bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infective endocarditis of mitral valve, valve replacement or repair?- a meta-analysis of 10,965 patients
Authors: Fathy M H , Elnagar M A , Elbadawi M A , Awad A K 
Published: October 2022

Abstract

Background
Being characterized by high mortality and recurrence rates, native mitral valve infective endocarditis (IE) constitutes a burden on both patients and surgeons from its poor prognosis and debatable interventions. Mitral valve repair (MVRr) and mitral valve replacement (MVRp) are two main surgical methods. Nevertheless, which of them carries an outweigh benefit over the other is still controversial. Thus, in our meta-analysis we aimed to further investigate the efficacy of each technique on both short term and long-term outcomes.

Methods
Our search strategy was applied on several databases including the PubMed, Scopus, Web of science, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk and hazard ratio (RR and HR) and 95% confidence interval (CI) were pooled and analyzed using RevMan 5.0.

Results
A total of 22 relevant publications with a total population of 10,965 patients, with 3,557 patients having undergone MVRr and 7,408 patients having undergone MVRp, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR 0.44; 95% CI, 0.38–0.51; p&lt;0.00001; I2=0%), a higher long-term survival rate (HR 0.56; 95% CI, 0.36–0.76; p&lt;0.001; I2=0%), and a lower risk of recurrence (RR 0.66; 95% CI, 0.40–0.93; p=0.05; I2=0%). Although the risk of reoperation was observed lower for MVRr, it was not statistically significant (RR, 0.86; 95% CI, 0.36–1.36; p=0.76; I2=37%).

Conclusion
Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.

Conclusion
Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.

Funding Acknowledgement
Type of funding sources: None.
Validation of expert criteria proposed by the “German Cardiac Society” for predicting procedural complexity in transcatheter edge-to-edge mitral valve repair
Authors: Metze C , Kavsur R , Sugiura A , Tanaka T , Becher U , Nickenig G , Baldus S , Koerber M I , Pfister R , Iliadis C 
Published: October 2022

Abstract

Background
Following up on the original EVEREST criteria and several years of procedural experience, the German Cardiac Society (GCS) proposed refined criteria indicating morphological complexity in transcatheter edge-to-edge mitral valve repair (TEER) procedures which so far have not been validated.

Methods
In a retrospective analysis of transesophageal echocardiography images of consecutive patients undergoing TEER in two high-volume centres, complexity was classified according to GCS criteria as optimal (neither characteristics of “complex” nor “very complex', see Table 1), complex (any of the “complex” criteria but no “very complex” criteria) and very complex (any of the “very complex” criteria). Associations with the procedural outcome, reintervention, survival, and heart failure rehospitalization were tested.

Results
633 patients (mean age 79 years, range 50 to 96 years, 59% male) were included, with 35% having dominant primary and 65% having dominant secondary mitral regurgitation (MR). 19% of patients were classified as having optimal, 40% as complex, and 41% as very complex morphologies. Successful clip implantation and reduction in MR ≤2 at discharge were achieved in 100% and 97% in the optimal, in 96% and 88% in the complex, and in 95% and 88% in the very complex morphologies, respectively (p for difference 0.13 and 0.42). The rate of successful clip deployment was significantly lower and the rate of reintervention significantly higher in patients with a mitral valve orifice area ≤3 cm2, compared to patients with a mitral valve orifice area &gt;3 cm2. Pathology extent of MR likely requiring &gt;2 clips was significantly associated with a lower rate of MR reduction to grade ≤2. Midterm (median follow-up time 640 days) mortality or hospitalization due to heart failure was significantly higher in patients with a posterior mitral leaflet length of 7–10 mm.

Conclusion
In the setting of experienced heart valve centres only a few of the complexity criteria proposed by the GCS impact on procedural and clinical outcomes. Even in the case of complex or very complex mitral valve morphology, TEER can be performed effectively with reduction of MR to ≤2 in 88% of cases.

Funding Acknowledgement
Type of funding sources: None.
Staging heart failure patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair
Authors: Stolz L , Karam N , Von Bardeleben R S , Pfister R , Petronio A , Butter C , Melica B , Praz F , Massberg S , Kalbacher D , Lurz P , Adamo M , Metra M , Bax J J , Hausleiter J 
Published: October 2022

Abstract

Background
Heart failure with reduced ejection fraction (HFrEF) and secondary mitral regurgitation (SMR) are closely related. Progression of HFrEF-SMR is associated with characteristic pathophysiological changes. Recently, staging of HFrEF-SMR patients showed prognostic value in a SMR cohort on medical therapy. Whether these stages are prognostic for SMR patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) in addition to drug therapy is unknown.

