Larissa Stanberry

Impact of Transcatheter Mitral Valve Repair on Left Ventricular Remodeling in Secondary Mitral Regurgitation: A Meta-Analysis

ABSTRACT Background: Secondary mitral regurgitation (MR) arises from left ventricular (LV) dilatation and remodeling, and commonly is treated with transcatheter mitral valve repair. We examined the impact of MitraClip on reverse cardiac remodeling in patients with severe, symptomatic secondary MR. Methods:: An electronic search was performed through January 2018 for studies that reported cardiac chamber dimensions prior to and after treatment with MitraClip in patients with secondary MR. The mean difference (MD) with 95% CI was calculated using fixed or random inverse variance models. Outcomes of interest were changes in LV end-systolic and end-diastolic volumes (LVESV, LVEDV) and dimensions (LVESD, LVEDD). Secondary outcomes included left atrial (LA) volume, systolic pulmonary artery pressure (sPAP) and LV ejection fraction (LVEF). Results: A total of 16 studies with 1,266 patients were included in the present analysis. The weighted mean follow-up period (±SD) was 11.5 ± 7.2 months. MitraClip was associated with significant reduction in LVEDV (−14.24 ml, 95% CI [−22.53, −5.94], p = 0.0008), LVESV (−7.67 ml, CI [−12.30, −3.03], p = 0.001), LVEDD (−2.92 mm [−3.65, −2.19 mm], p < 0.00001), and LVESD (−1.92 mm [−2.92, −0.92], p = 0.0002). MitraClip was also associated with reduction in LA volume (−16.36 ml [23.23, −9.49 ml], p < 0.00001) and sPAP (−6.93 mmHg [−8.76, −5.10], p < 0.00001), and a significant increase in LVEF (+ 2.78% [0.91, 4.66], p = 0.004). Conclusions: In patients with severe symptomatic secondary MR, MitraClip is associated with modest, but favorable LV and LA reverse remodeling. The impact of these changes on clinical outcomes deserves further study.

IMPACT OF THE COMMERCIAL INTRODUCTION OF TRANSCATHETER MITRAL VALVE REPAIR ON MITRAL SURGICAL PRACTICE

With the commercial introduction of transcatheter mitral valve repair with MitraClip into the U.S. in 2013, there has been uncertainty regarding the effect of this therapy on cardiac surgical practice. The present investigation was undertaken to examine the impact of this introduction in the context

Incidence, predictors, management and outcomes of coronary perforations

We examined the contemporary incidence, types, predictors, angiographic characteristics, management and outcomes of coronary perforation.

Impact of sleep deprivation on the outcomes of percutaneous coronary intervention

This study sought to compare the clinical outcomes of percutaneous coronary interventions (PCIs) performed by sleep deprived and non‐sleep deprived operators.

Prevalence, trends, and outcomes of higher risk percutaneous coronary interventions among patients without acute coronary syndromes

BACKGROUND/PURPOSEnPatients and lesions at a higher procedural risk for percutaneous coronary intervention (PCI) are an understudied population. We examined the frequency, clinical characteristics, and outcomes of higher risk and non-higher risk PCIs at a large tertiary center.nnnMETHODS/MATERIALSnThe following procedures were considered higher risk: unprotected left main PCI, chronic total occlusion PCI, PCI requiring atherectomy, multivessel PCI, bifurcation PCI, PCI in prior coronary artery bypass graft surgery (CABG) patients, pre-PCI left ventricular ejection fraction ≤30%, or use of hemodynamic support.nnnRESULTSnOf the 1975 PCIs performed from 6/29/09 to 12/30/2016 in patients without acute coronary syndromes, 1230 (62%) were higher risk. Patients undergoing higher risk PCI were more likely to have a history of CABG, myocardial infarction, PCI, cerebrovascular disease, peripheral arterial disease, or congestive heart failure. Higher risk PCIs required more stents (2.0 vs. 1.0, pu202f<u202f0.001), and had longer median fluoroscopy times (17.3 vs. 8.5u202fmin, pu202f<u202f0.001) and higher median contrast doses (160 vs. 120u202fmL, pu202f<u202f0.001). In higher risk PCIs, the risks for technical failure and periprocedural complications were 2.9 (95% CI 1.2-7.4) times and 2.2 (95% CI 0.9-5.4) times higher as compared with non-higher risk PCI procedures.nnnCONCLUSIONSnIn summary, over half of the PCIs performed in non-acute coronary syndrome patients were higher risk and were associated with lower odds of technical success and higher periprocedural complication rates as compared with non-higher risk PCIs.nnnSUMMARYnWe examined the frequency, clinical characteristics, and outcomes of higher risk and non-higher risk PCIs at a large tertiary center. Higher risk PCI was associated with lower odds of technical and procedural success and higher odds of procedural complications as compared with non-higher risk PCI. However, the risk/benefit ratio may still be favorable for many of these higher-risk patients and should be estimated on a case by case basis.