-literature
Project description: Not available
| S-EPMC10580168 | biostudies-literature
Project description:Residual and recurrent mitral regurgitation after transcatheter edge-to-edge repair are therapeutically challenging. In the present case report, we describe a simplified, transapical electrosurgical laceration and stabilization of clip procedure that represents an alternative and direct approach for electrosurgical laceration of mitral valve leaflets enabling transcatheter mitral valve replacement for recurrent mitral regurgitation after mitral valve transcatheter edge-to-edge repair.
| S-EPMC10774767 | biostudies-literature
Project description:BackgroundSevere mitral regurgitation (MR) is associated with progressive heart failure and impairment of survival. Degenerative MR accounts for most MV repair surgeries. Conventional mitral valve repair surgery requires cardiopulmonary bypass and is associated with significant morbidity and risks. Transapical beating-heart mitral valve repair by artificial chordae implantation with transesophageal echocardiography (TEE) guidance has the potential to significantly reduce surgical morbidity. We report the first-in-human experience of degenerative MR repair using a novel artificial chordae implantation device (MitralstitchTM system).MethodsTen patients with severe MR underwent transapical artificial chordae implantation using MitralstitchTM system. The procedure was performed through a small left thoracotomy under general anesthesia and TEE guidance. Patients underwent transthoracic echocardiography and other assessments during the follow-up.ResultsAll 10 patients with an average age of 63.7 ± 9.6 years successfully received transapical artificial chordae implantation. Their MR reduced from severe to none or trace in five patients, mild in five patients before discharge. Five patients received one artificial chordal implantation, four patients received two, and one patient received three and edge-to-edge repair by locking two of them. The safety and efficacy endpoint were achieved in all patients at 1-month follow-up. At 1-year follow-up, six patients had mild MR, three patients had moderate MR, one patient had recurrence of severe MR and underwent surgical repair.ConclusionsThe results of this first-in-human study show safety and feasibility of transapical mitral valve repair using MitralStitch system. Patient selection and technical refinement are crucial to improve the outcomes.
| S-EPMC9305231 | biostudies-literature
Project description:BackgroundPrior to the approval of the Sapien valve in 2020, there were no commercially available short-frame valves for transapical mitral valve-in-valve (MVIV) implantation. In January 2019, we first attempted the reverse mounted J-valve for transapical MVIV implantation with good clinical results. The present study aimed to explore the safety and effectiveness of transapical MVIV implantation with the J-valve reversely mounted on the delivery system.MethodsPatients who underwent transapical MVIV implantation using the J-valve were analyzed from January 2019 to December 2020 with a 1-year follow-up. Before the procedure, computed tomography (CT) angiography data were analyzed to determine the inner diameter, left ventricular outflow tract (LVOT), and coaxial angel. An oversize rate of 5-10% was used to select the J-valve depending on the scanned inner diameter of the original mitral bioprosthesis. During the procedure, the three U-shape graspers were one-to-one buckled with the three tissue valve struts with the assist of echo and fluoroscopy. The implant depth into the left atrium was a 0-20% part of the J-valve, and the valve was then released under rapid pacing. Post-balloon dilatation was used when needed.ResultsNineteen patients (mean age 70.05±11.19 years), with a mean Society of Thoracic Surgeons score of 8.01%±4.20%, were included. By transesophageal echocardiography, we found that the mean transvalvular gradient was 6.21±2.63 mmHg. The mean follow-up time was 20.31±7.23 months, and the survival rate was 94.74% at the last follow-up. The transvalvular gradient decreased from 15.06±3.00 mmHg at basal to 7.13±2.28 mmHg at the 1-year follow-up (P<0.001). The left ventricular ejection fractions (LVEF) increased from 60.31%±7.30% to 59.94%±7.72% at the 1-year follow-up (P=0.863). Thirteen (81.25%) patients had no or trace paravalvular leak (PVL), two (12.50%) patients had minor PVL, one (6.25%) patient had moderate PVL, and there were no cases of major regurgitation at the 1-year transthoracic echocardiography (TTE) examination results.ConclusionsThe J-valve reversely mounted on the delivery system can be used for transapical MVIV implantation with less operative morbidity and favourable outcomes.
| S-EPMC8825539 | biostudies-literature