Purpose
The present study aimed at classifying HFrEF-SMR patients undergoing M-TEER into progressive disease stages based on cardiac and extracardiac involvement. We sought to evaluate the impact of the disease stages on survival outcome and symptomatic improvement after M-TEER

Methods
Based on echocardiographic transthoracic evaluation, patients were assigned into one of the following subsequent HFrEF-SMR stages representing disease progression (Figure 1): left ventricular (LV) dysfunction alone (Stage 1, LV end diastolic volume ≥159 ml and/or LV ejection fraction &lt;50%); left atrial (LA) involvement (Stage 2, history of atrial fibrillation and/or indexed LA volume &gt;34 ml/m2); right ventricular (RV) pressure/volume overload (Stage 3, tricuspid regurgitation ≥3+ and/or systolic pulmonary artery pressure &gt;65 mmHg); biventricular failure (Stage 4, RV to pulmonary artery coupling &lt;0.274 mm/mmHg). A Cox regression model was implemented to investigate the impact of HFrEF-SMR stages on two-year all-cause mortality and symptomatic outcome was assessed with New York Heart Association (NYHA) functional class at follow-up.

Results
Among a total of 849 included patients who underwent M-TEER for symptomatic MR from 2008 until 2019, 9.5% (n=81) presented with LV dysfunction alone, 46% (n=393) with LA involvement, 15% (n=129) with pressure/volume overload and 29% (n=246) with biventricular failure. At baseline and follow-up, successive HFrEF-SMR stages were associated with more severe heart failure symptoms as expressed by NYHA functional class. An increase in HFrEF-SMR stage was associated with increased two-year all-cause mortality rates after M-TEER (Hazard ratio 1.39, confidence interval 1.23–1.58, p&lt;0.01, Figure 2).

Conclusions
Classifying HFrEF-SMR patients undergoing M-TEER into subsequent disease stages provides prognostic value regarding heart failure symptoms and survival.

Funding Acknowledgement
Type of funding sources: None.
Outcome of trans-catheter edge-to-edge mitral valve repair in patients with severe left ventricular dilatation
Authors: Raphael R , Makmal N M , Silbermintz N S , Faierstein K F , Moeller C M , Canetti M C , Maor E M , Kuperstein R F , Hai I H , Butnaru A B , Oren D O , Guetta V G , Fefer P F 
Published: October 2022

Abstract

Introduction
The COAPT trial established the benefit of trans-catheter edge-to-edge mitral valve repair (TEER) for patients with symptomatic secondary mitral regurgitation (MR). However, patients with severe LV dilatation were excluded from this study. Furthermore, disproportionate LV dilatation has been proposed as a possible explanation for the lack of benefit in the Mitra-FR trial.

Purpose
The purpose of this study was to evaluate the safety and efficacy of TEER in patients with severe LV dilatation.

Methods
We categorized patients with secondary MR and severe LV dilatation based on LVEDD/BSA ratio using a cut-off of &gt;3.6cm/m2 in men and &gt;3.7cm/m2 in women.

Results
We included 121 patients, 25 patients with severe LV dilatation (S) and 96 without (NS). Mean LVEDD was 68.9±6.6mm in the S group vs 58.5±6.5mm in the NS group. Compared to the NS patients, patients with severe LV dilatation were younger (age 69±10 vs 74±10 years), had lower LVEF (37+14% vs 29+7%), and lower GFR (44±21 vs 55±26). There was no significant difference in MR grade (3.3 vs 3.3), however the S group had numerically greater EROA (EROA 0.45 vs 0.35). No significant differences were noted in NYHA class (2.8 vs 2.76) or SPAP (59mmHg for both). Peri-procedural adverse events were rare in both groups. One peri-procedural death was noted, 2 patients underwent urgent dialysis, 1 had cardiogenic shock, and 2 had prolonged ventilation after the procedure, all of these occurred in the NS group. At 1-year follow-up, there was marked improvement in MR grade (2.4±1.4 vs 2.2±1.2 for S and NS respectively). Both groups had a small reduction in LVEDD of about 3mm. Patients in the S group had improved GFR at 1-year follow-up (44±21 to 51±32). No differences were noted in 1, 2, or 5 year mortality between groups (Figures).

