Eric Yamen

Percutaneous mitral valve repair with the MitraClip: early results from the MitraClip Asia-Pacific Registry (MARS).

AIMS Percutaneous MitraClip therapy has been shown to be safe and efficacious in mitral regurgitation (MR). Our aim was to describe early outcomes in patients from the Asia- Pacific region. METHODS AND RESULTS The MitraClip Asia-Pacific Registry (MARS) includes data from eight different centres in five countries in the Asia-Pacific region. The primary efficacy outcome was reduction in MR to ≤2+ at 30 days. The safety outcome was 30-day freedom from major adverse events (MAE), defined as the composite of death, myocardial infarction, non-elective cardiac surgery, renal failure, transfusion of ≥2 units of blood, ventilation for >48 hours, septicaemia, and new onset atrial fibrillation. A total of 142 patients underwent the MitraClip procedure from February 2011 to October 2013. Fifty-three point five percent (76) of patients had functional MR, 45.8% (65) had degenerative MR and 0.7% (1) had mixed MR. The acute procedural success rate was 93.7% (133). Thirty-one point seven percent of the patients were in NYHA Class I-II at baseline, compared to 82.1% at 30 days (p<0.001). Zero percent (0) of the patients had ≤2+ MR at baseline compared to 76.8% (109) at 30 days (p<0.001). CONCLUSIONS Results from the Asia-Pacific region show that the MitraClip procedure is effective in reducing mitral regurgitation and has favourable short-term safety outcomes.

Use of a low-profile, compliant balloon for percutaneous aortic valvuloplasty†

Objectives: To determine the safety and immediate efficacy after balloon aortic valvuloplasty (BAV) with a new, low‐profile balloon. Background: BAV has a continuing role in the management of high‐risk patients with severe aortic stenosis (AS). BAV with traditional noncompliant balloons requires a large femoral arteriotomy and is associated with high rates of access site complications. Methods: We retrospectively reviewed medical records of 20 consecutive patients undergoing BAV for severe AS. Retrograde transfemoral BAV was performed with a low‐profile, compliant valvuloplasty balloon. Before and after BAV, transaortic gradients were measured invasively and by echocardiography, and aortic valve area (AVA) calculated. Access site complications, functional class and survival were recorded. Results: Patients were 79 ± 12 years old and had an estimated mortality from open aortic valve replacement of (12.5 ± 9.6)%. By catheterization, mean aortic gradient fell from 44 ± 15 to 29 ± 10 mm Hg (P < 0.001) and AVA increased from 0.63 ± 0.22 to 0.89 ± 0.33 cm2 (P < 0.001). New York Heart Association functional class improved from 3.5 ± 0.7 to 2.7 ± 0.8. Procedural mortality was 0%. There were no vascular complications or significant worsening of aortic regurgitation. Conclusion: Transfemoral BAV using a low‐profile compliant balloon is feasible with acceptable immediate results and safety.

Percutaneous Mitral Valve Repair in a High-risk Australian Series

BACKGROUND The prognosis for patients with symptomatic, severe mitral regurgitation (MR) who have comorbidities precluding mitral valve surgery is poor. Treatment of MR using a percutaneous edge-to-edge technique may improve survival, quality of life and reduce hospitalisations. To date, there are few studies reporting outcomes after percutaneous mitral valve repair in high-risk patients and none reported from Australia. METHODS The first 25 patients undergoing percutaneous mitral valve repair using the MitraClip in our Institution had follow-up to six months. These patients had severe, symptomatic MR and were deemed too high-risk for mitral valve surgery by a multidisciplinary heart team, including an interventional cardiologist and cardiothoracic surgeon. RESULTS There were no peri-procedural deaths; the only peri-procedural morbidity was blood transfusion in three patients. Three patients had died at six months and there were six readmissions to hospital. There was a significant improvement in heart failure symptoms, 6-minute walk test and quality of life at six months. There was a significant improvement in the proportion of patients with MR ≤2+, but no significant change in other echocardiographic parameters. CONCLUSIONS Percutaneous mitral valve repair is safe in patients at high-risk for surgery, and improves symptoms and quality of life.

HbA1c Assessment in Diabetic Patients with Acute Coronary Syndromes

Guidelines for the management of acute coronary syndromes (ACS) advocate for maintaining adequate long‐term glycaemic control in diabetic patients. Glycosylated haemoglobin (HbA1c) measurement is commonly used to monitor long‐term glycaemic control in diabetes.

The MitraClip Asia‐Pacific registry: Differences in outcomes between functional and degenerative mitral regurgitation

The objective of this study is to describe and compare the use of the MitraClip therapy in mitral regurgitation (MR) patients with degenerative MR (DMR) and functional MR (FMR).

Inadvertent Thebesian Vein Cannulation During Radial Access Ventriculography

The first case is of a 72-year-old woman undergoing angiography for aortic stenosis workup via the right radial approach. An Multipurpose 1 (MPA-1) catheter, Cordis Corporation, East Bridgewater, New Jersey) was used to direct the wire across the valve and subsequently used for ventriculography due

Glycosylated haemoglobin assessment in diabetic patients with acute coronary syndromes.

Guidelines for the management of acute coronary syndromes (ACS) advocate for maintaining adequate long‐term glycaemic control in diabetic patients. Glycosylated haemoglobin (HbA1c) measurement is commonly used to monitor long‐term glycaemic control in diabetes.

Balloon aortic valvuloplasty: modern indications and techniques for a niche therapy

Degenerative aortic stenosis (AS), previously termed ‘senile’ AS, is the most common clinically significant cardiac valvular lesion in developed countries [1], and there are no effective medical tr...

REACTED – Reducing Acute Chest pain Time in the ED: A prospective pre-/post-interventional cohort study, stratifying risk using early cardiac multi-markers, probably increases discharges safely

ED chest pain assessments can be challenging, lengthy and contribute to overcrowding. Rapid accurate risk stratification strategies should improve ED length of stay (EDLOS). Emergency, Biochemistry and Cardiology implemented new guidelines using paired (<3 h) multiple cardiac markers to stratify patients. The intervention would reduce chest pain EDLOS. We observed for safety and disposition effects.

TCT-697 Outcomes from MitraClip Therapy in Functional Compared to Degenerative Mitral Regurgitation: Multi-centre Experience from the MitraClip Asia-Pacific Registry (MARS)

events included: IABP support (13%), renal replacement therapy (6%), infections (3.6%). No cerebrovascular events or AMI occurred. Median length of hospital stay was 5 days. At discharge, 87% patients had MR 2+. At 1 year months EF was 34.7 10.4% (p1⁄40.002 compared to baseline value). Actuarial survival at 1 year was 89.6 3%. Actuarial freedom from MR 3+ at 1 year was 79.4 4%. At 1 year, MLHFQ improved from 40 15 to 22 16 (p<0.0001). Complete QoL restoration at 1 year was achieved in 43% of the survivors. At multivariate analysis, preoperative value of serum pro-BNP 1600 pg/ml was identified as independent predictors of QoL restoration at 1 year (OR 0.2; p1⁄40.03). Conclusions: MitraClip therapy is a safe and effective therapeutic option for high-risk patients with FMR, leading to clinical and QoL improvements. Higher pro-BNP levels are associated with reduced likelihood of QoL restoration at 1 year.