Conclusion
Trans-catheter edge-to-edge mitral valve repair in patients with severe LV dilatation is safe and seems to provide similar short-and long-term outcomes compared to patients with less severe dilatation. Further studies are needed to establish the efficacy of TEER for these patients.

Funding Acknowledgement
Type of funding sources: None.
Tricuspid regurgitation severity and transcatheter tricuspid annuloplasty
Authors: Ortega Perez R , Martinez Moya R , Pardo Sanz A , Salido Tahoces L , Sanchez Recalde A , Rivas Garcia S , Abellas Sequeiros M , Sanchez Vega D , Arteagoitia Bulumburu A , Fernandez Golfin C , Garcia Martin A , Hinojar Baydes R , Zamorano Gomez J L 
Published: October 2022

Abstract

Introduction
Transcatheter tricuspid annuloplasty is a promising therapeutic alternative for the treatment of tricuspid regurgitation (TR) in patients with a high surgical risk. To date, the published experience with percutaneous tricuspid devices is quite limited. The objective of this study is to present the impact of the transcatheter tricuspid annuloplasty with band implantation on the degree of TR and on several echocardiographic parameters in a series of 27 patients.

Methods
A single-center cohort of 27 patients was followed up prospectively after the transcatheter tricuspid annuloplasty with band implantation (mean follow-up: 10,39 months) (Figure 1). The degree of tricuspid regurgitation (mild, moderate, severe, massive, torrential) was measured before and after the procedure, as well as at 6 months and one year of follow-up. Other parameters have also been considered, such as the septal-lateral end-diastolic diameter of the tricuspid annulus, the vena contracta (VC), regurgitant orifice area (ROA) 2D, tricuspid annular plane systolic excursion (TAPSE), right ventricular ejection fraction (RVEF) and fractional area change (FAC).

Results
Initially, there were 22.3% of patients with torrential TR, 29.6% massive and 48% severe. After the procedure, these percentages were reduced to 3.8%, 7.7% and 23.1% respectively, leading to an amount of 65% of patients with mild or moderate TR.
With respect to the the diameter of the lateral septum ring, the mean was initially 44.74 mm. After the procedure, it decreased to 34.5 mm (22% of reduction) and, as can be seen during follow-up, it remains stable over time.
The ROA and VC were also significantly reduced while TAPSE, CAF and RVEF do not show significant changes (Figure 2).
Percutaneous tricuspid annuloplasty demonstrated a notable impact on the degree of tricuspid regurgitation reduction in the patients in our study. The differences are already noticeable from the moment of the procedure and are maintained throughout the follow-up, where the stability of the diameter of the septolateral ring, the ERO and the vena contracta is observed.

Funding Acknowledgement
Type of funding sources: None.
Three-year outcomes following transcatheter tricuspid valve edge-to-edge repair
Authors: Hausleiter J , Stolz L , Weckbach L , Wild M , Doldi P , Braun D , Stocker T , Higuchi S , Naebauer M , Massberg S 
Published: October 2022

Abstract

Background
Tricuspid regurgitation (TR) has long been neglected due to limited therapeutic options. Within the past five years, transcatheter tricuspid valve edge-to-edge repair (T-TEER) has become a valuable tool in the treatment of TR besides diuretic medical therapy and valve surgery. Owing its novelty, data on long-term survival after T-TEER for relevant TR are sparse. Beyond that, there is uncertainty on the impact of TR reduction on outcomes after successful T-TEER.

Purpose
This study sought to investigate long-term survival outcome after T-TEER for relevant symptomatic TR. We evaluated the impact of TR reduction on outcome in patients with successful T-TEER.

Methods
Consecutive patients who underwent successful isolated T-TEER for relevant TR from 2016 until 2022 at a high-volume university center were included in the study. Procedural success was defined as at least one degree TR reduction. Long-term survival endpoint was three-year all-cause mortality. Survival follow-up was completed via phone calls with the patients themselves, the next of kin, local practitioners and using the German national population registry. Post-procedural TR was assessed by interventionalist and echocardiographer at the end of the T-TEER procedure.

Results
A total of 244 patients who underwent successful T-TEER in the study period were included in the present analysis (mean age 77.7±8.7 years; 50.8% female). Patients were highly symptomatic as represented by New York Heart Association functional class ≥ III in 95.9% of cases. TR was 4+ in 128 patients (52.2%), 3+ in 106 patients (43.4%) and 2+ in 10 patients (6.1%). The etiology of TR was predominately functional (88.5%), while 5.4% presented with degenerative TR and 6.1% with TR of mixed etiology. Median time to last contact or death was 365 days (interquartile range 166–809 days). Three-year follow-up was available in 98% of eligible patients. T-TEER was performed using a mean number of 2.0±0.6 devices (Mitra-/TriClip 53%; PASCAL 47%). Post-procedural TR was 1+ in 126 patients (51.6%), 2+ in 101 patients (41.4%) and 3+ in 17 patients (7.0%). Survival rates at one, two and three years were 76%, 68% and 56%. Among patients with procedural success (at least 1° TR reduction), a higher degree in post-procedural TR was associated with a trend towards reduced postinterventional survival (Figure 1). The absolute degree of TR reduction did not impact survival rates in patients with procedural success (Figure 2).

Conclusion
T-TEER effectively reduces TR severity and shows high rates of procedural success. While the extent of TR reduction did not yield prognostic value in terms of long-term survival, the degree of post-procedural TR showed a trend regarding survival outcome. These results indicate that procedural techniques and strategies should be refined to achieve TR1+ at the end of the procedure.

Funding Acknowledgement
Type of funding sources: None.
Feasibility and mid-term results of transcatheter pulmonary valve replacement using Edwards-Sapien valves
Authors: Calvo-Barcelo M , Belahnech-Pujol Y , Betrian-Blasco P , Dos-Subira L , Pijuan-Domenech A , Giralt-Garcia G , Miranda-Barrio B , Gordon-Ramirez B , Gonzalez-Fernandez V , Rodenas-Alesina E , Roses-Noguer F , Garcia-Del Blanco B , Ferreira-Gonzalez I , Marti-Aguasca G 
Published: October 2022

Abstract

Background
Transcatheter pulmonary valve replacement (TPVR) is an alternative to surgery in certain patients with pulmonary valve dysfunction. When feasible, a percutaneous approach is increasingly common in congenital heart disease (CHD). There is paucity of data to support the use of the Edwards Sapien (ES) 3 or XT valves for TPVR.

Purpose
To describe the feasibility and outcomes of TPVR with the ES valve.

Methods
Consecutive patients who underwent TPVR between 2014 and 2021 in a tertiary referral center for CHD were retrospectively included. Outcomes assessed included complications during admission, echocardiographic parameters of ventricular remodeling after TPVR as well as mortality and valve-related complications during follow-up.

Results
During the study period, 70 patients underwent TPVR with the ES valve. Of them, 70% were men with a median age of 28.3 years. The underlying cardiac conditions were tetralogy of Fallot (N=35, 45.7%), pulmonary atresia or stenosis with ventricular septal defect (N=10, 14.3%), pulmonary stenosis (N=10, 14.3%) and Ross procedure (N=5, 7.1%). The main reason for TPVR was pulmonary regurgitation (N=23, 33.3%), pulmonary stenosis (N=10, 24.6%) or a combination of both (N=29, 42.0%). Transfemoral access (N=68, 97.1%) was more common than transjugular (N=2, 2.9%). TPVR was performed in a native or patch-extended right ventricular outflow tract (N=26, 37.1%), as a valve-in-valve procedure in a previous bioprosthetic valve (N=23, 32.9%) or within a conduit (N=21, 30.0%: 11 homografts, 9 heterografts and 1 Dacron conduit), and stenting before deploying the valve was performed in 48 (68.5%) cases.
TPVR was successful in 69 (98.6%) patients with iatrogenic tricuspid damage in 2 cases, with a median hospital length of stay of 1 day, no deaths and 4 serious complications during admission (2 pulmonary edema, 1 femoral vein rupture and 1 pulmonary bleeding). Urgent surgery was not required in any case. No cardiovascular deaths, pulmonary thromboembolisms or strokes were observed during a median follow-up 25.9 months. During this period, there was 1 non-cardiac death, 1 heart transplant, 3 endocarditis (without valve dysfunction), 1 prosthetic valve degeneration and 1 subclinical prosthetic thrombosis. After 1 year, the mean echocardiographic transprosthetic peak gradient was 23 mmHg and there was a reduction in the number of patients presenting moderate-to-severe tricuspid regurgitation (22.9 to 14.8%).

Conclusions
TPVR with ES valves is feasible and safe in a variety of substrates and ACHD population, with a short length of stay and a low rate of adverse events both in the medium-term follow-up.

Funding Acknowledgement
Type of funding sources: None.
Supraventricular arrhythmia following patent foramen ovale percutaneous closure
Authors: Guedeney P , Laredo M , Zeitouni M , Hauguel-Moreau M , Wallet T , Alamowitch S , Sabben C , Deltour S , Benyounes N , Obadia M , Collet J P , Rouanet S , Hammoudi N , Silvain J , Montalescot G 
Published: October 2022

Abstract

Background
Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (&lt;6%) but have relied on patients-reported symptomatic episodes, thus true incidence and timing of AF after PFO closure remain unknown.

Objective
To prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure based on loop recorder monitoring.

Methods
Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 in our center by mean of implantable loop recorder (ILR) monitoring in patients considered at higher risk of AF (age ≥55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder (ELR) monitoring in other patients. The primary endpoint was the incidence of AF, flutter, or atrial tachycardia lasting &gt;30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed with stepwise logistic regression model.

Results
A total of 225 patients were included. The primary endpoint occurred in 47/225 (20.9%) patients, including n=13 (9.9%) and n=24 (28.9%) among ELR- and ILR-monitored patients, respectively. Among ILR-monitored patients, median follow-up was 428 (211–752) days, and four more cases of supraventricular arrhythmia were diagnosed beyond 28 days (Figure 1). Overall, median delay from procedure to arrhythmia was 14.0 (6.5–19.0) days and half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.18–2.36, per 10-year increase), device left disc diameter ≥25mm (aOR: 2.67, 95% CI: 1.19–5.98) and male sex (aOR: 4.78, 95% CI: 1.96–11.66) (Figure 2).

Conclusion
Using prolonged loop recorder monitoring, supraventricular arrhythmia was diagnosed in one patient out of five with a median delay of 14 days suggesting that this post-procedural event has been so far, underestimated.

Funding Acknowledgement
Type of funding sources: None.
Atrial function analysis after percutaneous umbrella device and suture-mediated patent fossa ovalis closure: a prospective study
Authors: Tarsia C , Gaspardone C , De Santis A , D'Ascoli E , Piccioni F , Sgueglia G A , Iamele M , Leonetti S , Posteraro G A , Gaspardone A 
Published: October 2022

Abstract

Background
Suture-mediated patent fossa ovalis (PFO) closure is a new technique, achieving closure of the PFO by means of a simple suture. The difference between traditional occluders and a simple suture might have different impact on atrial structure, geometry and function.

Purpose
Aim of this study was to evaluate bi-atrial function after closure of PFO by direct suture and traditional occluders.

Methods
We studied 40 age and sex matched patients, 20 undergoing PFO closure by device and 20 by suturing. Only patients with no residual right-to-left shunt, assessed by contrast-enhanced echocardiography, were included. Left and right atrial function was evaluated by using speckle-tracking analysis assessing the following parameters: strain values of the reservoir (r-ED), conduit (cd-ED) and contraction phase (ct-ED). All patients underwent transthoracic echocardiographic examination the day before and 1 year after the procedure. All exams and measurements were conducted by two echocardiographers and validated with common consent by two other expert operators.

Results
Compared with values baseline PFO closure, at one year follow-up, patients underwent occluder implantation had significantly worst indices of left (LA) and right (RA) atrial reservoir function (LA r-ED p&lt;0.001; RA r-ED p&lt;0.001), conduit function (LA cd-ED p&lt;0.001; RA cd-ED p&lt;0.001) and contraction function (LA ct-ED p&lt;0.05; RA ct-ED p&lt;0.05).
In patients underwent suture-mediated PFO closure, no significant differences were observed in the same indices of reservoir (LA r-ED p=0.848; RA r-ED p=0.183), conduit (LA cd-ED p=0.156; RA cd-ED p=0.419) and contraction function (LA ct-ED p=0.193; RA ct-ED p=0.375).

Conclusions
Suture-mediated PFO closure does not alter atrial function. Conversely, PFO closure by metallic occluders is associated with worse atrial function. This detrimental effect on atrial function could favor the development of atrial arrhythmias.

Funding Acknowledgement
Type of funding sources: None.